Annovera (segesterone acetate/ethinyl estradiol) is a prescription vaginal ring that’s used to prevent pregnancy. It’s used in 28-day cycles.

Annovera is prescribed to adolescent and adult females* who have started their period and would like to prevent pregnancy.

Annovera has two active ingredients: segesterone acetate and ethinyl estradiol. An active ingredient is what makes a drug work. It belongs to a group of drugs called combined hormonal contraceptives.

Hormonal contraceptives use synthetic hormones, such as estrogen and progestin, to prevent pregnancy.

This article describes the dosage of Annovera, as well as its strength and how to use it. To learn more about Annovera, see this in-depth article.

* In this article, we use the terms “male” and “female” to refer to someone’s sex assigned at birth. For information about the difference between sex and gender, see this article.

This section describes the usual dosage of Annovera. Keep reading to learn more.

What is Annovera’s form?

Annovera comes as a hormone-releasing vaginal ring. The flexible ring is inserted into your vagina.

What strength does Annovera come in?

Annovera contains:

  • 103 milligrams (mg) of segesterone acetate
  • 17.4 mg of ethinyl estradiol

What are the usual dosages of Annovera?

The information below describes the usual recommended dosage of Annovera for adults. But be sure to use the dosage your doctor prescribes for you. They’ll determine the best dosage to fit your needs.

Dosage for pregnancy prevention

Annovera is used in 28-day cycles. You’ll insert the vaginal ring at the start of the cycle and leave it in for 21 days. Then you’ll remove the vaginal ring and keep it out for 7 days. During the 7 days without the ring, you’ll likely have your period.

The average amount of drug that’s released into the body each day the vaginal ring is present is:

  • 0.15 mg of segesterone acetate
  • 0.013 mg of ethinyl estradiol

Annovera vaginal ring lasts for 13 cycles (about one year).

What’s the dosage of Annovera for adolescents?

The dosage of Annovera for adolescents is the same as for adults. For details, see “What are the usual dosages of Annovera” above.

For more information about Annovera’s dosage for adolescents, talk with your child’s doctor.

Is Annovera used long term?

Yes, Annovera is typically used as a long-term treatment. If you and your doctor determine that it’s safe and effective for you, you’ll likely use Annovera vaginal ring long term.

Annovera is used in 28-day cycles. You’ll insert the vaginal ring at the start of the cycle and leave it in for 21 days. Then you’ll remove the vaginal ring and keep it out for 7 days.

It’s important to insert and remove Annovera on a consistent schedule. The manufacturer has an app you can download to help you keep track of when to insert and remove Annovera.

This section describes how to insert and remove Annovera. You can also see this video from the manufacturer.

Inserting Annovera vaginal ring

Your doctor will discuss when to first insert Annovera. The timing will depend on your menstrual cycle and other factors, such as whether you’ve been on certain types of birth control or recently been pregnant.

Before inserting Annovera, you’ll wash the ring with mild soap and warm water and dry it with a paper towel or clean towel. You’ll also want to wash your hands with soap and water before insertion.

To insert Annovera, you may choose a position that’s comfortable for you. This may be squatting, standing with one foot up on a chair, or lying down. Pinch the two sides of the vaginal ring with your thumb and index (pointer) finger so that it’s narrow.

Insert the pinched ring high into your vagina. It should be inserted as far into your vagina as it will go. You don’t have to worry about it going too high. You should not feel Annovera once it’s in place. If you feel discomfort, remove and reinsert the ring until it’s positioned so that you don’t feel it.

While Annovera is in, do not use oil- or silicone-based vaginal lubricants. They could damage the ring and affect how well it works. Water-based lubricants are safe to use.

When you’re first prescribed Annovera, your doctor may recommend using another barrier form of birth control, such as condoms, for the first 7 days.

Removing Annovera vaginal ring

After 21 days, it will be time to remove the ring. To remove Annovera, wash your hands with soap and water, then insert your index finger into your vagina and hook your finger around the ring. You can then pull out the ring.

Once it’s removed, wash the ring with mild soap and warm water. Pat it dry with a paper towel or clean towel before storing it in its case for 7 days.

For information on the expiration, storage, and disposal of Annovera, talk with your doctor or pharmacist. You can also see the “Annovera expiration, storage, and disposal” section of this article.

Accessible drug containers and labels

Some pharmacies provide medication labels that:

  • have large print
  • use braille
  • feature a code you can scan with a smartphone to change the text to audio

Your doctor or pharmacist may be able to recommend pharmacies that offer these accessibility features if your current pharmacy doesn’t.

If you forget to insert Annovera after 7 days, insert it as soon as you remember. If it’s inserted later than the originally scheduled date, it may not prevent pregnancy. In this case, for at least 7 days after inserting Annovera, you should use a barrier method of birth control or abstain from sex.

You’ll then restart the 21-day cycle on the new insertion date. You can use the Annovera app to help you keep track of insertion and removal dates.

If Annovera falls out before the end of the 21-day cycle and you’re able to reinsert it within 2 hours, you typically won’t need additional backup contraception to prevent pregnancy. But if Annovera has been out for more than 2 hours, you should use a barrier form of contraceptive, such as a condom, until the ring has been in place for at least 7 days.

If you forget to remove Annovera after 21 days, remove it as soon as you remember. Then reinsert it after 7 days and follow the new 28-day cycle dates for inserting and removing Annovera.

Do not use more hormonal contraceptives than your doctor prescribes, as this can lead to harmful effects.

What to do in case you’ve used Annovera with other hormonal contraceptives

Call your doctor right away if you think you’ve used another hormonal contraceptive with Annovera. You can also call 800-222-1222 to reach America’s Poison Centers or use its online resource. But if you have severe symptoms, immediately call 911 (or your local emergency number) or go to the nearest emergency room.

Below are answers to some commonly asked questions about Annovera’s dosage.

How long does it take for Annovera to start working?

It usually takes 7 days of using Annovera before you can rely on it to prevent pregnancy. Your doctor will likely recommend that you use a barrier form of birth control, such as a condom, during the first 7 days.

In some cases, depending on the timing of your menstrual cycle and other birth control medication you’ve recently been taking, you may not need to use a backup method of contraception.

If you have other questions about when to expect Annovera to start working for you, talk with your doctor.

Can Annovera be used for heavy menstrual bleeding? If so, what’s the dosage?

Annovera is not approved for heavy menstrual bleeding. But your doctor may prescribe Annovera off-label for this use. With off-label use, doctors prescribe a drug for a purpose other than what it’s approved for.

A review of studies suggested that combined hormonal contraceptives may have some benefit in treating heavy menstrual bleeding.

The drug’s manufacturer doesn’t provide dosage recommendations for unapproved uses. If you’d like to learn more about treatments for heavy menstrual bleeding, talk with your doctor.

The sections above describe the usual instructions provided by the manufacturer. If your doctor recommends Annovera for you, they’ll discuss the best dosage and schedule that’s right for you.

Remember, you should not change your Annovera schedule without your doctor’s recommendation. Only use Annovera exactly as prescribed. Talk with your doctor if you have questions or concerns about Annovera.

Here are some examples of questions you may want to ask your doctor:

  • Would I have a higher risk of side effects if I forget to remove Annovera?
  • Is there a different dosage for Annovera based on body weight?
  • Would I need a different dosage of Annovera if I have liver problems?
  • How long after I quit smoking can I be prescribed Annovera?

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Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.