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The Annovera Birth Control Ring: Is It Right for You?

The Annovera Birth Control Ring: Is It Right for You?

Learn the benefits and deal-breakers of Annovera.

  • Sonia Easaw, M.S., MPH
    By: Sonia Easaw, M.S., MPH
    Reviewed By: Julie Lamonoff, CNM, OBGYN-NP
    Updated:

Annovera™ is a new, FDA-approved birth control ring. It's the first vaginal ring to last all year, making it super helpful for women.

Because Annovera lasts a year, you wouldn't have to worry about picking up your birth control prescription each month. In the time of COVID-19 when many women have lost their jobs and health insurance, having that peace of mind goes a long way. If you're in a similar boat or are considering a longer-lasting birth control option, see if you're eligible to have Annovera prescribed and delivered to your door for free.

Annovera is pretty convenient to use. Using a birth control ring like Annovera can be more convenient than the pill, since you don't need to remember to take a pill every day.

But it isn't the right birth control choice for everyone. Let's look at the positives and negatives of Annovera so you can decide if it's a good birth control choice for you.

What is Annovera?

Annovera is a vaginal birth control ring made of silicone. It's soft and flexible so you can comfortably insert it into the vagina. You can insert and remove it yourself, so Annovera can provide more than a year of birth control without having to order or pick up a new prescription every month.

Annovera is inserted inside the vagina for 21 days, releasing a small amount of progestin and estrogen. These are the same hormones in a combination birth control pill, but the Annovera ring has them at a lower dose. Progestin and estrogen prevent ovulation and change the lining of your uterus, preventing pregnancy.

6 benefits of using Annovera

Technically speaking, Annovera is the first of its kind. Unlike other birth control rings, it's washable and lasts a year. It's a hormonal birth control product that could offer you the convenience of only needing 1 prescription for 13 months of birth control, without any other procedures or injections, and lets you avoid having to take a daily pill. It's a good option for women who are comfortable inserting and removing the ring and are at low risk for the possible side effects.

Some of the biggest benefits of using Annovera instead of birth control pills or other hormonal birth control implants are convenience and control. It's also a highly effective method of birth control.

Here are some of the pros of using Annovera if you're eligible:

1. Annovera is highly effective with a low failure rate.

Harvard doctors say that only about 2 to 4 women out of 100 women get pregnant in a year of using Annovera.

2. One prescription lasts for a year of birth control, without having to order or pick up additional birth control.

3. You have effective hormonal birth control without having to remember to take a pill every day.

Because you leave the ring in for three weeks, you would only need to think about it twice a month—when you take out the ring and when you reinsert it back in.

4. You don't have to go to a doctor's office for any procedures or injections, since you insert and remove the ring yourself.

5. Gynecologists at UC Davis Health say that you can easily stop using the ring at any time if you want to become pregnant or want to switch to another method like the birth control pill or patch.

6. Researchers say that vaginal rings allow for lower doses of hormones than other methods, because they steadily release hormones instead of the daily ups and downs of hormones you'd get with birth control pills.

4 cons of using Annovera

Annovera isn't for everyone. There are some disadvantages that you can talk to your doctor about if you're considering a birth control ring.

Here are some of the cons of using Annovera:

1. You still have to remember to take out Annovera and put it back in twice a month.

Although taking a daily pill can be a pain, it may simply become part of your routine, unlike Annovera. Because Annovera must be removed on a specific day after three weeks, then re-inserted after a week, you'll have to set reminders for yourself. There is a handy mobile app that you can download called the Annovera Birth Control Tracker for iPhone or for Android to help remind you to take Annovera out and put it back in.

2. The Annovera ring can accidentally come out; for example, during sex.

However, as long as you clean it and replace it within 2 hours, you don't have to worry about getting pregnant. You can read more about what happens in these cases at the FDA's drug data website on Annovera.

3. Not everyone is eligible for using Annovera because of their medical history.

If you're considering Annovera, your doctor will let you know if it's right for you. Annovera isn't safe for smokers over age 35.

4. Like for any drug, there are side effects that could happen.

Some of these may include nausea, headache, breast tenderness. There are also risks that include blood clots and high blood pressure.

How does Annovera work

After 21 days of being placed inside the vagina, you can remove the Annovera ring, wash it, and store it in its case.

You'd remove the ring for 7 days, during which you'll have your usual period. Then you'd insert the ring again for another 21 days. This cycle can be repeated 13 times—13 months of use—before a new Annovera ring is needed.

Cost of Annovera

Some insurance companies may cover Annovera under certain plans. With insurance, Annovera could cost as low as $0. See if you're eligible to get Annovera from Pill Club for $0.

If you have to pay out-of-pocket, Annovera is definitely not one of the cheaper birth control options available. Without using insurance to cover the price, Annovera costs roughly $2,000 to $2,400 for 13 months of birth control. However, the manufacturer offers a savings card and claims that with the card it could cost as little as $60.

By comparison, the least expensive birth control pill offered by Pill Club is Vienva, which at the time of this writing, costs about $115 for a year without insurance (or $0 if covered by insurance).

How is Annovera similar to NuvaRing™

Annovera is similar to an earlier birth control vaginal ring called NuvaRing™. NuvaRing only provides 1 month of birth control, so you would need to insert a new ring every month. According to the Food and Drug Administration, Annovera uses a different and newer form of progestin from the one used in the NuvaRing.

Like NuvaRing, Annovera releases a very small amount of hormones into your body every day: 0.013 mg/day of ethinyl estradiol and 0.15 mg/day of segesterone acetate, according to the manufacturer. Not many hormonal birth control methods offer lower amounts of daily hormone than this.

How does Annovera compare to Nuvaring?

Using Annovera is pretty similar to using NuvaRing, in terms of how you insert and remove the ring. The Annovera ring is somewhat thicker (because it has to hold a larger supply of hormone), but not so much that it affects insertion and removal.

Since you have to remove the Annovera ring every 3 weeks and re-insert it after your period week has ended, you'll be inserting and removing a ring from your vagina just as often with Annovera as with NuvaRing. The big difference is that you'll use the same Annovera ring for 13 months, whereas with NuvaRing, you need a new ring every month.

NuvaRing costs roughly $60 to $70 per month, which works out to less than $1,000 for 13 months, about half the cost of Annovera without insurance.

According to a press release from the manufacturer, in late 2019 the FDA approved the first generic version of the NuvaRing, called the EluRyng. Other manufacturers are also developing generic versions of NuvaRing, which will likely cost less than Annovera and possibly less than NuvaRing. There is no generic version of Annovera.

How easy is it to use Annovera birth control?

The Annovera ring is relatively easy to use, depending on your comfort level inserting and removing things from your vagina. If you've used tampons or a menstrual cup, using an Annovera ring shouldn't be difficult.

How to insert Annovera

Insertion can be done in whatever position is most comfortable for you, whether that's lying down, standing, or squatting. You squish the ring with your fingers and insert it into your vagina, where it opens back into its ring shape and stays in place. To remove, you insert your finger, hook your finger around the edge of the ring, and gently pull it out.

How long to keep Annovera inserted

The ring is left in for three weeks, so make sure to note that date and approximate time you inserted it, so it can be removed on schedule.

After three weeks, it should be removed, washed with mild soap and warm water, then dried and placed in its case.

You'll leave it out for one week---during that week you'll have a period, which is sometimes known as "withdrawal bleeding."

After a week, you should gently wash the ring again before re-inserting it.

You can also remove the ring during sex if you or your partner prefer. Just be careful to put it in its case to keep it safe. However, it's fine to leave the ring in during sex.

Can Annovera fall out of the vagina

Some activities could cause the ring to fall out accidentally, including sex, some forms of exercise, removing a tampon, or straining during a bowel movement. If this happens, the ring should be washed and dried and re-inserted.

As long as it's re-inserted within 2 hours, it will remain effective. If you remove it frequently for sex, it shouldn't be left out for more than 2 cumulative hours in a 3-week cycle.

If you do leave it out for more than 2 hours, or more than 2 cumulative hours in a cycle, make sure to use a back-up barrier birth control method such as a condom until your next Annovera cycle starts.

Risks and effectiveness of Annovera

Annovera was approved by the FDA in 2018 after thorough evaluation and three clinical trials.

Studies found that Annovera has a 97.5 percent success rate, across multiple studies on women of various ages and in multiple countries around the world.

Side effects

Most of the side effects and risks of Annovera are similar to the risks associated with any combination hormonal birth control. This includes an increased risk for pulmonary problems, including deep vein thrombosis or pulmonary embolism. This risk is higher for women over 35 who smoke. If you have any other risk factors for pulmonary disease or high blood pressure, Annovera may not be a good choice for you.

Annovera is not recommended for women with a body mass index higher than 29. During drug trials, two participants with a BMI above 29 suffered venous thromboembolisms, and participants with a BMI above 29 were later withdrawn from the trial.Annovera is also not recommended if you are breastfeeding. Your health care provider can give you more information, though.

Additional risks

Because Annovera is a physical object placed inside the vagina, it has some additional risks.

Women who are sensitive to the silicone material it's made out of, who have recently given birth or had an abortion, or who have other bleeding problems or sensitivities in their uterus will probably not want to use Annovera.

Sometimes an Annovera user can feel the ring, and sometimes sexual partners can feel it during sex. It shouldn't ever be painful, but it may be irritating or distracting.

Women who participated in the Annovera drug trials experienced some side effects. The most prevalent were headaches, nausea, yeast infections, and abdominal discomfort.

What can decrease Annovera's effectiveness

Annovera should not be used if you're also taking certain Hepatitis C drugs. Other drugs can either increase or decrease the amount of hormones the ring releases each day.

The drug interactions can be complex, and we can't list them all here, so it's very important to consult with your doctor about possible drug interactions if you want to use Annovera.

Oil-based lubricants can also affect the amount of hormones the ring releases, so only use water-based lubricants for sexual activities.

Finally, keep in mind that if you're having an Annovera ring delivered to you, it has to be shipped overnight and signed for, because it can be damaged by extreme temperatures (so it can't sit in a mail truck or be left in your mailbox for hours).

This is definitely not a full list of all the possible side-effects or risks associated with Annovera, so again, it's very important to discuss using Annovera with your doctor.

Where can you get Annovera?

Annovera can be prescribed by your doctor. You can also see if you're eligible to get Annovera from Pill Club prescribed online.

Innovations like the birth control ring Annovera have been designed to help provide a more convenient, longer-lasting option for women. Knowing the pros and cons when you talk to your doctor will help lead you to the right decision.


With contribution from Ed Grabianowski

Sources:

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