Vaginal contraception with NuvaRing decreases symptoms and uterine features of adenomyosis: A prospective evaluation

Abstract

Objective: We aimed to assess the effects of contraception with NuvaRing on ultrasound signs and symptoms of women with adenomyosis.

Study design: We conducted a prospective self-controlled observational study on women with adenomyosis who required contraception with NuvaRing. Exclusion criteria were actual use or contraindications to hormonal contraception. NuvaRing was administered in a continuous regimen, one ring every 3 weeks without hormone-free intervals, to avoid menses. Adenomyosis, suggested by clinical signs, was confirmed by ultrasonography. Before and after 6 months of NuvaRing, we evaluated uterine volume, direct and indirect ultrasound signs of adenomyosis, and the severity of menstrual, intermenstrual pain, and pain during intercourse, by a 10-cm visual analog scale (VAS).

Result(s): This study included 42 women, 30.0 ± 4.5 years old, with a BMI of 22.8 ± 1.8 kg/m². All were nulliparous except one. Following 6 months of NuvaRing, uterine volume decreased of 14.4 ± 13.5% (p = 0.001). A similar decrease was observed in six women switching from dienogest. Direct ultrasound signs of adenomyosis per patient (total signs/n women) decreased from 0.5 (range 0-3) to 0.08 (range 0-2) (p = 0.003), and indirect signs, from 2.8 (range 1-5) to 1.5 (range 0-5) (p = 0.001). The VAS for menstrual pain decreased from 8.3 ± 1.2 to 3.9 ± 2.5 (p = 0.001), for intermenstrual pain from 6.6 ± 1.4 to 2.9 ± 1.7 (p = 0.001), and for pain during intercourse from 7.0 ± 1.4 to 2.9 ± 1.7 (p = 0.001). The decrease of menstrual pain was significantly associated with the reduction of uterine volume (p = 0.003).

Conclusion(s): Our findings demonstrate that contraception with NuvaRing is a viable contraceptive option for women with adenomyosis.

Implications: In women with adenomyosis contraception with NuvaRing is useful and can be proposed because it reduces the clinical signs and the uterine ultrasound features of adenomyosis.

Keywords: Adenomyosis; Chronic pelvic pain; Contraceptive ring; Dysmenorrhea; Hormonal contraception; Ultrasound.