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NuvaRing for Menstrual Migraine: Blood Clot Risk?

Since starting the NuvaRing to manage menstrually associated migraine attacks four years ago, I’ve recommended it to numerous women who have migraine without aura. The NuvaRing is more effective than birth control pills because it provides a steady dose of hormones, while hormone levels still fluctuate throughout the day with the pill. But recent reports have raised questions about NuvaRing’s safety.

All hormonal birth control raises a woman’s risk of blood clots, but there is speculation that NuvaRing users are at greater risk than those who use oral contraceptives. Merck’s agreement to pay a $100 million settlement for thousands of liability lawsuits, announced on Friday, looks rather suspicious.

There are three studies that come into play when considering this risk. NPR summarizes them as:

“One funded by Merck, published in the journal Obstetrics and Gynecology in October, and another funded by the FDA, with data from Kaiser Permanente and Medicaid databases. The former found a similar risk for the ring and combined oral contraceptive pills. The latter found no difference in risk between new users of low-dose combined hormonal contraceptives and the NuvaRing or the birth control patch. (There was a higher risk found with pills that contain drospirenone, which is found in the pill Yaz.)

“But a study from Denmark, published in the British Medical Journal in May 2012, found a notably higher risk of blood clots from NuvaRing. Women using the NuvaRing were about six times more likely to get venous thrombosis than women who didn’t use any form of hormonal contraceptive. Compared to combined oral contraceptives with levonorgestrel, NuvaRing users were about twice as likely to form blood clots.”

Findings from the Danish study are not included in NuvaRing’s U.S. “label” (that’s FDA-speak for the detailed information that’s included with prescriptions). Again from NPR:

“FDA spokeswoman Andrea Fischer told Shots in an email that the agency ‘questioned the design and study population, and did not have the opportunity to independently review the original data.’

“For one thing, the study compares ‘all users,’ rather than just new users. ‘When using any hormonal contraceptive, the risk of blood clots is higher during the first few months of use,’ according to Fischer, so including both new and longtime users in the same study may make it seem like newer contraceptives are riskier, when actually new users of any method are already at a higher risk.”

The new versus all users distinction eased my mind considerably, though it still seemed kind of scary. The rest of NPR’s detailed explanation of the risks calmed me considerably. It’s too much to post here — it’s the entire second half of the long article — but take a look at Birth Control and Blood Clots: Women Still Weighing the Risk if you’re curious or concerned.

Personally, I’m going to continue using it for now. The risk just isn’t that great and I’ve already been on it for four years — if I were going to have problems with it, they probably would have shown up by now.

Still, since I’m older than 35 (the age at which women are warned to stop using hormonal birth control) and my migraines are no longer as constant or as devastating as they were when I started using the NuvaRing, I’ll probably go off it in a few months to see how I do without it. When I started hormonal birth control to manage menstrually associated migraine attacks, triptans were completely ineffective for me. Now that triptans are a viable option, they may ultimately be a better choice than hormonal birth control.

As with any medication, ask your doctor what your individual risk is given your own medical history and what your other treatment options are. With that information in mind, consider how much risk you’re OK with — a minute risk is acceptable for some women, for others any risk is a deal-breaker.

One Response to NuvaRing for Menstrual Migraine: Blood Clot Risk?

  1. Kat says:

    I’ve been using the Nuvaring to prevent menstrual migraines, menorrhagia and dysmenorrhea for at least a decade – I didn’t used to keep track of health dates like these, I certainly do now. I kind of lucked into finding it. In my early 30’s I decided to become sexually active again, after many years of avoiding such complications in my life (long story that). But I didn’t have health insurance, and while your standard generic BC pill was fairly cheap, I’d had some messed up reactions when I took them in high school. Luckily though, the state did have a medicaid-like program that specifically covered yearly gynecologist visits and birth control for women who were poor enough and without insurance. And someone told me that I could get said annual/BC care at the Planned Parenthood in IA (we are on the border and don’t have a PP on the IL side anymore).

    So, on my first appointment I expressed an interest in what other BC methods were available to me, and also mentioned that I would be nearly non-functional during my periods, thanks to the excessive pain and bleeding, and while the headaches weren’t that bad their longevity was disturbing. The doctor offered up Nuvaring as check in every box – less side-effects because of low-dosage, can prevent all those symptoms that came with periods by eliminating the periods. She also was the first to tell me they were a form of migraine, but I actually hadn’t heard the term “menstrual migraine” before tonight.

    Through the PP-health care, a year on BCBS thanks to ACA and then later – as a recession and the complexities of my health impeded my ability to work- qualifying for Medicaid, I’ve had to fight to keep my rings a few times. One doctor at PP saw “migraine” on my charge and went “whoa!” I had to explain to her, repeatedly, that not once in my entire life have I experienced any headache that could be called a migraine, other than these days-long headaches that just hover, which only happen around my periods – and those have none of the traditional migraine markers like light sensitivity or nausea. My sister has actual traditional migraines, I know the difference between my occasional tension headaches and the kind of migraine that makes you a higher risk for problems with the Nuvaring.

    Then it was the blood clots. Two different doctors and a lot of me trying not to roll my eyes, as they failed to grasp the obvious. If I take an aspirin, I get a nosebleed. If my B12 levels go too low, I start getting random bruises on my body. And my father dealt with the same borderline-anemic reactions before he died of Leukemia, that I’ve dealt with my whole life. My blood is so thin that I’ve never had a hemoglobin level high enough to donate blood. Obviously, anyone can get a dangerous blood clot, but on my list of medical worries, that’s just above testicular cancer (and no, I don’t have testicles).. And it’s certainly doesn’t justify not using the Nuvaring due to clotting risks.

    I understand the elevated precautions that have come from further study of the potential effects of the Nuvaring, but it’s frustrating that so many doctors want to knee-jerk a reaction to these precautions, and not look at the whole medical situation before doing so – particularly when these are effects that would’ve shown up before now, for those of us who are long-term users. Unless there comes a point where it’s clear that they’re doing more harm than good, I’m going to continue to fight to keep using the ring for as long as possible – or until menstruation is over, which could be another 20 years based on family history. For me, the migraines suck, but they’re at least manageable. The extreme cramps and bleeding are not going to be treated with migraine meds, are a bigger impediment to my life, and are only marginally helped with pain medications.

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