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Annovera Ring 101: What It Is, How It Works, Effectiveness

Annovera Ring 101: What It Is, How It Works, Effectiveness

  • Sonia Easaw, M.S., MPH
    Reviewed By: Julie Lamonoff, CNM, OBGYN-NP, Shannon DeVita DNP, FNP-BC, CPNP-PC
  • Top takeaways:
  • Annovera™ is an FDA-approved, reusable hormonal birth control vaginal ring.
  • One prescription of Annovera gives pregnancy protection for an entire year.
  • It's just as effective as birth control pills and has similar side effects.
  • Using a vaginal birth control ring has its benefits, but it's not for everyone.

Only 3% of women in the U.S. used a birth control ring like Annovera™ last year, compared with 37% who used birth control pills. We need more info on new contraceptive options for women—here's everything you need to know about the "newish" vaginal birth control ring, Annovera.

Let our medical team help you choose if Annovera is right for you.

The basics of Annovera

One prescription for the reusable Annovera birth control ring gives you pregnancy protection for an entire year. The flexible, squishy ring is inserted into the vagina for 3 weeks and then removed for 1 week during menstruation.

Annovera is just as effective as birth control pills and carries similar side effects. If you have health insurance, getting Annovera may be free from out-of-pocket costs.

See if you're eligible to get Annovera prescribed for free.

What is Annovera?

The FDA approved the Annovera birth control ring in 2018. It's a hormonal vaginal ring that—just like birth control pills—contains lab-made progestin and estrogen, specifically, hormones called segesterone acetate and ethinyl estradiol.

Here are some key characteristics of Annovera:

  • Purpose: Hormonal birth control ring used to prevent pregnancy

  • Effectiveness: 97% effective in preventing pregnancy

  • Type of contraception: Reversible, ethinyl estradiol vaginal system

  • Placement: Inserted into the vagina and removed by the user

  • Hormones: Segesterone acetate and ethinyl estradiol

  • Usage: Monthly cycle of remaining in place for 3 weeks, removed for 1 week

  • Lifespan: 1 full year (13 menstrual cycles)

  • Size: 2.2 inches in outer diameter; a little over a 1/4 inch thick

  • Material: Silicone elastomer (latex-free)

Annovera is a soft, flexible vaginal system made of silicone elastomer, a type of rubber used in other vaginal rings. It's designed to be comfortable and placed in the upper part of the vagina, so you shouldn't feel it, even during sex.

There are 2 different types of birth control rings in the U.S. For the user, the main difference is that Annovera is reusable and lasts an entire year, while the Nuvaring and its generics are designed to last a month. Both types of rings have the same estrogen, but a different type of progestin.

Since you can insert it and remove it yourself, Annovera is a reversible form of contraception that you can stop using at any time if you no longer need or want it.

You can control Annovera, unlike the IUD, which has to be inserted and removed by a doctor.

Is Annovera a good birth control method?

Just like the birth control pill, patch, or shot, Annovera primarily works by preventing ovulation (the part of the menstrual cycle when the ovaries release eggs). If no eggs are released, then the sperm can't fertilize them!

Doctors declare that Annovera is highly effective at preventing pregnancy: In a large, one-year-long study on the Annovera vaginal system, researchers found a 2.9% pregnancy rate for women over 1 year. The FDA approved Annovera after looking at this finding, saying that based on these clinical trials, about 2 to 4 women out of 100 women may get pregnant during their first year of using Annovera.

Who should use (or shouldn't use) Annovera

Annovera, a hormonal birth control method like the pill, is safe for most women. If you already take birth control pills, you might consider using Annovera instead because of its convenience. Since it lasts for one year, you wouldn't have to go to the pharmacy every month or every 3 months to pick up a refill.

Begin our online health questionnaire to see if our medical team thinks Annovera is right for you.

You should know that not everyone can use Annovera.

Consult a healthcare provider to determine whether Annovera is safe for you. Like the pill, you shouldn't use Annovera if you smoke and are older than 35.

Doctors say that you shouldn't use Annovera if any of the following applies to you:

  • Uncontrolled high blood pressure

  • Heart problems

  • Diabetes

  • Increased risk of blood clots

  • Undiagnosed abnormal uterine bleeding

  • Potential hepatitis C drug combinations containing ombitasvir, paritaprevir, or ritonavir (with or without dasabuvir)

  • Migraine headaches with aura

  • Liver disease or liver tumors

  • A history of estrogen- or progestin-sensitive cancer (like breast cancer)

  • Women who are breastfeeding

The FDA mentions one limitation in using Annovera: It hasn't been studied sufficiently in women with a BMI of 29.

What are the side effects of Annovera?

Researchers across the globe looked at Annovera safety data from 9 studies of over 3,000 women. They found that Annovera is just as safe as other hormonal contraceptives like birth control pills.

Common side effects of Annovera

Because it contains the same kind of hormones as the pill, Annovera usually has similar side effects. Here are some less serious side effects that some women may experience with Annovera (though, like side effects of birth control pills, they are usually mild and often disappear after you use them continuously):

  • Breast tenderness

  • Headache

  • Nausea

  • Vaginal discharge

  • Dysmenorrhea (painful menstrual periods)

  • Abdominal pain

  • Irregular bleeding

  • Mood changes

Women who participated in safety research trials of Annovera said that headache and nausea were two of the most common side effects. Researchers did find side effects unique to the vaginal ring, which were different from the patch or pill: Ring users had more vaginal irritation and discharge than pill users, but less acne, nausea, and emotional changes.

You might want to know how many women experience side effects. Annovera safety trials found that they happened with at least 5% of women.

Rare side effects of Annovera

Like with the pill, Annovera does carry some serious risks. The FDA says that hormonal birth control can have rare but severe side effects like:

  • Heart attack

  • Blood clots

  • Stroke

  • High blood pressure

  • Toxic shock syndrome (according to the Annovera manufacturer)

What are the pros and cons of using Annovera?

Using the Annovera birth control ring has several advantages, but it's not for everyone. Try reflecting on your comfort level when deciding on the pros and cons of Annovera.

Benefits of Annovera

Researchers and women's health advocates call Annovera a global step forward because of some of its biggest advantages are:

  • Annovera is woman-controlled because you can insert it and remove it yourself, unlike the IUD.

  • It's pretty easy to use and store (it doesn't need refrigeration).

  • It's easy to clean; according to the manufacturer, you'd just use mild soap and lukewarm water.

  • The innovative silicone ring delivers hormones to your body at a steady rate, allowing for continuous, lower doses of hormones than the pill.

  • Annovera is reusable and lasts for 13 menstrual cycles (1 year).

  • You wouldn't have to get another ring for 1 whole year; what a big contrast to having to go to the pharmacy every few months (or every month!) to get a refill for the pill.

If it's the right fit, you can even get Annovera prescribed online by our medical team and sent to your door for free.

Potential disadvantages of Annovera

The Annovera birth control ring may not work for everyone, and that's okay. Here are some potential cons to think about:

  • Annovera can fall out of the vagina (this happened at least once for 25% of women in a large-scale safety study of Annovera). You'd need to wash it with mild soap and reinsert it within 2 hours.

  • It may cause more vaginal irritation and discharge than the pill.

  • Annovera has common side effects like headache, nausea, and breast tenderness or more severe side effects like cardiovascular events, similar to other hormonal birth control methods.

  • You'd still need to remember to take out Annovera after 3 weeks of keeping it in place, and then reinsert it after 1 week.*

  • You'll have to be comfortable enough with your body and genital area to insert and remove the ring from the vagina.

  • If you're paying cash (in the event it is not covered by your health insurance), Annovera is more expensive than regular birth control pills.

*Tip: You can use the Annovera Birth Control Tracker app App store for iPhone or on Google Play to help remind you when to insert, remove, and reinsert your ring.

Talk to your doctor about the pros and cons of Annovera. Our medical team can help you decide if Annovera or another form of birth control is right for you.

How to use Annovera

The fact that Annovera is convenient and easy to use is one of its most outstanding achievements. That said, you'd still have to get used to using it!

What to know about using Annovera

Here are some basics on using Annovera:

  • Annovera is "soft and squishy"—it should feel comfortable after you insert it, leave it in for 21 days, and then leave it out for 7 days.

  • The ring should be washed and dried with mild soap and lukewarm water and then patted down dry with a clean cloth or paper towel every time you insert it.

  • You can use Annovera during sex.

  • You should try and keep Annovera inserted for 21 days in a row. Sometimes, it can fall out, but you have to make sure that you don't remove it for more than 2 hours total during those 3 weeks.

Do I need to wash it frequently? In a study of how women used Annovera, researchers realized that women who removed Annovera to wash it, or before sex were more likely to have it removed for more than 2 hours, which is not recommended. Doctors should let you know that using the ring doesn't increase vaginal infections or need frequent washings.

Inserting Annovera into the vagina

  1. The manufacturer of Annovera provides detailed steps of how to place Annovera inside the vagina, which we've summarized here:
  2. Step One: With clean hands, wash the ring with mild soap and water and pat dry.
  3. Step Two: While in a comfortable position, use your index finger and thumb to squeeze Annovera together into the size of a tampon.
  4. Step Three: Insert the ring as far up into the vagina as it will go. You shouldn't be able to feel it.

To remove Annovera, wash and dry your hands and insert your index finger inside the vagina, hooking the ring onto your finger and pulling it downward. Then, wash and dry the ring and store it in its case for 7 days until it's time to reinsert. In case you're wondering, you wouldn't leave Annovera inside the vagina all year long!

How does Annovera feel?

Researchers wanted to find out how satisfied women were with Annovera and if they chose to continue with it. They found that women who felt the ring when they wore it had twice the odds of being dissatisfied.

Here's the thing, though: The authors of the study mentioned above say that when you place Annovera in the upper two-thirds of the vagina, you shouldn't be able to feel the ring sensation because of the type of tissue that's up there. Most women who participated in the study (71%) said they never felt Annovera during sex (though half of the women who were dissatisfied with it said they sometimes or always felt it).

How to get Annovera

You need a prescription to get Annovera, just like you would with any other hormonal birth control. From there, you can go and get the prescription filled at a pharmacy.

See if you're eligible to get Annovera prescribed online by our medical team and delivered to your door for free.

The good news is if you'd rather not have to go in person to get a prescription, you may be able to get the Annovera birth control ring prescribed online and delivered to your door. Here's some more information about getting Annovera from us, The Pill Club, a telemedicine provider.

Suppose you don't have a regular primary care practitioner or gynecologist—not to worry. You can also go to a health clinic like a student health center or Planned Parenthood to get a prescription for Annovera.

Annovera is on the expensive side without health insurance. However, if your health insurance covers Annovera, you may be able to get it free of cost.

If you want to check how much your insurance will cover, see how much you'll pay for Annovera by filling out some information, including the name of your doctor and health insurance information. The Annovera manufacturer says that if the ring isn't free with your insurance, you can download their savings card to get it for as low as $0.

Annovera 101: Takeaways

Since the FDA approved Annovera in 2018, this vaginal birth control ring has offered women a reusable contraceptive that lasts for 1 full year and is highly effective at preventing pregnancy. It's an option that's long-lasting, convenient, and easy to use, though it carries the same risks as other birth control methods.

If you're interested in learning more about Annovera, your health care provider is a great person to consult. If you don't have a primary care practitioner or gynecologist, our medical team can help you decide whether Annovera or another form of birth control is right for you. Congrats, you've completed the first step in making the best contraceptive choice for you: knowing about your options, including Annovera!


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