A 32-year-old woman has used an ethinylestradiol/etonogestrel vaginal ring for 12 months. During each 7-day ring-free interval, she develops a

Question

A 32-year-old woman has used an ethinylestradiol/etonogestrel vaginal ring for 12 months. During each 7-day ring-free interval, she develops a bilateral pressure-type headache beginning 2 days after ring removal and resolving within 24 hours of inserting the next ring. She has no nausea, photophobia, aura or focal neurological symptoms, and does not experience headache while the ring is in situ. Her blood pressure is normal, she does not smoke, and review identifies no contraindication to combined hormonal contraception. She wishes to continue the vaginal ring and would prefer to avoid both the headaches and scheduled withdrawal bleeding. Which vaginal-ring regimen is most appropriate?

Accepted Answer

Replace each ring after 21 days without a ring-free interval

Answer

Use rings continuously until breakthrough bleeding occurs for 3–4 days, then take a 7-day ring-free interval

Answer

Use one ring for 21 days followed by a 4-day ring-free interval

Answer

Use three rings consecutively, each for 21 days, followed by a 7-day ring-free interval

Answer

Use one ring for 21 days followed by a 7-day ring-free interval

Hormone-free interval-associated headache — DFSRH MCQ