Annovera (Generic Segesterone + Ethinyl Estradiol): Complete Medication Guide
Key Takeaways
Annovera is a long-acting birth control ring that you insert yourself and wear for three weeks at a time.
It contains two hormones—segesterone and ethinyl estradiol—that prevent pregnancy by stopping ovulation.
You wear the ring for 21 days, then remove it for 7 days to allow a period-like bleed.
Common side effects include headaches, nausea, and breast tenderness, which often improve over time.
Serious side effects are rare but may include blood clots or stroke; discuss your personal risk with your doctor.
Annovera Overview
Annovera is a flexible vaginal ring that releases hormones to prevent pregnancy. It belongs to a class of medications called combined hormonal contraceptives because it contains both a progestin (segesterone) and an estrogen (ethinyl estradiol). The ring works by stopping your ovaries from releasing an egg each month—the primary way pregnancy is prevented. It also thickens cervical mucus and thins the uterine lining, making it harder for sperm to reach or implant an egg.
Unlike birth control pills you take daily, Annovera is a once-a-month option. You insert it yourself into your vagina, wear it for three weeks, then remove it for one week. During that week off, you typically have a period-like bleed. After seven days, you insert a new ring and repeat the cycle. This long-acting approach makes it easier to remember, and it allows your body to maintain steady hormone levels throughout your cycle.
Annovera is more than 99% effective at preventing pregnancy when used perfectly, though real-world effectiveness is around 91% because people sometimes forget to follow the schedule. It's a reversible method—your fertility may return quickly once you stop using it. If you're looking for flexible contraceptive options to consider, Doctronic's AI doctors can help you explore what works best for your body and lifestyle.
Side Effects
Most people tolerate Annovera well, and side effects often settle down within two to three months as your body adjusts to the hormones. Common effects are usually mild, but it's important to know what to expect and when to reach out to your healthcare provider.
Common Side Effects
Headaches – Ranging from mild to moderate; may occur more frequently in the first few months of use
Nausea – Often improves if you take the ring out during meals or insert it at night before bed
Breast tenderness – Usually temporary and lessens as your body adapts to hormone levels
Mood changes – Some people report feeling more irritable or emotional, though this is not universal
Spotting or breakthrough bleeding – Light bleeding between periods may happen, especially in the first three months
Vaginal irritation or discharge – The ring itself may cause mild discomfort or increase vaginal discharge
Serious Side Effects
Blood clots – Rare but serious; more likely if you smoke, are over 35, or have a family history of clots
Stroke or heart attack – Very uncommon but possible, especially with smoking or high blood pressure
Liver problems – Jaundice (yellowing of skin or eyes) or abdominal pain may signal a serious liver issue
High blood pressure – Hormonal contraceptives can raise blood pressure in some people
Severe allergic reaction – Difficulty breathing, swelling of lips or throat, or hives require immediate care
When to Seek Medical Attention
Contact your doctor right away if you experience chest pain, shortness of breath, sudden vision changes, severe leg pain or swelling, or sudden severe headache. These symptoms could signal a blood clot, stroke, or heart problem. Also seek care if you develop severe abdominal pain, yellowing of the skin or eyes, or signs of infection around the ring insertion area.
If side effects like nausea or headaches don't improve after three months, talk to your healthcare provider about whether Annovera is right for you or if another contraceptive might be better.
Dosage
Dose Level or Form |
Dose |
Key Detail |
Standard Ring |
Segesterone 120 mcg + Ethinyl Estradiol 13 mcg (daily release) |
Insert vaginally for 21 consecutive days |
Usage Cycle |
One ring per cycle |
Remove after 21 days; stay ring-free for 7 days |
Repeat Schedule |
New ring every 28 days |
Insert a new ring on the same day of the week |
Storage |
Room temperature (68–77°F) |
Keep away from direct heat and sunlight |
Important: Do not stop using Annovera without talking to your doctor, even if you experience side effects. If you remove the ring accidentally before day 21, rinse it with cool water and reinsert it within three hours if possible. If it's been more than three hours, you may need backup contraception for the next seven days. Always follow your doctor's instructions on how to handle a missed or late reinsertion.
Drug Interactions
Annovera's effectiveness can be reduced by certain medications, supplements, and foods. Inform your healthcare provider of all medications and supplements you take before starting Annovera.
Antibiotics (Rifampin, Rifabutin)
These antibiotics speed up how your body breaks down hormones in Annovera, making the contraceptive less effective. You may need backup contraception or a different birth control method if you need these antibiotics.
Anticonvulsants (Phenytoin, Carbamazepine, Phenobarbital)
These seizure medications increase the breakdown of ethinyl estradiol and segesterone in your body, reducing contraceptive protection. Your doctor may recommend additional contraceptive methods during and after taking these medications.
St. John's Wort
This herbal supplement used for mood support can reduce Annovera's effectiveness by speeding up hormone metabolism. Avoid St. John's Wort or inform your doctor if you're taking it, as you may need backup contraception.
HIV Medications (Protease Inhibitors and NNRTIs)
Some antiretroviral drugs interact with hormonal contraceptives and may reduce effectiveness. Your healthcare provider can help determine if Annovera is appropriate or if you need additional protection.
Over-the-Counter NSAIDs (Ibuprofen, Naproxen)
While generally safe, NSAIDs may slightly reduce the contraceptive effect in rare cases and can increase breakthrough bleeding. Use the lowest dose for the shortest time needed, and discuss frequent use with your doctor.
Acetaminophen
Annovera may reduce how well your body absorbs and clears acetaminophen, possibly increasing its levels in your blood. Monitor yourself for signs of acetaminophen overdose (stomach pain, unusual tiredness) if you use it regularly.
If you're taking any other hormonal contraceptives like ethinyl estradiol levonorgestrel, discuss this with your provider before starting Annovera. Also review what to avoid when taking ethinyl estradiol norgestimate and drospirenone ethinyl estradiol if you've used those in the past.
Continue Learning
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Pros and Cons
Pros
Long-lasting protection – One ring lasts 28 days, so you don't have to remember daily pills
Reversible and discreet – Fertility returns quickly after removal, and no one can see the ring
Fewer periods – You have one period-like bleed per cycle instead of multiple bleeds
Predictable bleeding – Your period-like bleed happens during the seven-day ring-free week
Lower hormone dose – Segesterone releases steady, low levels of hormones compared to some other contraceptives
Cons
Cost – Without insurance coverage, Annovera can be expensive (around $300+ per ring)
No STI protection – You still need condoms to prevent sexually transmitted infections
Hormonal side effects – Nausea, headaches, and mood changes affect some people, especially early on
User-dependent insertion – You must insert and remove the ring yourself; forgetting increases pregnancy risk
Vaginal irritation – The ring may cause discomfort, irritation, or increased discharge in some users
Frequently Asked Questions
Get answers to common questions about Annovera.
Annovera is over 99% effective with perfect use, meaning used exactly as directed every cycle. With typical use (allowing for human error), effectiveness drops to about 91%. This means about 9 out of every 100 people using it for a year may become pregnant. Using it correctly—inserting on day one and removing on day 21—maximizes protection.
Annovera can usually be used while breastfeeding, but timing matters. Many doctors recommend waiting at least three to six weeks after delivery before starting to ensure your milk supply is well established. Hormonal contraceptives in very small amounts pass into breast milk, but this is generally considered safe. Always discuss your specific situation with your doctor.
If the ring falls out, rinse it with cool (not hot) water and reinsert it within three hours if possible. If more than three hours pass, use backup contraception (condoms) for the next seven days. If the ring becomes stuck or causes severe discomfort, remove it and call your doctor. Never try to push a stuck ring deeper into your vagina.
No, Annovera does not affect long-term fertility. Your menstrual cycle and fertility may return within one to three months after removing the ring. Some people get pregnant immediately, while others take a few months to conceive. There's no link between using Annovera and infertility or pregnancy complications later.
Yes, you can skip the ring-free week by inserting a new ring after 21 days instead of waiting seven days. This will usually prevent a period-like bleed. However, you may experience more breakthrough bleeding during the month. Discuss this option with your doctor to make sure it's safe for you and to get guidance on managing any breakthrough bleeding.
The Bottom Line
Annovera is a convenient, long-acting vaginal ring that offers over 99% effective pregnancy prevention with correct use. It combines segesterone and ethinyl estradiol to stop ovulation and thicken cervical mucus, working continuously for three weeks at a time. While common side effects like headaches and nausea are usually temporary, serious risks like blood clots exist—especially if you smoke or have other cardiovascular risk factors. The ring is reversible, discreet, and requires no daily action once inserted, making it an appealing option for many people. However, it doesn't protect against STIs, and you need to remember to insert and remove it on schedule.
Your healthcare provider can help determine whether Annovera fits your health history, lifestyle, and contraceptive needs. Doctronic's AI doctors have handled over 22 million consultations with 99.2% treatment alignment with physicians. Get a free AI consultation or schedule a $19 text or $39 video visit with a licensed doctor today to discuss whether Annovera is right for you. Ready to take control of your health? Get started with Doctronic today.
