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How Does the Annovera Contraceptive Ring Actually Work?

The manufacturers of the new, long-lasting contraceptive ring Annovera argue that the device, which is self-insertable and can be worn internally for up to a year, will revolutionize birth control for low-income women.

by Sirin Kale
Aug 15 2018, 9:12am

Population Council / Hailie Easley

Although the burden of contraception continues to fall disproportionately upon women, health care providers are innovating new solutions to the age-old problem of preventing unwanted pregnancies. One new offering, Annovera, is being trumpeted as a major breakthrough: the first-ever contraceptive vaginal ring that can be used for an entire year, without having to visit pharmacies or physicians. It’s been heralded as a democratizing, readily accessible form of contraception for low-income women in particular. But how does it actually work?

Approved by the FDA on August 10, Annovera was developed by the nonprofit The Population Council and will be licensed for distribution by pharmaceutical company TherapeuticsMD. Users insert and remove the flexible silicone ring measuring two and one-quarter inches in diameter on their own (it’s intended to be worn for 21 continuous days, with a seven-day break in between insertions). Annovera releases progestin and estrogen into the user’s bloodstream to provide contraception for up to 13 28-day menstrual cycles.

“Annovera offers the convenience of a long-acting method like the IUD because there is no daily action needed, but the control of a short-acting method like the pill because a woman can start or stop it at any time,” Julia Bunting of The Population Council explains in emailed comments to Broadly. “A woman can insert and remove the ring by herself and it is reusable for up to a year without a return trip to the doctor or pharmacy. Unlike other rings, it does not require refrigeration.”

In a press release, Annovera’s manufacturers say, "The Population Council is continuing efforts to make Annovera available worldwide, including in low- and middle-income countries where more than 214 million women have an unmet need for contraception." The product doesn't require the regular visits to healthcare providers that may prohibit women from low-income communities or with extensive childcare commitments from picking up repeat contraceptive prescriptions.

According to one 2017 study from the University of Texas, published in the journal Obstetrics & Gynecology, low-income women find it significantly more difficult to access long-acting reversible forms of birth control (LARCs), such as IUDs and implants.

"LARCs are incredibly cost-effective," explains Dr Gillian Dean of Planned Parenthood. "Most people do not experience bothersome side effects with LARCs, and satisfaction and continuation rates are very high."

“Because it's effective for up to 13 cycles (one year) and does not require refrigeration, Annovera may be a good option for women living without regular access to health care providers or electricity,” Bunting says.

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Bunting declines to provide an estimated price for the device, but explains that they plan to work with insurance providers to obtain coverage at an affordable out-of-pocket cost to women in the United States. “As part of its license agreement with the Population Council, TherapeuticsMD has agreed to provide significantly reduced pricing to federally designated Title X family planning clinics serving lower-income women,” Bunting explained.

Like other long-acting contraceptives, Annovera can be worn during penetrative sex, and the majority of women do not feel the device during sex. If removed, Bunting explains, the ring needs to be reinserted within two hours of sex to prevent pregnancy.

Annovera isn’t the magic contraceptive device to end the lifelong struggle for affordable contraception that doesn’t make you sick, hormonal, or depressed: It’s not effective for smokers aged 35 and over, and it has not been proven to work on those with a body mass index greater than 29kg per meter squared. However, its manufacturers believe that the longevity of the product, its affordability, and the fact that it doesn’t require refrigeration make it a powerful weapon in the fight for reproductive justice for low-income women.

Those searching for affordable, long-lasting contraception will have to be patient, however: Annovera won’t hit market until the end of 2019 or early 2020.