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Annovera

segesterone acetate / ethinyl estradiol
Used for Birth Control
Used for Birth Control

Annovera (segesterone acetate / ethinyl estradiol) is a combination birth control that contains a progestin (segesterone acetate) and an estrogen (ethinyl estradiol). It's a vaginal contraceptive ring that’s inserted vaginally for 3 weeks, removed for 1 week, and then reinserted. Each ring contains enough hormones to be reused through 13 cycles (about 1 year). Annovera (segesterone acetate / ethinyl estradiol) is 97% effective at preventing pregnancy when used as directed. Some common side effects include headaches, nausea or vomiting, and vaginal yeast infections.

Reviewed by:
reviewer
Lejla Rahmanovic
reviewer
Connie Zheng, PharmD
reviewer
Cydnee Ng, PharmD
Last reviewed on November 19, 2024
BasicsSide effectsPros & consPharmacist tipsFAQsWarningsDosageCostContraindicationsAlternativesLatest newsImagesReferencesPricesMedicare
basics-icon

What is Annovera (segesterone acetate / ethinyl estradiol)?

What is Annovera (segesterone acetate / ethinyl estradiol) used for?

  • Prevent pregnancy

How Annovera (segesterone acetate / ethinyl estradiol) works

Annovera (segesterone acetate / ethinyl estradiol) is a combination birth control that contains two hormones: segesterone acetate (a progestin) and ethinyl estradiol (an estrogen). These two medications work together to lower your chances of becoming pregnant by:

  • Preventing the release of an egg (ovulation)

  • Thickening the cervical mucus so sperm has a harder time traveling through the uterus to get to and fertilize the egg

  • Thinning the uterine lining so the fertilized egg can’t implant

Are you looking for information on NuvaRing (etonogestrel / ethinyl estradiol) or progesterone (Prometrium) instead?

Drug Facts

Common BrandsAnnovera
Drug ClassProgestin / Estrogen combined contraceptive
Controlled Substance ClassificationNot a controlled medication
Generic StatusNo lower-cost generic available
AvailabilityPrescription only

More on Annovera (segesterone acetate / ethinyl estradiol) essentials

Annovera: four contraceptive rings holding one-1329750785

What Is Annovera? How It Works, Side Effects, and Efficacy

Written by Christina Aungst, PharmD
Health: Birth control: GettyImages 1329750744 2

How Is Annovera Different From NuvaRing?

Written by Christina Aungst, PharmD
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What are the side effects of Annovera (segesterone acetate / ethinyl estradiol)?

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

  • Headache, migraine (39%)
  • Nausea, vomiting (25%)
  • Vaginal rash, pain while urinating, and other symptoms of yeast infection (15%)
  • Stomach pain (14%)
  • Painful period cramps (13%)
  • Vaginal discharge (12%)
  • Pain while urinating, frequent urge to urinate, and other symptoms of urinary tract infection (UTI) (10%)
  • Breast pain, tenderness, discomfort (10%)

Other Side Effects

  • Diarrhea
  • Changes in period bleeding patterns
  • Genital itching

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.
  • Stroke: feeling confused, numbness on one side of the body, trouble seeing with one or both eyes, difficulty speaking, headache
  • Heart attack: dizziness, chest pain, trouble breathing, clammy skin, pain or discomfort in arm, jaw, back, neck
  • Pulmonary embolism (blood clot in the lungs): feeling light-headed, difficulty breathing, fast heartbeat, sweating, cough
  • Deep venous thrombosis (blood clot in the leg): leg cramps, swelling in the legs, warm skin around the painful area
  • Serious liver problems: yellowing skin or eyes, stomach pain, loss of appetite, dark yellow or brown urine
  • Toxic shock syndrome: flu-like symptoms, fever, nausea, vomiting, diarrhea, headaches, cough, dizziness, sudden skin redness

Source: DailyMed

The following side effects have also been reported

Side effects that you should report to your care team as soon as possible:

  • Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
  • Blood clot—pain, swelling, or warmth in the leg, shortness of breath, chest pain
  • Gallbladder problems—severe stomach pain, nausea, vomiting, fever
  • Increase in blood pressure
  • Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
  • New or worsening migraines or headaches
  • Stroke—sudden numbness or weakness of the face, arm, or leg, trouble speaking, confusion, trouble walking, loss of balance or coordination, dizziness, severe headache, change in vision
  • Unusual vaginal discharge, itching, or odor
  • Vaginal pain, irritation, or sores
  • Worsening mood, feelings of depression

Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):

  • Breast pain or tenderness
  • Dark patches of skin on the face or other sun-exposed areas
  • Irregular menstrual cycles or spotting
  • Nausea
  • Stomach pain
pros-and-cons

Pros and cons of Annovera (segesterone acetate / ethinyl estradiol)

thumbs-up

Pros

Can be reused for a year, so less trips to your pharmacy

Might be more convenient to use compared with birth control pills (don’t need to take a pill daily)

Stored at room temperature, so convenient while traveling

thumbs-down

Cons

Can't be used by people with certain medical conditions, such as high blood pressure and blood sugar (higher risk for blood clots)

Not recommended for those sensitive to vaginal irritation/ulceration

Needs to be cleaned before and after each use

pharmacist-tips

Pharmacist tips for Annovera (segesterone acetate / ethinyl estradiol)

pharmacist

  • Annovera (segesterone acetate / ethinyl estradiol) can be used through 13 cycles (about a year). When you’re done using it, place your ring into its case, and find a drug take-back location. If you’re unable to find a location, throw away your ring and case in the trash. Don’t flush your ring down the toilet.

    • Annovera (segesterone acetate / ethinyl estradiol) shouldn’t fall out by itself. But doing certain activities such as having sex or removing a tampon might make it more likely for your ring to come out. If your ring comes out, just wash it and reinsert it within 2 hours.

      • Annovera (segesterone acetate / ethinyl estradiol) should be inserted into the vagina for 3 weeks, then removed for a week. If the ring has been outside the vagina for a total of 2 hours or more within the 3-week period, you should reinsert the ring and use a non-hormonal birth control as back up (e.g., condoms) until the ring has been inside your vagina for a week.

        • Headaches are a common side effect of Annovera (segesterone acetate / ethinyl estradiol). But if you’re experiencing a headache or migraine that’s hard to manage, very painful, keeps coming back, or doesn’t seem to go away, call your your healthcare team. This can be a sign of a more serious problem.

          • While using Annovera (segesterone acetate / ethinyl estradiol), you might notice dark patches on your face or other areas of your body that are exposed to the sun. Protect yourself from the sun by wearing protective clothing and applying sunscreen while outside.

            • Annovera (segesterone acetate / ethinyl estradiol) can interact with other medications. Before starting Annovera (segesterone acetate / ethinyl estradiol), talk to your healthcare team if you’re taking levothyroxine (Euthyrox) or steroids like prednisone. They might need to adjust your medication dose.

              • Though rare, it’s possible for Annovera (segesterone acetate / ethinyl estradiol) to trigger a serious swelling attack called hereditary angioedema. You’re at a higher risk for swelling attacks if someone in your family has this condition. Get medical help right away if you experience swelling in the hands, feet, limbs, and face.

                More tips on how to use Annovera

                • Before you use Annovera (segesterone acetate / ethinyl estradiol), check out this video and guide on how to use your ring. Ask your gynecologist or pharmacist if you’re uncertain about how to use Annovera (segesterone acetate / ethinyl estradiol).

                  • Wash your hands before inserting Annovera (segesterone acetate / ethinyl estradiol) to lower your risk of infections from any germs on your hand.

                    • When you’re ready to insert Annovera (segesterone acetate / ethinyl estradiol), get into a comfortable position such as lying down, squatting, or lifting one leg onto the toilet seat. Squeeze the ring with your thumb and index finger to make a narrow, oval-like shape. Then, insert it into the vagina as far as it can go by pushing it in with your index finger.

                      • When you’re ready to remove Annovera (segesterone acetate / ethinyl estradiol), get into a comfortable position and hook the ring with your index finger to pull down.

                        • Once removed, clean Annovera (segesterone acetate / ethinyl estradiol) with mild soap and warm water, and pat it dry. Store the ring away for 1 week inside its case. Remember to clean the ring again before inserting it back into the vagina when it’s time to start a new cycle.

                          • When you’re not using Annovera (segesterone acetate / ethinyl estradiol) during the ring-free week, store it away from children and pets so they don’t accidentally touch the ring. The ring contains hormones and can get absorbed through their skin and might cause harm.

                            faqs

                            Frequently asked questions about Annovera (segesterone acetate / ethinyl estradiol)

                            How long does Annovera (segesterone acetate / ethinyl estradiol) last?
                            Each Annovera (segesterone acetate / ethinyl estradiol) ring contains enough hormones to last through 13 cycles, which is about a year. Each cycle is 4 weeks total (3 weeks with the ring inside the vagina and 1 week out). During your ring-free week, clean and store the ring away in its case. Clean the ring again right before you reinsert it at the start of your new cycle. To keep track of the cycles, write down the date and time of when you need to insert and remove Annovera (segesterone acetate / ethinyl estradiol). You can also put the dates into your phone or use a medication reminder app.
                            How long do Annovera (segesterone acetate / ethinyl estradiol) side effects last?
                            It depends on which side effects you're experiencing. For example, people commonly experience headaches after starting Annovera (segesterone acetate / ethinyl estradiol). This side effect might last a few days out of each cycle and is likely caused by changing levels of hormones in the birth control. Research suggests you're less likely to have headaches after using Annovera (segesterone acetate / ethinyl estradiol) for a few months. Another side effect of Annovera (segesterone acetate / ethinyl estradiol) is spotting, which is breakthrough bleeding in the middle of the cycle when the vaginal ring is still in your body. You're more likely to experience this side effect during the first month after starting Annovera (segesterone acetate / ethinyl estradiol), and it should get better over time. Talk with your primary care provider or gynecologist if you have questions on a specific side effect.
                            How effective is Annovera (segesterone acetate / ethinyl estradiol)?
                            Studies show that Annovera (segesterone acetate / ethinyl estradiol) is about 97% effective at preventing pregnancy when you use it as directed. This means inserting the vaginal ring and leaving it in the body for 3 weeks, removing it for 1 week, and then reinserting the ring at the start of a new cycle for up to 13 cycles. Talk with your healthcare team if you have more questions about how well Annovera (segesterone acetate / ethinyl estradiol) works.
                            What's the difference between Annovera (segesterone acetate / ethinyl estradiol) and NuvaRing (etonogestrel / ethinyl estradiol)?
                            Both Annovera (segesterone acetate / ethinyl estradiol) and NuvaRing (etonogestrel / ethinyl estradiol) are vaginal rings used to prevent pregnancy. One main difference is that they contain different progestin hormones: Annovera contains segesterone, while NuvaRing contains etonogestrel. Another difference is how many times you can use each ring. Each Annovera ring can be reused through 13 cycles, while each NuvaRing needs to be thrown out after each cycle. Ask your gynecologist or pharmacist if you have other questions about other differences between NuvaRing and Annovera.
                            Can I keep Annovera (segesterone acetate / ethinyl estradiol) in to skip periods?
                            Talk with your gynecologist if you want to skip your period while using Annovera (segesterone acetate / ethinyl estradiol). This vaginal ring is only FDA-approved to be inserted for 3 weeks, then removed for 1 week, and reused through 13 cycles. Typically, you'll have a period during the ring-free week. Using Annovera (segesterone acetate / ethinyl estradiol) in any other way is considered an off-label use. If you want to skip your period, your gynecologist might direct you to use Annovera (segesterone acetate / ethinyl estradiol) off-label by keeping the ring in your body continuously, without taking it out during the typical ring-free week. Keep in mind that keeping the ring in longer might raise the risk for breakthrough bleeding.
                            Can you leave Annovera (segesterone acetate / ethinyl estradiol) in all year?
                            Ask your healthcare team if you want to leave Annovera (segesterone acetate / ethinyl estradiol) in all year. This vaginal ring is only FDA-approved to be inserted for 3 weeks, then removed for 1 week, and reused through 13 cycles. So leaving it in continuously is considered an off-label use. But sometimes, your gynecologist might instruct you to do if you want to skip your period. If you decide to use Annovera (segesterone acetate / ethinyl estradiol) continuously, one thing to note is that the hormones in the ring might not last for a full year. Based on the FDA-approved dosing, this vaginal ring is designed to release medication for 273 days total, which is about 9 months.
                            Am I protected the week Annovera (segesterone acetate / ethinyl estradiol) is out?
                            Yes, if you've been using Annovera (segesterone acetate / ethinyl estradiol) as directed, the hormones from the vaginal ring will continue to protect you from pregnancy the week when you remove the ring. But if you've left Annovera (segesterone acetate / ethinyl estradiol) outside your body for longer than a week, then you're at higher risk for becoming pregnant. In this case, you should to use a non-hormonal birth control as back up until the ring has been reinserted for a week.
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                            What are the risks and warnings for Annovera (segesterone acetate / ethinyl estradiol)?

                            Annovera (segesterone acetate / ethinyl estradiol) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

                            risk-warning

                            Cigarette smoking and serious heart conditions

                            • Risk factors: Females over the age of 35 years old who smoke cigarettes

                              If you smoke cigarettes, using CHCs that contain estrogen (such as Annovera (segesterone acetate / ethinyl estradiol)) can raise your risk for serious blood clots. This means you’re more likely to experience heart or blood vessel problems, such as heart attacks or strokes. If you're 35 years or older and smoke cigarettes, talk to your doctor about safer birth control options because you’re at higher risk for serious blood clots.

                              risk-warning

                              Serious blood clots

                              • Risk factors: Females age 35 years and older | People identified as obese | People who smoke | High blood pressure | High blood sugar | History of blood clots | Not moving for a long time | Recent surgery (<2 weeks ago) | Recent childbirth (<1 month ago)

                                Annovera (segesterone acetate / ethinyl estradiol) can raise your risk for serious blood clots. These blood clots can form anywhere in your body, including the eyes, heart, and brain. If you have medical conditions that put you at higher risk for clots, such as high blood sugar or blood pressure, you might not be able to use Annovera (segesterone acetate / ethinyl estradiol). Before starting Annovera (segesterone acetate / ethinyl estradiol), talk to your prescriber about any family or personal history of clotting problems. Look out for symptoms of clots in any area of your body:

                                • Brain: sudden weakness in one arm, leg, or on one side of the body; face drooping; changes in speech, vision, balance, or coordination; severe headache

                                  • Eyes: double vision, partial or complete blindness, trouble seeing

                                    • Lungs: shortness of breath

                                      • Heart: chest pain, arm pain, dizziness, cold sweat

                                        • Legs: swelling or pain in the leg

                                          Get immediate medical attention and call 911 if you have any of these symptoms.

                                          risk-warning

                                          High blood pressure

                                          • Risk factors: Blood pressure that’s not under control | Older females | Long-term use of CHCs

                                            CHCs, like Annovera (segesterone acetate / ethinyl estradiol), can raise your blood pressure. You shouldn’t use Annovera (segesterone acetate / ethinyl estradiol) if you have blood vessel damage from high blood pressure or if your blood pressure isn’t under control. If you have well-controlled blood pressure and are using Annovera (segesterone acetate / ethinyl estradiol), then continue to monitor your blood pressure at home and at your follow-up appointments. Contact your primary care provider if you notice symptoms of very high blood pressure such as irregular heartbeats, vision changes, confusion, chest pain.

                                            risk-warning

                                            High blood sugars and high cholesterol (fats)

                                            Annovera (segesterone acetate / ethinyl estradiol) might raise your blood sugars and triglyceride (fat) levels. If you have diabetes, check with your primary care provider if Annovera (segesterone acetate / ethinyl estradiol) is safe for you before you start. You won’t be able to use it if you have diabetes plus other risk factors, such as age over 35 years old and high blood pressure, because you’re at higher risk for blood clots. When you use Annovera (segesterone acetate / ethinyl estradiol), your primary care provider might ask you to monitor your blood sugar at home. Inform your primary care provider of any changes in your blood sugar levels.

                                            If you currently have high cholesterol, using Annovera (segesterone acetate / ethinyl estradiol) might raise your risk for pancreatitis. Let your primary care provider know if you have symptoms of pancreatitis, such as nausea, vomiting, stomach pain, and fever.

                                            risk-warning

                                            Liver problems

                                            • Risk factors: Long-term use of CHCs | Hepatitis C | Other liver problems | Taking certain medications for hepatitis C

                                              Though rare, you might be at higher risk for liver problems or liver tumors if you use CHCs, such as Annovera (segesterone acetate / ethinyl estradiol). Contact a healthcare professional if you notice symptoms of liver problems, such as yellowing of the skin or eyes, stomach pain/swelling, dark urine color, chronic fatigue,

                                              Don’t use Annovera (segesterone acetate / ethinyl estradiol) if you’re also taking certain hepatitis C medications, like Viekira Pak that contain ombitasvir, paritaprevir, and ritonavir. Doing so can cause further liver damage. You can use Annovera (segesterone acetate / ethinyl estradiol) again once it has been at least 2 weeks since you’ve completed the hepatitis C treatment.

                                              risk-warning

                                              Gallbladder problems

                                              • Risk factors: Gallbladder problems | people identified as overweight

                                                Some studies have shown that CHCs, like Annovera (segesterone acetate / ethinyl estradiol), might cause gallbladder problems. You’re at higher risk if you already have gallbladder problems or if you’ve experienced these problems in the past while taking CHCs. If you notice yellowing of eyes or skin, dark urine, fever, chills, nausea, or vomiting, contact a healthcare professional.

                                                risk-warning

                                                Breakthrough bleeding (spotting) or absence of period

                                                Annovera (segesterone acetate / ethinyl estradiol) can change your period bleeding patterns. You might experience bleeding in between your periods (also known as breakthrough bleeding or spotting) when you use the Annovera (segesterone acetate / ethinyl estradiol) ring. This is more common within the first 3 months after you start this birth control. It’s also possible that you might have periods less often or none at all for some time. If you’ve missed 2 periods in a row, take a pregnancy test to make sure that you’re not pregnant. If the abnormal bleeding continues or happens again even after you have a normal cycle, let your gynecologist know so they can check your health.

                                                risk-warning

                                                Depression

                                                If you’re taking Annovera (segesterone acetate / ethinyl estradiol) and have a history of depression, monitor yourself for any signs and symptoms of depression or changes to your mood. Talk to a healthcare professional if your mood changes while you're using Annovera (segesterone acetate / ethinyl estradiol).

                                                risk-warning

                                                Toxic shock syndrome (TSS)

                                                • Risk Factors: Using a tampon at the same time

                                                  Some people who used vaginal rings have reported having toxic shock syndrome (TSS). TSS is a serious, life-threatening condition caused by bacteria toxin. It occurs when bacteria enters your bloodstream through open wounds, cuts, or abrasions. Your risk for TSS is higher if you’re using a tampon at the same time. While there are no reports of TSS linked with Annovera (segesterone acetate / ethinyl estradiol) use so far, you should still look out for TSS symptoms, such as flu-like symptoms, nausea, diarrhea, and headaches. If you experience any of these, remove Annovera and get medical help right away.

                                                  risk-warning

                                                  Breast cancer

                                                  • Risk factors: Using CHCs for a long time (8 years or longer) | Family history of breast cancer

                                                    Research isn't clear about whether or not CHCs cause breast cancer. A few studies report that CHCs might raise your risk for breast cancer, especially if you've been taking it for a long time. Talk to your prescriber if you have any concerns about CHCs and cancer. Let them know if you notice possible signs of breast cancer, such as new lumps on your breasts, swollen breast, breast pain, or redness or flaky skin on the breast.

                                                    Don't use CHCs, like Annovera (segesterone acetate / ethinyl estradiol), if you have or have had breast cancer in the past. It's possible that your cancer is sensitive to estrogen, meaning that it'll grow faster when there is estrogen around. Ask your prescriber for birth control options that don't contain estrogen.

                                                    risk-warning

                                                    Cervical cancer

                                                    • Risk factors: Using CHCs for a long time (8 years or longer)

                                                      Although the research isn’t clear, there’s a possibility that CHCs might raise your risk for cervical cancer. It might also put you at risk for having abnormal tissue cells on the surface or lining of certain organs (intraepithelial neoplasia). If you notice symptoms such as more blood spotting than usual, light bleeding between your periods or after your period, bleeding that is longer in duration and heavier, more vaginal discharge than usual, pain during sex, let your gynecologist know right away.

                                                      dosage

                                                      Annovera (segesterone acetate / ethinyl estradiol) dosage forms

                                                      The average cost for 1 ring of 0.15mg/0.013mg of Annovera (segesterone acetate / ethinyl estradiol) is $575.00 with a free GoodRx coupon. This is 80.27% off the average retail price of $2914.35.
                                                      ring
                                                      Ring
                                                      DosageQuantityPrice as low asPrice per unit
                                                      0.15mg/0.013mg1 ring$575.00$575.00

                                                      Typical dosing for Annovera (segesterone acetate / ethinyl estradiol)

                                                      Each Annovera (segesterone acetate / ethinyl estradiol) ring releases about 0.15 mg of segesterone acetate and 13 mcg of ethinyl estradiol daily.

                                                      The typical dose is to insert 1 ring into the vagina and to leave it there for 3 weeks. Then, remove the ring for 1 week. After the ring-free week is over, you’ll repeat this cycle again with the same ring.

                                                      Each ring can be used for 13 cycles, which is about 1 year.

                                                      drug-cost

                                                      How much does Annovera (segesterone acetate / ethinyl estradiol) cost?

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                                                      contraindications-icon

                                                      Annovera (segesterone acetate / ethinyl estradiol) contraindications

                                                      Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Annovera (segesterone acetate / ethinyl estradiol) will not be safe for you to take.
                                                      alternatives

                                                      What are alternatives to Annovera (segesterone acetate / ethinyl estradiol)?

                                                      There are a number of medications that your doctor can prescribe in place of Annovera (segesterone acetate / ethinyl estradiol). Compare a few possible alternatives below.
                                                      Annovera (segesterone acetate / ethinyl estradiol)
                                                      Used for:

                                                      • Prevent pregnancy

                                                      $575.00 Lowest GoodRx priceView Prices
                                                      NuvaRing (etonogestrel / ethinyl estradiol)
                                                      Used for:

                                                      • Prevention of pregnancy

                                                      $171.44 Lowest GoodRx priceView Prices
                                                      images

                                                      Annovera (segesterone acetate / ethinyl estradiol) images

                                                      white round - Annovera 0.15mg-0.013mg / 24 hr Vaginal System
                                                      This medicine is White, Round Ring.white round - Annovera 0.15mg-0.013mg / 24 hr Vaginal System

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                                                      References

                                                      Best studies we found

                                                      Allais, G., et al. (2009). Headache induced by the use of combined oral contraceptives. Neurological Sciences. 

                                                      American College of Obstetricians and Gynecologists. (2023). Abnormal uterine bleeding.

                                                      Archer, D. F., et al. (2019). Efficacy of the 1-year (13-cycle) segesterone acetate and ethinylestradiol contraceptive vaginal system: Results of two multicentre, open-label, single-arm, phase 3 trials. The Lancet Global Health.

                                                      View All References (6)

                                                      Bolanca, I., et al. (2008). Chloasma--the mask of pregnancy. Collegium Antropologicum.

                                                      Lee, A. L. (2020). Segesterone acetate and ethinyl estradiol vaginal ring (Annovera). for contraception. American Family Physician.

                                                      Loder, E. W., et al. (2005). Headache as a side effect of combination estrogen-progestin oral contraceptives: A systematic review. American Journal of Obstetrics & Gynecology.

                                                      Mayne Pharma Commercial LLC. (n.d.). How to use it.

                                                      National Cancer Institute. (n.d.). Intraepithelial neoplasia.

                                                      TherapeuticsMD, Inc. (2022). Annovera- segesterone acetate and ethinyl estradiol ring [package insert]. DailyMed.

                                                      GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.
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