Terrified of your birth control yet? We don't blame you. A recent Vanity Fair article highlighted the fact that thousands of people have filed lawsuits against NuvaRing and raised the question: Is this birth control killing women? But while the anecdotes are devastating, you may not want to throw out your ring just yet.
First, the bad news: Several studies show that birth control can increase your risk of blood clots (also known as a venous thrombroembolism, or VTE). It's not really newsÃ¢â‚¬”this is something you've probably seen on your prescription pack for years now, and your doctor may have discussed it with you. And yes, some studies show that newer forms of birth control (like the patch, the ring, and Yaz) may up your risk even more (more on that below). But there are a few things you should know before you decide to switch to a different form of birth control (or go off of it altogether).
Increased Risk Isn't the Same Thing as High Risk
According to the 2012 study in the British Medical Journal cited in the Vanity Fair article, your risk of getting a blood clot is 6.5 times greater when you use the ring compared to no hormonal contraceptives. Sounds scary, right? But unfortunately, the Vanity Fair article didn't explain what that really means: Without hormonal birth control, about 2.1 women out of 10,000 will get a blood clot each year; while on the ring, that number goes up to about 7.75 out of 10,000. And if you're taking a more traditional oral contraceptive with levonorgestrel, that number is about 6.2 out of 10,000. While this is a small yet significant increase, it's important to keep in mind that the study also didn't take into account other risk factors like obesity and family history of blood clots.
Another study funded by the FDA in 2011 looked retrospectively at records from Kaiser Permanente and Medicaid. Vanity Fair reported that the study showed NuvaRing carried a 56 percent increased risk of blood clots when compared to older hormonal birth control pills. But that's not the whole story, says lead study author Steve Sidney, M.D., director of research clinics at Kaiser Pemanente Northern California. As Sidney explains, that was the result before researchers adjusted the study to look only at new birth control users. Here's why that's crucial: "If you're starting with people who have used contraceptives before, it adds a lot of complications as to why they stopped using them, what they were using before, and other characteristics that we can't measure," says Sidney. (For instance, some of these women may have switched from a different form of birth control to the NuvaRing because of problems with that first birth controlÃ¢â‚¬”which could indicate they had health issues that put them at a higher risk of experiencing a blood clot.) "It's a much cleaner, straightforward analysis when you look at all people who are starting [birth control] for the first time."
When Sidney and his colleagues compared only new birth control users, they found no significant increase in blood clot risk for the ring. However, they did find a 77 percent higher risk in women taking drospirenone-containing pills (like Yaz and Yasmin), resulting in about 13.7 blood clots per 10,000 women per year. But Sidney still cautions against putting too much weight on these numbers. "It doesn't take into account that there is a lot of statistical variability around that estimate," says Sidney.
What Really Ups Your Risk of a Clot
The biggest blood clot culprit isn't a new risky birth control method. Ironically, it's getting pregnant. Your risk of developing a blood clot is highest during and right after pregnancy, according to board certified OB/GYN Mary Jane Minkin, M.D., clinical professor at Yale University School of Medicine. Studies show your risk of developing a blood clot during this time is 10 to 20 out of 10,000. So if fear of clots is keeping you up at night, it wouldn't be wise to just toss your NuvaRing in the trash without talking this through with your doctor. "The increased riskÃ¢â‚¬”if there is an increased riskÃ¢â‚¬”is very, very small," says Minkin. "Your risk of a blood clot is much higher if you get pregnant inadvertently."
So how does birth control factor in to your risk? Blame it on estrogen. "Oral estrogen increases the blood clotting possibility because it stimulates the liver, and blood clotting factors are made in the liver," says Minkin. So when estrogen reaches the liver, it causes your body to produce more blood clotting factors, which is why higher doses of estrogen increase your risk of clots. This proven mechanism is why all estrogen-containing birth control methods warn that they may increase your risk of blood clots.
But why would some birth control methods raise your risk more than others? Some theories exist about the role of progestins (specifically the newer generation versions found in Yaz, Yasmin, or the ring), but researchers don't have a proven answer yet. "There is no obvious biological mechanism like there is with estrogen," says Minkin. "One of the theories is that some of the newer progestins may act more like estrogen than others." Another theory is that non-oral medications like the patch or the ring may give you a higher dose of estrogen because of the way they're absorbed, says Minken. And finally, it could be that newer birth control methods appear to be riskier because they're being compared against tried and true medications. "There's a new-kid-on-the-block phenomenon," says Minkin.
MORE: The Morning After Pill Won't Work for Women Over 175 Pounds
Should You Switch?
Even with all the studies in front of you, the right birth control method for you still may not be an obvious choice. Is 7.75 cases out of 10,000 a huge risk? Not exactly, especially considering that all medications come with some risks. But for the women profiled in the Vanity Fair piece and their families, that small risk may have led to serious health consequences. There is no question that these types of horrible incidents do happen, but the evidence isn't concrete enough to say that the NuvaRing carries a bigger risk than more traditional birth control methods, says Sidney: "The data are, quite frankly, mixed."
MORE: Does the Pill Really Cause Depression?
If you love the ring, haven't had a problem with it, and aren't at an elevated risk for blood clots, Minkin suggests sticking with it. Plus, the research shows that the highest risk of developing a blood clot while on birth control is in the first six months of being on the medication. (That's not to say that you couldn't get a blood clot after being on something for years, but your risk is certainly lower.) If you're really anxious about it or you have other risk factors (you smoke, you're overweight, or you have a family history of blood clots), talk to your doctor about finding a better method for you. You might like the IUD, for example, an incredibly effective method that has not been shown to raise your risk of blood clots.
Most importantly, don't panic, says Minkin. Heart-wrenching stories of women who died while taking birth control are enough to make anyone second-guess her script. But until the research is conclusive, NuvaRing will continue to be offered as a safe and effective option for women. "These are horrible outcomes, but they're rare," says Sidney. "And you need lots and lots of well collected data to be able to make any kind of reasonable conclusion about them."
MORE: Scientific Consensus Finds HPV Vaccine Safe