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.
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.
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.
Purpose: Hormonal birth control ring used to prevent pregnancy
Effectiveness: 97% effective in preventing pregnancy
Type of contraception: Reversible, ethinyl estradiol vaginal system
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)
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!
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.
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.
Uncontrolled high blood pressure
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)
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
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
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
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.
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.
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 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
Step One: With clean hands, wash the ring with mild soap and water and pat dry.
Step Two: While in a comfortable position, use your index finger and thumb to squeeze Annovera together into the size of a tampon.
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?
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.
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.
Virro J et al. Long-Lasting, Patient-Controlled, Procedure-Free Contraception: A Review of Annovera with a Pharmacist Perspective. Pharmacy (Basel). Published September 2020.
U.S. Food & Drug Administration. Birth Control. Updated February 11, 2020.
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