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Every person’s biology is unique, which means different types of birth control work for different people.

A lesser-known form of birth control is the Annovera Ring. It’s a flexible ring that is inserted into the vagina. Although the Annovera ring is similar to the NuvaRing, there are a few key differences.

The Annovera ring is a flexible ring that releases hormones over time. Like birth control pills, the Annovera ring contains lab-made progestin and estrogen, which prevent ovulation.

You insert and remove the Annovera ring yourself. It’s placed into the upper part of the vagina, close to the cervix. You can remove the Annovera ring in order to get a “period” (technically, this is withdrawal bleeding, not a period). You then reinsert it after one week. You repeat this cycle — 3 weeks on, 1 week off — every month.

It has around a 97 percent efficacy rate when used as directed. One ring lasts a full year, making it a convenient birth control option. If you decide you would like to get pregnant, or if you want to stop using the ring for any reason, you can simply remove it yourself.

As with all forms of birth control, the Annovera ring has both pros and cons.

It’s a good idea to discuss any potential side effects with your doc before deciding whether Annovera is right for you.

As with most forms of hormonal birth control, the Annovera ring contains progestin and estrogen, which prevent ovulation and thus lower your chances of pregnancy. It also changes the uterus lining to make it harder for fertilized eggs to implant. Lastly, it changes the cervical mucus, making it harder for sperm to enter.

Like the NuvaRing, the Annovera ring steadily releases low amounts of hormones directly into the vaginal tissues.

You insert the ring into your vagina, leave it in place for 3 weeks, and remove it for 1 week to get your “period” (withdrawal bleed).

One large study looked at the efficacy rate of Annovera over a year-long period and found a 2.9 percent pregnancy rate. In other words, 2.9 percent of participants became pregnant over the course of the year.

When the FDA approved Annovera, it noted that, based on these clinical trials, 2 to 4 people out of 100 people may get pregnant over the course of one year of using Annovera.

More generally, the Centers for Disease Control and Prevention (CDC) reports that with typical use (hey, you’re only human!) the failure rate of the ring birth control hovers around 7 percent.

One major issue with the Annovera ring is that it has not been studied sufficiently in people with a BMI of 29 or more. This isn’t necessarily to say that people with a BMI of 29 or more can’t use the ring, but the efficacy might be different.

Once you get your Annovera ring, it’s time to insert it. Unlike an IUD, the Annovera ring isn’t inserted by a medical professional — it’s easy enough for you to insert yourself.

How to insert the Annovera ring

  1. Wash your hands.
  2. Wash the ring with mild soap and water. Pat it dry with a clean towel or paper towel.
  3. Get into a comfortable position. With your index finger and thumb, squeeze the ring in half so it’s about the size of a tampon.
  4. Insert the ring into your vagina, as far up as it can go. It should unfold into place.

Your ring needs to stay in for 21 days. After this, it should be removed for 7 days, during which you will have a withdrawal bleed (which will resemble a period).

How to remove the Annovera ring

  1. Wash your hands.
  2. Get into a comfortable position.
  3. Insert your fingers into your vagina to grip the ring. Usually, the index and middle finger work well for this, but you can try your index finger and thumb if that doesn’t work.
  4. Gently remove it.
  5. Wash it with mild soap and water. Pat it dry with a clean towel or paper towel.
  6. Put it into its case and reinsert after 7 days.

Don’t remove the ring to wash it too often. You should, of course, wash it before inserting it after the 7 days are up. You should also wash it if it accidentally falls out. However, removing the ring needlessly might reduce its effectiveness.

Worried you’ll forget to remove or reinsert it? Fortunately, you can download the Annovera Birth Control Tracker app in the App store for iPhone or on Google Play. This app reminds you to remove and reinsert your ring.

Is the Annovera ring safe? One large review of studies looked at data from nine different studies, comprising over 3,000 participants. Researchers concluded that it’s as safe as other forms of hormonal birth control.

However, it does have some side effects. According to research, these side effects happen to at least 5 percent of users.

Annovera has similar side effects to the pill and NuvaRing because they use the same kind of hormones. Some less serious side effects include:

  • headaches
  • nausea
  • abdominal pain
  • increased period pain
  • vaginal discharge
  • irregular bleeding
  • changes in mood
  • vaginal irritation

Some research from 2013 has suggested that, when compared to the pill, the vaginal ring is more likely to give you vaginal irritation and less likely to give you acne, nausea, and emotional changes.

The ring might have more serious side effects like:

  • heart attack
  • blood clots
  • stroke
  • high blood pressure
  • toxic shock syndrome

There are some contraindications of Annovera. You shouldn’t use Annovera if you:

  • are over 35 and smoke
  • are at high risk of arterial or venous thrombotic diseases
  • take certain hepatitis C medications
  • have had breast cancer
  • have liver disease

It’s important to discuss your medical history with your doctor when deciding whether Annovera is right for you.

The Annovera ring and NuvaRing are quite similar in how they work. Both are flexible rings that release low levels of hormones directly into the vaginal tissue. However, there are a few key differences.

How long it lasts

The major difference between the Annovera ring and NuvaRing is that you can use the same Annovera ring for a year, while you’ll need to replace your NuvaRing every month. As such, the Annovera ring is more convenient.

Hormones

Both NuvaRing and Annovera contain estrogen and progestin. However, Annovera has a unique kind of progestin hormone called segesterone acetate.

Segesterone acetate was developed specifically for the Annovera ring. In combination with estrogen, segesterone acetate makes it possible for one ring to last a whole year.

Size, shape, and flexibility

The Annovera ring is 2.25 inches in diameter while the NuvaRing is 2.13 inches in diameter — not a big difference. However, the Annovera ring is about twice as thick as the NuvaRing. It’s a bit softer and more flexible than a NuvaRing, which is why it needs the added thickness — it helps it stay in place.

Comfort

Neither the NuvaRing nor the Annovera ring should be painful or uncomfortable to wear. It might take time for you to feel comfortable inserting it. Anecdotally, some people seem to find the Annovera ring more comfortable because it’s softer, although others prefer the NuvaRing.

Side effects and efficacy

Both seem to be quite effective at preventing pregnancy — around 97 percent if used correctly. Similarly, both are associated with the same side effects.

If you’d like to get the Annovera ring, you have a few options.

  • Talk with your doctor. If it’s a suitable method for you, they can provide you with a prescription.
  • Try an online healthcare provider such as Nurx or Pill Club. This can be a convenient way to get a prescription for birth control and have it shipped to you.
  • Visit a local clinic, student health center, or Planned Parenthood.

Can I leave the Annovera ring in all month?

You might want to use the Annovera ring to skip periods by keeping it in all month. Clinical trials have not looked at the safety and efficiency of the Annovera ring if you use it to skip periods. If you want to use Annovera to skip your period, talk with your doctor first.

Can you feel the Annovera ring during sex?

If it’s inserted properly, you shouldn’t be able to feel the ring. Your partner may be able to feel the ring if they penetrate you manually or with a penis, but this shouldn’t be uncomfortable for them.

And yes, you can use an external condom while wearing the Annovera ring, which can provide an extra level of protection against pregnancy. It might be difficult to use an internal condom (also called a female condom) with the ring as it can interfere with placement.

What is the ring made out of?

The Annovera ring is made out of silicone elastomer, which is latex-free.

Do you need a prescription for the Annovera ring?

Yes. If you can’t afford or don’t have access to see a doctor, you can try Planned Parenthood or a student health clinic. A local family planning organization in your area might also be able to help.

How much does the Annovera ring cost?

It costs around $2,000 and lasts all year. However, it should be free under your health insurance. The Annovera manufacturer has some information on accessing Annovera if cost is a concern for you.

Can the Annovera ring get lost inside me?

No! Your vagina is less like a tunnel and more like a pocket: It’s closed at the top end. Your cervix lies at the top of your vagina, and your ring will not be able to get into the tiny open hole in your cervix.

If you’re finding it hard to grip your Annovera ring, breathe and try to approach it from a new position. You might want to try squatting or raising one leg on a toilet.

Can I use a tampon or menstrual cup with the Annovera ring?

Yes. A tampon or menstrual cup should not interfere with the Annovera ring.

Although you’d usually remove the ring for 7 days, you might have to reinsert it when you’re still having a withdrawal bleed. For this reason, it might be necessary to use menstrual products.

The Annovera ring is an effective and convenient form of birth control. Although it might not be suitable for everyone, it can be very helpful to those who can use it. To maximize its effectiveness, be sure to insert and use it correctly.

Sian Ferguson is a freelance writer and editor based in Grahamstown, South Africa. Her writing covers issues relating to social justice, cannabis, and health. You can reach out to her on Twitter.