The Livv Ring || How an MS Diagnosis Sparked a New Era in Hormone-Free Birth Control

Contraception has long been treated as a solved problem, yet for the women living with its side effects, the search for something better has never really stopped.

Mood changes, headaches, cardiovascular concerns, and disrupted cycles are among the most commonly reported complaints tied to hormonal birth control, and research consistently shows that side effects are among the leading reasons women discontinue use. For Dr. Jennifer Johnston, a Nova Scotia-based family physician, this reality was never abstract. She witnessed it daily across a decade of clinical practice, watching patients cycle through options with nowhere left to turn. Then she became the patient herself, and everything changed.

Johnston was diagnosed with multiple sclerosis in 2021. As she began researching the condition, she encountered emerging evidence that hormonal contraception may carry a link to autoimmune risk. A case-control study presented at the American Academy of Neurology found that women with MS were more likely to have used oral contraceptives in the three years before their diagnosis; researchers noted a possible connection between hormonal contraceptive use and the rising rate of MS among women, though the science remains an active and evolving area of inquiry. For Johnston, who had spent two decades on hormonal birth control, the data raised questions she could not ignore. "I discovered my twenty-year history of taking hormonal contraception may have contributed to my own diagnosis," she says.

That realization, layered on top of years of clinical frustration, set her on a different path. She founded Elle, MD Biotechnologies Inc. in 2023, with one clear intention: to build the contraceptive option she had never been able to offer her patients, an option that could protect her own daughters in the future.

The product she is developing, The Livv Ring (previously called The Better Ring), is a copper-based, hormone-free vaginal contraceptive ring designed to prevent pregnancy without entering the bloodstream or disrupting a woman's natural cycle. Copper has long been recognized as a spermicide; the copper IUD has used this mechanism for decades. Johnston's insight was to apply that same non-hormonal principle in a vaginal ring format, modelled in part after the NuvaRing, the hormonal contraceptive ring first developed by Organon and approved in the early 2000s. The key distinction is what The Livv Ring leaves out: Because it contains no systemic hormones and is designed to avoid a significant foreign body response, it is not expected to alter period flow the way the copper IUD can. "It just acts very locally in the reproductive tract," Johnston explains. "It isn't designed to have systemic effects.”

Getting to that design required iteration. Early prototypes explored a silicone diaphragm enhanced with a copper element, before Johnston concluded that a ring format would offer more reliable placement, greater comfort, and continuous efficacy. Her engineering team began producing early ring prototypes, and the project steadily attracted a mission-aligned team, built almost entirely through referrals, along with a growing portfolio of research partnerships and grant support.

Today, Elle, MD is working toward a first-in-human trial, with a proof-of-concept study to follow in 2027, and a larger pivotal trial anticipated in 2028-2029. If the regulatory path in Canada proceeds as planned, Johnston hopes to bring The Livv Ring to market by 2029-2030. Canada's classification of the device as a medical device, rather than a combination drug-device product as it would be classified in the United States, offers a more direct regulatory route for first entry.

Johnston holds the timeline firmly in mind because, for her, this is personal on every level. She is building The Livv Ring for the patients she could not help and for her own daughters as they enter adulthood. "That sets the bar incredibly high for me," she says. "It needs to be extremely safe, extremely effective, and really easy to use.”

That standard, set by a physician who is also a mother and a patient, may be exactly what the field has been waiting for.