Annovera

What is Annovera?

Annovera is a soft vaginal ring containing two hormones that stop you getting pregnant. The first is a type of synthetic progesterone, called segesterone, and the second is a synthetic estrogen, called ethinyl estradiol.

You’ll use Annovera in 28-day cycles, where it’s in your vagina for three weeks (21 days) at a time, then out for the final week (before starting another 28-day cycle). You’ll still be protected from pregnancy the week Annovera is out, and it’s reusable, too – you just need to gently wash it after removing it. One Annovera ring will last you for a full year.

How does Annovera work?

Annovera is a type of combined birth control, containing the hormones progesterone (in the form of segesterone) and estrogen (as ethinyl estradiol).

These hormones stop you getting pregnant by inhibiting the release of luteinizing hormone and follicle-stimulating hormone. This stops the development of the follicles that release your egg during ovulation, and prevents the surge in luteinizing hormones. If the follicle isn’t developed, and there’s no luteinizing hormone surge, you won’t ovulate.^[1]

The hormones in Annovera also cause your cervical mucus to thicken, and make mobility through your fallopian tubes more difficult.^[1] They cause the lining of your uterus to thin as well, which may make it harder for a fertilized egg to attach during implantation (although there’s no proof of this right now).^[2]

The majority of the protection provided by Annovera is from progestin. The estrogen does help prevent pregnancy a bit, but it’s mainly there to stop unscheduled bleeding.^[2]

Who is Annovera for?

Annovera is typically safe for most ovulating women to take.

However Annovera’s safety and efficacy in people with a BMI higher than 29 isn’t fully understood. People with a BMI higher than 29 had to be excluded from clinical trials after two people in this group got blood clots. Higher body weight is also associated with lower exposure to the hormones in Annovera, meaning it might not be as effective in those with a higher BMI.^[3]

Annovera also isn’t suitable for people over 35 who smoke cigarettes. Smoking while on Annovera puts you at greater risk of serious heart issues.^[3] For more information on the contraindications of Annovera, take a look at the patient information leaflet.

What doses does Annovera come in?

There’s only one dosage of Annovera. It contains 103 mg of segesterone acetate and 17.4 mg of ethinyl estradiol. Annovera releases around 0.15 mg of segesterone and 0.0013 mg of estradiol every day.

How to use Annovera

Annovera is worn in 28-day cycles, where you’ll insert the ring for 21 days and then remove it for the final seven. How you start Annovera depends on whether you’ve been using a different birth control treatment beforehand, or if you’ve been pregnant recently.

If you haven’t used hormonal contraception in the last month:

• Insert Annovera between days two and five of your period. You don’t need any back-up birth control. If your period isn’t regular, or you insert your ring five days after your last period, you’ll need to use a barrier method (like condoms) for the first week of Annovera.

If you’re switching from a combined hormonal contraceptive:

• You can switch to Annovera on any day of your 28 day cycle, and won’t need back-up birth control, so long as there’s no chance of you being pregnant. There shouldn’t be more than seven days that you’re not taking hormones before you start Annovera.

If you’re swapping from a progesterone-only mini pill, injection, implant, or intrauterine system (IUS):

• Begin Annovera at the time you’d take your next mini pill, the time of your next injection, or the time your implant or IUS is removed. You’ll need back-up birth control for the first week of Annovera, like condoms.

For use after a recent abortion or miscarriage:

• Annovera can be started within five days of a first trimester abortion or miscarriage without the need for any additional methods of birth control. If more than five days have passed, you should insert Annovera between days two and five of your next period. You’ll need barrier contraception up until your period, and for the first seven days of using Annovera.
• You shouldn’t start Annovera within four weeks of a second trimester abortion or miscarriage, as you can be at a greater risk of a blood clot if you do.

If you’ve recently had a baby:

• You can only start using Annovera four weeks after giving birth, as using it before can increase your risk of getting a blood clot. You can only use Annovera postpartum if you’re choosing not to breastfeed. You’ll need an extra method of birth control, such as condoms, for the first seven days of Annovera if you haven’t had your period yet.

To insert your Annovera patch:

• Wash and dry your hands with soap and water;
• Take Annovera from its packaging, and wash it with mild soap and water. Rinse the ring off, and pat it dry;
• Get into a position that’s comfortable to insert Annovera – either lying down on your back with your knees raised, squatting down, or standing with one leg up;
• Holding Annovera between your thumb and index finger, squeeze the sides of the ring together to narrow it;
• While squeezing the sides of your ring, gently insert it into your vagina;
• Push Annovera as far as you can – it can help to push down with the muscles in your vagina while inserting your ring. There’s no ‘one way’ to insert Annovera, it can be in different positions in your vagina and still work the same;
• If you can feel the ring in your vagina, or if you’re getting discomfort, Annovera might not be inserted far enough. Use your index finger to carefully push Annovera as far as you can into your vagina. Don’t worry, there’s no danger of your ring being inserted too far, or getting lost.

To remove Annovera:

• Wash and dry your hands;
• Choose a position that’s comfortable for you to remove Annovera, the same as when inserting it;
• Insert an index finger into your vagina and hook it through the ring. Then, carefully pull down and forwards to remove the ring from your vagina. It can help to push down with the muscles in your vagina to help remove Annovera;
• Wash Annovera with mild soap and warm water, pat it dry with a clean towel, and place it back in its storage case.

How long does it take Annovera to work?

If you insert Annovera between day two and five of your period, you won’t need any back-up birth control; you’ll be protected from pregnancy immediately. If you didn’t start Annovera within five days of your period you’ll need to use barrier contraception for the first seven days.

What should I do if I make a mistake taking Annovera?

You should use Annovera exactly as your doctor instructs you to. If you don’t take Annovera as recommended it might not work properly.

If your Annovera ring accidentally falls out your protection from pregnancy shouldn’t be affected as long as you reinsert it within two hours. Just wash the ring with mild soap and warm water, rinse it off and pat it dry with a clean towel before you do. If it’s out for more than a combined total of two hours in one cycle you’ll need to use back-up birth control until the ring has been in for seven consecutive days.

If you forget to put Annovera back in place after your seven day break, you should consider whether or not you could have become pregnant. You’ll need barrier contraception, like condoms, until Annovera has been inserted for seven consecutive days. Speak to your doctor about options for emergency contraception while using this birth control method, as combined hormonal contraceptives (that contain estrogen) aren’t recommended for use while on Annovera.

If you forget to remove your Annovera ring after 21 days, simply take it out for seven days. Then reinsert it for 21 days to start a new 28-day cycle.