Hormonal birth control—starting with the pill— transformed the power women have over our bodies. For the first time, we had a convenient way of preventing pregnancy that didn’t require any action on the part of our partners. Since the FDA approved it as contraception in 1960, the birth control pill has seen widespread adoption: four out of five sexually experienced women have used the pill. We can celebrate this medical advancement that resulted in more personal and financial independence for women. But that doesn’t mean it’s right for everyone. While hormonal birth control has proven effective and convenient, there are many reasons women might want to try non-hormonal birth control, too.
Before we get to non-hormonal birth control options, let’s understand how hormonal birth control changes our menstrual cycles. The birth control pill, which contains synthetic estrogen and progesterone, works by preventing ovulation. In other words, there’s no egg for the sperm to meet up with each month. The hormones also thicken cervical mucus, acting as a barrier for sperm to enter the vagina, and thin the uterine lining to make implantation difficult. Hormonal IUDs like Mirena contain just synthetic progesterone and thicken cervical mucus, while often preventing ovulation, too. IUDs also change the uterine lining to make implantation difficult. Other hormonal birth control options — like the patch, ring, or implant — work in similar ways.
While these forms of birth control are ideal for many women, others are looking for natural or hormone-free birth control methods. Maybe they’ve experienced side effects, are breastfeeding, or simply want to ditch hormonal methods to get back in touch with their menstrual cycles. If you’re looking for an alternative, you might feel overwhelmed, but there are numerous options and methods to choose from. Below is a list of your options, as well as the pros and cons of each.
Non-hormonal Birth Control Options
The Copper IUD:
How it Works: Instead of calling on hormones, a small amount of copper is wrapped around this T-shaped device that is inserted into the uterus. Since sperm doesn’t like copper, this non-hormonal IUD works as a natural spermicide, impairing the little swimmers before they can reach an egg. Copper IUDs also change the uterine lining, preventing implantation if sperm does in fact meet an egg. Currently, the Paragard IUD is the only copper IUD available in the US.
Success Rate: Copper IUDs are more than 99 percent effective at preventing pregnancy for up to 12 years.
Pros and Cons: Once you get a copper IUD, you likely don’t have to think about contraception again for years. There’s no taking a pill every day or interrupting sex to use a condom. When you do take it out, you can get pregnant right away. In addition, a copper IUD can be used as emergency contraception. When inserted up to five days after unprotected sex, they are about 99 percent effective at preventing pregnancy. Since they’re hormone-free, you won’t experience any hormone-related side effects.
IUDs can be painful when inserted by doctors and they do not protect against STDs. With the copper IUD, you may experience heavier periods or worse cramps, but they should subside in three to six months. You could also experience an ectopic pregnancy, where an embryo implants outside the uterus, but copper IUDs do not increase your risk of ectopic pregnancy. In fact, the risk of such pregnancy is much lower than the risk to women not using contraception. If you’re at a higher risk of contracting gonorrhea or chlamydia, you should avoid getting an IUD, since STDs can lead to complications.
How it Works: The most famous barrier method of birth control is the condom. It works by covering the penis with latex, plastic, or lambskin and collecting semen during sex so sperm cannot enter the vagina. Condoms can prevent pregnancy as well as STDs.
Condoms aren’t the only form of birth control that creates a barrier between your genitals and your partner’s genitals. The internal condom (or female condom) can be placed in the vagina or anus to stop sperm from reaching the egg or from transferring potential STDs.
Other barrier methods include a diaphragm, cervical cap (FemCap), or contraceptive sponge. A nurse or doctor can fit you for a diaphragm, which is a silicone disk inserted into the vagina to block sperm from getting in. A diaphragm is meant to be used along with spermicide. You also have to be fitted for a cervical cap, which is smaller than a diaphragm but also made of silicone to cover your cervix. The sponge, which is made of plastic and includes spermicide, is also placed in your vagina before sex to block the entrance.
You can insert a diaphragm two hours before sex and leave it in for 24 hours, while a cervical cap can go in up to 42 hours before having sex and stay in your vagina for up to two days. The sponge can be inserted up to 24 hours before having sex, and shouldn’t be left in for more than 30 hours. You should leave all of these options in your vagina for at least six hours after intercourse.
Success Rate: Condoms are 85 percent effective, internal condoms are 79 percent effective, diaphragms are 88 percent effective, the sponge is 76 to 88 percent effective, and a cervical cap is 71 to 86 percent effective.
Pros and Cons: Condoms and internal condoms are the only forms of contraception that protect against STDs. The diaphragm, cervical cap, or sponge do not, but they do provide effective, hormone-free protection against pregnancy. The main downsides of barrier methods are that you have to use them every time you have sex and they could change the sensation for you or your partner.
How it Works: You place spermicide deep into your vagina before having sex. This contraceptive method blocks sperm from getting inside and also impairs them so they can’t effectively reach an egg. While it’s a chemical, spermicide is considered hormone-free birth control. You can use spermicide on its own or with other forms of birth control, including barrier methods.
Success Rate: Spermicide is 71 percent effective. When used with other forms of contraception, the rate goes up.
Pros and Cons: You can buy spermicide at your local drugstore. Since you can put it in your vagina before having sex, you don’t have to interrupt the act itself to use it. Since it does contain chemical ingredients, it could be irritating to you or your partner and can taste unpleasant. And it does not protect against STDs.
How it Works: There are two common forms of permanent, non-hormonal birth control: tubal ligation and vasectomy. Tubal ligation involves surgically closing or blocking your fallopian tubes, also known as having your “tubes tied.” After the procedure, sperm cannot get to an egg. During a vasectomy, the doctor will cut or block the tubes in a man’s scrotum that transport sperm.
Success Rate: Both tubal ligation and a vasectomy are more than 99 percent effective, but each can take up to three months to start working.
Pros and Cons: Sterilization does not protect against STDs. Tubal ligation is not reversible or the right choice if you want to get pregnant again. Vasectomies are also meant to be permanent, but they are easier to reverse than tubal ligation. Like any medical procedure, there are small risks of infections or complications.
On the upside, tubal ligation won’t change your periods or interfere with hormones. For men, a vasectomy won’t change the way they orgasm or have any noticeable impact on the character of their semen. Basically, everything stays as it was before—except you can’t get pregnant or get someone pregnant.
How it Works: The pull-out method works by pulling out the penis before ejaculation. This keeps the sperm from entering the vagina.
Success Rate: In practice, the pull-out method is 80 percent effective. If you do it perfectly every time, you can get that rate up to about 95 percent.
Pros and Cons: The pull-out method is better than nothing and could be a good option if you and your partner become pros at it. That being said, it is easy to mess up and there is a small risk that precum could include live sperm. In addition, as a woman, you have to truly trust your partner to get it right. With the pull-out method, you are ceding control of your contraception. It also doesn’t protect you from STDs.
Fertility Awareness Method (FAM):
How it Works: If you ever have tried to conceive, you might have learned to look for the signs of ovulation. In the context of wanting to get pregnant, these fertility signals tell you now is the time to have sex. If you don’t want to get pregnant, you can use the same signs as forms of natural birth control that let you know when to avoid having sex or when to add extra protection like a condom. This method is called the Fertility Awareness Method (FAM).
This form of “birth control”—also known as “natural family planning” and “the rhythm method”—involves tracking when your body is releasing an egg. By taking your basal body temperature every day so you can spot a spike, looking for stretchy “egg white” cervical mucus, and charting your cycle on a calendar, you can begin to spot your fertile days and act accordingly. Your fertile window can last up to 10 days, and that’s when you want to avoid unprotected sex. There are various apps that will help you stay on top of everything.
Success Rate: Practicing fertility awareness is anywhere from 76 to 88 percent effective. It can also help improve the effectiveness of other non-hormonal birth control methods, if you only have protected vaginal sex on your non-fertile or less-fertile days.
Pros and Cons: With fertility awareness you work with your body’s natural cycle to avoid pregnancy. But you have to be dedicated to tracking your cycle every day and open to avoiding vaginal sex or using another form of birth control for part of the month. It also won’t work if you have irregular periods or ovulation patterns. And of course, it doesn’t protect against STDs.
The Case for Non-hormonal Birth Control
“The thing that most non-hormonal contraceptives have in common is the absence of high-dose estrogen,” Dr. Jerilynn C Prior told me. She’s a Professor of Endocrinology at the University of British Columbia and founder of the Centre for Menstrual Cycle and Ovulation Research. While the dose of this synthetic form of estrogen (known as ethinyl estradiol) has decreased by about 80 percent from the 1960s to today, it can still cause side effects.
“The number of women having adverse reactions has decreased, but feeling a dulled interest in sex, lowered vitality, sore breasts, or fluid retention do occur for some women,” she explained. Other adverse effects of hormonal birth control, according to Prior, could include delayed fertility for about nine months after stopping, or decreased bone density in teens. For teens specifically, Prior recommends the copper IUD, for its ease and lack of hormones.
Even if you’ve taken the pill for a decade with no medical side-effects or love that your Mirena IUD has made your monthly period disappear, there could be other reasons to switch to a non-hormonal option.
“Aside from the health impact, there is value in having a changed relationship with your period,” Holly Grigg-Spall, author of “Sweetening the Pill: Or How We Got Hooked On Hormonal Birth Control,” told me. While she acknowledges that menstruation can come with painful symptoms like period cramps, she believes seeing your natural menstruation pattern as a whole cycle and not just a singular event or means to pregnancy can change your relationship with your body. “I believe it can combat shame, the menstrual taboo, and feelings of fear of your body. I think it can increase confidence and body positivity. I think you’re in a stronger position to be more empowered and have agency,” she said.
What Happens When You Switch to Non-Hormonal Birth Control?
When you make the switch from hormonal to non-hormonal birth control, you may experience irregular ovulation or slightly longer cycles for six to nine months, Dr. Prior told me. Eventually, your body should return to its previous type of cycle. So if you didn’t have periods before, you would return to having no flow. Or if they were heavy, you can expect that again. If you haven’t had your period in a while, choosing which brand of feminine hygiene products you want to buy may feel overwhelming. Brands like Cora offer organic tampons and pads, which many women seeking a more natural lifestyle can feel good about purchasing.
Grigg-Spall encourages women to own their natural cycles. “Everything we discuss around reproductive biology is very negative. You’re taught that you’re lesser for having a period, and that’s aside from the issues you may have with your period,” she pointed out, adding that we’re taught it’s best to hide or not experience a period. Grigg-Spall finds that getting back in touch with your cycle can be very transformative: “You can have ownership over your body through knowledge of your body. That can impact the conversations we have around consent, when and if we want to get pregnant, and power.”
More than 99 percent of sexually active women of reproductive age in the US have used at least one form of birth control. While the desire to prevent pregnancy at some point in our lives is almost universal, the options for doing so vary. Once you truly understand the options—including non-hormonal birth control—you can choose the best one for you with confidence.