How do I use the ANNOVERA ring correctly?

Insert the ring into the vagina for 21 days, then remove it for 7 days. Clean the ring with mild soap and water during the week it is out.

Can I smoke while using ANNOVERA?

If you are over 35 and smoke, you should not use ANNOVERA because it significantly increases your risk of serious heart problems.

What should I do if I become pregnant while using ANNOVERA?

Remove the ANNOVERA ring immediately if you confirm you are pregnant.

Does ANNOVERA affect breastfeeding?

Yes, ANNOVERA may reduce your breast milk production, so it is not recommended for nursing mothers.

Will ANNOVERA protect me from STIs?

No, ANNOVERA does not protect against HIV or other sexually transmitted infections.

What are the most common side effects of ANNOVERA?

The most frequent side effects include headaches, nausea, vaginal yeast infections, and abdominal pain.

Can I use vaginal lubricants with ANNOVERA?

You can use water-based lubricants, but you must avoid oil-based or silicone-based lubricants as they can interfere with the ring.

What should I do if I miss the timing for removing or inserting the ring?

You should use a backup method of contraception, like a condom, if the ring is out for more than 7 days or has been out of the vagina for more than 2 hours total during the 21-day period.

Segesterone Acetate | CAS 7759-35-5 | CKFBRGLGTWAVLG

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Combination hormonal contraceptive

ANNOVERA is a vaginal ring used by females of reproductive potential to prevent pregnancy. It contains two hormones: segesterone acetate and ethinyl estradiol. The ring is inserted into the vagina for 3 weeks and then removed for 1 week, repeating this cycle for up to one year.

How it worksANNOVERA prevents pregnancy primarily by stopping ovulation (the release of an egg).

Brand names:Annovera

Used for

Pregnancy prevention

Conditions

Pregnancy prevention

Class

Hormonal ContraceptiveEstrogenProgestinCombination hormonal contraceptiveFemale Reproductive SystemCardiovascular SystemHepatic System

How to take

FormsVaginal system (ring)

RoutesVaginal

One ring is inserted into the vagina for 21 days (3 weeks) at a time, followed by a 7-day (1 week) break where the ring is removed. This cycle repeats for up to 13 cycles.

The ring should be cleaned with mild soap and warm water during the weekly removal. It should be inserted behind the pelvic bone. Do not use oil-based or silicone-based lubricants with the ring.

Missed dose: If the ring is out for more than 2 hours cumulative during the 21 days, or if the 7-day break exceeds 7 days, use a backup method of contraception.

Key warnings

Smoking increases the risk of serious cardiovascular events (like heart attack or stroke) when using combination hormonal contraceptives. Females over age 35 who smoke should not use ANNOVERA.

·Smoking increases the risk of serious cardiovascular events (like heart attack or stroke) when using combination hormonal contraceptives. Females over age 35 who smoke should not use ANNOVERA.
·Increased risk of blood clots (venous thromboembolism).
·Risk of serious cardiovascular events like stroke or heart attack, especially in older users, smokers, or those with high blood pressure.
·Potential for liver enzyme elevations; stop use if jaundice occurs.
·May cause irregular bleeding or changes in menstruation.
·Risk of blood clots is higher in females with a BMI greater than 29 kg/m².

Do not use if

·High risk of blood clots or heart disease.
·Current or history of blood clots (DVT or pulmonary embolism).
·Smokers over age 35.
·Uncontrolled high blood pressure.
·History of breast cancer.
·Liver tumors, acute hepatitis, or severe liver disease.
·Undiagnosed abnormal uterine bleeding.
·Hypersensitivity to any ingredients in the ring.
·Use of specific Hepatitis C drug combinations (ombitasvir/paritaprevir/ritonavir).

Side effects

Common

Headache or migraineNausea or vomitingVaginal yeast infectionAbdominal painPainful periodsVaginal dischargeUrinary tract infectionBreast tenderness or painIrregular bleedingDiarrheaGenital itching

Serious

·Blood clots (venous thromboembolism)
·Stroke
·Heart attack
·Liver disease or jaundice
·Unexplained vision changes
·Severe headache

Seek help if

·Sudden vision changes
·Severe headache
·Signs of blood clots (leg swelling or pain, shortness of breath)
·Jaundice (yellowing of skin/eyes)

Interactions

·Certain medications that speed up liver enzymes (like St. John's wort, anticonvulsants, or some HIV/HCV medications) may make ANNOVERA less effective.
·Some medications (like certain HIV protease inhibitors) may increase hormone levels.
·Oil-based or silicone-based vaginal lubricants can change how the ring works.
·Certain medications used for Hepatitis C may interact with ANNOVERA.

Special populations

PregnancyANNOVERA should not be used during pregnancy. If you confirm you are pregnant, remove the ring immediately. There are no studies on ANNOVERA use in pregnant women.

BreastfeedingANNOVERA may reduce breast milk production. It is not recommended for breastfeeding mothers; use another method of contraception until you have finished breastfeeding.

PediatricANNOVERA is for women of reproductive age. It is expected to work similarly in teenagers (postpubertal adolescents) but should not be used before a girl has started her first period.

GeriatricANNOVERA has not been studied in women who have reached menopause and is not intended for use in that group.

Talk to your doctor

Monitor

·Blood pressure
·Blood glucose levels
·Signs of blood clots
·Signs of liver issues like jaundice
·Changes in headache patterns

Questions to ask

·Am I at high risk for blood clots?
·Is my blood pressure well-controlled?
·Do I have any history of liver disease?
·How will my other medications interact with this ring?

Pharmacokinetics

OnsetAbsorption occurs with a median t max of about 2 hours.

Half-lifeSegesterone acetate has a mean half-life of 4.5 hours; ethinyl estradiol has a mean half-life of 15.1 hours.

DurationConcentrations become more constant after 96 hours post-dose.

Protein bindingSegesterone acetate is approximately 95% bound to human serum proteins. Ethinyl estradiol is highly protein bound.

MetabolismBoth components are metabolized by the CYP3A4 enzyme.

ExcretionEthinyl estradiol is excreted in urine and feces as conjugates and undergoes enterohepatic recirculation.

Practical

OverdoseNo serious ill effects from overdose have been reported, but it may cause nausea or withdrawal bleeding. If an overdose is suspected, remove the ring and seek medical attention.

StorageStore in the provided case. Do not flush down the toilet. Keep out of reach of children and pets.

DisposalUse a drug take-back option if available. Otherwise, discard in a waste receptacle out of reach of children and pets.

Ingredients

Inactive

dibutyltin dilauratesilicone elastomerssilicone medical adhesivetitanium dioxide

Educational summary derived from FDA labeling, AI-assisted. Not medical advice — consult a healthcare professional. Updated 2026-04-25.