Pseudotumor cerebri (PTC) has been linked to NuvaRing. Many people with PTC suffer from chronic migraine headaches and they need surgery to drain excess cerebrospinal fluid from the skull.
What is NuvaRing?
NuvaRing is a hormonal birth control device that is manufactured by Merck & Co. Each vaginal ring contains a combination of two hormones, ethinyl estradiol (estrogen) and etonogestrel (progestin). NuvaRing was approved by the FDA in 2001.
NuvaRing and Pseudotumor Cerebri (PTC)
Pseudotumor Cerebri (PTC) occurs when pressure inside the skull increases due to excess cerebrospinal fluid. Normally, this fluid surrounds the brain and acts like a protective shock-absorber. When there is too much, pressure on the brain and optic nerve increases. Unless fluid levels are reduced, this can damage the optic nerve and cause blindness. PTC is currently known as Idiopathic Intracranial Hypertension (IIH).
Birth Control and PTC
The National Institute of Health (NIH) warns that birth control is a possible risk-factor for PTC. These warnings were issued because studies published since the 1990s have associated dozens of cases of PTC with birth control. One study, published in 1995, reported 56 cases of PTC in young women on a subcutaneous birth control implant.
The most serious complication of PTC occurs when intracranial pressure damages the optic nerve, which transmits signals between the brain and eyes. Blindness occurs in about 5% of people with PTC, but over 60% report vision problems like double-vision (diplopia), blurry vision, and sensitivity to light. Another vision problem, papilledema, occurs when there is swelling of the optic disc (head of the optic nerve located in the blind spot).
The British Medical Journal published a study in 2012 linking the use of NuvaRing with a 6.5-fold increased risk of blood clots compared to women who did not use hormonal birth control. NuvaRing was also linked to a doubled risk of blood clots compared to women who used birth control pills with levonorgestrel.
Blood clots in the brain can cause secondary intracranial hypertension, a condition that is similar to PTC because it also involves high pressure inside the skull due to excess cerebrospinal fluid.
Over 90% of people who are diagnosed with PTC report headaches. In clinical trials of NuvaRing, 11.2% of women reported headaches. Although it is not clear that the conditions are related, the Prescribing Information for NuvaRing recommends seeking a medical evaluation if you develop headaches that are severe or persistent.