NuvaRing is a popular combination hormone contraceptive (CHC) like birth control pills and patches. But a series of studies have identified increased risks for serious and potentially fatal side effects associated with the novel birth control ring.
Erika Langhart had traveled to 37 countries and served on the staff of a presidential nominee before even graduating college. Just before Thanksgiving 2011, her boyfriend came home to find the young law student on the floor of their apartment in extreme pain.
Paramedics were already on the way, but Langhart suffered two heart attacks before they got her to the hospital and slipped into a coma. She died on Thanksgiving Day. Langhart was 24 years old.
One of the first questions the emergency room doctor asked family members was if Langhart was using birth control. When her mother, Karen, said Erika had been using NuvaRing, the doctor told her of a link between the contraceptive and pulmonary embolisms.
These deadly blood clots are among the most serious risks associated with the popular NuvaRing birth control ring. Warnings of the risks would not be added to NuvaRing’s label until almost two years after Langhart’s death.
Despite the label warnings added in 2013 that include a risk of “thromboembolic events,” NuvaRing remains a popular contraceptive choice because it is convenient and effective.
It is inserted in the vagina once a month and only IUDs and injectable contraceptives have better rates of preventing pregnancy when used as directed. NuvaRing’s effectiveness is equal to birth control pills and patches.
NuvaRing, like the patch and pill, is a combined hormonal contraceptive (CHC) — a combination of estrogen and progestin. The use of any CHC increases the risk of a venous thromboembolism (VTE) — a blood clot that begins in a vein.
VTEs are life-threatening conditions. If you suspect you have either a DVT or a PE, you should seek immediate medical attention.
DVT usually affects the lower leg or thigh, and most often occur only on one side of the body.
PE can be a fatal result of a blood clot in the leg breaking free and reaching the lungs.
While smoking, obesity, and a family history of VTE can increase the risk for women using a CHC, several studies have found an association between one of the hormones in NuvaRing, etonogestrel, and a higher risk of VTE than that of birth control pills. Some studies found the risk of VTE for NuvaRing users was almost double that of women using oral contraceptives.
In October 2011, the U.S. Food and Drug Administration (FDA) released a study of more than 835,826 women that found use of NuvaRing was “associated with a significantly higher risk of VTE” compared to low-dose oral contraceptives. The authors said the finding was “new and raises concern” and called for further studies.
Another study published in May 2012, which followed more than 1.6 million Danish women from 2001 to 2010, was “compatible with the [FDA] study,” in the words of its authors. The 2012 study included data on “all Danish non-pregnant women aged 15-49” who were “free of previous thrombotic disease or cancer.”
Researchers found that “vaginal rings increased the risk of venous thrombosis 6.5 times compared with non-use of hormonal contraception.”
“[NuvaRing] conferred a 90 percent higher risk of blood clots than oral contraceptives containing levonorgestrel.”
In June 2012, the New England Journal of Medicine published another Danish study based on 15 years of data. This study found increased risks of myocardial infarctions (heart attacks) and thrombotic strokes.
“Our data suggest a relatively high risk of thrombotic stroke with the use of a vaginal ring and possibly with the use of transdermal patches,” the researchers wrote.
In October 2013, the FDA approved new warnings for NuvaRing’s label.
By this time, court documents showed hundreds of women in the U.S., or their survivors, had suffered VTEs or other serious complications while using NuvaRing.
NuvaRing’s label lists other warnings and precautions of possible conditions women may experience.
|Toxic shock syndrome||A serious disease caused by staphylococcus bacteria involving fever, shock and problems with several organs||Confusion, diarrhea, headaches, high fever, chills, low blood pressure, muscle aches, nausea vomiting, organ failure, redness of eyes, mouth, and throat, sunburn-like rash, seizures|
|Liver disease||Liver function may be disrupted, liver tumors called hepatic adenomas may burst causing potentially fatal bleeding, and long-term use can increase risk of certain liver cancers||Jaundice, pain or mass in abdomen|
|High Blood Pressure||An increase in high blood pressure has been reported by women using CHCs. This risk increases with age. It can result in stroke, heart failure, heart attack, and kidney failure||Symptoms do not usually appear until the body is damaged from chronic high blood pressure|
|Headaches||Women who experience new, more frequent, severe headaches should consult their doctor while using NuvaRing||New, recurring, persistent, or severe headaches|
|Uterine bleeding||Unscheduled bleeding may occur with users of CHCs in the first three months of use. If this persists beyond three months while using NuvaRing, you should talk to your doctor||Unscheduled bleeding and spotting|
|Amenorrhea||Lack of a scheduled period while using NuvaRing — this may indicate pregnancy||Failure to experience a period on schedule|
|Oligomenorrhea||Infrequent periods||Periods occur more than 35 days apart|
Women with certain medical conditions or characteristics should not use NuvaRing.
You should let your doctor know if you meet any of these conditions when discussing NuvaRing.
The National Institutes of Health recommends you talk to your doctor immediately if you experience any of these symptoms while using NuvaRing.
Please seek the advice of a medical professional before making health care decisions.
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