Unexpected Menstrual Bleeding After Initiating Blood Thinners
I am a 27-year-old female who has been using the Nuva Ring consistently for around three years for managing symptoms associated with PCOS. For nearly a decade, I haven't experienced any menstrual bleed, as I previously had a Mirena IUD. Recently, due to a trauma-induced DVT, I was prescribed blood thinners, specifically apixaban. To my surprise, while still using the Nuva Ring, I had a light period. This light bleeding is consistent with my past experiences when I did menstruate. I am curious whether this occurrence is typical or if it raises any concerns. A hematology specialist I consulted a few days ago offered little insight, only suggesting I follow up with my gynecologist. She recommended discontinuing estrogen after my course of blood thinners, but also mentioned that I might continue with the Nuva Ring if I was comfortable with remaining on a low dose of blood thinner after the initial three-month treatment. In contrast, my GP reassured me that using the Nuva Ring poses no risk, particularly since my DVT was triggered by injury and the estrogen dose in the ring is considerably lower than that found in oral contraceptives. Additional information: - Current apixaban dosage: 5mg twice a day (I just switched from the starting weekly dose of 10mg twice a day). - I have also been prescribed iron supplements due to low iron levels over the past year, which raises additional concerns regarding any further blood loss. Any guidance on this situation would be greatly appreciated.
Answers (1)
2/11/2026, 11:01:50 PM
OpenHealth AI
It's understandable to be concerned about unexpected menstrual bleeding, especially after starting blood thinners like apixaban. Let's break down this situation:
Key Points
- Light bleeding while using the Nuva Ring, after not menstruating for a long time, can sometimes occur due to hormonal changes.
- Blood thinners like apixaban can affect bleeding tendencies but are not typically linked to reinitiating menstrual-like bleeding.
- The advice from your healthcare providers shows mixed opinions about the continued use of the Nuva Ring with blood thinners, which can be confusing.
Explanation
The Nuva Ring works by releasing hormones that help regulate your menstrual cycle. After a long period without menstruating, having light bleeding could potentially be a result of the hormonal balance being disrupted by starting new medications or changes in your health status. Your history of PCOS, previous hormonal birth control, and the initiation of blood thinners are all factors that may play a role in this change.
Bleeding after initiating anticoagulation therapy is generally monitored, particularly because your hematology specialist has mentioned follow-ups. The mixing of hormonal therapy and anticoagulants can have varied effects, and the potential for increased bleeding risk is a concern that merits attention. However, your GP reassured you about the safety of the Nuva Ring, particularly at the low dose you're using.
Next Steps
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Monitor Your Symptoms:
- Keep a diary of your bleeding patterns, noting the flow, duration, and any other symptoms (such as pain or unusual changes).
- If the light bleeding persists or changes significantly (like becoming heavier), it’s important to report this.
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Follow Up with Your Gynecologist:
- Schedule a follow-up appointment to discuss your current bleeding, your use of the Nuva Ring, and your ongoing treatment with apixaban.
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Assess Your Hemoglobin Levels:
- Since you’re on iron supplements due to low iron levels, regular monitoring of your hemoglobin (via blood tests) is crucial to ensure that any additional blood loss doesn’t exacerbate the situation.
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Consider Your Comfort and Risk:
- If you have concerns about continued bleeding, you might want to discuss alternative contraceptive methods with your gynecologist, especially while on blood thinners.
Conclusion
Unexpected light bleeding can happen in your situation, but ongoing surveillance of your symptoms and open communication with your healthcare providers are key. Taking action by tracking your symptoms and ensuring you have regular consultations will help you manage this effectively and give you peace of mind. Please let me know if you need more information or support regarding any of these steps.
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