Non-Hormonal Birth Control: What Are My Options?
When we first choose a birth control method, we’re confronted with a number of options. Usually a doctor rattles off a long list of options and then advises that the pill will be easy and effective. Maybe they recommend an IUD if taking a pill everyday seems unlikely.
They’re right. These hormonal options are simple, they prevent pregnancy and might even temporarily affect acne or other hormonal issues – but they can also cause a battery of side effects.
Despite this, other alternatives (like non-hormonal methods) are quickly brushed over or dismissed altogether as dated, unreliable, or overly-complicated. They’re positioned as hoaky, pseudo-scientific methods that were popular in the ‘70s and should only be used if you’re “only-sorta trying not to get pregnant.”
Luckily, this couldn’t be further from the truth.
There are several non-hormonal options, some more common than others, that are reliable, simple and effective. Best of all, most have little to no side effects.
Consider this your introduction to non-hormonal birth control. Haven’t heard of some of these methods before? Don’t worry, we’ve got you. Welcome to the education you wish you got in school.
Fertility Awareness Method (FAM)
For this method, the user tracks their cycle and fertility signs daily. There are different schools of thought and methods of FAM, but most suggest that you track at least two of the following markers:
Basal body temperature
Cervical fluid
Cervical positioning
LH hormone levels
By recording these markers, you’re able to determine when you’re fertile and should avoid intercourse. This method is up to 99.6% effective with perfect use – this means practicing the rules that have been taught by a qualified professional. And no, watching a few TikToks from someone who uses FAM does not count!
With typical use, efficacy falls between 80-87%. This is because people have sex during their fertile window or do not track accurately. Others don’t learn from a qualified instructor or are not clear about the rules.
Like other non-barrier methods, FAM doesn’t protect against STIs.
When done correctly, FAM is a fabulous option because it’s hormone and side-effect free. It’s low cost (just buy a thermometer and some LH strips) and relies mostly on your self-observations. And the best part: it tracks more than your ovulation and period. Noting these markers and understanding your cycle informs you about our hormonal functioning, immune system, liver, thyroid and overall health. It can also cultivate a deeper connection with, and empathy for, your body.
FemTech Devices: Daysy and Natural Cycles
These methods are like automated FAM – they use algorithms to predict when you are and are not fertile. Unlike FAM, this is a temperature only method. With perfect use, it’s about 98% effective but typical efficacy is around 93%.
Natural Cycles costs about $100 CAD per year including the thermometre, it’s FDA approved and CE marked. Daysy, a similar service has an upfront one-time cost of $430 CAD. For this method, you simply input your temperature and menstruation days, and it does the rest.
“In 2023, we’re on the cusp of some really exciting developments. Tons of research is being done to bring more hormone-free products to market that are safe, easy and effective.”
But remember: our bodies can change from day to day and cycle to cycle. You may want to learn more about your fertility signs and track those in addition to your FemTech method for maximum efficacy. As with FAM, this method does not protect against STIs.
Copper IUD (Paraguard)
This is a non-hormonal intrauterine device, a T-shaped implement that’s inserted into the uterus to prevent pregnancy. It works by reducing sperm survival and motility – with the copper IUD, the sperm can’t find and fertilize the egg.
It’s FDA approved for up to 10 years of use, so this method is a good option for those interested in a long-term solution. The copper IUD is 99%+ effective and unlike hormonal versions, it does not suppress your ovulation or natural cycle.
Condoms
Condoms, probably the most common barrier method, are placed on an erect penis before having sex.
*Cue mental image of sex-ed teacher putting a condom on a banana*
With perfect use they’re 98% effective at preventing pregnancy, but efficacy falls to 85% with typical use. Condoms can fall off, have defects, or pre-ejaculatory fluid can come into contact with fertile cervical mucus. As a result, and because they only cover a limited surface area, they’re not considered a reliable way to protect against STIs.
They’re most often made of latex, rubber, plastic or other synthetic fibers. These can contain harmful chemicals, but luckily there are non-toxic options on the market like Jems.
Sterilization (also called Tubal Ligation)
Surgical sterilization blocks the fallopian tubes so that sperm can’t reach the egg and the egg can’t implant into the uterus. It’s a 99%+ effective permanent solution for preventing pregnancy.
It’s also the most common contraceptive used world wide. As of 2019, 23.7% of women currently using contraception – that’s around 219 million women – rely on sterilization. Alarmingly though, over ⅓ of women and people who menstruate who have undergone sterilization struggle with a host of post-procedure issues, including headaches, loss of libido and chronic fatigue.
Sterilization has a complex and fraught history. It’s been used on many – mostly women of colour – without their knowledge or consent. Others, especially those who are young or have not had kids, are often denied access to the procedure. In fact, many feel like they have to convince their doctors to perform the procedure on them.
Tubal ligation is not wholly good or bad. It’s been used both as a tool of oppression and liberation, and people’s experience of the procedure depends greatly on their position in society.
Some Less Common Non-Hormonal Birth Control Methods:
Diaphragm (Cervical Cap)
This is a thin silicone dome-like structure that’s inserted through the vagina before penetrative sex. It covers the cervix and prevents sperm from moving through to the fallopian tubes. This method is usually used with spermicides to prevent sperm survival.
Used perfectly every time, it’s about 92-96% effective. But of course, people don’t always follow the directions and sometimes even forget to use it, so realistically the diaphragm’s only 87% effective. Additionally, it doesn’t protect against STIs.
Though it’s an option, it’s not the best method on the market. Spermicides can cause unwanted side effects like vaginal irritation and discharge.
Sponge
The sponge is a piece of plastic foam that’s inserted into the vagina before intercourse. It works like the Diaphragm, by covering the cervix and preventing sperm from moving past it. But unlike the Diaphragm, it doesn’t have to be supplemented with spermicides – it already contains spermicides which it releases to help kill sperm.
Interestingly, this method is almost 10% more effective for those who have never given birth. This is because the cervix can stretch or change shape after giving birth. With perfect use, it’s about 80-88% effective in preventing pregnancy, but usually more like 76%.
The sponge isn’t the most reliable contraceptive option. It’s also not ideal to have to insert a plastic instrument into a highly absorbable area of the body, every time you have penetrative sex. And, as with the Diaphragm, introducing spermicides into the body can cause unwanted consequences.
Phexxi®
This is a new method recently made popular by Schitts Creek Star Annie Murphy. It’s not a spermicide, but it works in a similar way. Phexxi is a prescription gel that’s inserted into the vagina before intercourse. It changes the pH of your vagina, preventing sperm motility and survival, and can be up to 99% effective.
Though Phexxi is part of an exciting trend of innovation in non-hormonal contraceptive options, changing the pH balance of your vaginal environment can cause unwanted side effects like burning, itching, yeast infections, bacterial vaginosis and general discomfort.
Internal/Female Condoms
Female condoms are similar to, but less common than, male condoms. Rather than being applied to an erect penis, they’re inserted into the vagina before penetrative sex. With perfect use they can be 95% effective and they help protect against STIs.
So there you have it, a quick introduction to the world of non-hormonal birth control. Some options might suit you better than others, but it’s important to remember that you have several choices. The pill isn’t the only answer and scary side effects are not your destiny.
Disclaimer! This does not constitute medical advice or replace the work of a licensed provider. Always check with your doctor before beginning any protocol.
