Patient case (clinical description): A 43-year-old woman, gravida 3 para 3, comes to the clinic complaining of recently painful menstrual cycles.  The patient's last menstrual period was 2 weeks ago. Urine β-hCG is negative. Menarche was at age 12, and menstrual periods occur every 28 days and lasts for 5 days.  She is sexually active with her husband and does not have pain with intercourse. BMI is 23 kg/m2 and Vital signs are normal.  On physical examination, the uterus is uniformly enlarged and tender. She is candidate for hysterectomy with the diagnosis of adenomyosis.

Patient's own account: I'm 43, and I paid a visit to my doctor because my last few periods were insanely painful. My last periods were 2 weeks ago. I already had three pregnancies that gave me the three lovely children. I did a urine test to check for potential pregnancy, and it came back negative. I started to have my periods at the age of 12, and I have been pretty regular with periods every 28 days for 5 days. I'm sexually active with my husband and I do not have any pain when we have sex. My BMI is 23 and my vitals were normal. The doctor performed a physical exam and found that my uterus was tender and enlarged. She proposed me a hysterectomy and diagnosed me with adenomyosis.

Clinical trial: Study of the Safety, Efficacy and Cycle Control of a Contraceptive Vaginal Ring

Eligibility criteria:
Inclusion Criteria:

          -  Healthy women, aged 18-<40 years who wish to use a combined hormonal contraceptive.

          -  Women not intending to become pregnant for 13 months.

          -  Intact uterus and both ovaries.

          -  Prior history of regular menstrual cycles of 28 ± 7 days when not using hormonal
             contraception; if postpartum or postabortal, history of regular menstrual cycles of
             21-35 days in length and at least one cycle (2 menses) with a cycle length consistent
             with her past cycles.

          -  Sexually active (currently) and willing to discontinue current contraceptive method to
             participate in the study.

          -  In the opinion of the investigator, able to comply with the protocol, e.g. live within
             the study site catchment area or within a reasonable distance from the site.

          -  Do not meet any of the exclusion criteria.

          -  Signed informed consent prior to entry into the trial.

        Exclusion Criteria:

          -  Known hypersensitivity to estrogens or progestins.

          -  Known hypersensitivity to silicone rubber.

          -  Known or suspected pregnancy.

          -  History of infertility of >1.0 year in woman or her male partner.

          -  History of vasectomy or sterility in male partner; tubal ligation (sterilization) in
             women

          -  Undiagnosed abnormal genital bleeding.

          -  Undiagnosed vaginal discharge or vaginal lesions or abnormalities. (Subjects diagnosed
             at screening with Chlamydia or gonorrhea may be included in the trial following
             treatment; partner treatment is also recommended. Investigators should make a
             determination if subjects are at high risk for reinfection, e.g. multiple sex
             partners, untreated partner, and whether such subjects can be included.)

          -  History of pelvic inflammatory disease since last pregnancy episode.

          -  History of toxic shock syndrome.

          -  Current abnormal Pap smear (women who have abnormal Paps but are ASCUS HPV negative
             may participate provided there is follow up for this finding per standard of care).

          -  Cystoceles or rectoceles or other anatomical abnormality that would preclude use of a
             vaginal ring.

          -  Women planning to undergo major surgery.

          -  Smoking in women who are 35 years and over or will be 35 years during the course of
             the trial; Women < 35 years who smoke 15 cigarettes or more must be evaluated by the
             PI for inclusion based on risk factors that would increase their risk for CVD, e.g.
             lipid levels, glucose level, BP, BMI, family history of CVD at a young age.

          -  Breastfeeding.

          -  Current or past thrombophlebitis or thromboembolic disorders.

          -  History of venous thrombosis or embolism in a first-degree relative <55 years of age
             suggesting familial defect in blood coagulation system, which in the opinion of the
             principal investigator, suggests use of a hormonal contraceptive could pose a
             significant risk.

          -  Cerebrovascular or cardiovascular disease.

          -  History of retinal vascular lesions, unexplained partial or complete loss of vision.

          -  Known or suspected carcinoma of the breast.

          -  Carcinoma of the endometrium or other known or suspected estrogen-dependent neoplasia.

          -  Past history of any other carcinoma unless in remission for more than 5 years.

          -  Current or past medically diagnosed severe depression, which, in the opinion of the
             investigator, could be exacerbated by use of a hormonal contraceptive.

          -  Headaches with focal neurological symptoms.

          -  Severe constipation.

          -  History of cholestatic jaundice of pregnancy or jaundice with prior steroid use.

          -  Benign or malignant liver tumors; active liver disease.

          -  Diastolic blood pressure (BP) ³85 mm Hg and/or systolic BP ³135 mm Hg after 5-10
             minutes rest.

          -  Known or suspected alcoholism or drug abuse.

          -  Abnormal serum chemistry values according to the physician's judgment.

          -  Participation in another clinical trial within last 30 days.

          -  Weight >95 kg or >209 lbs.

          -  Use of liver enzyme inducers on a regular basis.

          -  Use of monthly injectable contraceptives (e.g. cyclofem) unless suspended 2 months
             before initiation of treatment. Use of Depo-Proveraâ [depo-medroxyprogesterone (DMPA)]
             unless suspended 6 months before treatment.

          -  Current use of implanted hormonal contraceptives, including Mirenaâ [progestin
             containing intrauterine system (IUS)], Jadelleâ, Norplantâ or Implanonâ (subjects
             using any of these methods who request removal for reasons unrelated to the purpose of
             enrollment in this study may be considered for participation).

          -  Current use of a non-hormonal IUD. Subjects with IUDs who request removal for reasons
             unrelated to the purpose of enrollment in this study may be considered for
             participation.

          -  Known HIV infection.

          -  Women at high risk of contracting HIV, e.g. women with multiple sex partners who need
             to use condoms consistently, injection drug users. If women enrolled in the study do
             use condoms to protect against STIs, they should be instructed that this occasional
             use should be with non-N-9 containing condoms and they should record condom use in
             their diaries. Women found to have an STI at screening will be treated prior to
             inclusion in the study (with the exception of those infected with HIV).
Female
Accepts Healthy Volunteers
Subject must be at least 18 Years old.
Subject must be at most 39 Years

Eligibility (NLI label): Contradiction