The pill is the most widely used female birth control in the U.S. It and other hormonal contraceptives change your hormone levels to keep your eggs from being released, thicken your cervical mucus so sperm can’t get through, or thin your uterine lining so that any fertilized egg can’t attach and grow.
But you may not always want or be able to use hormones to prevent a pregnancy. If so, you have several hormone-free options. Many of these methods work by killing the sperm or blocking it from meeting the egg.
Why Not Hormones?
Hormonal contraceptives like the pill, vaginal ring, patch, and the implant can be convenient and very reliable. But they might not be the ideal choices for you. Reasons include:
- You have to remember to take the pill at the same time every day.
- You need to see a doctor for prescriptions or for the procedure to insert the device.
- Hormonal contraceptives don’t protect you from sexually transmitted diseases.
- They may raise your chances for blood clots or breast cancer, or cause side effects like mood swings or weight gain.
- You may not have sex often enough to need ongoing birth control.
- You’re concerned about passing hormones to your baby through breastfeeding.
Many of these are called barrier methods because they physically come between the egg and sperm. Your chances of getting pregnant in a given year vary widely depending on the device, from less than 1 in 100 for copper T IUDs to more than 1 in 4 for spermicides.
How well does it work? If you use the diaphragm correctly and couple it with spermicide, you have a 6% chance of getting pregnant after a year’s use. But the odds double if you use it imperfectly or not always, the way a typical person does.
Pros and cons. You can carry your diaphragm and insert it just before you have sex. It’s reusable for 12 months. If you decide you want to start a family, stop using it. The downside is that a diaphragm won’t protect you from STDs. You have to leave it in for at least 8 hours after intercourse. You also may be more likely to get vaginal or urinary tract infections.
What is it? It looks like its name: a little hat-shaped piece of silicone that you put over your cervix to keep out sperm. As with a diaphragm, you must be fitted by your doctor and should couple it with spermicide.
How well does it work? The cervical cap isn’t widely prescribed, and it can take practice to use it right. It can fail about 20% of the time, meaning 20 out of 100 women will get pregnant in a year.
Pros and cons. You can leave the cervical cap on for up to 48 hours after sex. You can try to get pregnant anytime. It won’t prevent STDs. It can up your chances of bladder infections. It’s not recommended if you have sex at least three times a week or have a history of pelvic diseases.
What is it? Made of foam, it works the same way as a diaphragm or cervical cap. The two big differences with the sponge is that it already contains spermicide, and you can buy it over the counter without a prescription.
How well does it work? The sponge can be among the least reliable birth control for some people. It prevents pregnancy about 91% of time for women who’ve never given birth and who use it correctly and consistently every time. But that drops to just 76% for women who have had children and who use it the way most people do.
Pros and cons. The polyurethane foam feels like your vaginal tissue. You can have intercourse multiple times in a 24-hour period. You can stop using it and try to start a family right away. It won’t prevent STDs.
What is it? This T-shaped plastic is a non-hormonal type of intrauterine device. It goes into your uterus. It’s wrapped in copper, which is toxic to sperm and keeps them from swimming through the vagina to reach your egg or, failing that, prevents the fertilized egg from attaching to your womb.
How well does it work? IUDs are some of the best-working forms of birth control. Copper versions are less effective than hormone-based IUDs, but they still prevent conception more than 99% of the time.
Pros and cons. You can leave a copper IUD in for 10 years. It can work as an emergency contraception up to 5 days after you’ve had unprotected sex. If you decide you want to become pregnant, you’ll need a doctor to take it out. It doesn’t protect against STDs, so you’ll need to use a condom if that’s a concern. The device can cause bleeding between periods or give you cramps.
What is it? You put this chemical into your vagina to kill or paralyze sperm. You can buy spermicide over the counter in several forms, including gels, foams, and suppositories.
How well does it work? Not well. Spermicide alone can fail about 28% of the time. It can be used with condoms, diaphragms, and other contraceptives to boost their effectiveness.
Pros and cons. Some people are allergic or sensitive to the main chemical used in spermicide, nonoxynol-9. You shouldn’t rinse out your vagina for at least 8 hours after using a spermicide, and some may leak out. It will not protect you against STDs like HIV. In fact, infections might be more likely if the spermicide irritates your vagina.
What is it? A lubricated man-made latex (rubber) tube that you put inside your vagina. It has flexible rings on both ends, one of which is closed to keep out sperm.
How well does it work? In a given year, about 1 in 5 women get pregnant. You have to use it every time and in the right way for it to work well.
Pros and cons. Condoms for females and males are the only forms of birth control that guard against both unplanned pregnancies and STDs, including HIV. You can buy them in drugstores or online. Allergies and side effects are rare. It may not be a good choice if you’re young or have a lot of sex and have a higher chance of getting pregnant.