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Often, women talk about the side effects of hormonal birth control as if they just come with the territory. There’s the mood swings, heavy bleeding and cramps, and sometimes even spotting between periods.
Danielle Sinay, a Brooklyn-based writer, struggled with severe migraines, mood swings, and cramps for 10 years while taking Loestrin (a combination birth control pill). Last year, the 29-year-old finally quit taking the pill and started using a fertility awareness method (FAM) where she tracks her cycle with an app so she knows when to skip sex (or use protection) to avoid getting pregnant.
Now, she says she’s feeling much better: “I feel more clear-headed, almost lighter, and my pre-period migraines, which were regular, have significantly lessened in severity,” she explains.
Hormonal birth control methods—like the pill, ring, patch, or IUD—are the go-to choice for many women. For some, they can help regulate cycles, ease cramps and heavy bleeding, and dial down acne.
But for others, hormonal birth control can come with unwanted side effects like nausea and a lower libido. Plus, they come with an increased risk of depression, blood clots, and breast and cervical cancers. As a result, some women are turning to non-hormonal birth control alternatives, many of which are just as safe and effective.
But which non-hormonal birth control options are best? And how do they work? Here are 10 great alternatives to consider—with insights from real women who have tried them.
1. Copper IUD
“Many of us in the gynecology community recommend long-acting reversible contraceptions (LARCs) like the copper IUD,” says Mary Jane Minkin, M.D., a clinical professor of obstetrics and gynecology and reproductive sciences at Yale Medical School. Since half of pregnancies in the U.S. are unintended (and many can be linked to “user error,” like forgetting to take pills), the non-hormonal IUD (Paragard) is a smart place-and-forget-it pick, she says.
The copper IUD is over 99.9% effective.
It can be used within five days of unprotected sex as the strongest method of emergency contraception.
It lasts for 12 years.
Things to consider:
Insertion pain can range from very mild to severe.
It can cause heavier periods and cramping 3-6 months after implantation.
It doesn’t protect you from STIs.
In rare cases, you may experience pelvic inflammatory disease or perforation of uterine walls, or the device could move or fall out.
If you’re anxious, have a low pain tolerance, or have never been pregnant before, ask your doctor about pain management options before insertion.
Seek medical help if you experience chills, fever, heavy bleeding, or severe cramps after getting the IUD put in.
Non-steroidal anti-inflammatory drugs (NSAIDs) may help reduce copper IUD-related cramping and bleeding so talk to your doctor about side effect management.
After I was diagnosed with an endocrine disorder, I needed to have my hormonal IUD removed, but I still wanted a highly effective, temporary form of BC. Paragard fit the bill! Aside from very temporary discomfort during insertion, I’ve loved it. My periods are pretty light, normal in length, and I get at most 1/10 cramping a day before my period starts. I encourage my friends to try it. If you hate it, you can always get it taken out. —Sarah Cook, 38
2. Barrier methods
Barrier methods are not as effective as BC pills or the implant, injection, or IUD, but using more than one can increase the odds in your favor.
“Condoms, the sponge, and diaphragms are quite good together with a reliability almost comparable to pills with ideal usage,” says Dr. Minkin. However, you always need to use them—and sometimes, in the heat of the moment, that doesn’t happen.
Here’s what you need to know about different barrier methods and how they can be combined for greater effectiveness:
There are two types of condoms to choose from. The “male” condom is a thin sheath made of latex (rubber), polyurethane (plastic), or animal membrane (lambskin) worn on the penis. The “female” or internal condom is a thin pouch made of plastic with an inner ring at the cervix and outer ring at the opening of the vagina.
They’re affordable. You can get “male” condoms for less than $1 each when you buy them in bulk, and you can find “female” condoms for about $2-3 each or for free at many health centers.
“Female” condoms can be inserted up to 8 hours before sex.
Latex and polyurethane “male” condoms can protect against STIs including HIV while “female” condoms provide some protection from STIs.
Things to consider:
Condoms can be irritating if you’re allergic to latex or polyurethane.
Lambskin condoms don’t protect against STIs.
They may take some getting used to but can be incorporated into foreplay and could increase pleasure by making sex last longer.
Condoms are most effective in protecting against pregnancy and STIs when used with other barrier methods like spermicide.
Use water-based or silicone lubricant to prevent condoms from tearing or breaking.
Avoid oil-based lubricants like petroleum jelly (Vaseline), lotion, or baby oil which damage and could break latex condoms.
Don’t “double up” on male and internal condoms—they’re designed to be used alone, per Planned Parenthood
Store condoms in a cool, dry place (read: not inside your car) and check the expiration date and look for holes in the wrapper before use since they can break down over time.
When I was taking hormonal BC (Aviane combination pills and then the NuvaRing), I felt despondent a lot more than usual and would get a bad depressive episode once a month like clockwork. I quit using BC after a breakup and found that my personality and moods changed back to the way they were before. I’ve used condoms ever since and have been really lucky to never have a pregnancy scare. It’s slightly annoying to keep them on hand all the time, but I consider that a small price to pay for essentially getting my life back. —Kate Sloan, 28
The Diaphragm or Cervical Cap
Similar to menstrual cups, diaphragms and cervical caps are shallow cups made from soft silicone or latex that you put inside your vagina along with spermicide to cover your cervix and keep sperm away from an egg, according to the American College of Obstetricians and Gynecologists (ACOG). They’re about 71 to 88% effective, so around 12 to 29 out of 100 women who use one will become pregnant each year.
They’re affordable, small, and easy to keep on-hand.
They won’t kill the mood since you can put them in before sex.
They’re reusable and could last up to a year or so with good care and cleaning, according to Planned Parenthood.
Things to consider:
For them to work, you must add spermicide.
They may move out of place during heavy thrusting.
They don’t protect against STIs.
You’ll need a prescription before you can purchase one.
While rare, toxic shock syndrome (TSS) is a possible complication, so do not leave it in for over 24 hours or during your period, and call a doctor if you notice a sudden high fever, sunburn-like rash, diarrhea or vomiting, a sore throat or muscles and joints, or dizziness and weakness, notes ACOG.
Meet with a healthcare provider for a proper fit (and check in yearly to get it refitted if you gain or lose weight or become pregnant), advises Planned Parenthood.
Keep it in place for six hours after sex to ensure the spermicide has time to do its job. If you have sex again, simply apply more spermicide according to label instructions without removing the diaphragm and wait another six hours before removal, per ACOG.
In the past, hormonal BC made me feel imbalanced and moody. Now, I use the Caya diaphragm with Contragel, an all-natural alternative to traditional spermicide. It works great, and I don’t have any side effects. Most people think diaphragms are outdated, but it’s so easy to use and makes me feel very empowered. The only con is that sometimes it takes away from the spontaneity of the moment, but it’s just a quick delay and you can plan ahead on most occasions. —Linda Miriam, 38
A round piece of soft foam that contains spermicide, the sponge also covers your cervix and blocks sperm from reaching an egg. It’s around 88% effective if you’ve never given birth or 76% effective if you have given birth. For more protection, it can also be used with condoms.
It’s available over-the-counter.
It’s easy to keep on hand or pick up last-minute.
Packs of three cost about $15, and you may be able to get low-cost or free sponges at local health centers.
It provides protection for 24 hours and you can put it in before sex.
Since it’s soft and squishy, most people—partners included—don’t feel it, notes Planned Parenthood.
Things to consider:
The sponge shouldn’t be used when you have your period or vaginal bleeding, and it can increase your risk of TSS, according to Planned Parenthood.
It doesn’t protect against STIs.
It can be difficult to use correctly and must be left in six hours after sex but no longer than 30 hours.
It’s not reusable.
Sponge removal can be difficult, so “push” with your vaginal muscles to help.
If you notice the sponge causes dryness, add a water-based or silicone lubricant to increase your comfort.
Because the sponge is less effective after giving birth, wait six weeks for your uterus and cervix to return to their “normal” size before using it as BC, suggests ACOG.
I like the sponge because it's easy to access, cheap, and can be put in before any sexual encounters. It works great—I haven't gotten pregnant! But it can move around during sex, so make sure you know how it works with your anatomy (and your partner’s) to keep it in place. —Carly Sommerstein, age 55
Approximately 22% of American women choose tubal ligation (aka, female sterilization) while about 7% of Americans opt for a vasectomy (male sterilization), according to the Guttmacher Institute. Both methods are over 99% effective, making them great options if you’re sure pregnancy is not a part of your future plans. Here's what you need to know about both options:
Tubal ligation (female sterilization)
During a tubal ligation, the doctor either snips or blocks portions of your fallopian tubes. You typically get local anesthesia, and the procedure take 20-30 minutes. You can usually go home the same day.
It’s effective, convenient, and permanent.
Things to consider:
It typically cannot be “undone”—so you want to be sure this is the right decision for you.
It doesn’t prevent STIs.
There are rare but possible risks associated with surgery so talk out any safety concerns with your doctor.
If possible, give yourself a couple of days off to recover and avoid lifting heavy objects for one week, advises Planned Parenthood.
Call your doctor ASAP if you experience signs of a complication such as bleeding from incision, rash or fever, difficulty breathing, unusual vaginal discharge, or severe and constant belly pain.
Vasectomy (male sterilization)
If you’re with a partner who has a penis, a safe and nearly 100% effective alternative to female birth control is a vasectomy (a.k.a. male sterilization), according to Planned Parenthood.
During the procedure, which lasts about 30 minutes, a doctor cuts or blocks off the vas deferens, small tubes in the scrotum that carry sperm. Within three months, your partner’s semen should be sperm-free, making pregnancy an impossibility.
The procedure may sound scary but “most men can have it done on a Friday and be able to work on Monday,” says Elizabeth Kavaler, M.D., a urogynecologist and urological surgeon at Lenox Hill Hospital in New York City.
While generally quick and easy, vasectomies are designed to be permanent and typically cannot be reversed, so you’ll want to be sure this is the right decision for you as a couple. However, should you change your mind, you can try for a reversal or extract sperm from the testicles for in vitro fertilization (IVF), notes Dr. Kavaler.
A vasectomy is highly effective contraception.
It won’t change your partner’s sex drive, hormones, experience of an orgasm or ejaculation, or semen (besides the absence of sperm).
It’s generally six times cheaper than female sterilization options.
It gives your partner the ability to take the burden of contraception off of your shoulders.
Things to consider:
Vasectomies are meant to be a permanent solution and are difficult to reverse.
For the first three months, use backup birth control methods like condoms as sperm may still be present in semen, according to Planned Parenthood.
I decided to get a tubal ligation because I knew I never wanted to have children. The surgery went very smoothly with minor incisions and only mild soreness and some bloating that went away after a few days. I’ve heard about women facing pushback from doctors or requiring a partner’s consent. That’s ridiculous. If you know what you want, it’s your body and you should pursue it. Two years have passed, and I have no regrets. —Aurora Smith, 31
After I got my IUD taken out, I considering getting my tubes tied, but my husband offered to get a vasectomy instead. His friends had told him that the procedure was affordable, less invasive, and easier to recover from compared to a tubal ligation. We talked it over and agreed that this was his opportunity to “take one for the team” after I’d carried, given birth to, and breastfed our three children. —Rucha Depina, 31
4. Fertility awareness methods
Fertility awareness methods (FAMs), also known as natural family planning and the rhythm method, help you track your menstrual cycle so you know when you’ll be most fertile. Days near ovulation—when your ovaries release an egg each month—are the days you’re most likely to become pregnant, so that’s when you either avoid having sex or use barrier methods, per Planned Parenthood.
All in all, the effectiveness of FAMs is about 76-88%. Dr. Minkin says they’re fine to use if you wouldn’t be devastated by a pregnancy. But, if you’re a teenager going off to college, for example, it’s best to choose a more reliable form of birth control.
There are three main FAMs to consider:
The temperature method: Take your temperature every morning before you get out of bed or do anything else. Your temperature is typically lower in the first part of your cycle and rises when you ovulate (think: 96-98 degrees Fahrenheit before, 97-99 degrees Fahrenheit during ovulation). “Safe” sex days (meaning you can have unprotected vaginal sex) begin after the increase in your temperature lasts for at least 3 days and end when your temperature drops just before your next period, according to Planned Parenthood.
The cervical mucus method: Check your cervical mucus (vaginal discharge) every day before you pee with white toilet paper or tissue or clean fingers. Like your temperature, your cervical mucus changes during your menstrual cycle from dry to wet, sticky, cloudy, and slippery, notes Planned Parenthood. Typically, dry days after your period and cloudy or sticky days are “safe,” while days on your period or slippery days (when your cervical mucus can “stretch” when you separate your thumb and index finger) are fertile or “unsafe” days, indicating that you’re about to ovulate or ovulating.
The calendar method: Use a calendar or app like Spot On to track your menstrual cycle from the first day of your period (day one) to the beginning of your next cycle to figure out the typical length of your menstrual cycle for at least six periods. Choose your shortest cycle (say, 27 days) and subtract 18 from the total number of days (27-18=9). Then, count that number from day 1 (day 9) and mark it with an X for your first fertile or “unsafe” day. To predict the last fertile day, find the longest cycle in your record and subtract 11 from the total number of days (for example: 31-day cycle, 31-11=20). That day (day 20) is your last fertile or “unsafe” day of the month and you can begin having unprotected sex the next day in your cycle.
The more you know about your menstrual cycle, the better, so Dr. Minkin recommends combining multiple FAMs for the best results. Using all three at once is known as the symptothermal method.
FAMs are safe, inexpensive or free, and non-hormonal.
They can make you feel more aware of your cycle and connected to your body than before—which could also make family planning much easier when you’re ready.
Things to consider:
FAMs require a lot of time and discipline, so they’re not a great option if you struggle to log or track fertility signs on a daily basis.
They’re not a good solution if you have irregular cycles or abnormal vaginal discharge.
They don’t protect against STIs.
There can be a learning curve for FAMs, so consult with a doctor, healthcare provider, or counselor for help getting started.
Since FAM apps can be expensive, ask for free charts from your healthcare provider or find them online from resources like Taking Charge of Your Fertility.
Use multiple FAMs together for increased effectiveness and leniency should you make a mistake or forget to log one.
Research emergency contraception methods like the morning-after pill or copper IUD as backup if need be.
I didn’t feel well on an estrogen-only BC pill, so I tried switching to a lower-estrogen pill but that caused extreme fatigue and mild depression. After that, I decided to completely stop BC and use the fertility awareness method according to the book Taking Charge of Your Fertility by Toni Weschler. I printed out paper charts, set alarms, and recorded my temperature every morning. This method worked wonders for me. I was able to prevent pregnancy for nearly a year until my husband and I decided to have kids. —Kealy Hawk, 27
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