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Reproductive Health

Pros and Cons of Annovera


For some women, taking a daily birth control pill is no biggie. For others, remembering and committing to the everyday contraceptive practice isn’t ideal. If you’re not stoked on the pill or you’re looking for a form of pregnancy prevention you can pretty much set and forget, then you might be curious about Annovera, the first-ever contraceptive vaginal ring that’s designed to be used for a whole year — no doctors appointments or pharmacy refills required.

On the surface, Annovera might sound like the perfect solution for anyone who’s sick of thinking about contraception every single day but also isn’t trying to make a baby. But like all medications (and major life decisions in general), Annovera has potential pros and cons, and understanding the facts can help you and your doctor make an informed decision around whether Annovera is right for you. 

What is Annovera?

“Annovera is a truly novel and super exciting hormonal contraceptive vaginal ring which works by preventing ovulation,” says New York-based OB/GYN, Alyssa Dweck, MS, MD, FACOG. “It provides a full year of reversible contraception without the need for an appointment for insertion.”

If you’ve brushed up on your birth control options, you might know that one common form of contraception is the vaginal ring, which, up until last year, came in just one form — NuvaRing. The hormonal device is a flexible, transparent plastic ring that’s inserted into the vagina for three weeks, removed for one week, and then replaced with a fresh ring for the next cycle. Annovera is also a hormonal vaginal ring, but unlike NuvaRing, there’s no replacement required for a whole year. That means the donut-shaped, silicon device is totally reusable and can be washed and stored for the seven days a month that it’s not in use. 

How Do Contraceptive Rings Work?

Even though they’re slightly different, NuvaRing and Annovera work in similar ways: both are inserted into the vagina and release the hormones progestin and estrogen into the vaginal mucosa. Similar to the way oral birth control pills work, the hormones in the vaginal rings help prevent pregnancy by:

  • Thickening the cervical mucus to prevent sperm from reaching the egg
  • Stopping ovulation to prevent eggs from leaving the ovaries in the first place

What makes Annovera different?

Annovera and NuvaRing may look similar and work in comparable ways, but Annovera has a unique distinction: women get a full year of use out of one single device. While the NuvaRing has to be replaced with a new device every four weeks, Annovera is built to last for up to 13 cycles, so it’s a longer-term option that doesn’t require any kind of procedure or medical intervention. Users still wear it for 21 days and remove it for seven each cycle, just like NuvaRing, but instead of then just tossing the used ring in the trash, Annovera users can wash and store their device until their seven days are up. Then they can use that same device again and again, for a whole year.    

Another Annovera distinction: it uses a new form of progestin that’s different from other forms of birth control. Known as segesterone acetate, this form of progestin, when combined with a widely used form of estrogen called ethinyl estradiol, has been shown to inhibit ovulation for an entire year. So if you and your doctor think it might be worth switching up the type of hormones in your contraception, Annovera might be worth considering — but like any medication, this one has its pros and cons too.    

The Pros of Annovera

  • It’s super convenient. If you hate having to set a daily alarm or keep a pack of pills on you at all times, then Annovera definitely has at least one distinct perk. Once you insert the ring, you leave it in place for three weeks — that means 21 days of a total brain vacation from worrying about your contraception. 
  • It lasts way longer than other forms of birth control. While you still have to remove the ring every three weeks (unless otherwise directed by your doctor), you don’t have to trash the device for a new one on the next cycle. Annovera can be washed and stored during the one-week break each month and then reinserted on the next cycle — and again on the next, etc. You can hold onto the same device for up to 13 months, so there’s no need to run back and forth to the pharmacy or get a prescription refill. 
  • It’s ridiculously easy to use — no doctor required. Like NuvaRing, Annovera is easy to use and insertion doesn’t require a special trip to the doctor’s office since you can do it yourself at home each month.

The Cons of Annovera

  • The risk of side effects are possible. For Annovera specifically, those risks can include headache/migraine, nausea/vomiting, yeast infections, abdominal pain, dysmenorrhea (painful menstruation), breast tenderness, irregular bleeding, diarrhea, and genital itching. More serious side effects are also a possibility for some women, so be sure to discuss all the risks with your doctor. 
  • It’s not for everyone. Annovera isn’t suitable for every type of person out there. It shouldn’t be used by women who are over 35 and smoke cigarettes and it shouldn’t be used by women who have: 
    • An increased risk of arterial or venous thrombotic diseases
    • A current case or history of breast cancer or other estrogen- or progestin-sensitive cancer
    • Liver tumors, acute hepatitis, or severe cirrhosis
    • Undiagnosed abnormal uterine bleeding
    • Hypersensitivity to any ingredients in Annovera
    • A condition that requires the use of hepatitis C drug combinations containing ombitasvir/paritaprevir/ritonavir, with or without dasabuvir
  • You could wind up paying a pretty penny. Since it hasn’t officially hit the market yet (it should be out later this year or in early 2020), it’s unknown how much Annovera will cost. If you’re counting on your insurance to foot the bill, you’ll have to check with your carrier once the medication becomes available since each and every plan is different and you don’t want to be hit with any surprises.