Annovera RingShare on Pinterest
Getty Images/mihailomilovanovic

We include products we think are useful for our readers. If you buy through links on this page, we may earn a small commission. Here’s our process.

Healthline only shows you brands and products that we stand behind.

Our team thoroughly researches and evaluates the recommendations we make on our site. To establish that the product manufacturers addressed safety and efficacy standards, we:
  • Evaluate ingredients and composition: Do they have the potential to cause harm?
  • Fact-check all health claims: Do they align with the current body of scientific evidence?
  • Assess the brand: Does it operate with integrity and adhere to industry best practices?
We do the research so you can find trusted products for your health and wellness.
Was this helpful?

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-shaped vaginal insert 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 ring-free week. You repeat this cycle — 3 weeks on, 1 week off — every month.

When you use the ring correctly, it has around a 97% efficacy rate. 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.

Pros

  • It’s convenient. One Annovera ring lasts a full year (13 menstrual cycles). This means you won’t have to go back and forth to the pharmacy or ask a doctor for a new prescription every few months.
  • It’s easy to use and remove. Because you can remove it yourself, you don’t have to see a doctor when or if you’re ready to have it removed (as you would for IUD removal, for example). It’s also easy to use, store, and clean.
  • It’s effective. The Annovera ring is around 97% effective with perfect use, and around 93% effective with typical use.
  • It’s comfortable. It’s typically pain-free to insert and remove, though it might be uncomfortable if you’re prone to vaginal pain, especially if you have a condition, such as dyspareunia.

Cons

  • It might cost you more. If it isn’t covered by your insurance, Annovera can be more expensive than other options. However, it should be covered by your insurance under the Affordable Care Act. The brand has more information about how to access Annovera on its official website.
  • It can fall out. In one study, the ring fell out more than once for 25% of people. The good news is that it’s easy to clean and reinsert: Simply wash it with mild soap and water, rinse, and put it back in place.
  • There are some side effects. For the most part, the Annovera ring’s side effects are similar to other forms of hormonal birth control. Mild side effects may include headache or nausea, while more severe ones may include cardiovascular issues.
Was this helpful?

Before using Annovera, it’s a good idea to discuss your medical history in detail with your doc.

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, making 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). You then re-insert the ring.

Even though you do not have the ring in during the withdrawal bleed week, you are still protected from pregnancy as long as you have been using it as prescribed.

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

When the Food and Drug Administration (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%.

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 body mass index (BMI) of 29 or more can’t use the ring, or that there’s an official Annovera weight limit, but the efficacy might differ.

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 fingers 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, needlessly removing the ring might reduce its effectiveness.

If the ring has been out for more than two hours, it’s recommended that you use backup contraceptives for the next 7 days.

If you have trouble remembering when to remove or reinsert the ring, you can download the Annovera Birth Control Tracker app in the App store for iPhone or on Google Play. This app sends reminders when it’s time to remove and reinsert it.

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% of users. The hormones inside the Annovera ring are similar to the pill and NuvaRing, which is why they can cause similar side effects.

Some mild Annovera ring side effects include:

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

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 a doctor when deciding whether to use Annovera or try another form of contraceptive.

The Annovera ring and NuvaRing are quite similar in how they work. Like Annovera, the NuvaRing is a flexible vaginal ring contraceptive that works by releasing small amounts of hormones 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. According to Annovera ring reviews, some people seem to find it more comfortable because it’s softer, although others prefer the NuvaRing.

Price

The Annovera ring costs around $2,000 and lasts a year, while the NuvaRing costs up to $200 but needs to be replaced monthly. As such, the Annovera ring price may work out cheaper in the long run. If you have health insurance, both options should be covered.

Side effects and efficacy

Both seem quite effective at preventing pregnancy — if you use the ring correctly, it’s about 97% effective. Similarly, both are associated with the same side effects.

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

  • Talk with a doctor. They can provide you with a prescription if it’s a suitable method.
  • Try an online healthcare provider such as Nurx. 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.

Although it’s meant to be used for 21 days followed by a ring-free week, some people might want to use the Annovera ring to skip withdrawal bleeds 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 a withdrawal-bleed week, talk with a doctor first.

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.

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

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.

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.

Vaginal ring contraceptives like Annovera work by releasing hormones directly into the vaginal tissue. The Annovera ring hormones include lab-made progestin and estrogen, which prevent pregnancy by stopping ovulation.

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.

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

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

The main difference is that the same Annovera ring can be used for a year while the NuvaRing has to be replaced every month. Both vaginal ring contraceptives are around the same size, but Annovera ring is slightly softer and thicker.

The Annovera ring is an effective and safe form of birth control. Although it might not be suitable for everyone, Annovera does offer convenience and ease of use to those who can use it. To maximize its effectiveness, be sure to insert and use the ring correctly.

Sian Ferguson is a freelance health and cannabis writer based in Cape Town, South Africa. She’s passionate about empowering readers to take care of their mental and physical health through science-based, empathetically delivered information.