All You Need to Know About Nonhormonal Birth Control Options

Hormonal birth control is not suitable for everyone. Some women prefer to avoid hormones due to potential side effects, health concerns, or personal preference, especially those who are nursing.

While hormonal birth control methods like those containing estrogen and progesterone are highly effective, various nonhormonal options exist that cater to different needs and circumstances and they don’t negatively impact women’s overall health.

Understanding Birth Control Effectiveness: Perfect vs. Typical Use

Birth control effectiveness is often discussed in terms of “perfect use” versus “typical use.” Perfect use refers to how effective a method is when used exactly as instructed every time.

Typical use accounts for real-world factors where the method might not be used consistently or correctly. Even with perfect use, no birth control method is 100% effective.

Consulting with a healthcare professional can help determine the best option.

Nonhormonal Birth Control Methods

Barrier methods prevent sperm from entering the uterus and are used only during sexual intercourse.

These methods generally have fewer side effects than hormonal options and can be purchased over the counter or with a prescription.

External Condoms: Male condoms are 98% effective with perfect use and provide STI protection. They are convenient, inexpensive, and do not require a prescription. Some individuals may experience allergies to latex or find that condoms reduce sensation.
Diaphragm: A flexible silicone cup inserted into the vagina to cover the cervix, used with spermicide. It is 94% effective with perfect use and 83% effective with typical use. The diaphragm requires a prescription and fitting by a healthcare professional.
Spermicides: These are chemicals placed in the vagina before sex to immobilize sperm, available in creams, gels, and suppositories. Spermicides have a 21% failure rate with typical use but are more effective when combined with other methods like the diaphragm or cervical cap.
The Sponge: Made of plastic foam and containing spermicide, the sponge covers the cervix to prevent sperm from entering. It is less effective for those who have been pregnant before, with a failure rate of 20-22% for these individuals.
Cervical Cap: Similar to the diaphragm but smaller, it fits over the cervix and is used with spermicide. It is 86% effective with perfect use for those who have not given birth and less effective for those who have. The cervical cap can be used for up to 48 hours but requires a prescription and fitting.
Internal Condoms: Female condoms are 95% effective with perfect use and also protect against STIs. They are latex-free and available without a prescription, though they can cause irritation and are generally more expensive than male condoms.
Phexxi: A newer nonhormonal vaginal gel that lowers vaginal pH to prevent sperm from moving effectively. It is 93% effective with perfect use and 86% effective with typical use. Phexxi is used before sex and does not protect against STIs.

Long-Term and Permanent Solutions

For individuals seeking long-term or permanent nonhormonal birth control options, several methods are available.

Paragard, a copper IUD, is less than 1% likely to fail each year, making it one of the most reliable nonhormonal contraceptives. It offers up to 10 years of protection without releasing hormones, making it suitable for those who prefer to avoid hormonal methods.

However, it does not protect against sexually transmitted infections (STIs), and some users may experience side effects such as cramping and heavier menstrual periods.

Sterilization methods, such as tubal ligation for females and vasectomy for males, provide permanent solutions. Both are highly effective in preventing pregnancy, but they are generally considered irreversible. Like Paragard, these methods do not protect against STIs, so additional protective measures may be needed.

Alternative Methods

For those who prefer hormone-free alternatives, several methods are available with varying degrees of effectiveness.

The withdrawal method involves withdrawing the penis from the vagina before ejaculation. It is 96% effective with perfect use but drops to 78% effectiveness with typical use due to the difficulty of timing withdrawal correctly every time.

It does not provide STI protection and requires considerable self-control and experience.

Natural Family Planning (NFP) involves tracking menstrual cycles, basal body temperature, and cervical mucus to determine fertile days. When used correctly and consistently, NFP can be effective, but typical use failure rates range from 12-24%.

It requires diligent daily tracking and a good understanding of one’s menstrual cycle. Similar to the withdrawal method, it does not protect against STIs.

Additional Information on Alternative Methods

Fertility Awareness Methods (FAMs) include the Calendar Method, the Temperature Method, and the Cervical Mucus Method.

These methods can be up to 99% effective with perfect use, but typical use effectiveness ranges from 76-88%. Successful use requires education and training to correctly monitor fertility signals.

Barrier methods, such as condoms, diaphragms, and cervical caps, are also common hormone-free alternatives.

Male condoms are about 98% effective with perfect use and 85% effective with typical use, while female condoms are about 95% effective with perfect use and 79% effective with typical use. Condoms provide the added benefit of protecting against STIs.

Spermicide, a chemical that kills sperm, is often used with other barrier methods to increase effectiveness. When used alone, spermicides are about 72% effective with typical use. However, spermicide does not protect against STIs and may cause irritation in some users.

Choosing the Right Nonhormonal Birth Control

Choosing the right birth control method depends on individual preferences, health considerations, and lifestyle factors.

It’s important to decide whether long-term protection like the copper IUD or permanent methods such as sterilization are preferred over short-term options like condoms or natural family planning.

For those wanting to avoid hormonal effects, nonhormonal choices like the copper IUD or barrier methods may be suitable.

Consideration should also be given to whether protection against sexually transmitted infections (STIs) is needed. Condoms are the only method that offers this dual protection. Additionally, assess the ability to adhere to the method’s requirements, as some methods require daily or periodic use.

Consulting with a healthcare provider is crucial to understand each method’s effectiveness, potential side effects, and suitability based on individual health history and goals.

Financial aspects, accessibility, potential side effects, health benefits, and cultural or personal beliefs should also be taken into account when making a decision.

By carefully evaluating these factors and seeking guidance from a healthcare provider, individuals can choose a birth control method that aligns with their needs and preferences effectively.