SKIP AHEAD. . .
What is nonhormonal birth control?
Non-hormonal birth control is pretty much what it sounds like: Contraceptive methods that don’t have hormones, and thus don’t influence your own hormones. Non-hormonal birth control is mostly barrier methods that prevent sperm from reaching the egg and causing pregnancy (14). However, there are also methods that paralyze sperm (sorry lil’ dudes!), including spermicide and the copper IUD.
These are different from hormonal birth control methods, like the pill and the ring, which contain synthetic forms of progesterone and estrogen (though the hormones and their ratio vary)—for example, the combined pill contains both ethinyl estrodiol (synthetic estrogen) and progestin (synthetic progesterone) and the mini pill contains only progestin (2). These synthetic hormones do a few things to prevent contraception, like suppressing ovulation, thickening the cervical mucus so sperm can’t reach the uterus, and making it more difficult for an egg to implant on the off chance it does get fertilized. And don’t worry, we’ll get into allll the types of non-hormonal birth control below.
Why to choose/not choose
Well, firstly, it’s just a good thing to have options! All bodies are different, and some feel better with hormonal B.C., while others don’t.
Non-hormonal birth control is a great option for people who are breast/chestfeeding or have health concerns that may affect their ability to safely take hormones. For example, those with past or current breast cancer and/or high blood pressure might be advised to avoid hormonal birth control (14). Non-hormonal birth control is also an option if you don’t need ongoing birth control, have changes in health insurance (hormonal methods tend to be more expensive and require a prescription, while many non-hormonal methods are cheaper and available without a doctor’s visit), or you want a backup method in addition to hormonal birth control. Most non-hormonal birth control also has minimal or no side effects. It’s also a good option for people who don’t want to alter the natural cycle of their bodies with hormones.
But there are downsides to non-hormonal B.C., including that many of these methods have to be used each time you have sex (so you can’t forget, even once!), some methods can’t be used during menstruation, and many vagina-havers find some of the devices uncomfortable (11). Plus, there are also reasons to opt for BC that does have hormones! People might choose hormonal methods due to hormone imbalances, acne, cramping and other symptoms associated with menstrual cycles that may be mediated by hormonal birth control. Also, it’s more effective than most non-hormonal methods. So really what it comes down to is making the choice that’s best for your unique body.
Types of nonhormonal...
There are a ton of different kinds of non-hormonal B.C. varying from LARC (long-acting reversible contraception) to one-time-use situations, like a condom. Let’s list ‘em out:
You’ve probably heard of the condom before, so let’s just go over the basics: The external condom goes over the penis and, when being used to protect against pregnancy, acts as a barrier to prevent sperm from entering the vagina. Condoms can be made of different materials, like latex, plastic (polyurethane, nitrile, or polyisoprene) (2), or lambskin—so if you’re allergic to latex, you’ve got options! When used perfectly, the condom is 98% effective (and please see how to perfectly use a condom right this way), but because people don’t always use condoms correctly, they’re about 85% effective when accounting for human error. You have to use a new one after each ejaculation—they’re one-use only, people! And you have to remember to use them every time or there is a risk of pregnancy. Condoms are also the only form of BC that protects against STIs/STDs, but please note that lambskin condoms are the exception and WILL NOT prevent STIs/STDs, and also that using oil-based lubes with latex condoms is a no-no (it can make the condom break).
Okay so this is like an external condom, but just worn on the other side of the sexual interaction. It’s a pouch inserted into the vagina (or anus!) and works by keeping sperm in the condom. It’s made of nitrile (a synthetic rubber) so it’s fine for those with latex allergies. Internal condoms might be a little more difficult to find than an external condom, but they are available in stores and online with no prescription or health insurance needed. Internal condoms are a little less effective than external condoms, at 79% efficacity with typical use (and 95% with perfect use) (8). Again, like external condoms, these babies are one-time use only, and you have to use them every time you have sex. Bonus: They also protect against STIs/STDs.
Not your kitchen sponge, this is a special soft round plastic sponge that is inserted inside the vagina to cover the cervix, and is loaded up with spermicide (4) to paralyze sperm before it can reach an egg. The sponge, which is 76-88% effective (4), can be found in most drugstores and online, with no prescription or health insurance needed. Each sponge can only be used for only one insertion and it can be inserted up to 24 hours before sex, and once it is in, you can leave it in and have sex as many times as you want in the next 24 hours without replacing it (4). Just note that it has to be left in for at least six hours after sex to make sure that you’re fully protected.
Similar to the sponge in the way that it covers the cervix to prevent sperm from entering (#youshallnotpass), this baby (which is shaped like a lil’ sailor’s hat) is made of soft silicone and needs a prescription, but then you can buy it at a pharmacy, drugstore or health center. As for how well it can protect ya, it’s 86% effective for those who haven’t given birth, and 71% effective for those who have (5). You’ll need a physical exam to be fit for the cervical cap, which can cost between $0 and $275 for both the exam and the cap (5). However, many insurances cover at least some, if not all, of these costs. Longer lasting than a single-use sponge, the cervical cap can last for one to two years—but make sure you’re washing it properly (5)! Similarly, it must be left in place for at least six hours after sex but shouldn’t be left in for more than 48 hours (5). And FYI, Planned Parenthood says that the diaphragm’s slightly more effective at preventing pregnancy than the cervical cap, so keep that in mind (5).
The diaphragm is a shallow dome-shaped cup made of silicone which covers the cervix to keep sperm from entering the uterus and is 88% effective when accounting for human error (and 94% effective if used perfectly) (6). Like the cervical cap, you’ll need an exam and fitting for a diaphragm, which can cost between $0 and $250, depending on your insurance. These can be made of latex, which needs to be replaced between 1-3 years, or silicone which can last up to ten years (6) as long as you take care of it. You can put the diaphragm in up to six hours before sex, and it must be left in for six hours after ejaculation (6), so get those timers ready to go. You can leave the diaphragm in for up to 24 hours before removal, meaning that you can have sex multiple times while it is in (6). P.S. It’s most effective when you throw some spermicide into the mix.
Just like it sounds, this stuff targets sperm. Usually, spermicide is a gel/cream/foam/suppository made of chemicals that stop sperm from moving so they can’t get to an egg (1). Spermicide is inserted deep inside the vagina to prevent sperm getting through the cervix, but each kind can be a little different, so be sure to read the directions for the specific type that you bought (1)! It can be found in most drugstores, some supermarkets, as well as online and doesn’t require a prescription. The price varies depending on the type and brand, but can be about $0.50-$3 per dose. It should be used each time you have sex, but also in combination with other methods, as it is only moderately effective by itself—28 out of 100 people who use spermicide become pregnant every year (15).
Copper IUD (Paragard)
The copper IUD is the only non-hormonal IUD, and it’s a T-shaped piece of flexible plastic that’s wrapped with copper and placed in the uterus. There is a small copper filament in the IUD that releases copper ions which are toxic to sperm and prevents them from reaching the egg (10). The copper also causes some moderate inflammation in the endometrium (aka the lining of the uterus), which creates an environment where it’s hard for a pregnancy to thrive (10). And while this BC method is *super* effective (more than 99%) and long lasting (up to 12 years), there are some side effects, including irregular periods, heavier/longer periods, cramping during periods, spotting between periods, and the potentially painful/triggering insertion process (10). But here are the pros: The cost of the copper IUD depends on your insurance, which typically ranges between free and relatively low cost. The Paragard lasts for 12 years (or until you want to take it out), and it’s considered a very low maintenance method of non-hormonal birth control (10)—it’s recommended to check for the strings regularly to make sure that the IUD is in place, but you don’t have to think about it every time you have sex. It can also be used as a highly effective emergency contraception method if it is inserted within five days of sex (10).
Sterilization is quite a high maintenance method, as it requires surgery, but can prevent all future pregnancies. It can be done as tubal ligation (aka “having your tubes tied”), or vasectomy (for penises), and both methods are over 99% effective at preventing pregnancy (16, 17), however, sterilization is an expensive option and may not be covered by insurance. With tubal ligation, the surgical procedure permanently blocks the fallopian tubes, so sperm can’t reach the egg. You’ll still get your period and be vulnerable to STIs/STDs, but you won’t be able to get pregnant again without surgery to attempt to reverse it, so make sure that this is the right choice for you (16)!
Vasectomies are generally an easier procedure with fewer risks. The procedure works by cutting or blocking off the small tubes in the scrotum that carry sperm, which prevents sperm from leaving the body and, most importantly, making it to an egg to fertilize (17)! Like tubal ligation, the procedure is meant to be permanent (though it rarely can be undone in a complicated and costly surgery), so make sure it’s something you want (17)! The surgery won’t protect you from STIs/STDs, and, again like tubal ligation, it will take about 3 months to work. You should definitely be speaking with a doctor or two to understand the extent of the procedure and possible side effects and costs associated.
Fertility Awareness Method
This method, also called natural family planning, consists of tracking your menstrual cycle/ovulation so that you can avoid intercourse during fertile times, therefore preventing pregnancy (7). You can use this method as long as you want to, but it requires you to be consistent with tracking and to be rigid in terms of when you can have sex. Planned Parenthood reports that FAM is 76-88% effective (7), while the American College of Obstetrician and Gynecologists reports that when used correctly (emphasis on used correctly), FAM is 95-99% effective (18).
So how does FAM work? You can keep track of your ovulation by tracking your basal body temperature (details here), checking your cervical mucus (more about that here) or if you’re super regular, charting your cycle on a calendar or using an app. The most effective way to do FAM is by using all three to make sure that you know the days when you’re most likely to get pregnant and should avoid vaginal sex.
Also known as pulling out, withdrawal involves physically removing the penis from the vagina before ejaculation (and that is all ejaculation, including pre-cum). You have to use this method each time you have sex (duh) and ejaculators have to be very precise timing-wise. Note that withdrawal is only 78% effective and will not—we repeat, will NOT—protect from STIs/STDs, so you might want to combine it with condoms (9).
One surefire way to not get pregnant? Don’t have vaginally penetrative sex with a penis! But it also means, no vaginally penetrative sex with a penis… For some people, this is their preferred choice; and that’s great! For others, not as much. It’s important to know that abstaining isn’t the only way you can prevent pregnancy and should be an informed choice instead of one you are pressured into by your school teachers 🙂
How to choose the right kind for you?
The best way to choose which is right for you is to consider your lifestyle, personal habits and what you could realistically do. Can you be consistent, and follow the instructions of each method? If you’re quite forgetful or lose track of time easily, the sponge, cervical cap and diaphragm might be difficult to keep consistent. Know which methods protect against STIs/STDs and which are pregnancy-prevention only. It’s also perfectly okay to try something and then decide it doesn’t work for you and move onto another method; we all have a bit of trial and error. Consult your doctor or midwife and discuss what would work best for you based on your insurance and your body.
Written by: Lorean Cassidy
Medically Reviewed by: Danielle LeBlanc, RN
All content found on this Website, including: text, images, audio, or other formats, was created for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
(1). Bedsider.org, “Spermicide,” last updated 2016 https://www.bedsider.org/methods/spermicide
(2). Mayoclinic, “Vasectomy,” February 14 2019 https://www.mayoclinic.org/tests-procedures/vasectomy/about/pac-20384580
(3). NHS, 2018, “The Progestogen-Only Pill” https://www.nhs.uk/conditions/contraception/the-pill-progestogen-only/
(4). Planned Parenthood, 2019, “Birth Control Sponge” https://www.plannedparenthood.org/learn/birth-control/birth-control-sponge
(5). Planned Parenthood, 2019, “Cervical Cap” https://www.plannedparenthood.org/learn/birth-control/cervical-cap
(6) Planned Parenthood, 2019, “Diaphragm” https://www.plannedparenthood.org/learn/birth-control/diaphragm
(7) Planned Parenthood, 2019, “Fertility Awareness” https://www.plannedparenthood.org/learn/birth-control/fertility-awareness
(8) Planned Parenthood, 2019, “How do I buy internal condoms” https://www.plannedparenthood.org/learn/birth-control/internal-condom/how-do-i-buy-internal-condoms
(9) Planned Parenthood, 2019, “Pull-Out Method” https://www.plannedparenthood.org/learn/birth-control/withdrawal-pull-out-method
(10) Planned Parenthood, 2019, “What are non-hormonal IUDs,” https://www.plannedparenthood.org/learn/birth-control/iud/non-hormonal-copper-iud
(11) Stang, Debra, “Hysterectomy: Purpose, Procedure and Risks,” January 11 2016, Healthline, https://www.healthline.com/health/hysterectomy