Abstract
To the editor,
Dear editor,
The NuvaRing is a hormonal vaginal contraceptive ring (VCR), which is frequently prescribed.
We briefly describe here a young female, NuvaRing user with a pulmonary embolism to raise awareness of the occurrence of acute pulmonary embolism in young healthy women and to highlight what the Food and Drug Administration concluded that the vaginal contraceptive ring is associated with an increased risk of venous thromboembolism similar to that of oral contraceptives.
A 29-year-old female, user of a VCR NuvaRing, presented to our emergency department with an eight-day history of dyspnea and chest pain. Usually she runs almost every day but since eight days she finds it difficult even to walk slowly due to dyspnea.
Her father was known with an antiphospholipid syndrome with pulmonary embolism but
Her respiratory rate was 24 breaths/min and her SpO2 was 100% while breathing ambient air.
The patient’s temperature was 36.8° and a C-reactive protein (CRP) was 16.
Her blood pressure was normal and her chest x-ray showed no abnormalities (Figure 1).
Chest radiograph.
The D-dimer level was 6 mg/l and a diagnosis of bilateral central pulmonary embolism was confirmed by computed tomography (Figure 2).
CT shows central pulmonary embolism.
Discussion
The NuvaRing was introduced in the USA in 2001 as an alternative to combined oral contraception and is the first FDA-approved available combined vaginal contraception ring. 1
It contains the hormones estrogen and a progestin, which are slowly released and absorbed through the vaginal tissue.
The NuvaRing is frequently prescribed, and the development of venous thromboembolic events associated with VCR has been reported previously but there are only few reports about vaginal contraception (as opposed to
Vaginal rings are easily inserted and removed by the patient which could lead to the failure of patients to remember being on a vaginal ring. 2
The Food and Drug Administration concluded that the VCRs were associated with an increased risk of venous thromboembolism similar to that of oral contraceptives. 3
Acute symptomatic central pulmonary embolism in young healthy women is potentially life threatening
Footnotes
Authors’ contribution
All authors had access to the data and played a role in writing this manuscript.
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Patient consent was