Nuvaring vs. Annovera: Which birth control option is better for you?

Like IUDs or birth control implants, vaginal rings offer an alternative to birth control pills for hormone-based pregnancy prevention. These thin plastic rings sit imperceptibly at the base of the cervix, and because you only have to manage them monthly, the mostly “set it and forget it” design is highly effective yet easy to use.

But how exactly does a vaginal ring work, how long does it last, and what side effects might you experience? We asked OB-GYNs what you should know about two of the most commonly prescribed ring options, Annovera and NuvaRing.

What is a vaginal ring?

A vaginal ring is a loop of thin, pliable plastic or silicone about two inches in diameter that you place (and leave) in your vagina against the cervix, not unlike a menstrual cup or the diaphragms of yore. These rings slowly release hormones—a combination of estrogen and progestin, specifically—to cease ovulation and create an inhospitable environment for sperm, effectively reducing the risk of unwanted pregnancy by up to 99%.

“Vaginal rings are long-acting, reversible contraceptives, so you don't have that factor of ‘I'm human, I'm forgetting,’ [as with the pill],” says Dr. Mary Jane Minkin, an OB-GYN and professor at Yale University School of Medicine. Control over their placement and removal is also part of the vaginal ring’s appeal: They don’t require follow-up visits with your doctor or medical provider like IUDs or implants do.

Rings made by NuvaRing and Annovera are the most commonly prescribed in the U.S., though generic versions of Nuvaring are also available. They all work the same way, though there are a few small differences in their makeup and how you use them (more on this coming).

How do vaginal rings work?

Using a vaginal ring is easy: You fold the flexible circle in half and insert it in your vagina with your fingers, pushing it in as far as you’re able to, so it pops open and into place at the top of the vagina against the cervix. The estrogen and progestin within the ring are then absorbed through your vaginal wall to cease ovulation, or the releasing eggs from the ovaries. “What happens is that the ovary goes to sleep,” says Dr. Minkin. “But it’s reversible, so when you pull the ring out, the ovaries wake up and start doing their thing again.” Vaginal rings also thicken cervical mucus, making it more difficult for sperm to swim to a potential egg should one sneak out.

To use a ring, you insert it into your vagina at the end of your period, leave it in for three weeks, and remove it for a week to get your period. There’s no need for a doctor’s visit once you have your prescription—though you’ll need to pick up said prescription from the pharmacy—and after your cycle ends, you repeat the process.

How effective are vaginal rings?

When used correctly, the ring is 99% effective. But in reality, vaginal rings are about 91% effective due to human error, according to Planned Parenthood. Just like the birth control pill, timing is everything: If you insert your ring at 8 a.m. on a Monday, you should remove it four Mondays later at 8 a.m, and re-insert it the following Monday, yes, at 8 a.m. Waiting longer to re-insert your ring or following an irregular schedule can decrease its effectiveness.

In addition, certain antibiotics, antifungals, HIV medications, and anti-seizure medications may also make the ring less effective. Check with your doctor about any potential interactions before getting a prescription.

What’s the difference between Annovera and NuvaRing?

The main differences between Annovera and NuvaRing are the frequency with which you get a new ring, and the level and types of hormones used.

One Annovera ring lasts for a full year, or 13 cycles. You insert it right after your period for three weeks for pregnancy protection and remove it for a week to start your period, then re-insert the same ring at the end of your cycle. Annovera comes with a case to store the ring when not in use—you just wash it with some mild soap before storing and again before reinsertion. Some may prefer Annovera’s year-long effectiveness, as there are no monthly trips to the pharmacy or the risk missing a prescription refill.

One NuvaRing offers protection for up to five weeks but is typically used in a four-week cycle, meaning you insert NuvaRing and leave it in place for three weeks before removing it for one week to get your period. You then start the next cycle with a new ring.

Annovera also contains less estrogen than NuvaRing, about 13 micrograms compared to 30 micrograms both dispersed over a 21-day cycle. With less estrogen, you may experience fewer unwanted side effects, such as breast tenderness. The type of progestin that Annovera contains, segesterone, more closely mimics the natural hormone produced by the body. As some people find that some synthetic hormones cause more unpleasant effects such as bloating or mood swings, this may be a deciding factor in opting for Annovera.

What are the side effects of vaginal rings?

As with any hormonal form of birth control, possible unpleasant side effects of rings include headaches, nausea, breast tenderness, and spotting. However, because vaginal rings sit in place for weeks and emit a steady stream of hormones, some may find they experience fewer side effects as compared to the pill, which allows your body to absorb a daily dose of hormones as soon as you ingest it. Many women also may find they experience lighter or less painful periods while on the ring. Finally, though rare, a ring may become dislodged during sex; if this happens, you can just reinsert it.

That said, if you experience any unpleasant effects with a ring or decide you want to try to get pregnant, you can remove the ring yourself to discontinue use; with an IUD or under-skin implant, you must see your doctor. If you go that route but you don’t want to get pregnant, make sure to use another birth control method, like condoms.

“When I start anybody on any contraceptive, I tell them that this is not written in stone,” says Dr. Minkin. “[If you] don't like how [you] feel on whatever birth control product, you can always switch.”

Is there anyone who shouldn’t use a vaginal ring?

Smokers, especially those over 35, should avoid using a vaginal ring (or any other hormone-containing birth control) due to the increased risk of blood clots. Additionally, if you have a history of cardiac disease, high blood pressure, or diabetes, a vaginal ring may not be right for you.

It’s also important to mention that neither Annovera or NuvaRing is FDA-approved for continuous use without removal to have a period, which doctors may prescribe for women to do with birth control pills to skip periods and the painful cramps or other symptoms that may accompany them. If your aim is to not have a period at all, talk to your doctor about whether this is possible or safe with a vaginal ring.

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