NuvaRing and Blood Clot Risk

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A recent Vanity Fair article regarding the potential risks associated with the prescription contraceptive NuvaRing is raising concerns among users. Much of the article centers around the death of 24-year-old Erika Langhart; her family says she died of a blood clot directly resulting from the use of NuvaRing.

While anecdotal information can be compelling, it’s important to not lose sight of the big picture. Here’s what the science says about the risks associated with NuvaRing.

The Real Risk of Using NuvaRing

The BMJ study cited in the Vanity Fair article states that women using NuvaRing have a greater risk of developing a blood clot than women who do not take any form of combined hormonal contraceptive (birth control that contains the hormones estrogen and progestin). But the same study also confirms that the overall risk of blood clots for NuvaRing users is very low.

How is that possible? Simply stated, increased risk doesn’t translate to high risk. Here are some scenarios to consider:

Likelihood of Developing a Blood Clot Over the Course of One Year

Women taking no form of birth control~4 in 10,000
Women using any form of oral contraceptive~7 in 10,000
Women using NuvaRing ~7 in 10,000
Women using birth control containing the synthetic hormone drospirenone, like Yaz~10 in 10,000
Women who are pregnant or are in the 6-week postpartum period~25 in 10,000

So while it’s true that the risk of a clot is slightly but significantly increased for NuvaRing users, the odds of actually developing one while using this form of birth control are overwhelmingly low–and much lower than the risk of developing one if you become pregnant.

About Blood Clots

A blood clot is a blockage in the vein or artery that occurs when blood thickens in the vessels. A pulmonary embolism (PE)–used to describe Langhart’s cause of death in the Vanity Fair article–is one type of blood clot.

A PE refers specifically to a clot that lodges in the lungs. PEs are most often caused by another type of clot known as deep venous thrombosis, or DVT, which commonly forms in the legs, but can sometimes form in the arms before traveling through the bloodstream and embedding in the lungs. Every year, 2 million people develop DVT and up to 200,000 die of it. Though PEs are less common, it’s estimated that 50,000 people die from them every year.

Several studies have shown that birth control can increase the risk of blood clots, and contraceptive companies are required to communicate that risk on product labels.

But it’s important to note that not all blood clots are deadly. In fact, 99 percent of people with blood clots survive them. In addition, the risk of death for women taking newer combined hormonal contraceptives, including Yaz and NuvaRing, is just 1 in 100,000.

Many factors can contribute to an increased risk of blood clots, including obesity, smoking, and prolonged immobilization during a long flight, car ride, or hospitalization. A woman’s risk of developing a blood clot is actually highest during and about six weeks after pregnancy, when estrogen is increased and blood clots more easily.

Deciding to Start or Continue NuvaRing

The decision to choose a form of birth control is a personal one. At One Medical, we encourage our patients to be proactive about their health by discussing the risks and benefits of health care decisions with their provider. If you or your family has a history of blood clots or stroke, or you smoke cigarettes, you may be at an increased risk for clots and should let your provider know.

However, current research is continuing to confirm that hormonal birth control, including NuvaRing, is overwhelmingly safe. If you still have concerns about your current method of birth control or any questions about your personal risk, we’re here to help you.

Editor’s Note: Special thanks to Lauren Bosin, RN, and Gabriella Cardi, PA-C of the One Medical Group virtual care team for their contributions to this article.

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The One Medical blog is published by One Medical, an innovative primary care practice with offices in Boston, Chicago, Los Angeles, New York, Phoenix, the San Francisco Bay Area, Seattle, and Washington, DC.

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