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Contraception in Hypertensive Women Using a Vaginal Ring Delivering Estradiol and Levonorgestrel^*

Service de Medecine 8, Hopital Broussais,Departement de Medecine Interne and Laboratoire d'Hemostase Hotel-Dieu, Paris Laboratoire des Hormone INSERM Le Kremlin Bicetre France The Population Council New York, New York 10021

Address requests for reprints to: Dr. Francois Elkik, Service de Nephrologie, Hopital Saint-Louis, 2 Place du Dr. A Fournier, 75475 Paris Cedex 10 France.

Contraception with a vaginal ring (CVR) that delivers estradiol and levonorgestrel was used during a mean of 15.6 menstrual cycles in 12 hypertensive women. Blood pressure (BP) was measured 5 times on each visit during 2 pretreatment control cycles; during the 1st, 2nd, 4th, 6th, and from the 9th to 12th cycles of CVR use; and again after a 1-month recovery period. No significant change in BP occurred during CVR use in any of the subjects. Plasma renin substrate and antithrombin III activity did not vary significantly, which suggests the utility of administering natural estradiol via the vagina, thus avoiding the first pass effect that occurs with oral contraceptives. Significant decreases in plasma sex hormone-binding globulin, cholesterol, high density lipoprotein cholesterol, phospholipids, and triglycerides occurred, indicating an androgenic effect of levonorgestrel. We conclude that the CVR is a method of contraception that does not elevate BP in hypertensive women. (J Clin Endocrinol Metab63: 29, 1986)

^* This work was undertaken as part of the contraceptive development program sponsored and coordinated by the International Committeefor Contraception Research of The Population Council (New York, NY). The financial support provided by the U.S. Agency for International Development (Grant AID/pha 1116),the International Development Research Centre of Canada, the Ford Foundation, the Rockefeller Foundation, and the George J. Hecht Fund is gratefully acknowledged. The content does not necessarily reflect the policy of any of the funding sources.

Received April 30, 1985.