Non-Hormonal Birth Control Options & Finding What’s Right For You

The full DL.

By Lauren Zielinski, MSN, CNM

Women decide to move away from hormonal birth control for many reasons, and from my experience working as a women’s health provider – the requests for more natural options are greater than ever before. Maybe this sounds familiar? Or perhaps you’re curious about why one would choose non-hormonal vs hormonal birth control?

Read on for my take on the benefits and a breakdown of options and efficacy of each birth control option!

photo by Kristen Kilpatrick

Reasons You May Consider Ditching Hormones

1. They’re killin’ your vibe! Hormonal birth control can be life rocking for some women. Not every one of these side effects plague every user but when they do – they kinda stink- bloating, weight gain, increased appetite, increased risk for blood clots, migraines or headaches, a decrease in sex drive and a decrease in natural vaginal lubrication are a few of the most common side effects from hormonal birth control. Not surprising that some women just do not dig taking estrogen.

2. Other women are planning to conceive sooner than later and want to begin to track their natural cycle, get in the rhythm and see what their body does off of hormones. It can take up to 9 months to conceive after stopping hormonal birth control so it’s not unwise to ditch the pill, patch, ring or shot well in advance of when you would like to make a baby.

3. Other women simply prefer not to use synthetic hormones in their bodies– would like a “break” after using them for many years – or are concerned about the effects of long term estrogen.

While there are certainly some risks associated with hormonal birth control, I’m a firm believer in the large bodies of research that show the benefits outweigh the risks for the majority of the population – however not everyone is the majority, and it’s not the right time in everyone’s life to use hormonal BC – it’s important to listen to your body and choose wisely for yourself—and if that means no hormones, you have many options! Let’s look at them below: 

Non-Hormonal Birth Control in Order of Effectiveness:

Copper IUD (99% Effective)

What: The Copper IUD is a small T shaped piece of plastic wrapped in copper that is inserted into your uterus by a trained provider:

*Size* think half the length of your pinky finger with a diameter about as wide as a cooked spaghetti noodle (I know, weird reference) 

During a speculum exam (similar to when you get a pap smear), the provider will use a very thin insertion device to go through the small opening in your cervix called the cervical os to then place the IUD inside your uterus.  When your provider is done placing the IUD, two small strings about 3 centimeters long  (they’re soft like fishing wire) will protrude out of the opening of the cervix. These strings are attached to the bottom of the IUD and allow the provider to pull out the device when it’s time and allow you to check for correct placement while it’s in (These strings are typically not felt or noticed by your partner). The IUD stays in your uterus for up to 10 years preventing pregnancy very well that entire time.

How:  The copper IUD works by way of the fact that sperm and copper are not friends. The IUD releases copper ions that act as spermicide and create an unfriendly environment to host a pregnancy. 

Good To Know: If you have very heavy periods or very bad cramps naturally, the copper IUD is not the best option for you – it tends to make cramps and periods a little bit stronger and longer.

photo by Hannah Haston

Diaphragm (88% Effective)

What: The diaphragm– blast from the past ya’ll – these cute little devices reminiscent of a pink bubble that gained popularity in the 70’s and 80s are baaaaack. Why? Because they are natural, hormone free, easy to use and work pretty well. The diaphragm is a soft, shallow, flexible silicon cup that is placed in the back of the vagina to cover the cervix before sex. You cover the bubble in spermicide and insert it into the vagina, over the cervix, before sex and leave it in for 6 hours after to be sure no sperm sneak through in the meantime. 

How: It physically blocks sperm from entering through the cervix into the uterus combined with the chemical and phagocytic (sperm destroying) action of the spermicide.

Good to know: You can insert the diaphragm before you go out for the night or before you think you *may* have sex to try to increase the spontaneity and decrease the “hang on one second while I insert my diaphragm moment.” You just need to apply a little more spermicide right before intercourse if it’s been more than 3 hours since insertion. You also don’t want to keep the diaphragm in your vagina for longer than 24 hours as it can increase your risk for toxic shock syndrome.

If you’re interested I would ask for this new brand of diaphragm called Caya. It’s one size fits all, and is really easy to insert and remove.

I recommend you use this awesome natural and vegan spermicide that doesn’t contain Nonoxynol-9 which is a harsh chemical found in most spermicides, it’s called contragel, available on amazon here.

Condoms (85%)

What: Most people know what condoms are, you may have even awkwardly applied one to a banana in Jr. high. Fun fact: one time I went to a gay bar in San Francisco where individually wrapped condoms were showering the dance floor (being released from the ceiling in waves in 30 minute intervals) and I slipped on one and fell over dancing in heels and a skirt. These thin latex sheaths have a reservoir for ejaculate and are applied over the penis before sex (yes, this should occur before any penetration happens).

How: Condoms act as a physical barrier between sperm and your reproductive organs.

Good to Know: Condoms are only 85% effective with “typical use.” That includes the timing of when the condom is put on and accounts for the risk of it breaking or leaking. To increase the effectiveness be sure your partner applies it before his penis gets anywhere close to your vagina, that it fits him well, and that you’re using water based or silicone based lubricant as other lubes (like coconut oil) can decrease the integrity and increase the chance the condoms breaks. The more “perfect your use” the higher the efficacy.

photo by Kristen Kilpatrick

Coitus Interruptus / Pull Out or Withdrawal Method (78% Effective)

What: Another oldie but goodie. The pullout method dates back 2,500 years, it was first mentioned in the Torah! Whoa! This is the physical act of the penis being withdrawn from the vagina before ejaculation occurs.

How: This method relies solely upon your partner’s judgement and the success is dependent on their ability to withdraw at a very precise time. Self control, a good sense of timing and and the ability to remove their penis totally out of the vagina pre-orgasm are important for your partner.  This method also does not account for “pre-ejaculation” and any sperm that may find their way into your body before they ejaculate.

Good to Know: This method is more effective the more “perfectly” you use it, however it’s very difficult to determine how well you’re doing. The efficacy could be increased by using both withdrawal and the fertility awareness method below. Used alone 4 women in 100 will get pregnant using only “pulling out”.

Fertility Awareness Method / Cycle Tracking (76-88%)

What: This method utilizes many different “signals” from your body that assist you in predicting when you’re ovulating, when you’re potentially fertile and when you may be safe to have unprotected or somewhat protected sex.

How: By tracking your period on a calendar or in a period tracking app, checking your cervical mucus for signs of fertility (thin and stringy = fertile, thick and creamy = non fertile *Typically*), checking your temperature, checking the position of your cervix, or checking your urine with a dipstick for “ovulation hormones,” women are often able to successfully avoid pregnancy. Not every woman uses all of the above “signs” from their body to predict when they may be fertile. Some women use calendar tracking + temperature or some use calendar + discharge etc. Your period must be very regular to accurately use this method. You typically ovulate about two weeks before the first day of your last period (if your cycles are regular), so you’re able to predict when you will ovulate every month based on what’s average for you and avoid sex during high risk times (before, during and after ovulation).

Good To Know: This method also heavily relies on your motivation, ability to use protection or abstain from sex during fertile or ovulatory windows and often requires daily maintenance. It’s a beautiful way to get in tune and in sync with your body and empower yourself with information, it’s also a great jump start if you’re considering pregnancy soon as it will be easier to time when you need to have sex.  This method deserves an article all it’s own and there is a ton of great literature online with more detailed instructions. I also recommend the book Taking Charge of Your Fertility By Toni Weshler. 

Whatever method you choose be sure you’re well informed, using it appropriately and understand the potential for pregnancy. It’s all about where you are in life and how comfortable you are with the % of risk you’re willing to take on. It’s a great idea (if you have a partner)  to get them on board and talk about what they feel comfortable with, how willing they are to participate and assist in the effort and let that help guide your decision. Happy well protected and empowered sex to you all my friends!