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Non-Hormonal Birth Control Options: Your Top 4 Methods

Non-Hormonal Birth Control Options: Your Top 4 Methods

  • Sonia Easaw, M.S., MPH
    Reviewed By: Shannon DeVita DNP, FNP-BC, CPNP-PC, Julie Lamonoff, CNM, OBGYN-NP
    Updated:

You might be looking into non-hormonal birth control for several reasons. Maybe it's a medical reason, concern over side effects, or a desire to leave the body's natural hormone levels alone.

Regardless of the reason, we're here to help you find the right non-hormonal birth control option for you—one that is safe and effective in preventing pregnancy. As you might suspect, there are more than a few different methods.

What's the best non-hormonal birth control method?

Do you know what percent of couples who don't use any form of birth control get pregnant within one year? The answer is 85%. If you're reading this article, then you'd probably want to bring that number way down by using contraception. When you're talking non-hormonal contraception, there are a few methods that are better than others.

The top non-hormonal birth control method: The copper IUD

Now, when we ask what about the "best" non-hormonal birth control option to mean the most effective one, then the copper intrauterine device (IUD) wins every time, hands down. (Well, technically, the number one way to prevent pregnancy is not to have sex. But that's not why we're here.)

Out of 100 women who use the copper IUD (ParaGard™), less than 1 will get pregnant in the first year. This means your chances of getting pregnant are close to 0% (the exact number from the CDC is 0.8%) if you have the copper IUD.

Editor's Note: The top method of non-hormonal birth control for everyone may not mean it's the best fit for you as an individual. You have to choose what's most effective and is something you're comfortable with using.

In a nutshell: The top non-hormonal birth control options

We'll go into this more in detail later, but here's a quick list of the top 4 non-hormonal contraceptive methods, when ranked by effectiveness rate for the typical user in the first year (source: FDA birth control chart):

  1. Copper IUD - less than 1 out of 100 will get pregnant

  2. Diaphragm with spermicide - about 12 out of 100 women may get pregnant

  3. Phexxi (new kind of vaginal gel) - about 14 out of 100 women may get pregnant

  4. Male condom or female condom - For the male condom, about 18 out of 100 women whose partners use condoms may get pregnant. For the female condom, about 21 out of 100 women may get pregnant.

What is "typical use"? Researchers came up with the numbers above after following women for a year who said they were using these methods. However, the women surveyed may have said they used a condom every single time (or another method), but the reality could be different. The "typical use" numbers include women who might have forgotten a few times (because who's perfect?). When you look at perfect use of the male condom, then less than 2 women out of 100 may get pregnant in the first year.

What about effectiveness compared with the pill? Keep in mind that except for the copper IUD, the above methods aren't as effective as hormonal birth control. Hormonal methods like the pill, patch, or ring contain the hormones progestin and estrogen, which primarily help prevent ovulation (releasing an egg). And it's hard for sperm to fertilize an egg when there isn't one there, to begin with! Hence, the success rate of hormonal birth control: When using the pill, patch, or ring, about 9 out of 100 women may get pregnant in the first year with typical use; with perfect use, less than 1 out of 100 women may get pregnant in the first year.

How to choose the right option for you

The best option for you when it comes to birth control without hormones is the one you can use confidently and correctly every single time you have sex. The Office on Women's Health says that the best type of birth control for you depends on:

  • Your health

  • Whether you want kids now, sometime in the future, or ever

  • If you need to protect against sexually transmitted infections (STIs)

The top 4 non-hormonal birth control methods

We based the list below on the effectiveness of the method for the average person. Your individual "top" method could be based on multiple factors, like cost (e.g., if you don't have insurance), the convenience of using it, how comfortable you are with it, or how easily you can access the method.

"Typical use" vs. "perfect use." We need to clarify that when we talk about the effectiveness or how often someone could get pregnant if they use a particular method, we give the numbers in terms of "typical use" and "perfect use." Essentially, "typical use" is how someone in a real-world situation would use the method. For example, if you're on the pill and forget to take it sometimes, that's "typical use." If you use the pill consistently and correctly every single time, that's "perfect use."

Number 1: Copper IUD

The copper IUD is available by prescription only from your health care provider. The brand name is called ParaGard.

Effectiveness: Less than 1 out of 100 women may get pregnant in the first year of use. The copper IUD is over 99% effective.

What is it: The copper IUD (intrauterine device) is a T-shaped plastic device wrapped in copper, a little less than 1.5 inches wide and long. It's something your doctor would insert inside the uterus in a non-surgical procedure taking less than a few minutes.

How it works: The copper IUD works by releasing copper ions that are toxic to sperm. Its T-shape also blocks sperm and keeps them from reaching the egg.

How long does it last: The copper IUD can keep you from getting pregnant for a max of about 10 years but can be removed by a doctor at any time.

Pros: The copper IUD definitely has its pros:

  • 100% hormone-free

  • It's highly effective - over 99% - with no hormonal side effects.

  • You don't have to think about using a condom or another method each time you have sex. It's in for as long as you'd like to keep it, with a max of about 10 years.

  • The copper IUD can also be used as emergency contraception if inserted within 5 days or 120 hours after unprotected sex.

  • It starts working immediately, unlike other hormonal methods, where you sometimes have to wait 7 days before having unprotected sex (no condom).

  • It's safe if you can't use hormonal birth control because of the estrogen; for example, women who smoke over the age of 35 usually can't take birth control pills but can opt for the copper IUD.

Cons: The copper IUD does have some disadvantages:

  • Some women report side effects like cramps, heavy periods, and spotting between periods. The CDC says that irregular bleeding is expected during the first 3 months of using the copper IUD but decreases as time goes on.

  • You wouldn't be able to use the copper IUD if you have an allergy to copper or an active condition of pelvic inflammatory disease.

As with similar medical devices, Harvard Medical School says there is a risk for possible problems with the copper IUD:

  • A small risk that the uterus can expel the copper IUD (this happens to about 6 women in 100 during the first year)

  • A small risk of infection

  • A very rare risk that the insertion can puncture the uterus

Whom it's for: Many women who can't use birth control with hormones or choose not to opt for the copper IUD. The copper IUD is probably best for you if you're not thinking of having children anytime soon and would rather have the convenience of this "set-it-and-forget-it" method. Younger women and teens, or moms who don't want to have children for a few years or are done with having kids, could benefit from getting the copper IUD. Also, researchers have found that for women with diabetes, the copper IUD is a safe option.

Number 2: The diaphragm with spermicide

Okay, so now we're going to get into the barrier methods*, the non-hormonal birth control methods that provide a physical barrier between the sperm and the egg. These methods make sure that the sperm and egg do not meet! Because if they do, the sperm can fertilize the egg, and from there, the fetus begins developing. And that's what we don't want to happen.

*Editor's Note: Just a heads-up: We'll talk more about barrier methods like male and female condoms, cervical caps, and contraceptive sponges later in this article.

You can get the diaphragm with a prescription from your doctor. You would have to go into the office to get the diaphragm fitted for your body, but you can put it in and take it out yourself after that. Some brand names of the diaphragm are Koromex™ and Ortho-Diaphragm™.

Effectiveness: With typical use, about 12 out of 100 women may get pregnant using the diaphragm. With perfect use, 6 out of 100 women may get pregnant in a year.

What is it: The diaphragm is a dome-shaped flexible disk made from silicone that's designed to cover the cervix (the top area of the vagina). You'd need to put spermicidal jelly, cream, or foam on the inside of it before inserting it into the vagina.

How it works: It blocks sperm from coming into the cervix, and the spermicide will kill any sperm (beware, sperm!) that come into contact with it.

How long does it last: Once you get it fitted, diaphragms are reusable and can last up to 2 years with proper care.

Pros: These are the advantages of the diaphragm:

  • It's a hormone-free method that you can insert ahead of time, about 2 hours before you have sex.

  • Once you get it fitted, you can insert it and remove the diaphragm yourself, making it convenient and giving you control.

  • It's safe to use if you're breastfeeding.

Cons: There are also disadvantages to using the diaphragm:

  • Compared to the copper IUD (99% effective) and the male condom, it's less effective, even if you use it perfectly.

  • You have to insert it every time you have sex.

  • It can slip out during sex.

  • You may have to get it re-fitted by the doctor if you lose or gain 10 pounds or if you have a baby.

Whom it's for: The diaphragm is convenient for women who want a method they can control, reusable over a couple of years. The diaphragm can be a good option for those who cannot use methods with hormones and want a short-acting, reversible form of birth control.

Number 3: Phexxi vaginal gel

Phexxi™ is a "first-of-its-kind" non-hormonal vaginal gel approved by the FDA in August of 2020. Long story short, it's a much-improved version of something a lot older: a spermicide. You would need a doctor's prescription for Phexxi.

Effectiveness: In the phase 3 trial of Phexxi, it was shown to be 86.3% effective.

What is it: Phexxi is a vaginal gel containing lactic acid (a harmless chemical that is constantly produced by our bodies), citric acid (found in citrus fruits), and potassium bitartrate (often used in cooking). Phexxi comes as a gel in a pre-filled applicator that's applied into the vagina right before sex.

How it works: Basically, Phexxi works by temporarily lowering the pH of the vagina, making it an inhospitable environment for sperm. It's cool because it essentially is capitalizing on one of the vagina's natural defenses: its acidic pH, which helps to stop incoming sperm in their tracks and make them stop swimming.

Pros:

  • Phexxi is a hormone-free method that is woman-controlled

  • Unlike traditional spermicides like nonoxynol-9, Phexxi should be less harsh and gentler on the vagina

  • Easy to combine with other methods like the diaphragm and condom for even greater protection

Cons:

  • Phexxi may cause side effects for some women, including burning, pain, itching, or overall discomfort in or around the vagina

  • Phexxi is not available over-the-counter; you'd need a doctor's prescription to get it.

  • Phexxi can be expensive if you have to pay out of pocket. Drugs.com reports that the cost of 12 applicators without insurance is around $288.

Whom it's for: Researchers at the University of Illinois developed the science behind Phexxi to give women more control and other options to choose from to prevent pregnancy. Phexxi is an option for women who want a non-hormonal method that they have control over. An article in Nature about better birth control options says Phexxi might pair with women "who are not in long-term relationships and who need reliable, once-in-a-while contraception." It could work for those who can't use hormonal birth control or don't want a long-term prescription for birth control pills, for example.

Number 4: Male or female condoms

The male condom is used quite a bit: The CDC says that according to 2011 data, about 1 out of 3 men ages 15--44 used a condom the last time they had sex. You can find male or female condoms like FC2™ at drugstores or other retail chains.

Effectiveness: The male condom is 82% effective with typical use. The female condom is about 75% to 82% effective with typical use.

What is it: Male condoms are thin covers worn over the penis during sex, made of latex rubber or polyurethane. Female condoms fit inside the vagina and have a ring on each end. They are also made of polyurethane.

How it works: Male and female condoms have one job: To be a physical barrier to keep sperm away from the egg. They do this by preventing sperm from getting into the vagina.

Pros:

  • The only birth control method that can protect against pregnancy AND sexually transmitted infections

  • Convenient and affordable to buy (don't need a prescription)

  • Female condoms can be placed up to 8 hours before sex and are a woman-controlled method

Cons:

  • You have to remember to use a condom every time you have sex.

  • If the condom breaks or tears in any way, this could increase your chances of getting pregnant.

  • You could experience irritation or a rare allergic reaction to latex.

Whom it's for: Condoms are a good choice for anyone looking to prevent the spread of sexually transmitted diseases. Though condoms are less effective at preventing pregnancy than other methods like the IUD, they are better than no method at all. Some women double up on protection and use a condom AND another method, like spermicide, for extra pregnancy prevention.

Other barrier methods: Cervical cap and sponge

So far, in this article, we've talked about 2 barrier methods: the diaphragm and the condom. But there are two additional barrier methods that some women use:

  • The cervical cap with spermicide. About 17-23 out of 100 women who use the cervical cap may get pregnant.

  • The contraceptive sponge with spermicide. About 12 out of 100 women who use the contraceptive sponge may get pregnant. About 24 out of 100 women who've given birth may get pregnant using the sponge.

The cervical cap is a soft rubber or silicone cup made to fit over the cervix (the top of the vagina). You'd use spermicide on the outer rim of the cap and inside the cap itself. To get it, you'd have to see your health care provider so they can figure out the right size for you. Then they can prescribe it.

The contraceptive sponge goes into the vagina to cover the cervix and block sperm from coming in. It's also used with spermicide. The nice thing about it is you don't need a prescription for it.

What about permanent non-hormonal birth control?

So far, we've talked about reversible methods that you can use to prevent pregnancy. But what if you're done with having kids or choose not to have them? Then, a permanent form of birth control might be something to consider.

Here are the different options for permanent birth control:

  1. Vasectomy: This one's for the guys who are sure they never want to have children or do not want any more. It's a permanent surgery that's done once. Though sometimes it's possible to reverse the surgery, there's no guarantee, and it's a complicated surgery at that. So your guy has to be sure, case closed. Out of 100 women whose partners have had a vasectomy, less than 1 may get pregnant.

  2. Sterilization surgery (trans-abdominal surgical sterilization): This one's for the women who are sure they don't want children in the future (or are done with having kids). It's a permanent surgery that is not easily reversible. Doctors do the surgery called tubal ligation, which is when the fallopian tubes are tied and cut (hence "getting your tubes tied"). The tubes can also be sealed with an electrical current or closed with clips or clamps. Less than 1 out of 100 women who've had sterilization surgery get pregnant.

How about natural forms of birth control?

Okay, so this article has spanned the range of effectiveness when it comes to non-hormonal birth control. We've talked about the uber-effective ones, like the copper IUD and permanent sterilization. We've also talked about the barrier methods. Now come the natural options, which you've might have heard of (there's a lot of self-awareness and calendaring involved). These are legitimate methods that women use, but know that these are some of the least effective ways to prevent pregnancy.

  1. The withdrawal method. Also known as the "pull and pray" method. This already sounds a bit unreliable, yeah? It's essentially when the male partner "pulls out" of the woman's vagina before ejaculation. For couples who use the withdrawal method, about 22 out of 100 women may get pregnant. This number is a guess based on the risk of pregnancy from pre-ejaculate fluid.

  2. Natural family planning method (aka the rhythm method): You might also hear this called a fertility-awareness-based method. As it sounds, this option relies on you know precisely which days you're most fertile and then avoiding sex (or using a condom) on those days. It's not considered a reliable method but could be the best fit for some couples. It takes a lot of planning every month. The CDC says this method is only about 24% effective, or that out of 100 women who use natural family planning, about 24 may get pregnant.

What about breastfeeding? If you need a short-term birth control method and have just had a baby within the last 6 months, you might consider this option. The Office on Women's Health says that the risk of pregnancy is less than 2 out of 100 if:

  • Your baby is less than 6 months old.

  • You exclusively feed your baby directly from your breast. This means that you have to provide breast milk to your baby directly from the breast, as breast milk from pumping would not offer you the same birth control benefit.

  • You've not had a period after giving birth.

Recap: Which non-hormonal birth control method is best for you?

Okay, so there you have it! The "best" non-hormonal birth control method is the one that is most effective AND fits your lifestyle.

You should think about the following when choosing the right birth control method for you:

  • Your overall health

  • If you'd like to have kids in the future

  • How often you have sex

  • If you'd need a prescription for the method

  • If you need to protect against sexually transmitted infections

When it comes to the most effective non-hormonal birth control method, the copper IUD wins, and permanent procedures of birth control like sterilization surgery. Then, you have your barrier methods, like the diaphragm and male or female condoms. Included in the list is the new vaginal gel called Phexxi, which is a much-improved spermicide. You have options, which is the essential part. Don't hesitate to ask your doctor about which method is right for you. And now, onwards and upwards in your journey!

Sources:

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