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Annovera
Annovera is a combined hormonal contraceptive in the form of a vaginal ring. It contains ethinyl estradiol (an estrogen) and segesterone acetate (a progestin) and is used to prevent pregnancy. Annovera is unique because it is reusable for up to 1 year (13 cycles). It works by releasing a steady, low dose of hormones that prevent ovulation, thicken cervical mucus, and thin the uterine lining, making it difficult for sperm to reach an egg and for an egg to implant.
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Frequently Asked Questions
How long does Annovera last?
Annovera is designed to be used for 1 year (13 cycles), with each cycle consisting of 3 weeks of continuous use followed by 1 week off.
Can Annovera be used by women who smoke?
Annovera should not be used by women over 35 years old who smoke, as this increases the risk of serious cardiovascular side effects like blood clots, stroke, and heart attack.
What should I do if Annovera comes out during sex?
If Annovera is out for more than 2 hours, rinse it with lukewarm water and reinsert it as soon as possible. Use a backup method of contraception, such as condoms, for the next 7 days.
Can I use tampons while using Annovera?
Yes, tampons can be used while Annovera is in place. Be careful when removing tampons to avoid displacing the ring.
Does Annovera protect against sexually transmitted infections (STIs)?
No, Annovera does not provide protection against STIs. Use condoms to reduce the risk of contracting or spreading infections.
Comprehensive Drug Guide
How Does Annovera Work?
Annovera works primarily by preventing ovulation. The hormones ethinyl estradiol and segesterone acetate work together to stop the release of an egg from the ovaries. Additionally, these hormones thicken the cervical mucus, which prevents sperm from entering the uterus, and thin the lining of the uterus, making it less likely for an egg to implant if fertilization occurs.
Common Dosages
- Vaginal ring: Contains 13.5 mg of segesterone acetate and 2.7 mg of ethinyl estradiol, delivering an average daily dose of 0.15 mg of segesterone acetate and 0.013 mg of ethinyl estradiol.
Typical Dosing
- Use the ring for 21 days (3 weeks), followed by 7 days without the ring (1 week off). During this week, you may have a withdrawal bleed (similar to a period).
- After the 7-day break, reinsert the same ring for another 3-week cycle. This continues for up to 1 year.
Typical Dosing
FDA Approved Indications
- Contraception (pregnancy prevention) in women of reproductive age
Who Shouldn't Take Annovera?
- A history of blood clots, stroke, or heart attack
- Known or suspected breast cancer or other estrogen-dependent tumors
- Liver disease or liver tumors
- Uncontrolled high blood pressure
- Migraines with aura
Advice From The Pharmacist
- Annovera should be inserted into the vagina and left in place for 3 weeks, then removed for 1 week. It can be stored at room temperature when not in use.
- If Annovera is out of the vagina for more than 2 hours during the 3-week cycle, use a backup method of contraception (such as condoms) for the next 7 days.
- Do not smoke while using Annovera, as smoking increases the risk of serious cardiovascular side effects, especially in women over 35.
- If you forget to reinsert the ring after the 1-week break, insert it as soon as you remember and use a backup contraceptive method for the next 7 days.
Side Effects of Annovera
Common Side Effects
- Headache
- Nausea
- Vaginal discharge
- Breast tenderness
- Mood changes
Uncommon/Severe Side Effects
- Blood clots (deep vein thrombosis or pulmonary embolism)
- Stroke or heart attack, particularly in women who smoke or have other risk factors
- Liver tumors or changes in liver function
Risks and Warnings of Annovera
- Cardiovascular risk: Women over the age of 35 who smoke should not use Annovera, as it increases the risk of serious cardiovascular events such as blood clots, heart attack, or stroke.
- Blood clots: Annovera, like other hormonal contraceptives, may increase the risk of venous thromboembolism (VTE), particularly in women with pre-existing risk factors.
- Breast cancer: Hormonal contraceptives, including Annovera, may slightly increase the risk of breast cancer, particularly in women with a family history of the disease.
Interactions with Annovera
Common Drug Interactions
- Certain antibiotics (such as rifampin) and antifungal medications may reduce the effectiveness of Annovera. Use a backup method of contraception while taking these medications.
- Antiepileptic drugs (such as carbamazepine) may reduce the effectiveness of Annovera, increasing the risk of unintended pregnancy.
- St. John’s Wort, a common herbal supplement, may interfere with Annovera's effectiveness and increase the risk of contraceptive failure.
Alternatives to Annovera
- NuvaRing (etonogestrel/ethinyl estradiol): Another vaginal ring contraceptive, replaced monthly rather than annually.
- Oral contraceptive pills: Daily pills containing either a combination of estrogen and progestin or progestin-only, such as Loestrin or Micronor.
- IUDs (Intrauterine devices): Long-term, reversible contraception, such as Mirena (hormonal) or ParaGard (copper).
- Contraceptive implants: Long-term options like Nexplanon, which is a progestin-only method implanted under the skin.
