Is It Better to Stay on the NuvaRing (Vaginal Birth Control Ring) During TT & BBL Surgery or Discontinue It for the Month?

Question

Hello, I was wondering if it would be better to stay on my current birth control method of the Nuva Ring (Vaginal Ring w estrogen progestin) or to stop it the month of surgery. Would taking low dose ASA after surgery be enough of a blod clot preventative or should an injection like Lovenox/Heparin be used? This will be my 5th consecutive month on the Nuva Ring and I feel that my horomones and cycle have finally stabalized. Your opinions & comments are appreciated!

Kurtis Martin, MD · Answer

I would stop it 1 month before surgery. Any hormone similar to this can increase your chance for DVT (blood clot) so why not decrease the risk.

Kenneth Hughes, MD · Answer

Any method of hormonal birth control represents a risk factor for DVT.  I always advise patients to discontinue this around the time of surgery.

	 

	 

	Kenneth Hughes, MD Los Angeles, CA

Robert Singer, MD · Answer

Safety should always be the primary concern in any elective surgery. Since it is known that taking birth control pills or using devices that release estrogen increase the risk of developing deep venous thrombosis (DVT) which can travel to the lung and be potentially life threatening, especially in a larger surgical procedure like a tummy tuck, it is recommended in the valid scientific literature that these birth control pills and devices should ideally be stopped for 1 month prior to surgery and for 2 weeks postoperatively. The pros and cons of doing this should be discussed with your plastic surgeon and an alternative method of birth control should also be discussed with your gynecologist.

	Whether Lovenox, which is a blood thinner, should be utilized in addition to intermittent compression stockings, adequate fluid replacement, and early ambulation depends on your individual risk factors.  I would suggest you find a plastic surgeon certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.   

	Robert Singer, MD  FACS 

	La Jolla, California

Jeffrey Zwiren, MD · Answer

Since the Nuva ring releases estrogen it is best to discontinue this prior to surgery to eliminate one souse of risk. If it can not be removed I would not think it was be a deal breaker but clincial correlation is required.

Lewis Ladocsi, MD, FACS · Answer

Hi FNP. I think the length of your surgery is an important predictor of your blood clot risk during surgery. Certainly, hormone replacement therapy can increase your risk for blood clots, but the increased risk may be low, depending on other important factors. If your surgery is performed with calf-compressing devices, a pillow behind your knees, and in a reasonable amount of time, then the risk of a clot developing during the perioperative period are low. Postoperative clot risk-reducing measures include early ambulation and drugs including aspirin, heparin and lovenox. I think hormonal imbalance is a difficult thing to adjust, and being out of balance may negatively impact your recovery. You should discuss these issues with your plastic surgeon.

Is It Better to Stay on the NuvaRing (Vaginal Birth Control Ring) During TT & BBL Surgery or Discontinue It for the Month?

Answers (5)

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