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Meet ANNOVERA—a vaginal contraceptive ring offering one year of birth control

Each ANNOVERA can be used for up to a year, no refrigeration needed.

by Robin Watkins, CNM, WHNP-BC

published 02/20/20

The FDA approval of ANNOVERA brings a new user-controlled, reversible, vaginal contraceptive ring that can be used for up to one year without refrigeration. ANNOVERA is a soft, flexible silicone ring, roughly 2 inches in diameter releasing an average of 13 mcg of estrogen (ethinyl estradiol) and a new progestin (segesterone acetate). This makes ANNOVERA one of the lowest estrogen dose methods available and the new non-androgenic progestin it contains, means fewer changes in lipid profile, acne, and weight gain. In clinical trials, ANNOVERA was 97.3% effective in preventing pregnancy when used correctly and 9 out of 10 of those who used ANNOVERA found that it was easy to use, comfortable, and did not affect their sex life.

The basics of using ANNOVERA

  • ANNOVERA is placed in the vagina by the user and removed after 21 days. It is replaced after 7 ring-free days (it comes with a small case for storage while it’s out).
  • Each ANNOVERA ring is reusable for 13 cycles, up to one year.
  • Unlike NuvaRing, the current vaginal contraceptive ring, ANNOVERA never needs to be refrigerated.
  • ANNOVERA does not need to be removed during sex or at any time during the 21 days, but can be removed from the vagina for 2 hours without the need for a backup method.
  • Before reinserting ANNOVERA, the user must wash it with mild soap and water and pat it dry.
  • If ANNOVERA remains in the vagina for more than 21 days, it should be removed for 7 days and then reinserted for 21 days to resume a 21/7 schedule.

Starting ANNOVERA

You can encourage patients to start using ANNOVERA anytime you can be reasonably certain that they aren’t pregnant. If ANNOVERA is quick started after day 5 of the menstrual cycle, advise patients to use a backup method, like condoms, or abstain for the first 7 days of use.

Like other methods that contains estrogen, such as the patch, the combined birth control pill, or the NuvaRing, it may not be a good option for anyone with high risk of arterial or venous thrombotic diseases, current or history of breast cancer or other estrogen- or progestin-sensitive cancer, liver tumors, acute hepatitis, or severe (decompensated) cirrhosis, undiagnosed abnormal uterine bleeding, or use of Hepatitis C drug combinations containing ombitasvir/paritaprevir/ritonavir, with or without dasabuvir.

How to get ANNOVERA

ANNOVERA is now available from all commercial pharmacies, so you should be able to send a prescription to a local or mail-order pharmacy, like PillPack. Patients can also get their ANNOVERA delivered after a telehealth visit from The Pill Club or PlushCare, skipping the in-person visit altogether.

Many commercial insurance plans nationwide now cover ANNOVERA with no out-of-pocket cost. But for those who do not have coverage, the ANNOVERA savings program is available to ensure that people with a copayment pay as little as $60 for their ANNOVERA.

Bottom line

Since each ANNOVERA is good for a year, it could be a good option for anyone who wants an easy-to-use, long-lasting birth control option that can be started and stopped without a procedure.

Robin Watkins is the Director, Health Care at Power to Decide. Robin is a Midwife and Women’s Health Nurse Practitioner with experience in sexual and reproductive health care and community health centers. When she is not talking sex, placing IUDs or asking One Key Question, you can find her riding her bike on the streets of DC or eating ice cream for dinner.
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