What to know about nonhormonal birth control

For some people, hormonal birth control is not an option. They may want an alternative option to avoid hormones, want to experience side effects, have health concerns, or are nursing.
Some common types of birth control contain hormones such as estrogen and progesterone. While these types of birth control tend to be highly effective, there are various reasons a person may not be able to or want to use them.
Nonhormonal birth control options range from barrier methods to sterilization and other methods, such as natural family planning. The effectiveness of these methods also ranges depending on the method and how it is used.
This article explores 11 types of hormone-free birth control options and their effectiveness.
This article talks about perfect and typical use of birth control. Perfect use describes how effective a form of birth control is if people use it exactly as the instructions recommend every they have sex. Typical use describes how effective a form of birth control is if a person sometimes uses it per the instructions but may also use it irregularly or imperfectly.
Even with perfect use, contraception is not 100% effective. People should discuss birth control options with a healthcare professional to find the right option for them.
Barrier methods
Barrier methods of birth control prevent sperm from entering the uterus. People only use these methods during sexual intercourse, and people should use them correctly every time they have sex.
sperm
Some barrier methods can be purchased over the counter, whereas others require a prescription from a healthcare professional.
Barrier methods typically have fewer side effects compared to hormonal birth control options.
The diaphragm is a small, flexible cup made of silicone. A person inserts the diaphragm into their vagina to cover the cervix.
diaphragm
According to Planned Parenthood, the diaphragm is 94% effective if used correctly every single time.
Planned Parenthood
However, the real-life accuracy rate is around 83%, which means about 17 people out of 100 will still get pregnant using the diaphragm.
Diaphragms should be used along with spermicide. It can be applied to the diaphragm and around the edges before insertion. Spermicide comes in creams and gels. It destroys sperm and reduces the chances of pregnancy.
spermicide
Doctors prescribe and fit most diaphragms. These birth control options are effective immediately. A person can use reusable devices for up to 2 years. If inserted correctly, neither partner should feel it during sex.
Diaphragms are most often prescribed and fitted by a healthcare professional. However, one-size diaphragms that fit most people are also available.
Diaphragms remain in place for 6 hours after sex, but not for more than 24 hours. If a person has sex again during the 24 hours, they should reapply spermicide and then wait another 6 hours before removing the diaphragm.
A diaphragm does not protect against sexually transmitted infections (STIs), and individuals cannot use them during their period.
sexually transmitted infections (STIs)
period
The cervical cap is a small silicone cup that a person inserts into their vagina, fitting over the cervix. It is similar to the diaphragm but smaller. The only cervical cap available in the United States is available under the brand name, FemCap, which comes in three sizes.
According to Planned Parenthood, the failure rate for the FemCap is roughly 14% for people who have never given birth and 29% for those who have had a vaginal delivery.
Planned Parenthood
The cervical cap does not contain hormones and can be inserted before sex. A person can use the same cap for up to 2 years. People should always use spermicidal gel with the cervical cap to ensure its protective qualities. Much like the diaphragm, it requires a prescription, a doctor must fit it, and it is not suitable for use during periods.
As with the diaphragm, the cervical cap should be left in place for 6 hours after sex. Unlike the diaphragm, the cervical cap can stay in longer, up to 48 hours total. A person does not need to reapply spermicide again if they have sex more than once during this timeframe.
Spermicides are placed in the vagina before sexual intercourse to stop sperm from entering the uterus. They are available in creams, gels, and suppositories.
Spermicides have a failure rate of 21% with typical use, according to the Centers for Disease Control and Prevention (CDC). However, effectiveness increases when used with other methods, such as the diaphragm or cervical cap.
failure rate of 21%
This method is easy to use, does not require a prescription, and is inexpensive. Some people might experience side effects, such as irritation and allergic reactions.
Learn more about spermicide options.
Learn more about spermicide options.
The external, or male, condom is an effective way to guard against STIs.
It is also effective in preventing pregnancy by keeping semen from entering the vagina.
According to the World Health Organization (WHO), when people use male condoms correctly, they are 98% effective in preventing pregnancy.
World Health Organization (WHO)
The external condom is simple to use and safe. It is also convenient, inexpensive, easy to source, and does not require a prescription.
Condoms are not as effective as some other methods of birth control, and people need to use them every single time they have sex.
Some individuals are allergic to latex, and some people find condoms make sex less enjoyable by limiting sensation or requiring more lubricant.
allergic to latex
lubricant
When people are using a lubricant with condoms, they should choose a water-soluble or silicone variety, as oil-based lubricants can break down latex condoms.
The internal, or female condom, is a strong, thin protective covering with a ring on each side to hold it in place. It can protect against pregnancy and STIs.
female condom
According to the WHO, when people use the female condom correctly, it is 95% effective in protecting against pregnancy.
According to the WHO
The internal condom contains no hormones, is available without a prescription, and is inexpensive. They are latex-free, they can increase sexual pleasure, and they can give a person control over the use of birth control and condoms with a sexual partner.
can increase
However, the outer rings of the female condom may cause irritation, and many people feel it reduces feeling. Female condoms usually cost twice as much as male condoms.
The sponge is made of plastic foam and contains spermicide. A person inserts it into their vagina before sexual intercourse. It has a nylon loop for easy removal afterward. It is available at most drugstores and does not require a prescription.
sponge
The sponge prevents pregnancy by covering the cervix so that sperm cannot enter. It also releases spermicide to immobilize sperm.
According to Planned Parenthood, the birth control sponge is least effective in people who have previously been pregnant.
Planned Parenthood
In people who have never been pregnant, the failure rate is 9% when used correctly each time, and 14% with regular use. For people who have been pregnant before, the failure rate is 20% with ideal use and 22% with regular use.
The sponge carries an increased risk of yeast infection and toxic shock syndrome and should not be left in the vagina for more than 30 hours total. Vaginal dryness and allergic reactions are common side effects.
yeast infection
toxic shock syndrome
A newer nonhormonal birth control method is a prescription vaginal gel sold under the brand name Phexxi.
Phexxi
Phexxi is put into the vagina up to an hour before having sex using a prefilled applicator. It starts working immediately and is effective for up to 1 hour. It is not effective if a person uses it after having sex.
an hour
Phexxi prevents pregnancy by lowering the pH level in the vagina. This makes it difficult for sperm to move, decreasing the chance for sperm to meet the egg.
pH level in the vagina
Planned Parenthood states that with perfect use, Phexxi is 93% effective. However, it is 86% effective with typical use. A person should make sure to follow the instructions closely. Phexxi is suitable for use with some other birth control methods, such as condoms or a diaphragm.
Planned Parenthood
It is important to note that this method does not protect against STDs. However, it is safe to use while nursing.
nursing
There are some side effects associated with Phexxi, including:
bacterial vaginosis
bacterial vaginosis
vaginal burning, irritation, or itching
vaginal burning, irritation, or itching
yeast infections
urinary tract infections (UTIs)
urinary tract infections (UTIs)
vaginal discharge
vaginal discharge
allergic reaction
A person should speak with a healthcare professional for further information.
Long-term and permanent solutions
There are some long-term and permanent nonhormonal options that are safe and effective for most people.
In the United States, this nonhormonal intrauterine device (IUD) is available under the brand name Paragard. According to the Food and Drug Administration (FDA), less than 1 out of 100 people using Paragard get pregnant each year.
intrauterine device (IUD)
Paragard
Food and Drug Administration (FDA)
Paragard is hormone-free and prevents pregnancy for up to 10 years. It takes only a few minutes for a doctor to insert the device into the uterus. Once in place, the thin copper IUD causes an inflammatory reaction inside the uterus that prevents sperm from reaching the egg.
Paragard can be a good option for people who do not want to worry about daily or weekly birth control reminders or who do not want to use hormonal birth control. This method is completely reversible. A healthcare professional can remove Paragard at any time if a person decides they want to get pregnant or do not want to use it anymore.
Paragard does not protect against STIs.
Side effects include:
cramping
heavy periods
spotting between periods
spotting between periods
For people who want a permanent birth control method, sterilization may be an option. The procedure involves surgery that is difficult to reverse, and it will not protect against STIs.
For females, the surgical procedure is called tubal ligation, and for males, vasectomy surgery provides permanent sterilization.
tubal ligation
vasectomy surgery
When done correctly, these methods are highly effective in preventing pregnancy.
Another method of sterilization was available in the United States under the brand name Essure. It is a uterine device that does not require surgery, is hormone-free, and is fitted in a doctor’s office without general anesthesia.
The Essure device is a tiny spring-like device that a doctor inserts through the vagina to each fallopian tube. The mesh substance of Essure inflames the fallopian tubes, causing permanent scarring and blockage of the tubes over time.
According to the FDA, as of December 2019, Essure is no longer available for implantation in the United States. However, people who have been using the device as birth control successfully can continue to do so.
FDA
Other methods
While barrier methods and long-term birth control are popular options in the United States, some people prefer alternative hormone-free birth control.
The withdrawal method is the oldest form of birth control, but it is not the most effective. Withdrawal involves a person pulling their penis out of the vagina before ejaculation.
withdrawal method
According to Planned Parenthood, with perfect use, the method is 96% effective. However, this is a difficult method to use perfectly. Typical use is 78% effective. This means a little over 1 in 5 people who use this method will become pregnant.
Planned Parenthood
Some people may wish to try natural family planning or fertility awareness methods. It involves tracking the menstrual cycle to work out when a person is ovulating. While a person is ovulating, they should use barrier methods if they wish to prevent pregnancy.
ovulating
According to Planned Parenthood, there are three main methods:
Planned Parenthood
Temperature: A person takes their temperature every morning.
Cervical mucus: A person checks their vaginal discharge every day.
Calendar: A person records their menstrual cycle on a calendar.
A person can use one or more of these methods — a combination of all three is the most effective. Failure rates are between 12 and 24% depending on which method a person uses. Success rates are higher if a person uses a combination.
Natural Cycles, an app that is used for fertility awareness, has FDA approval.
Natural Cycles
However, it is important to note that natural family planning can be difficult, and a person may wish to consider a more effective method.
How to choose a nonhormonal birth control method
A person may wish to consider the following when choosing a nonhormonal birth control method:
the following
How much does it cost?
How long does it last?
Does it require a prescription?
How effective is it?
Does it protect against STIs?
How much do efficacy rates vary between perfect and typical use?
Are there any side effects?
Is it easy to use long term?
Summary
Deciding on a birth control method is a personal choice.
Each person should consider how birth control fits into their lifestyle and pick a method that is effective, safe, and convenient. It is also important to consider that some methods reduce the risk of STIs, and others do not.
People seeking information about birth control methods may also consider consulting a healthcare professional for further advice.