Birth Control


2 min read

What is it? How does it work?
Annovera is a new, FDA-approved vaginal ring that can be used up to one year (up to 13 cycles) without refrigeration. The small, flexible, reusable ring is inserted into the vagina by the user and does not require a procedure. It releases an average of 13 mcg of estrogen (ethinyl estradiol) and a newer type of progestin (segesterone acetate), which are hormones that prevent your ovaries from releasing eggs each month and thicken your cervical mucus. This makes Annovera one of the lowest estrogen dose methods available.

How to use it?
With clean hands, squeeze the ring together between your thumb and index finger and insert it like a tampon into the vagina. The ring should stay inserted for 21 days, at which point it should be removed for 7 days until the next cycle begins. Unlike Nuvaring, the same ring is used for one full year and does not require refrigeration. A gentle wash with soap and water in between cycles will keep the ring clean.

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 less than 2 hours without the need for a backup method.

Can you skip your period on Annovera?
Skipping your period on Annovera is considered an “off label” use, meaning it hasn’t been studied thoroughly enough to be recommended by the FDA, but it may be appropriate in some cases. In this scenario, off-label use is safe. You can speak with a doctor to see if this choice is right for you. Instead of removing the ring for 7 days each cycle, you would wear the ring continuously.

To avoid spotting, the doctor might recommend removing the ring every three months and leaving it out for 7 days. During this time, you would get your period. You would do this 4 times throughout the year.

Whether you decide to skip your periods or not with Annovera, Annovera is effective for 364 days.

How effective is it?
Annovera is 97.3% effective when used correctly.

What are the side effects?
The potential side effects are similar to other hormonal contraceptives, including headaches, nausea, yeast infections, breast tenderness, irregular bleeding, diarrhea, and genital itching. Other side effects with Annovera include abdominal pain and painful periods. Compared to other birth control methods, acne and weight gain are less likely due to the new non-androgenic progestin Annovera contains.

NuvaRing and Annovera - what is the difference?

While Nuvaring and Annovera are both vaginal rings, there are a few differences between them. NuvaRing lasts for 1 month, whereas Annovera lasts for 1 year (13 cycles). With Nuvaring, once you’ve taken out your ring, you will throw it in the trash and replace it with a new one. With Annovera, you will remove the ring and store it in the provided case until it’s time to reinsert it. Your insurance will likely cover either Nuvaring or Annovera for a $0 copay. If you’re paying out of pocket, there may be a price difference between Nuvaring and Annovera: 

Lastly, for most people it’s considered appropriate to skip your period using Nuvaring if you choose to do so (you can keep the ring in for 4 or 5 weeks and replace it with a new ring at the start of the 5th or 6th week). ‍Skipping your period on Annovera is considered an “off label” use, meaning it hasn’t been studied thoroughly enough to be recommended by the FDA, but it is appropriate in most cases.

Does Annovera protect me against sexually transmitted infections?
Annovera does not provide protection against sexually transmitted infections (STIs).

Looking for more personalized info? Message a doctor through Twentyeight to get medical advice based on your needs and lifestyle.

With the participation of
Dr. Eddie Garcia

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