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

Between 2017 and 2019, about 65% of women in the U.S. between ages 15 and 49 used some form of contraception (birth control). The majority of those who were using a reversible form of birth control were taking an oral contraceptive (also called “the pill”). But there are many forms of birth control available, allowing you to pick something that best fits into your lifestyle.

One birth control method available is a vaginal ring. This contraceptive is inserted into the vagina for a certain amount of time and then removed so you get a period. One of the vaginal birth control rings available is a product called Annovera (ethinyl estradiol / segesterone acetate).

Below, we’ll review the Annovera ring — what it is, how to use it, and what to expect should your healthcare provider prescribe it for you.

What is Annovera?

Annovera is a vaginal birth control ring that provides medication for a full year. It has two ingredients: ethinyl estradiol and segesterone acetate. Ethinyl estradiol is a form of estrogen, and segesterone acetate is a progestin (a type of progesterone). These are the two main sex hormones that regulate the menstrual cycle.

When birth control includes both an estrogen and a progestin, it’s called a combined hormonal contraceptive. The two hormones work together to stop your body from releasing an egg (ovulation). A pregnancy can’t happen unless an egg has been released. Stopping ovulation is the main way Annovera works to prevent pregnancy.

Combined hormonal contraceptives can also thin the lining of your uterus and thicken the mucus around your cervix. These actions help prevent pregnancy as well. A thin uterine lining can prevent a fertilized egg from implanting. Thicker mucus makes it harder for sperm to swim into your uterus.

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How do you use an Annovera ring?

Annovera should be inserted into your vagina and left in for 21 days in a row. After 21 days, remove the ring for 7 days. This will allow your body to have a period.

When you first start Annovera, it may take a few days to fully kick in. This depends on if your periods are regular and if you were previously using a different form of birth control. In some cases, you may not be fully protected for a week after inserting the Annovera ring for the very first time. Double check with your healthcare provider on when protection will kick in for you.

How to insert Annovera

To insert and remove Annovera, follow these steps:

1. Wash your hands with soap and water. Dry your hands.

2. Wash the Annovera ring with a mild soap and water. Use a clean towel to pat it dry.

3. Choose an insertion position that feels comfortable to you. You can lie down, stand, or squat to insert the ring. If you usually use tampons, it may be helpful to try the same position you use to insert a tampon.

4. Hold Annovera between your thumb and pointer finger. Gently squeeze the ring while inserting it into your vagina.

5. Push the ring as far as you can into your vagina. You shouldn’t be able to feel it after inserting it. If you can feel Annovera, you should reposition it.

6. When it’s time to remove Annovera, wash your hands. Use your pointer finger to reach inside your vagina. Hook your finger through the ring and pull it out.

After you remove Annovera, clean it with mild soap and warm water. Pat the ring dry with a clean towel, and place it in its original case. At the end of your ring-free 7 days, clean Annovera again right before inserting it into your vagina. Proper cleaning is important and will help lower the risk of infections.

What should you do if Annovera falls out?

It’s possible for Annovera to accidentally come out of your vagina. This could happen during sex or even while using the bathroom if you’re straining.

If your Annovera ring falls out, wash and dry it as described above and place it back in the vagina. If it’s been out of you for less than 2 hours total during the 21 days you have your ring in, you’re still protected against pregnancy.

If Annovera has been out of you for more than 2 hours, you should use a back-up method of protection (e.g., condoms) to prevent pregnancy. Continue using back-up protection until Annovera has been reinserted for 7 days in a row.

Are you protected the week Annovera is out?

Yes, you’re protected the week Annovera is out. The manufacturer specifically addresses this question. As long as Annovera has been out for no more than 7 days total out of each 28-day cycle, your protection against pregnancy remains the same.

How long does Annovera last?

Annovera can be used for 13 menstrual cycles (about a year). It may be helpful to keep track of how many times you’ve used your ring so far. That way, you know when it’s time to replace it. Using Annovera after 13 cycles may lead to unplanned pregnancies.

Is the Annovera ring effective as a birth control method?

Yes. During clinical trials, Annovera was found to be about 97% effective. This means that only 3 out of every 100 women got pregnant while using it. Annovera’s effectiveness is similar to the pill when it’s taken perfectly (meaning you take every pill at the same time every single day).

It’s important to note that Annovera doesn’t protect you from sexually transmitted infections (STIs), including HIV. Use barrier contraceptives, like male or female condoms, to protect yourself.

What are the benefits of using Annovera?

Besides being highly effective, the Annovera ring has a number of other benefits. It offers the positive features commonly experienced with both short- and long-acting birth controls.

Some benefits of Annovera include:

• You don’t have to remember to take a pill every day.

• Inserting Annovera is similar to using a tampon, and you shouldn’t feel it once it’s in place.

• It’s discreet. No one can see when you have it inserted.

• You only need to refill your Annovera prescription once a year.

• It’s less invasive to get started with than other long-lasting contraceptives, such as intrauterine devices (IUDs).

• You can remove Annovera at any time if you don’t like the way it’s working.

What are the side effects of using Annovera?

Like all hormonal birth controls, Annovera can cause side effects. But everyone’s experience is unique. Many people use Annovera without side effects.

The most common side effects of Annovera include:

• Headaches or migraines

• Nausea or vomiting

• Vaginal yeast infections

• Stomach pain

• Menstrual cramps

• More discharge than usual

• Urinary tract infections (UTIs)

• Breast tenderness or pain

• Breakthrough bleeding or spotting, especially during the first month you’re using Annovera

Contact your healthcare provider if any side effects become bothersome or excessive. There may be a different birth control that would work better for you.

Does Annovera cause weight gain?

No, Annovera doesn’t typically cause weight gain. During clinical trials, a small number of people reported weight gain. But researchers noted that there were no significant weight changes when looking at all study participants.

With a few exceptions, most hormonal birth control methods don’t cause weight gain. But during the first few months of using birth control, you may experience bloating. As your body adjusts to the hormones in your birth control method, you may notice mild water retention. This is temporary and should resolve on its own within a few months.

Can you skip your periods while using Annovera?

Yes, you can skip your period while using the Annovera ring. But you should talk to a healthcare provider before doing this on your own. Your provider will review your health history to make sure it’s safe for you to skip your ring-free week. Using Annovera in this way (called continuous use) isn’t right for everyone.

There’s one caveat to doing this: your Annovera ring won’t last an entire calendar year. Annovera is designed to release medication for a total of 273 days (about 9 months). When you follow a cycle of 21 days in and 7 days out, this math works out to 13 cycles.

There’s a possibility that your insurance may not pay for a refill of Annovera 3 months earlier than expected. It’s best to contact your insurance for details. They may need extra information from your provider before they cover continuous use of the Annovera ring.

Good to know: It’s possible that your period may become lighter or stop altogether with Annovera even if you’re following a ring-free week. But this side effect isn’t common.

Who shouldn’t use Annovera?

Because it contains estrogen, Annovera can raise your risk of blood clots, heart attacks, and other heart-related problems. If you’re over age 35 and you smoke, your risk of these complications is higher. If you have a history of blood clots or heart problems, make sure your healthcare provider knows this before you start using Annovera.

If you currently have or have had breast cancer that’s sensitive to hormones, Annovera may not be the safest option for you. It’s best to discuss your personal breast cancer risks with your healthcare provider when considering birth control methods.

Your liver breaks down the medications in Annovera. So if you have current or past liver problems, it might not be the best birth control for you. Let your healthcare provider know if you’ve ever been told you have liver issues.

As mentioned above, headaches or migraines are a common side effect of Annovera. If you have a migraine condition, this medication could worsen your symptoms. Make sure your healthcare provider is aware of any history of migraines before starting Annovera.

How to save on the Annovera ring

As part of the Affordable Care Act (ACA), many commercial plans must fully cover birth control. Vaginal contraceptive rings are included under this law. So it’s possible Annovera may cost $0 with your insurance. GoodRx can also help you find ways to save on Annovera, including with GoodRx coupons and copay savings cards.

• Save with GoodRx: Anyone with a valid prescription, regardless of insurance status, can use GoodRx to purchase 1 ring (a 1-year supply) of Annovera at an exclusive cash price of $575.

• Save with a copay savings card: If you have commercial insurance, you may be eligible to pay as little as $0 for Annovera using a savings card from the manufacturer.

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Written by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

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