Birth Control

Yearly birth control ring (Annovera)

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What is the yearly birth control ring (Annovera)? The yearly birth control ring might be right for you if... How do you use the yearly birth control ring? How much does the yearly birth control ring cost? What are the side effects and benefits of the yearly birth control ring? Where can you get the yearly birth control ring?

What is the yearly birth control ring (Annovera)?

Annovera is a white, bendable birth control ring that you can use for up to a year. You insert it into your vagina and keep it there for three weeks. At the end of the third week, you take it out, wash it with mild soap and water, pat it dry, and store it in its case at room temperature for a week. That’s usually when you get a withdrawal bleed, which is similar to a period. At the end of the fourth week, you put it back in your vagina and start the whole cycle again. After 13 cycles, it’s time for a new Annovera.

Annovera contains two different kinds of hormones, estrogen and progestin, that work together to prevent pregnancy. These hormones are absorbed through the vagina. The main way they prevent pregnancy is by stopping ovulation from happening, which means that the ovaries don’t release an egg.

Quick Facts

Very effective if you use it correctly. Easy to use and works like the pill, but you don't have to worry about it every day.

Effectiveness

The yearly ring (Annovera) is very effective the way most people use it.

Perfect use: 97% effective

Typical use: Not enough data

What are perfect use and typical use?
Hormones

The yearly ring contains two different kinds of hormones, estrogen and progestin.
Side effects

Most common—but usually temporary—side effects are irregular bleeding, headaches, sore breasts, and nausea.
Cost

Anywhere from $0 (with insurance) to $183 a month.
STI protection

The yearly ring doesn’t protect against STIs.
Ongoing effort

Ring in. Wait 3 weeks. Ring out. Wait 1 week. Repeat. Get a new ring after 13 cycles.

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The yearly birth control ring might be right for you if...

Effectiveness at preventing pregnancy is a top priority for you.

Annovera is 97% effective at preventing pregnancy when used perfectly (exactly as directed). That means about three out of every 100 people using Annovera perfectly for a year will get pregnant.

You’re looking for a lower dose of hormones.

The ring uses a lower dose of hormones than other hormonal methods, so there may be fewer side effects. And because you aren’t taking the hormones by mouth, they don’t pass through your gastrointestinal system, so you can expect fewer side effects that affect that system, like nausea.

You want to put in relatively little effort each month.

If having to remember to take a pill every day is not for you, the ring might be a good option. You only need to remember to do something twice a month (take the ring out and then a week later put the ring back in).

You want the option to skip periods.

If you want to skip a period, instead of taking your Annovera out after three weeks, you can just leave it in. You can skip a single period this way or multiple periods throughout the year. You can even skip all of your periods for a year by leaving it in continuously. It’s good for up to 13 cycles (a cycle is 28 days), which adds up to a calendar year.

You’re comfortable touching your body.

Using Annovera requires that you put your fingers inside your vagina. It’s a lot like putting in a menstrual cup or menstrual disc, so if you’re fine with doing those things, you’re good to go.

You aren’t looking for STI protection, or you’re okay with combining the ring with another method.

The ring doesn’t offer any STI protection. So if that’s something you’re looking for, you can use condoms or internal condoms along with the ring. Dental dams and/or gloves also offer STI protection, depending on what kind of sex you’re having. You may also want to consider PrEP (pre-exposure prophylaxis), which is a daily pill or an injection you can get every two months to decrease your risk of getting HIV.

You want a method that won’t permanently affect your fertility.

The only birth control method that permanently affects your future fertility is sterilization. Annovera does not affect your ability to get pregnant after you stop using it. In fact, you’ll return to whatever level of fertility is normal for you (which just means that you may be able to get pregnant again) quickly after you go off the ring. So if you’re planning to stop using the ring, and you’re not ready to be pregnant, start using another method right away.

You want a method that you can stop without help from a provider.

You can stop taking Annovera without seeing a provider. Just keep in mind that you will quickly return to whatever level of fertility was normal for you before using Annovera, which means you may be able to get pregnant quickly. If you don’t want to get pregnant, make sure to start using another form of birth control right away.

You don’t need to hide your method.

Annovera is not one of the birth control methods that is easy to hide completely. Unlike NuvaRing (the monthly birth control ring), Annovera doesn’t need to go in the fridge for long-term storage, but you do need a safe place to keep it stored in its case between cycles, so there’s a chance someone could find it.

Also, some people with penises say they can feel the ring during penis-in-vagina sex. (Yes, it’s designed for you to leave in during sex!) So if you’re trying to hide that you’re using birth control from someone you’re having sex with, the ring may not be the best choice.

You don’t have these risk factors.

The risk of blood clots while using the ring is very low for most people. But there are some things that will greatly increase your risk, like:

Previously having had a blood clot or having certain inherited conditions that increase your risk for a blood clot.
Smoking cigarettes if you’re 35 years old or older.
Having uncontrolled high blood pressure.
Having heart disease or having had a heart attack or a stroke.
Having recently had major surgery, if you won’t be able to get out of bed for a while.
Having migraine with aura.
Having had a baby less than three weeks ago.
Having tested positive for antiphospholipid antibodies.

If you have any of these risk factors for blood clots or if you have or have had breast cancer or serious liver disease, it’s not recommended that you use either type of ring, the patch, or any of the combined hormonal birth control pills (the most commonly used kind of birth control pill). Check with your medical provider about other options.

How do you use the yearly birth control ring?

Annovera is pretty easy to use. All you really need to remember is the schedule for inserting and removing the ring.

Once you insert the ring, leave it in for three weeks (21 days). Take it out for the fourth week (that means that you’ll leave it out for seven days). After taking it out, wash it with mild soap and water, pat it dry, and store it in its case at room temperature. When the ring is out, you’ll probably get withdrawal bleeding, which is like a period. After seven days, even if you’re still bleeding, put Annovera back in again.

You will always take your ring out and put your ring in on the same day of the week, meaning that if you put in your ring on a Sunday, you’ll take it out three weeks later, also on a Sunday, and you’ll put it back in one week after that, also on a Sunday.

During the three weeks (21 days) that you have the ring in, it’s important not to take it out. And it’s designed to keep it in during sex. But if it ever comes out, make sure to put it back in right away. If the ring is out of your vagina for more than two hours total during those 21 days, you will need to use a backup method of birth control for seven days after putting it back in. That means that if you add up all the time you have it out during those 21 days, and it’s more than two hours, you’ll need backup birth control. For example, if you take it out for six minutes a day for all 21 days, you will have exceeded a total of two hours and will need backup birth control like a condom or internal condom.

Here’s how to put Annovera in:

Wash your hands and the ring with mild soap and water.
Squish the ring between your thumb and index finger.
Insert it into your vagina as far up as you can get it with your finger. It’ll sit tucked up against the side of your vaginal wall. The exact position doesn’t affect how well it works to prevent pregnancy, as long as the entire ring is inside your vagina. Just make sure you’re comfortable and no part of it is coming out of your vagina. If you need to, you can take it out and try again or try just pushing it further into your vagina.

ring insertion pose

Here’s how to take the Annovera out:

Wash your hands.
Insert your finger into your vagina until you feel the edge of the ring.
Hook your finger on the edge of the ring and pull down to pull it out of your vagina.

Here’s a video showing how to put in and take out the Annovera.

You can use tampons or a menstrual cup while using Annovera. If the ring comes out when you’re removing your tampon or menstrual cup, just reinsert it right away.

How much does the yearly birth control ring cost?

With insurance

If you have health insurance—whether it’s from work, school, your parents, the ACA marketplace, or Medicaid—chances are good that you’ll be able to get this method with no out-of-pocket cost.

Without insurance

If you don’t have insurance, Annovera may cost up to $2,200 out of pocket for a year of birth control, which is about $183 per month. If you need help covering the cost of Annovera, there may be options. Check with your local family planning clinics to find out if they offer free or low-cost Annovera. You can also check out the Annovera website for coupons.

What are the side effects and benefits of the yearly birth control ring?

There are positive and negative things to say about every method. And everyone’s different—so what you experience may not be the same as what someone else experiences.

The Positive

There are lots of things about birth control that are good for your body as well as your sex life.

Here are some of the benefits of Annovera:

Easy to use—it’s just like putting in a menstrual cup
Doesn’t interrupt sex
May give you shorter, lighter periods
May clear up acne
May reduce menstrual cramps and PMS
Offers protection against some health problems, like endometrial and ovarian cancer, iron deficiency anemia, ovarian cysts, and pelvic inflammatory disease
Lasts a whole year—longer than monthly methods like the pill, patch, and the monthly ring—which means you don’t have to worry about refills for a whole year
You don’t have to see a provider to stop using it. You can just take the ring out and be done. Just make sure you start a new form of birth control immediately because you can get pregnant right away after stopping Annovera.

The Negative

It’s normal to worry about negative side effects, but for many people, they’re not a problem. Most people adjust to having Annovera pretty quickly, but it could take a few months.

Side effects that will probably go away after two or three months:

Bleeding in between periods
Breast tenderness
Nausea and vomiting

Side effects that may last longer:

Increased vaginal discharge, irritation, or infection
A change in your sex drive

For a very small number of people there are risks of serious side effects like blood clots, stroke, and heart attack. If you have abdominal pain, chest pain, severe headache, sudden changes in your vision, or severe pain in your calf or thigh, contact your health care provider or get emergency care right away.

In addition to potential side effects, there are some disadvantages to the ring:

May not be the easiest to hide
Doesn’t protect against STIs
Requires a prescription

Where can you get the yearly birth control ring?

You need a prescription from a health care provider to get Annovera. You can get a prescription from a provider you see in person or from a provider you see via telehealth. You can have the prescription filled by going to a pharmacy in person or by using an online pharmacy that will deliver Annovera to your door.

In person

If you need to find a provider who can prescribe you birth control, check out our clinic finder. Also, in some states, pharmacists can actually write you a prescription for birth control. If you’re in a state where pharmacists can prescribe birth control, check with your local pharmacy to find out if they do so.

Online

Getting birth control online has never been easier. To find out what’s available where you live, check out our telehealth search tool.