And Another Medical Journal Article Concludes Venous Thromboembolism (VTE) Risk Associated With NuvaRing Is As High As YAZ Or Yasmin And Ortho Evra
In May 2012 I wrote this article, "Merck Funded Study Says There Is No Blood Clot Risk With NuvaRing, While BMJ Medical Journal Article Reports A 90% Increased Risk", which pointed out some recent conflicting findings as regards serious NuvaRing side effects involving blood clots, such as pulmonary embolism (PE), deep vein thrombosis (DVT), and ischemic stroke (CVA).
Anne-Marie Amies Oelschlager -- as Associate Professor of Obstetrics and Gynecology at the University of Washington School of Medicine in Seattle, Washington, and the Director of Pediatric and Adolescent Gynecology at Seattle Children's Hospital -- spoke about these conflicting findings in a short video titled "The Contraceptive Ring and Relative Risk for VTE -- An Expert Weighs in on Recent Conflicting Findings", which was posted July 20, 2012 on the Medscape.com web site.
Therein she considers the two competing NuvaRing studies which I wrote about in May, namely:
1. Lidegaard O, Nielsen LH, Skovlund CW, Løkkegaard E. Venous thrombosis in users of non-oral hormonal contraception: follow-up study, Denmark 2001-10. BMJ. 2012;344:e2990. http://www.medscape.com/viewarticle/763778 Accessed July 12, 2012.
2. Dinger J, Pineda AA, ZEG-Berlin Center for Epidemiology and Health Research, Heinemann K (presenter). Risk of VTE in users of an etonogestrel-containing vaginal ring and combined oral contraceptives, Transatlantic Active Surveillance on Cardiovascular Safety of NuvaRing (TASC). Papers on Current Clinical and Basic Investigation; American College of Obstetricians and Gynecologists (ACOG) 60th Annual Clinical Meeting; May 7, 2012; San Diego, California. Paper #3; 4-5. http://classic.acog.org/acm/pdf/oralMon748.pdf Accessed July 12, 2012.
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From the transcript for Dr. Oelschlager's Medscape presentation:
Today I'm going to talk about 2 recent studies. One was published recently in the British Medical Journal ; the other was presented recently at the 60th Annual Clinical Meeting of the American Congress of Obstetricians and Gynecologists. Both of these studies looked at the relative risk or increased risk for venous thromboembolism (VTE) associated with combination hormonal contraceptives....
These 2 studies address the question of whether the [NuvaRing] transvaginal ring may increase the risk for VTE....
Putting this in perspective, the question is, what do we do with this information? One study showed an increase in risk; one study showed no increase in risk. I think there is biological plausibility that the [NuvaRing] contraceptive ring may increase the risk for VTE. We know that the serum concentrations [of sex hormone binding globulin] associated with the transvaginal route are higher than with combination oral contraceptive pills....
In the end, Dr. Oelschlager concludes that women who use the NuvaRing "should be counseled that [it may carry] an increased risk for VTE in comparison with other methods."
For some elaboration about this increased risk for VTE, or blood-clot side effects, we turn to a medical journal article, "Thrombotic risks of oral contraceptives", which will be published in the August 2012 edition of Current Opinion in Obstetrics and Gynecology.
From the Abstract for this new medical journal article:
Combined oral contraceptives (COCs) differ significantly regarding VTE risk depending on amount of estrogen and type of progestogen: COCs containing desogestrol, gestoden or drospirenone [(DRSP), which is found in YAZ and Yasmin] in combination with ethinylestradiol (so called third-generation or fourth-generation COCs) are associated with a higher VTE risk than COCs with ethinylestradiol and levonorgestrel or norethisterone (so called second-generation COCs). The VTE risk for transdermal COCs like vaginal ring (NuvaRing) or patch ([Ortho] Evra) is as high as for COCs of third or fourth generation.
We will continue to watch for new medical journal articles and expert commentary about the increased risk of blood-clot side effects such as pulmonary embolism (PE), deep vein thrombosis (DVT), and ischemic stroke (CVA) associated with NuvaRing use.
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