Pharmacokinetics and ovarian suppression during use of a contraceptive vaginal ring in normal-weight and obese women

Carolyn L. Westhoff, Anupama H. Torgal, Elizabeth Rose Mayeda, Kelsey Petrie, Tiffany Thomas, Monica Dragoman, Serge Cremers

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

OBJECTIVE: Many observational studies indicate higher oral contraceptive failure among obese women, but most clinical trials and physiologic studies do not support these differences. Limited data indicate higher failure rates among obese contraceptive patch users. Data regarding contraceptive vaginal ring performance in obese women are needed. STUDY DESIGN: Twenty normal weight (body mass index [BMI] 19.0-24.9; median, 21.65) and 20 obese (BMI 30.0-39.9; median, 33.7) women enrolled in a prospective study of ethinyl estradiol (EE 2) and etonorgestrel pharmacokinetics and of ovarian follicle development, endometrial thickness, and bleeding patterns, all measured biweekly during the second cycle of contraceptive vaginal ring use. RESULTS: Thirty-seven women completed follow-up. Mean day 0-21 EE 2 concentrations were lower among obese vs normal weight women (15.0 vs 22.0 pg/mL, respectively, P = .004), whereas etonorgestrel concentrations were similar (1138 vs 1256 pg/mL, respectively, P = .39). Follicular development was minimal in both groups, with only 5 women achieving a maximum follicle diameter >13 mm at any time during 3 weeks follow-up (3 normal weight and 2 obese women); these women had serum progesterone levels <1.0. Obese women reported more bleeding or spotting than normal weight women (3.6 vs 1.4 days, respectively, P = .01). CONCLUSION: Although obese women had lower EE 2 levels during contraceptive vaginal ring use, they had excellent suppression of ovarian follicle development, similar to normal weight women. This predicts that contraceptive vaginal ring effectiveness will be similar in women with a BMI up to 39.9. The lower serum EE 2 levels in the obese women may explain the greater reported bleeding or spotting days.

Original languageEnglish (US)
JournalAmerican Journal of Obstetrics and Gynecology
Volume207
Issue number1
DOIs
StatePublished - Jul 2012

Fingerprint

Female Contraceptive Devices
Contraceptive Agents
Pharmacokinetics
Weights and Measures
Metrorrhagia
Body Mass Index
Ovarian Follicle
Hemorrhage
Ethinyl Estradiol
Oral Contraceptives

Keywords

  • contraceptive vaginal ring
  • obesity
  • pharmacodynamics
  • pharmacokinetics

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Pharmacokinetics and ovarian suppression during use of a contraceptive vaginal ring in normal-weight and obese women. / Westhoff, Carolyn L.; Torgal, Anupama H.; Mayeda, Elizabeth Rose; Petrie, Kelsey; Thomas, Tiffany; Dragoman, Monica; Cremers, Serge.

In: American Journal of Obstetrics and Gynecology, Vol. 207, No. 1, 07.2012.

Research output: Contribution to journalArticle

Westhoff, Carolyn L. ; Torgal, Anupama H. ; Mayeda, Elizabeth Rose ; Petrie, Kelsey ; Thomas, Tiffany ; Dragoman, Monica ; Cremers, Serge. / Pharmacokinetics and ovarian suppression during use of a contraceptive vaginal ring in normal-weight and obese women. In: American Journal of Obstetrics and Gynecology. 2012 ; Vol. 207, No. 1.
@article{9a21f7e5a9664d159e1118f030b8be4b,
title = "Pharmacokinetics and ovarian suppression during use of a contraceptive vaginal ring in normal-weight and obese women",
abstract = "OBJECTIVE: Many observational studies indicate higher oral contraceptive failure among obese women, but most clinical trials and physiologic studies do not support these differences. Limited data indicate higher failure rates among obese contraceptive patch users. Data regarding contraceptive vaginal ring performance in obese women are needed. STUDY DESIGN: Twenty normal weight (body mass index [BMI] 19.0-24.9; median, 21.65) and 20 obese (BMI 30.0-39.9; median, 33.7) women enrolled in a prospective study of ethinyl estradiol (EE 2) and etonorgestrel pharmacokinetics and of ovarian follicle development, endometrial thickness, and bleeding patterns, all measured biweekly during the second cycle of contraceptive vaginal ring use. RESULTS: Thirty-seven women completed follow-up. Mean day 0-21 EE 2 concentrations were lower among obese vs normal weight women (15.0 vs 22.0 pg/mL, respectively, P = .004), whereas etonorgestrel concentrations were similar (1138 vs 1256 pg/mL, respectively, P = .39). Follicular development was minimal in both groups, with only 5 women achieving a maximum follicle diameter >13 mm at any time during 3 weeks follow-up (3 normal weight and 2 obese women); these women had serum progesterone levels <1.0. Obese women reported more bleeding or spotting than normal weight women (3.6 vs 1.4 days, respectively, P = .01). CONCLUSION: Although obese women had lower EE 2 levels during contraceptive vaginal ring use, they had excellent suppression of ovarian follicle development, similar to normal weight women. This predicts that contraceptive vaginal ring effectiveness will be similar in women with a BMI up to 39.9. The lower serum EE 2 levels in the obese women may explain the greater reported bleeding or spotting days.",
keywords = "contraceptive vaginal ring, obesity, pharmacodynamics, pharmacokinetics",
author = "Westhoff, {Carolyn L.} and Torgal, {Anupama H.} and Mayeda, {Elizabeth Rose} and Kelsey Petrie and Tiffany Thomas and Monica Dragoman and Serge Cremers",
year = "2012",
month = "7",
doi = "10.1016/j.ajog.2012.04.022",
language = "English (US)",
volume = "207",
journal = "American Journal of Obstetrics and Gynecology",
issn = "0002-9378",
publisher = "Mosby Inc.",
number = "1",

}

TY - JOUR

T1 - Pharmacokinetics and ovarian suppression during use of a contraceptive vaginal ring in normal-weight and obese women

AU - Westhoff, Carolyn L.

AU - Torgal, Anupama H.

AU - Mayeda, Elizabeth Rose

AU - Petrie, Kelsey

AU - Thomas, Tiffany

AU - Dragoman, Monica

AU - Cremers, Serge

PY - 2012/7

Y1 - 2012/7

N2 - OBJECTIVE: Many observational studies indicate higher oral contraceptive failure among obese women, but most clinical trials and physiologic studies do not support these differences. Limited data indicate higher failure rates among obese contraceptive patch users. Data regarding contraceptive vaginal ring performance in obese women are needed. STUDY DESIGN: Twenty normal weight (body mass index [BMI] 19.0-24.9; median, 21.65) and 20 obese (BMI 30.0-39.9; median, 33.7) women enrolled in a prospective study of ethinyl estradiol (EE 2) and etonorgestrel pharmacokinetics and of ovarian follicle development, endometrial thickness, and bleeding patterns, all measured biweekly during the second cycle of contraceptive vaginal ring use. RESULTS: Thirty-seven women completed follow-up. Mean day 0-21 EE 2 concentrations were lower among obese vs normal weight women (15.0 vs 22.0 pg/mL, respectively, P = .004), whereas etonorgestrel concentrations were similar (1138 vs 1256 pg/mL, respectively, P = .39). Follicular development was minimal in both groups, with only 5 women achieving a maximum follicle diameter >13 mm at any time during 3 weeks follow-up (3 normal weight and 2 obese women); these women had serum progesterone levels <1.0. Obese women reported more bleeding or spotting than normal weight women (3.6 vs 1.4 days, respectively, P = .01). CONCLUSION: Although obese women had lower EE 2 levels during contraceptive vaginal ring use, they had excellent suppression of ovarian follicle development, similar to normal weight women. This predicts that contraceptive vaginal ring effectiveness will be similar in women with a BMI up to 39.9. The lower serum EE 2 levels in the obese women may explain the greater reported bleeding or spotting days.

AB - OBJECTIVE: Many observational studies indicate higher oral contraceptive failure among obese women, but most clinical trials and physiologic studies do not support these differences. Limited data indicate higher failure rates among obese contraceptive patch users. Data regarding contraceptive vaginal ring performance in obese women are needed. STUDY DESIGN: Twenty normal weight (body mass index [BMI] 19.0-24.9; median, 21.65) and 20 obese (BMI 30.0-39.9; median, 33.7) women enrolled in a prospective study of ethinyl estradiol (EE 2) and etonorgestrel pharmacokinetics and of ovarian follicle development, endometrial thickness, and bleeding patterns, all measured biweekly during the second cycle of contraceptive vaginal ring use. RESULTS: Thirty-seven women completed follow-up. Mean day 0-21 EE 2 concentrations were lower among obese vs normal weight women (15.0 vs 22.0 pg/mL, respectively, P = .004), whereas etonorgestrel concentrations were similar (1138 vs 1256 pg/mL, respectively, P = .39). Follicular development was minimal in both groups, with only 5 women achieving a maximum follicle diameter >13 mm at any time during 3 weeks follow-up (3 normal weight and 2 obese women); these women had serum progesterone levels <1.0. Obese women reported more bleeding or spotting than normal weight women (3.6 vs 1.4 days, respectively, P = .01). CONCLUSION: Although obese women had lower EE 2 levels during contraceptive vaginal ring use, they had excellent suppression of ovarian follicle development, similar to normal weight women. This predicts that contraceptive vaginal ring effectiveness will be similar in women with a BMI up to 39.9. The lower serum EE 2 levels in the obese women may explain the greater reported bleeding or spotting days.

KW - contraceptive vaginal ring

KW - obesity

KW - pharmacodynamics

KW - pharmacokinetics

UR - http://www.scopus.com/inward/record.url?scp=84862654909&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84862654909&partnerID=8YFLogxK

U2 - 10.1016/j.ajog.2012.04.022

DO - 10.1016/j.ajog.2012.04.022

M3 - Article

VL - 207

JO - American Journal of Obstetrics and Gynecology

JF - American Journal of Obstetrics and Gynecology

SN - 0002-9378

IS - 1

ER -