can nuvaring cause depression?

Taking hormonal birth control might be associated with an increased risk for depression compared with those who don’t use contraception, according to a new study published in the journal JAMA Psychiatry last week.

The finding is something that users have long suspected, as about 30% of women who ever used the pill in the United States eventually quit because of dissatisfaction with side effects, according to a 2013 report from the Centers for Disease Control and Prevention (PDF).

“We have known for decades that women’s sex hormones estrogen and progesterone have an influence on many women’s mood. Therefore, it is not very surprising that also external artificial hormones acting in the same way and on the same centers as the natural hormones might also influence women’s mood or even be responsible for depression development,” said Dr. Øjvind Lidegaard, a professor at the University of Copenhagen in Denmark and lead supervisor of the study.

Lidegaard and his colleagues tracked the health of more than 1 million Danish women between the ages of 15 and 34 over 14 years, using data from the National Prescription Register and the Psychiatric Central Research Register in Denmark.

To ensure that depression was properly identified in connection with birth control use, women with a depression diagnosis before their 15th birthdays or the start of the data collection were excluded.

After analyzing the data, the researchers found that the use of hormonal birth control was positively linked to a subsequent depression diagnosis and use of antidepressants.

Among all hormonal birth control users in the study, there was a 40% increased risk of depression after six months, compared to women who did not use hormonal birth control, the researchers found. The mean age of birth control users in the study was 24.

The users of combined oral birth control pills experienced a 1.2-fold higher rate of subsequently taking antidepressants during the study period than those not using the birth control. Women who used progestin-only birth control pills experienced a 1.3-fold higher rate, according to the study.

As for non-oral forms of hormonal birth control, those who used the transdermal patch had a two-fold increased risk and those who used the vaginal ring had a 1.5-fold increased risk.

Similar rate increases were found for depression diagnoses, according to the study.

The researchers noted in their study that the difference in risk rates among women taking non-oral and oral forms of birth control might be due to a difference in dose rather than how the contraceptives are administered.

The researchers also noted that this association does not imply that birth control alone causes depression – and more research is needed to better understand the possible link.

“Adolescents seemed more vulnerable to this risk than women 20 to 34 years old. Further studies are warranted to examine depression as a potential adverse effect of hormonal contraceptive use,” the researchers wrote in their study.

One of the study authors has a history of consulting for two pharmaceutical companies, Lundbeck and AstraZeneca, and another author reported receiving funds for talks from Exeltis. No other conflicts of interest were disclosed.

Lidegaard said the study results could translate to women in the United States.

In the United States, about 62% of women 15 to 44 years old use some form of contraception (PDF).

Among those women, 16% use the pill, 15.5% use female sterilization, and 7.2% use long-acting reversible contraception, such as an IUD or implant, according to the National Center for Health Statistics.

What do other experts think of the new study? Dr. Kathryn Holloway, an ob-gyn practitioner at the Institute for Women’s Health in San Antonio, Texas, called it impressive.

However, while there may be a correlation between hormonal birth control with the prescription of antidepressants and perhaps a depression diagnosis, causation is hard to prove, she said.

“Although this study suggests an increased risk of depression with combined hormonal contraception, the increase does not seem so great as to significantly change how I counsel patients,” Holloway said, adding that, “Depression is not something to be taken lightly and should not be a missed diagnosis. It is important for physicians to monitor and evaluate for any possible side effects, even if rare, with any prescribed medication.”

While birth control comes with some negative side effects, from stomach cramps to increased risk of stroke, it can also provide some health benefits.

Hormonal birth control not only prevents unwanted pregnancies, but also can regulate menstrual cycles, treat endometriosis pelvic pain, control symptoms of fibroids, help acne breakouts, and reduce the risk of some cancers that affect reproductive organs.

There are some forms of birth control that are not hormonal, Holloway said.

The most common side effects of NuvaRing are: Tissue irritation inside your vagina or on your cervix. Headache (including migraine) Mood changes (including depression, especially if you had depression in the past).

NuvaRing side effects | Irregular periods | Yeast infections | Acne | Serious side effects | Depression | Blood clots | TSS | How long do side effects last? | Warnings | Interactions | How to avoid side effects

NuvaRing (progestin and estrogen) is a vaginal ring that’s a form of birth control for women. The ring is latex-free and flexible. NuvaRing is about two inches wide and transparent in color. As a combination hormonal contraceptive, NuvaRing releases two hormones continuously over a three-week period when inserted into the vagina. When used correctly, NuvaRing can be highly effective at preventing unwanted pregnancy. Like all forms of birth control, there are some NuvaRing side effects.

It is important for women to determine with their healthcare provider what form of birth control is right for them and their bodies. While NuvaRing may work great for some, it may not be a great fit for others. This article is going to dive into some of the possible side effects and interactions caused by NuvaRing.

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Here are some common side effects reported from women who have used the birth control method NuvaRing:

Less common side effects include:

Different methods of birth control (including birth control pills, the birth control shot, intrauterine devices also called IUDs) can affect your menstrual period in different ways.

While using NuvaRing, some women may experience bleeding during times when they are not on their menstrual period. The amount of bleeding can vary from person to person. This bleeding may present as slight staining to breakthrough bleeding much like a regular period. Bleeding between periods is more common for new users. However, for some women, this bleeding continues throughout use. Such bleeding usually does not suggest any serious problems.

Most women will still have a period while using NuvaRing. They can experience changes in their periods, including length of period and changes in flow.

It is possible to miss a period while using NuvaRing even if a woman is not pregnant. However, if a woman does miss her period, she should consider a chance of pregnancy if she removed NuvaRing during the usage time for longer than three hours or if she did not insert a new ring within a week of taking out the old one. A woman may also be pregnant after missing a period if she left NuvaRing in for a duration exceeding four weeks or if she misses two periods consecutively while using NuvaRing correctly.

Hormonal birth control can cause imbalances that lead to yeast infections. NuvaRing is a hormonal birth control method, so there is a chance that women who use it may experience yeast infections.

Hormone birth control methods can alter the balance of hormones in the body and cause an overgrowth of yeast in the vagina. Women’s bodies usually already have a healthy balance of yeast, but when there’s too much yeast, it can cause infections and discomfort.

If a woman thinks she may have a yeast infection, she can identify it with the following symptoms:

Usually, a yeast infection is treatable at home with over-the-counter (OTC) products. Women can go to their local pharmacy and find products to treat mild yeast infections.

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Women should go to their OB-GYN if they experience a severe yeast infection. If OTC treatment is not helping a yeast infection, a stronger medication may be needed that can only be prescribed by a professional. If women experience extremely painful or amplified symptoms, they should consult with their provider right away.

The following indicate a need to contact a healthcare professional:

Many women experience hormonal acne both during their period and in general. Hormone imbalances can cause acne, so it only makes sense that hormonal birth control could as well. NuvaRing does list acne as a potential side effect when using the product.

If women experience a hormone imbalance while using NuvaRing, they may experience more acne. On the flip side, NuvaRing can also decrease acne if women have a hormone imbalance before starting hormonal contraceptives. So for women experiencing hormonal acne and interested in a hormonal contraceptive option, NuvaRing could help decrease their acne while providing pregnancy prevention.

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NuvaRing has a black box warning, the FDA’s most strict warning for medications. Black box warnings are established to alert healthcare providers and patients about serious side effects that can result in injury or death. NuvaRing’s black box warning relates to cigarette smoking and how it increases the risk of serious cardiovascular side effects from combination contraceptive use. This risk increases with age and with heavy smoking (15 or more cigarettes per day) and has a higher risk in women over 35. Women who use combination hormonal contraceptives, including NuvaRing, should be strongly advised not to smoke.

While serious side effects are typically not common, there are instances reported where NuvaRing users have experienced more serious side effects. If women experience serious or persistent side effects, they should contact a healthcare professional promptly or seek medical help if necessary.

Another potential side effect while using NuvaRing is depression or changes in mood. Since hormone levels can greatly affect a person’s moods, depression can develop when the body adjusts to hormones when starting NuvaRing and during regular use.

Women who have suffered from depression previously are at higher risk of experiencing depression while using NuvaRing.

Women should always contact their healthcare provider if they think they may be experiencing depression. This is especially important if women have any thoughts of self-harm, suicide, or thoughts of harming others. For free and confidential support, there is the National Suicide Prevention Lifeline: 1-800-273-8255.

A serious potential side effect while using NuvaRing is blood clots. This side effect relates to the black box warning associated with NuvaRing. There are certain women who are at a higher risk for clotting including those who are older than 35, obese, or smoke.

The risk for blood clots is highest when women first start using NuvaRing and when they re-start NuvaRing after not using it for at least one month. In some studies of women who used NuvaRing, the risk of getting a blood clot was similar to the risk in women who used oral combination birth control pills. Examples of serious blood clots are:

Women should seek medical attention immediately if they experience any of the following symptoms associated with blood clots:

Another serious potential side effect of NuvaRing is toxic shock syndrome (TSS). This is a form of severe damage and illness that happens when bacteria release toxins into the bloodstream.

Since the ring is inserted into the vagina, there is the possibility that NuvaRing can provide a place for harmful bacteria to grow. It is very important to make sure NuvaRing is removed after using it for three weeks. If the user forgets to remove the ring, NuvaRing can safely be in place for up to four weeks.

Symptoms of TSS can be similar to the flu, but they can become serious very quickly. Since TSS is life-threatening, women should call their healthcare provider or get emergency treatment right away if they experience the following symptoms while using NuvaRing:

Many women experience some of the mild side effects of NuvaRing within the first one to three months of using this contraceptive method. During this timeframe, the body is adjusting to having the product in place and to the new hormones introduced into the system.

Most women will notice that these side effects decrease after the first couple of months. However, some women may experience mild to severe side effects during the entire time of use.

Many women experience spotting or spontaneous bleeding between periods in the first couple of months of using NuvaRing. For most women, this is a temporary side effect and stops after one to three months. For women who continue to experience unexpected bleeding while using NuvaRing, they should notify their doctor.

Some of the other mild NuvaRing side effects that women may experience during the first couple months of using NuvaRing include acne, changes in mood or sex drive, discharge, and vaginal discomfort.

There are more mild side effects that some women may experience, especially during the first few months. If women experience persistent side effects after the first couple months of use or severe symptoms during any time of use, they should notify their healthcare provider.

When the body has gotten used to hormonal contraception, women can experience symptoms when they stop using it. These symptoms are similar to the symptoms many women experience when they first start using NuvaRing.

When stopping hormonal birth control of any kind, like NuvaRing, women may experience the following symptoms:

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While NuvaRing can be a convenient contraceptive option for some women, it is not the best fit for everyone. Certain women should not use NuvaRing. If women have any of the following contraindications, they should consider alternative birth control methods:

According to the FDA, NuvaRing has an extremely rare chance of causing liver tumors and even liver cancer. Women should tell their provider if they have a history of liver disease.

NuvaRing should stay in place for three weeks and be removed for one week, and then a new NuvaRing should be inserted. If a woman forgets to remove her NuvaRing after three weeks, the NuvaRing can safely remain in place for a total of four weeks. After this amount of time, women are at risk for pregnancy.

Overdose of NuvaRing is not likely if the user follows the proper directions. If the NuvaRing breaks or loses its’ shape while in the vagina, it will not release a higher amount of the hormones. Women can become pregnant if NuvaRing is left in longer than advised.

For hygienic reasons, NuvaRing should not remain in place longer than four weeks. If women have forgotten to change their NuvaRing for longer than four weeks, they should consult their provider for medical advice.

Women should never use more than one NuvaRing at a time. This can cause an excess of hormones, leading to symptoms including bleeding, nausea, or vomiting.

Unsafe reactions can happen if NuvaRing is used with certain medications. It is important to not take the following medications while using NuvaRing:

While for some women NuvaRing side effects may be unavoidable, there are a few steps that can be taken to prevent side effects with NuvaRing.

One of the best ways to avoid side effects and complications while using NuvaRing is to follow the package directions. It is important to know that NuvaRing does not protect against HIV infection (AIDS) and other sexually transmitted diseases.

During a four-week cycle, NuvaRing is placed in the vagina for three weeks and then removed for one week. Women will typically have their period during the week without using the NuvaRing.

Some women have accidentally inserted NuvaRing into their bladder. If women have pain during or after insertion and can’t find NuvaRing in their vagina, they should call a health care provider right away. Only use NuvaRing with the supervision of a professional. Make sure to discuss any questions or concerns about birth control methods with your healthcare provider.

Before deciding to start using NuvaRing or any other form of hormonal birth control, always discuss it with a professional. Providers can look back at a woman’s medical history and note anything that may prevent NuvaRing from being the best and safest option. Make sure that NuvaRing is the best choice before starting it.

Certain drugs can interact with NuvaRing. It is important for women to talk with a doctor if they are using medications for HIV, hepatitis, or heavy menstrual bleeding before taking NuvaRing.

Picking the best birth control can feel challenging at times. The most helpful way to figure out the best option is to have a conversation with a provider. Do not start any form of hormonal birth control without first talking to a doctor or OB-GYN.

The accounts of women experiencing the negative side effects of the NuvaRing contraceptive are gruesome, and their stories are part of the evidence that led to the $100 million settlement last week with NuvaRing maker Merck & Co. The pharmaceutical company agreed to hand over $100 million for liability lawsuits claiming the ring caused blood clots that sometimes led to heart attacks and even death, although Merck denied fault. The women argued they were not adequately warned about these side effects, and about 3,800 of them are eligible to partake in the settlement.

Despite the well-publicized risks, some women are finding it difficult to ditch a contraceptive that has provided them with consistency and convenience. Oftentimes, finding the right birth control takes years of trial and error, and side effects range from weight gain to decreased libido. For this reason, when women find the right contraceptive, they tend to develop a certain loyalty to it.

Sarah, 26, a graduate student in New York City, struggled with finding the right birth control since she was 20 years old. During the year she was on the pill, she put on weight and was constantly having mood swings. She’d feel depressed one day and highly irritable the next. She switched to the NuvaRing five years ago after a friend suffering similar effects made the swap, and it has been smooth sailing ever since. “I hated the whole contraceptive experience, but with the NuvaRing I don’t experience any of that,” she says.

The NuvaRing ring is a flexible ring that women insert inside their vagina and remove for the week of their period. Like an oral contraceptive, it releases the hormones progestin and estrogen (though at lower levels), preventing ovulation and sperm from reaching the egg, but you don’t have to remember to take a pill every morning. Women prefer it for its convenience, the localized hormones, and the fact that there’s less accountability. In 2012, there were about 5.2 million prescriptions in the U.S. for the NuvaRing, according to IMS Health, a healthcare technology and information company.

According to the American College of Obstetricians and Gynecologists (ACOG)–the medical authority on all things related to baby-making–NuvaRing leads to a slight increased risk of deep vein thrombosis, heart attack, and stroke. And, as highlighted in a safety warning on NuvaRing’s website, the danger is higher for some women, like those over 35 who smoke more than 15 cigarettes a day or women who have multiple risk factors for heart disease. Its typical use failure rate is 9%, the equivalent of an oral contraceptive, according to the CDC.

Following the settlement Friday, Merck issued a statement saying, “We stand behind the research that supported the approval of NuvaRing, and our continued work to monitor the safety of the medicine.”

Though the side effects of the NuvaRing are very real, for many women it bears no complications. “I am extremely busy with very irregular hours and travel for my job,” says Julie*, 27, who works for a film production company in Los Angeles, California, “so the NuvaRing is the ideal fit for my lifestyle. I have virtually no side effects, so I plan to remain on it for the foreseeable future.”

Other women simply shrug off the dangers. “Every drug you take comes with risks, from Asprin to birth control to allergy medicine,” says Ricci Ellis, 31, a respiratory therapist in Little Rock, Arkansas, who switched from the pill after consistently forgetting to take it. “For me, the benefits of NuvaRing far outweigh the risks.” Because she’s not not a smoker and leads an active and healthy lifestyle, Ellis considers herself relatively safe from the risks of blood clots, strokes, and sudden death.

“It is absolutely essential that people are aware of the risks associated with each method of contraception,” says Bill Albert, the chief program officer at The National Campaign to Prevent Teen and Unplanned Pregnancy. The American Heart Association (AHA) recently recommended that women considering birth control get screened for high blood pressure, which can put them at a greater risk for clots and stroke. “Equally important, however, is how such risks compare to those of other methods, and to pregnancy as well.”

According to Albert, the side effects need to be placed in a broader context so that they are neither dismissed nor viewed with disproportionate alarm. “One of the highest risk of blood clots comes with pregnancy. Consequently, if an individual is having sex and doesn’t want to get pregnant, skipping birth control altogether for fear of blood clots is not the best way to protect your health,” says Albert. “This is not meant to be cavalier, but the doubling of a rare risk is still rare.”

Medical experts are careful to not trivialize the risks, but Dr. Eve Espey, the chair of ACOG’s Committee on Health Care for Underserved Women and a professor in the Department of Ob-Gyn at the University of New Mexico’s School of Medicine, says the NuvaRing settlement hasn’t changed how she counsels her patients. “It’s always tragic and horrible when a woman has a bad outcome or dies from a blood clot. But to then label that method as dangerous often translates into more unintended pregnancies with a higher risk than using the method,” says Dr. Espey. Though popular for its convenience, the NuvaRing isn’t the most effective form of birth control out there. And neither is the pill. The intrauterine device (IUD) and the implant are considered the two safest and most effective forms of birth control available, with a typical use failure rate of 0.8% and 0.05% respectively.

When asked if women currently using NuvaRing should talk to their doctors about other options, Dr. Espey said, “How do you prepare for the event that’s so rare?”

But it’s making Sarah think twice. “I’m definitely concerned about the risks,” she says. “I am making an appointment with my gynecologist to discuss options.”

Regardless of whether you’re experiencing detrimental side effects, coming off of hormonal birth control is always an option.

Before taking any steps, it’s always a good idea to visit a doctor or sexual health clinic for advice on how to stop the method you’re taking and how to prevent pregnancy, should you wish to do so.

Generally, pills and patches can be stopped at any time, and you’ll need to use another form of contraception immediately if you want to prevent pregnancy.

(But planning when you stop — like waiting until the end of the pill pack — can help you predict the timing of your next period.)

Implants and IUDs need to be removed by a healthcare professional. You’ll need to use an alternative contraceptive, such as condoms, straight away to prevent pregnancy.

With the birth control shot, things are slightly different. As you get the shot every few months, you can simply stop booking repeat appointments.

But its contraceptive effects can last for a while — up to 18 months in some cases. So talk with a doctor or other healthcare professional to find out when you may need to use another form of contraception.

If you’re still experiencing menstrual irregularities 3 months after stopping, have a doctor check that there’s nothing else going on.