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Ring risks: Separating hype from fact

Before you write off the NuvaRing because of scary headlines, make sure you've got all the facts.

Lately the ring has been making headlines—and some of the stories the articles tell are downright scary. Vanity Fair's piece, titled "Why Is Potentially Lethal Contraceptive NuvaRing Still on the Market?", asks: "Would a young woman use NuvaRing ... if she knew that ... there was a 56 percent increased risk of blood clots when it was compared with birth-control pills using earlier forms of progestin?"

We think you deserve the facts, so we're going to fearlessly wade into the science behind these stories.

Just the facts, ma'am.

The best sources of information on the risk of blood clots from using the ring are two enormous studies conducted by the U.S. Food and Drug Administration (FDA) and a Danish research team.

The studies:

  • looked at both ring users and patch users—though the patch hasn’t made headlines despite similar findings;

  • included more than 2.6 million women, and compared those who used the ring or patch to those who used pills containing estrogen and an “early progestin” like levonorgestrel, norethindrone, or norgestimate; and

  • had to collect many, many years of data ("years" means the total number of years that all the women in the study used their method) because blood clots are so rare in young women. How much data? A grand total of 68,796 years for women who used the ring and 57,861 years for women who used the patch.

The two studies had similar findings. Both showed that women using the ring or patch had an increased chance of blood clots—ranging from about a 50% increase to double the chance. Only the U.S. study asked whether there was an increased chance of death for women using the ring or patch and found no connection at all.

Okay, but how does that compare to other risks?

We've known for a long time that birth control methods that contain both estrogen and progestin—like the pill, patch, and ring—carry an increased risk of blood clots. That’s why a health care provider will take a woman’s blood pressure before prescribing the pill, for example.

Healthy young women who are not using hormonal birth control have an incredibly low risk of blood clots, so even when that risk is doubled, it's still pretty low. How low? Here are the annual chances of a blood clot for different groups of women:

  • Not taking any type of hormone: 2-5 per 10,000 women

  • Taking a pill with “early progestin”: 6-8 per 10,000 women

  • Taking a pill with drospirenone (Yaz or Yasmin): 10 per 10,000 women

  • Using the patch (Ortho Evra): 10 per 10,000 women

  • Using the ring (NuvaRing): 8-12 per 10,000 women

  • Pregnant or gave birth recently: 300-400 per 10,000 women

So...should I be worried?

It's important to keep in mind that the highest risk of blood clots comes with pregnancy—so skipping birth control altogether for fear of blood clots definitely isn't the best way to protect your health. There are medical and genetic conditions that make it more likely a woman will have a blood clot regardless of what birth control she uses, so it’s important to know whether you have any of these conditions before deciding what birth control method to use.

If you are at a higher risk for blood clots, you may not want to use the ring, the patch, or certain kinds of pills—fortunately there are plenty of alternatives, including the IUD, the implant, and the shot.

I understand your point, but I don't think this is purely "scare tactic". The whole premise of Bedsider is birth control OPTIONS. That's why it exists. Barrier and rhythm methods are given on a nod on this site, too. The power of comparing pregnancy--for me anyway-- is that pregnancy is a NATURAL, biological occurrence, and much of the uncertainty surrounding hormonal methods stems from our gut reaction to the idea of synthetic substances in our bodies. Yes, I think maybe under "Not taking any type of hormone" they should have listed non-hormonal birth control methods explicitly, and linked to information on those methods, but I think it was informative to include pregnancy as a comparison. Additionally, I would argue that for many women, getting pregnant, staying pregnant, and actively avoiding pregnancy are not such isolated options as you describe them to be. I would recommend refraining from projecting your own experiences onto others' reproductive life plans and circumstances.

2014-02-28 20:52:02 UTC

back of the class

Hello again. I am sorry if I seem annoying, but I am writing again about the statistics used for "Pregnant or gave birth recently" which I find very high. I sent you an email earlier telling you where I think those figures come from. You have never responded to my question about where you got your data, so I am continuing my research myself. It bothers me that different data is put up on different websites, and I can't help but wonder where this data comes from. I wonder now if the higher figures are for an international rate, which includes impoverished countries. I like that you have stats broken down for the following categories as it is much clearer than lumping all pills/patch/ring into one big pot. Not taking any type of hormone: Taking a pill with “early progestin”: Taking a pill with drospirenone (Yaz or Yasmin): Using the patch (Ortho Evra): Using the ring (NuvaRing): Could you tell me where you got the figures for these categories? This evening I decided to look at the FDA site and the actual NuvaRing insert that I found on the FDA site and this is what they say in the packaging (approved by the FDA). For your information 10,000 WY is 10,000 women in one year. The pregnancy rate is 5-20 The postpartum period is 40-65 FROM THE PACKAGE INSERT: Figure 1: Likelihood of Developing a VTE non-pregnant, non chc* user ranges = 1-5 chc user ranges = 3-12 Pregnancy** ranges = 5-20 Postpartum (12 weeks only) ranges = 40-65 *CHC=combination hormonal contraception **Pregnancy data based on actual duration of pregnancy in the reference studies. Based on a model assumption that pregnancy duration is nine months, the rate is 7 to 27 per 10,000 WY. Several epidemiology studies indicate that third generation oral contraceptives, including those containing desogestrel (etonogestrel, the progestin in NuvaRing, is the biologically active metabolite of desogestrel), may be associated with a higher risk of VTE than oral contraceptives containing other progestins. Some of these studies indicate an approximate twofold increased risk. However, data from other studies have not shown this twofold increase in risk.

2014-06-14 02:30:53 UTC


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