Informed Choice

In our classes we always mention that we can’t and don’t tell people which form of contraception is best for them. Our opinions have no place there. What we do promote is informed decision making. We share reproductive health information that is as unbiased as possible and encourage people to ask specific questions of themselves and their providers. Knowledge, of oneself and one’s choices, is power.

Early on, we found someone who shared this mission, or, rather, she found us and became a strong supporter. Karen Langhart came to us out of the lovely blue and into our inboxes.


I’m at the Woman Up Summit – a think tank and project connected to the documentary [Sweetening the Pill]. It’s organized by Karen Langhart, who lost her daughter to a NuvaRing created blood clot. She has a foundation – Informed Choice for AmErika – and she and her foundation director are keen to talk to you about the birth control road trip and funding.

Shall I put you in touch?

--Holly Grigg-Spall”

I had read about Karen and her daughter in Vanity Fair a few years before. At the age of 24, on Thanksgiving Day, Erika Langhart died of a double pulmonary embolism as a direct result of the Nuvaring. A pulmonary embolism is usually a blood clot that’s formed in the leg, breaks off, and travels to the lung, blocking a major blood vessel there.

 Erika Langhart

Erika Langhart

“In the ambulance Erika had two heart attacks, and she was semi-conscious by the time they reached Virginia Hospital Center. According to Karen, a doctor in the emergency room asked her over the phone: ‘Was your daughter using birth control?’ Karen said, ‘Yes, NuvaRing.’ He removed the device and said, ‘I thought so, because she’s having a pulmonary embolism.’”

Erika graduated from American University in Washington D.C., and it was important to Emily and I to have a class there, to share information about the risks of hormonal birth control, especially the increased risk of developing blood clots. 1 in 1,000 women per year who are taking combination birth control pills will develop a clot, and some studies have shown third generation, like the Nuvaring contains, and fourth generation progestins increase that risk even further.

Oorja Mehra, one of Emily’s dearest friends, helped us organize the AU class, which fell right in the middle of mid-term exams. Still, five students attended, impressively engaged, despite the late, studious nights. It was our first college class. This is an age group that is so critical to us to reach, and we were thrilled to be there. We feel so grateful to everyone who was able to attend. Plus, Oorja swiped us into the cafeteria afterward, making our post-grad dreams come true.

 Emily and Oorja at Steak 'n Egg diner in DC

Emily and Oorja at Steak 'n Egg diner in DC

Tanisha Ferguson, the communications director for Informed Choice for AmErika and one of Erika’s best friends, returned to her alma mater to attend our class. She spoke about Erika and two other American University classmates who experienced pulmonary embolisms related to the Nuvaring. She used names, not numbers, to describe the risks of hormonal birth control. When pharmaceutical commercials list side effects in hyper-speed and lettering is miniscule, it’s easy to dismiss and downplay the risks. Tanisha’s presence was impactful for all of us, because these risks are real and life changing.

We had the opportunity to spend five nights at Tanisha’s. We basically moved in. She and her family were incredibly generous, sharing their space, food, time, washer and dryer. Over lunches and dinners, Emily and I listened to Tanisha describe Erika. How Erika didn’t want to miss out on a single thing, to the point she was nearly asleep at the end of Tanisha’s wedding night but, rather than give into tiredness, ran around the hotel several times to wake herself up, to be 100% present. She lived so much life in her twenty-four years. Tanisha found out she was pregnant right before Erika passed and imagines her son and Erika high-fiving each other as they crossed the earthly threshold, Erika passing her vivaciousness to Luke, Tanisha’s son. We feel like we know Erika, if only a little. Thank you, Tanisha and family, for having us; it was a gift to stay with you.

Karen’s favorite quote was: Love is stronger than fear, life stronger than death, hope stronger than despair. Since starting this project, we have heard and read more real stories about severe injuries and deaths caused by hormonal birth control related blood clots. We find hope through a task force of individuals and organizations that are questioning contraceptive choices and demanding informed consent. We find hope in education as prevention, and the task force is growing, one class and person at a time.

 First class selfie-stick photo

First class selfie-stick photo

*In our classes, we always review the signs and symptoms of deep vein thrombosis (DVT) and pulmonary embolism (PE), because quick treatment can make a difference. We believe the more people who can recognize these signs and symptoms, the safer we will all be.*

What is DVT? It’s a blood clot that forms in the deep veins, usually in the legs, but sometimes in the arms.

Signs and symptoms of DVT

Contact your doctor immediately if you experience:

-Swelling, usually in one leg or arm

-Leg (or arm) pain or tenderness

-Reddish or bluish skin discoloration

-Leg (or arm) warm to the touch

What is a PE? Clots can break off from a DVT and travel to the lung, blocking a major blood vessel there.

Signs and Symptoms of Pulmonary Embolism

Call an ambulance or 911 for treatment in the ER if you experience these symptoms:

-Sudden shortness of breath

-Chest pain that’s sharp, stabbing, and may get worse with deep breaths

-Rapid heart rate

-Unexplained cough, sometimes with bloody mucous