Does Annovera Carry Risks for Women with High Blood Pressure?
Annovera, a combined hormonal contraceptive vaginal ring containing ethinyl estradiol (90 mcg initially, then 15 mcg) and segesterone acetate (13 mg), carries elevated cardiovascular risks for women with hypertension. The prescribing information warns against use in those with uncontrolled high blood pressure (systolic ≥160 mm Hg or diastolic ≥100 mm Hg), as it increases the chance of blood clots, stroke, heart attack, and high blood pressure worsening.[1][2]
Controlled hypertension (systolic <160 mm Hg and diastolic <100 mm Hg) may allow use with close monitoring, but only after assessing individual risks. Women with any hypertension history should have blood pressure checked before starting and regularly during use.[1]
What Do Clinical Studies Show on Blood Pressure Effects?
In trials with 2,322 women (18-35 years), Annovera slightly raised blood pressure in some users:
- Mean systolic increase: 2.0 mm Hg after 13 cycles.
- Mean diastolic increase: 1.1 mm Hg.
Discontinuations due to hypertension occurred in 0.2% of users. Women already hypertensive saw greater rises, prompting recommendations for monitoring or switching methods.[1][3]
No large-scale studies isolate Annovera in high-risk hypertensive groups, but data align with general warnings for estrogen-containing contraceptives, which promote sodium retention and vascular changes.[2]
Which Women Should Avoid Annovera Entirely?
Contraindications include:
- Uncontrolled hypertension.
- History of blood clots, stroke, or heart attack.
- Current or past breast cancer, liver tumors, or certain migraines.
Providers must weigh benefits against risks; non-users of tobacco or age <35 face lower absolute risks.[1]
What Happens If Blood Pressure Rises While Using Annovera?
Stop immediately if systolic reaches ≥160 mm Hg or diastolic ≥100 mm Hg. Symptoms like severe headaches, vision changes, or chest pain signal urgent risks—seek medical help. Backup non-hormonal contraception is advised during evaluation.[1][2]
Safer Alternatives for Women with High Blood Pressure?
Progestin-only options like the miniglovaginal ring (e.g., Phexxi, though not progestin) or implants (Nexplanon) have lower cardiovascular risk profiles. Copper IUDs (Paragard) avoid hormones entirely. Consult a doctor for personalized choices, as blood pressure control often permits low-estrogen pills cautiously.[2][4]
What Do Patient Reviews and Experts Say?
User forums report occasional blood pressure spikes leading to discontinuation, with some noting resolution after stopping. ACOG guidelines echo FDA warnings: estrogen contraceptives suit most normotensive women but require caution in hypertensives.[3][5]
Sources
[1]: Annovera Prescribing Information (FDA)
[2]: CDC Contraceptive Guidance: USMEC
[3]: Annovera Clinical Trials Data (PMDA)
[4]: ACOG Hypertension in Pregnancy Guidelines
[5]: Drugs.com Annovera Reviews