Women who use birth control may be at risk of Idiopathic Intracranial Hypertension (IIH). Long-term complications of IIH may include chronic headaches and blindness. Treatment may involve surgery to drain cerebrospinal fluid.
What is Ortho Evra?
Ortho Evra is a birth control patch that prevents pregnancy by slowly releasing hormones through the skin. It contains two hormones, estrogen (ethinyl estradiol) and progestin (norelgestromin). Women on Ortho Evra are exposed to 60% more estrogen than a typical birth control pill. Higher levels of hormones are generally associated with higher rates of side effects.
Contraceptive patches were associated with a 7.9-fold increased risk of blood clots in a study published by the British Medical Journal in May 2012. Blood clots in the brain can potentially increases pressure in the skull, causing a complication known as secondary intracranial hypertension.
Does Ortho Evra Cause IIH?
Ortho Evra is not known to cause Idiopathic Intracranial Hypertension (IIH). “Idiopathic” is a medical term that means “a disease of unknown cause.” However, many cases have been reported in women on birth control pills and the National Institute of Health (NIH) includes contraceptives in a list of possible risk-factors.
The concern is based on studies linking dozens of cases of IIH with birth control. One study, published in 1995, reported 56 cases of IIH among young women on a subcutaneous birth control implant. Estrogen and progestin-only injections have also been linked to case reports of IIH. Although evidence is growing, the link between birth control and IIH remains inconclusive.
Idiopathic Intracranial Hypertension (IIH)
Idiopathic Intracranial Hypertension (IIH) causes high pressure inside the skull due to high levels of cerebrospinal fluid. This fluid normally forms a protective layer between the brain and the skull, where it acts as a shock-absorber. When there is too much fluid, pressure on the brain and optic nerves increases.
Over 60% of people who develop IIH report visual disturbances, such as double-vision (diplopia), blurry vision, enlargement of the blind spot, central vision loss, and temporary blindness. In some cases, IIH is associated with papilledema (swelling of the optic disc). About 5% of cases of IIH result in some level of blindness.
Migraine headaches are a classic sign of IIH. They are also one of the most common side effects of Ortho Evra. In clinical trials, headaches were reported by 21% of women on Ortho Evra, and migraines occurred in 2.7% of women. Although it is not clear that the conditions are related, symptoms are very similar — throbbing pain, light-sensitivity, nausea, and visual disturbances are common. Without treatment, headaches associated with Ortho Evra may become constant and cause debilitating pain.