Ring risks: Separating hype from fact

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.