Table 1.

Product summary, efficacy, safety, benefits, and additional considerations of Annovera, Phexxi, Slynd, and Twirla

	Product summary	Efficacy	Safety/Adverse Events	Benefits	Additional considerations
Annovera	Contraceptive vaginal system releasing ethinyl estradiol 13 mcg/day and segesterone acetate 150 mcg/day	Pearl Index 2.98 (95% CI 2.13–4.06) Cumulative efficacy rate of 97.5% (95% CI: 96.5–98.1%)	Most common adverse events were headache, nausea, and vaginal discharge Limited evidence for BMI > 29.0 kg/m2 given exclusion of participants after two venous thromboembolism events occurred	1 ring can be used for 13 cycles	Cannot remove ring for more than 2 h during active use No evidence for continuous ring use without cyclic hormone-free interval
Phexxi	5 g of vaginal gel containing lactic acid, citric acid, and potassium bitartrate, pH regulator	Cumulative pregnancy rate of 13.7% (95% CI: 10.0–17.5%)	Most common adverse events were vulvovaginal burning sensation (20.0%), pruritus (11.2%), and urinary tract infections (5.7%)	On-demand use with intercourse, additional functions of personal lubricant	Currently being evaluated as a microbicide
Slynd	Drospirenone 4 mg pill	Pearl Index 4.0 (95% CI: 2.3–6.4)	Few cases of hyperkalemia (0.5%) Safe for those with contraindications to estrogen use	24-h missed pill window	Unscheduled bleeding in approximately 50% of users
Twirla	Contraceptive patch releasing ethinyl estradiol 30 mcg/day and levonorgestrel 120 mcg/day	Pearl Index 5.8 (95% CI: 4.5–7.2)	Most common adverse events were nausea (4.1%) and headache (3.6%) Five venous thromboembolism events occurred in obese participants	Weekly dosing	Lower efficacy in overweight compared with normal weight individuals