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How is the New Annovera Ring Different From NuvaRing?

  • Sonia Easaw, M.S., MPH
    Reviewed By: Julie Lamonoff, CNM, OBGYN-NP, Shannon DeVita DNP, FNP-BC, CPNP-PC

Though the ring is a significant advancement for birth control, you have every right to be skeptical of a ring that goes into your vagina. Here's what you should know about the Annovera® birth control ring and how it compares to the other contraceptive vaginal ring on the market, NuvaRing®.

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

Short answer: Annovera vs. Nuvaring

Annovera and NuvaRing are flexible birth control rings that can be inserted into the vagina and left in place for 3 weeks. After 3 weeks, you remove the ring for a 1-week break (when you get your period) and then repeat the same cycle month after month.

However, each product is unique.

For example, Annovera is the first reusable birth control ring to last an entire year, while you need to replace NuvaRing every month with a new ring.

Essentially, you wouldn't need to get monthly refills—just 1 prescription of Annovera lasts a whole year.

The newer Annovera ring isn't "better" or "worse" than NuvaRing in preventing pregnancy. If you use them perfectly as prescribed, either birth control ring is 99% effective.

How effective are Annovera and NuvaRing?

Annovera and NuvaRing work equally as well. The Food and Drug Administration (FDA) approved Annovera in 2018 and NuvaRing in 2001 after ensuring that each ring is safe and effective at preventing pregnancy.

Perfect use vs. typical use

If you use either NuvaRing or Annovera perfectly according to the directions, your chances of pregnancy are less than 1%. However, not everyone is perfect: When it comes to the birth control ring, the CDC says that for typical use in real-world situations, the failure rate is 7%.

Clinical effectiveness

The FDA says that about 2 to 4 women out of 100 women may get pregnant using Annovera in the first year. Back in 2001, clinical trials of NuvaRing had similar results, with only about 2 women out of 100 women getting pregnant in the first year of using NuvaRing.

How do Annovera and NuvaRing work?

Both Annovera and NuvaRing represent a massive innovation in the birth control world: A contraceptive vaginal ring that offers unique advantages.

Special vaginal delivery of hormones

Annovera and NuvaRing work the same way in that they deliver a combination of estrogen and progesterone into the body, just like the pill, patch, or shot. But what makes Annovera and NuvaRing special is their innovative design to deliver these hormones into your body. Hormones are delivered directly through the ring and into the layers of vaginal tissue.

Releasing low-dose hormones into the vagina

Delivering hormones through the vagina allows for continuous delivery of a lower dose of hormones to the body compared to most birth control pills. Annovera or NuvaRing will give you consistent levels of hormones, so you can avoid hormone fluctuations.

The same type of hormones as the pill

Like the pill, birth control rings have a combination of female hormones (estrogen and progesterone) that keeps your ovaries from releasing eggs, a process called ovulation.

Next, the ring's hormone combination does two more things: First, it changes the uterus lining to make it harder for pregnancy to develop. Second, it changes the cervical mucus that guards the opening of the uterus, making it harder for sperm to get in. No wonder hormonal birth control works so well to prevent pregnancy!

Annovera vs. NuvaRing: Similar, but different

Fundamentally, Annovera and NuvaRing work the same to prevent pregnancy. In addition, each of them is an excellent alternative to the pill, offering convenience and total control to women who can insert and remove it independently (unlike the IUD). Contrast this with the IUD, which needs a doctor's insertion and removal, and you'll see the big difference in control.

Annovera offers a full year of birth control

Despite these similarities, however, Annovera has been called a new "global step forward" that can outshine NuvaRing when you compare the two. So here is the main difference to you, the user, of how you'd experience Annovera:

You'd only have to get 1 reusable Annovera ring, which lasts a year, versus getting a new NuvaRing every month.

Same usage, different method with Annovera

You'd use Annovera and NuvaRing in the same way: Inserting the ring into the vagina, leaving it in place for 3 weeks, and then removing it for 1 week to get your period (withdrawal bleed).

Because Annovera lasts a full year (though it doesn't stay in the vagina for a full year!), you wouldn't throw it out and replace it every month with a new ring like you would with NuvaRing. Instead, when it's time to take out Annovera for a week, you'd wash it with mild soap, dry it off with a clean cloth or paper towel, and store it in its case until it's time to reinsert it a week later. It's okay and normal if you're still bleeding when it's time to reinsert Annovera; you can safely use tampons or pads while the ring is in.

Hormones: Same function, different form

Both NuvaRing and Annovera have estrogen (specifically, ethinyl estradiol), and each has a specific type of progestin. However, scientists created a different progestin hormone just for Annovera, called segesterone acetate.

Okay, Annovera has the hormones segesterone acetate and ethinyl estradiol, while NuvaRing has the hormones etonogestrel and ethinyl estradiol. So what does this mean for you?

Well, the new combination of hormones in Annovera means that a single ring can prevent ovulation for an entire year. That's a primary reason why the Population Council, a nonprofit dedicated to addressing family planning needs worldwide, developed Annovera.

Technical differences between the 2 rings

Annovera and NuvaRing have the same shape and flexibility (Annovera is a donut-shaped ring, same as the ring shape of NuvaRing). Yet, they are different in size, thickness, flexibility, and color.

Size. One is slightly bigger: Annovera is 2.25 inches in diameter, while NuvaRing is 2.13 inches in diameter. This size difference is only about 1/10 of an inch, however!

Thickness/Flexibility. Though they're very similar in size, Annovera is about twice as thick as NuvaRing. NuvaRing is 0.16 inches thick, while Annovera is 0.33 inches thick. However, there's a reason for the added width to Annovera.

In a sponsored post about Annovera, the manufacturer says "the increase in its width was purposeful because it is composed of a 'squishy' silicone elastomer to make it soft and flexible for easy insertion and removal while remaining comfortably in place throughout daily activities including sex."

Ultimately, this design innovation makes Annovera thicker and softer than NuvaRing.

Color. There is also a slight color difference: NuvaRing is transparent, "colorless to almost colorless," while Annovera is "opaque white" in color.

Choosing Annovera: pros and cons

The cons of using Annovera are pretty much the same as what you'd find with NuvaRing. For example, either ring can fall out of the vagina, and you'd need to re-insert it. Also, you'd need to remember to remove and re-insert the ring on a schedule: 3 weeks in, 1 week out (though there is an app to help you remember on the App Store or Google Play).

There are a few additional barriers unique to Annovera. Some women can't use it because insurance won't cover it (Annovera costs more than NuvaRing because no generic version exists). You also can't use it while breastfeeding. Lastly, [patient counseling information for Annovera]{.ul} says there could be some BMI considerations at a certain range.

However, there is a significant advantage of using Annovera over NuvaRing when it comes to convenience: 1 prescription of Annovera can deliver a full year of birth control, while you'd need to get monthly refills of NuvaRing. However, if you use NuvaRing, you might be able to get several rings at once and get them mailed to you. Still, having to worry about birth control only once a year with Annovera is a big advantage over having to make sure you have a new ring every month.

Who's not a good fit for Annovera?

The ring is safe for most people. However, just like with the pill, patch, or shot, the presence of estrogen in hormonal birth control like the ring can make Annovera (or NuvaRing) unsafe for certain people.

If you experience any of the following situations, your doctor may decide that Annovera isn't right for you because of contraindications:

Also, breastfeeding women shouldn't use Annovera.

What are the side effects of Annovera?

Because they have the same kind of hormones, both Annovera and NuvaRing share similar side effects. Here are some of the more common side effects of Annovera:

  • Headache

  • Nausea

  • Breast tenderness

  • Yeast infections

  • Irregular bleeding

  • Abdominal pain

  • Genital itching

During studies comparing the pill, patch, and ring, researchers found that women who used the ring had more genital irritation and vaginal discharge than women who used the pill.

As with any hormonal method of birth control, there are some rare but severe side effects of Annovera, including:

  • Increased risk of blood clots

  • High blood pressure

  • Liver problems

  • Gallbladder disease

  • Toxic shock syndrome

Rest assured that your doctor or healthcare provider will give you medical advice on birth control and ensure that Annovera is safe for you to use before writing a prescription.

Costs: Annovera vs NuvaRing

You should be able to get Annovera or NuvaRing for as low as $0 if your health insurance covers it. First, however, you'll need to check if the ring is covered under your insurance (though it should be one of the covered contraceptive methods as per the Affordable Care Act).

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

Without health insurance covering the cost, the ring is much more expensive than birth control pills. However, there is a generic version of NuvaRing, called Eluryng, which is less expensive. If you're interested, Annovera's manufacturer has more information on costs and potential savings on Annovera.

Takeaways: Choosing between Annovera and NuvaRing

If you're comparing the two or simply want to know why you should get Annovera over NuvaRing, consider how well each would fit your life. Either one works great as contraception and is just as effective as any other hormonal contraceptive like the pill.

The big advantage of Annovera is convenience: 1 ring gives you birth control for an entire year. So you wouldn't have to get monthly refills, for example, like you would for NuvaRing or birth control pills.

NuvaRing, on the other hand, has been around longer. There's a generic, lower-priced version of it on the market called Eluryng® that should cost less than Annovera if you had to pay out of pocket. With health insurance, though, you should be able to get NuvaRing or Annovera for as low as $0.

Whichever birth control method you choose, whether it be Annovera, NuvaRing, or another option like the pill, the most important thing is that you know about your options.


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