Non-hormonal birth control options

If you are among the millions of people looking into birth control, you’ve probably noticed that there are countless choices, including non-hormonal birth control options. Many people prefer contraceptives that don’t use hormones, like condoms and copper IUDs. Read on to learn about the different non-hormonal birth control options and their pros and cons.

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Approximately 65% of all women ages 15–49 in the United States currently use contraception (Daniels, 2018). Non-hormonal birth control methods do not use female hormones, unlike hormonal contraceptives (e.g., birth control pills), which use estrogen and progestins to prevent pregnancy. 

Some non-hormonal birth contraceptives—such as condoms, the sponge, and spermicides— create a physical barrier between the sperm and egg to prevent pregnancy. These barrier methods are some of the most common forms of non-hormonal birth control and are used only during sexual intercourse. Other non-hormonal options, like IUDs, create a physiological barrier and prevent pregnancy by making the uterus an inhospitable place for a fertilized egg via local inflammation.

When it comes to penetrative sex, there are a variety of non-hormonal birth control options out there. Methods vary in terms of their effectiveness, invasiveness, and how long they need to be used. Depending on the type of contraception you choose, you may get the added benefit of protection against sexually transmitted infections (STIs). 

Choosing a method may seem daunting, but here is an overview of your non-hormonal birth control options to help you make an informed decision.

Copper IUD

An IUD (intrauterine device) is a small T-shaped device inserted into the uterus by your healthcare provider. It works by releasing small amounts of copper, which creates local inflammation in the uterine lining. This inflammation keeps a fertilized egg from implanting in the uterus, thereby preventing pregnancy. IUDs are a form of long-acting reversible contraception (LARC) because they can be left in the uterus for years, providing continual birth control (Lanzola, 2020).

The main benefit of the copper IUD is its contraceptive ability; it is 99% effective at preventing pregnancy (Lanzola, 2020). Overall, people like using copper IUDs. One study looking at over 5000 users found that IUDs had a high user satisfaction rate compared with other reversible forms of birth control, like oral contraceptives (Peipert, 2013).  

Another benefit is that it can be safely used for up to 10 years and can be removed at any time. If your IUD expires, but you still don't want to get pregnant, you can have it replaced. People who want to avoid unnecessary hormones (like those with a history of breast cancer) can benefit from a copper IUD because there are no added hormones (Lanzola, 2020).  

While effective at preventing pregnancy, copper IUDs are not without some side effects or downsides. Some people report increased menstrual pain and bleeding early on, but this tends to decrease over time (Hubacher, 2009). There is a chance that the IUD can come out shortly after being placed, but your provider can place a new one for you. Lastly, IUDs do not protect against STIs like HIV, herpes, chlamydia, etc. 

Although not technically a hormone-free form of birth control, it’s worth mentioning hormonal IUDs. They contain a form of progesterone that is only released into the uterine tissue (it does not get into your bloodstream). The hormones cause changes in the uterus lining (endometrium) that prevent implantation and thicken the cervical mucus. These factors create a barrier to fertilization (Madden, 2020-a).

Hormonal IUDs only last 3–6 years, depending on the dose, and are slightly more effective at preventing pregnancies than copper IUDs. However, you may experience hormonal side effects like headaches, breast tenderness, and mood changes (Madden, 2020-a).

There are several myths surrounding IUDs (both copper and hormonal IUDs). This includes the misconception that IUDs can lead to pelvic inflammatory disease, HIV infection, and infertility. However, studies show that IUD users are not at any higher risk for these conditions when compared to non-IUD users. Ectopic pregnancies, where the egg implants outside the uterus (like in the fallopian tubes), are another concern. IUD users have a lower risk of developing an ectopic pregnancy because they are less likely to get pregnant when using an IUD than non-users. However, if you are using an IUD and you get pregnant, there is a higher chance that your pregnancy will be ectopic (Madden, 2020-b).  

Condoms

For many people, the word “condom” conjures an image of latex on a banana, but there are actually two versions: male and female. 

A male condom is a thin, flexible sheath that covers the penis to catch sperm after ejaculation. The female condom is a thin pouch that lines the vagina and blocks sperm from reaching the uterus (Beksinska, 2020). 

When used correctly, male condoms are 98% effective at preventing pregnancy. They are one of the most popular forms of non-hormonal birth control. You can buy one over-the-counter at almost any drugstore. 

A male condom must be placed over the tip of the penis when erect and rolled down to the base before penetrative sex. It loses effectiveness if it breaks or comes off during sex, so be sure to put the condom on appropriately. (Copen, 2017). Female condoms are not as effective as male condoms. However, they still prevent 95% of pregnancies when placed in the vagina before skin-to-skin genital contact happens (Hoke, 2020). Check the expiration date of your condoms and replace any that are expired. 

Male condoms provide double protection—they prevent unplanned pregnancy and the spread of STIs, including gonorrhea, chlamydia, syphilis, HIV, and HPV. Research suggests that female condoms also protect against STIs; however, data about female condoms is limited (Hoke, 2020). 

There aren’t any real side effects of condoms other than not using them properly. However, they do require an interruption of sex to put on, which can be disruptive to some couples. Also, some people have condom anxiety, which can affect sexual performance. 

Diaphragm

A diaphragm is shaped like a shallow cup and placed inside the vagina to prevent sperm from reaching the cervix. Diaphragms come in different sizes, so you might want to consult your healthcare provider to ensure a proper fit and maximize effectiveness. 

With typical use, 17 out of 100 women will get pregnant per year while using this method (CDC, 2020). You can improve the effectiveness by using your diaphragm with spermicides. Apply spermicide at the time of insertion; you’ll want to put in the diaphragm within an hour of sex and leave it there for at least six hours after sex. You can have sex multiple times in the same session using the same diaphragm, but you will need to reapply spermicide each time. Afterward, take it out and wash it with mild soap and water; with proper care, most diaphragms will last two years (Bartz, 2020). 

A significant downside of diaphragms is they are not as effective as some other birth control options. Additionally, some people need to be fitted for their diaphragm, which requires a trip to see their healthcare provider. Diaphragms have been associated with urinary tract infections (UTIs), vaginal irritation, and toxic shock syndrome (TSS). TSS is rare, but the risk goes up if you leave your diaphragm in for more than 30 hours total. Diaphragms do not protect against STIs (Bartz, 2020).

Cervical cap

The cervical cap (brand name FemCap) is another form of hormone-free birth control placed in the vagina before sex to prevent pregnancy. The device is a small reusable silicone cup with a round rim that fits tightly around the cervix. Cervical caps need added spermicide to be effective. 

The cap can be placed six hours before sex and must be left in for at least six hours after sex—but no longer than a total of 48 hours. You’ll need to add fresh spermicide each time you have penetrative sex. Out of 100 women who use this method over the course of one year, about 16 may get pregnant. Like some other methods, the cervical cap may be less effective in women who have previously given birth. Childbirth changes the shape of the cervix, making the cap fit less snuggly (Bartz, 2020).

Cervical caps do not require professional fitting but talk to your healthcare provider if you have any questions about insertion or maintenance. Side effects are minimal, including possible vaginal irritation or UTIs. Cervical caps do not protect against STIs (Bartz, 2020).  

Spermicide

Spermicides are creams, gels, or suppositories designed to kill sperm to prevent egg fertilization. They should be placed in the vagina at least 10 to 30 minutes, but not more than 60 minutes, before sex. If you don't wait long enough for the spermicide to disperse before having sex (at least 10 minutes), the method won't be as effective. You also need to apply a repeat dose of spermicide after each act of intercourse (Bartz, 2020). 

Alone, spermicide is not sufficient at preventing pregnancies. Spermicide is most effective in combination with other contraceptives like a condom, diaphragm, or cervical cap. For women using spermicide alone, approximately 20 out of 100 will become pregnant in a given year. Spermicides do not protect against STIs (Bartz, 2020). 

Birth control sponge

Birth control sponges are small, one-size-fits-all devices made of plastic foam that act as barriers to prevent sperm from entering the uterus. They also contain spermicide to kill any sperm that does get through. You can purchase contraceptive sponges over-the-counter without a prescription. Just insert the birth control sponge into your vagina up to 24 hours before sex, and then leave it in place for at least six hours after sex. You can have sex multiple times and then dispose of the sponge when you are finished with it. 

One of the benefits of contraceptive sponges is that you don’t need a special fitting or partner participation to use them. The sponge is about 88% effective with typical use but may be slightly less effective for women who have previously given birth (Bartz, 2020).

Side effects include vaginal dryness and irritation. You should never wear a sponge for longer than 30 hours total, as this increases your chance of developing TSS. While birth control sponges act as barriers to pregnancy, they do not protect against STIs (Bartz, 2020). 

Natural birth control

For those who prefer not to use a birth control device, natural family planning may be an option. This method uses various approaches based on tracking the menstrual cycle and ovulation to prevent unwanted pregnancies.

Also known as the fertility awareness method (FAM), this method uses various tools to track ovulation. Unfortunately, while some people may swear by it, it has a much higher failure rate in preventing pregnancy than some other methods available. On average, 24 out of 100 women who rely on FAM for birth control will get pregnant unintentionally (Sung, 2020).

The rhythm method helps women track their menstrual cycles to understand the best days to have or avoid unprotected sex. Two other fertility awareness methods for determining an ovulation window include tracking cervical mucus and the symptothermal method (which involves measuring your daily basal body temperature) (Sung, 2020).

Withdrawal, also called “pulling out” or coitus interruptus, is another form of natural birth control that involves removing the penis from the vagina before ejaculation. Unfortunately, this form is very unreliable and has a 22% failure rate with typical use. This means that almost 1 in 5 couples using this method have an unwanted pregnancy. Withdrawal also does not protect against STIs (Horvath, 2018). 

If you're looking for a 100% effective method for preventing pregnancy, there's only one way to go: abstinence. Some couples choose abstinence, which means refraining from sexual intercourse for religious, cultural, or medical considerations. Although not always the popular choice, abstinence is the most effective way to prevent pregnancy and reduce exposure to STIs.

Outercourse is another form of natural or non-hormonal birth control method. It encompasses all sorts of sexual activities, like kissing, masturbation, handjobs, etc., that don’t involve penile penetration—no penetration means no pregnancy. However, this method does not necessarily protect against STIs.

Surgical Sterilization

Alternatively, suppose you are absolutely sure that you do not want kids. In that case, you could opt for surgical sterilization, which does not use any hormones and provides permanent birth control. Surgical sterilization involves surgical procedures that are not intended to be reversible and have over a 99% effectiveness at preventing pregnancy. Male sterilization consists of a vasectomy procedure, while female sterilization uses tubal ligation, where the fallopian tubes are tied (Stormont, 2020; Sung, 2021).

There's no one-size-fits-all method of birth control, so it's important to do your research to determine what works for you and your reproductive health. You should also consult your healthcare provider to review your options, including hormonal contraceptive methods. Finally, if things do not go as planned and you're concerned about an unwanted pregnancy, you may consider emergency contraception.

Here is a summary of the reversible non-hormonal birth control options and their pros and cons.

Some questions you may ask yourself when choosing a birth control method include: 

• How often do you have sex? For women who have consistent sex with a consistent partner, IUDs can offer effective protection against pregnancy. Women having less frequent intercourse or more irregular partners might consider condoms to prevent both pregnancy and STIs.

• Do you want to have children someday? If so, how soon? None of these birth control options (other than surgical sterilization) will impact your ability to get pregnant in the future, but they might influence the timeline. If you're looking to have a baby in the next few months, an IUD might not be the best option for you since it needs to be inserted and removed by a healthcare provider. If you're looking to wait longer, an IUD can last up to 10 years. 

• Do you also need protection against HIV and other STIs? As we mentioned earlier, condoms and abstinence are the only non-hormonal birth control methods that protect people from pregnancy and STIs.

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Current version

May 11, 2021

Written by

Alexandria Bachert

Fact checked by

Yael Cooperman, MD

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About the medical reviewer

Yael Cooperman, MD, Ro

Yael Cooperman is a physician and works as a Senior Manager, Medical Content & Education at Ro.