A Different Nonhormonal Birth Control Option
- By Huma Farid, MD, Contributor
Until recently, people seeking hormone-free birth control have found few options available. The most effective and long-lasting nonhormonal option is the copper intrauterine device . Barrier methods sometimes are paired with spermicide to boost pregnancy prevention rates, or spermicides may be used alone . Apps and tests to track fertile days bring a high-tech sheen to the so-called rhythm method, but most ob/gyns do not recommend these as a way to prevent pregnancy.
Not until 2020 did the FDA approve a new nonhormonal birth control, Phexxi, which came on the market last fall. Should you try it if youre looking for a new option?
Being Informed May Help A Woman Choose The Right Birth Control For Her
Nearly half of all pregnancies every year in the United States are not planned, yet around one-third of women who could become pregnant don’t use contraception. Why might a woman who doesn’t want to become pregnant not use birth control? Reasons vary but may include lack of access or knowledge, infrequent sex or concerns about how their health will be affected.
When it comes to helping women decide to use birth control, information often plays an important role. One large study found that teenage girls who had thorough sex education before becoming sexually active were more likely to use some type of birth control when they had sex.
Understanding the differences between hormonal and non-hormonal birth control can help you make the best choice for your body and your lifestyle.
When Hormones Aren’t An Option
According to the Nature commentary, about one-third of women globally discontinue hormonal birth control methods within the first year of taking them, often because of side effects.
That was the case for Lenise Sunny Wilson, who attributes severe depression to the birth control pills she had been taking.
It completely changed who I was as a person, said Wilson, 38, of Tucson, Arizona. It messed with my emotions and my mental health so intensely.
Wilson has since stopped taking the pill and, for the most part, she said, has returned to her sunny self.
Some women, including those with certain cancers and heart conditions, cant take hormonal birth control. Erica Twidle, 33, from Gallatin, Tennessee, was diagnosed with a rare heart condition called peripartum cardiomyopathy while pregnant with her daughter, Della. The condition made Twidles heart weak and enlarged, and although she eventually recovered, Twidles doctors told her she shouldnt take hormonal birth control, or get pregnant, ever again. Both would jeopardize her heart.
Twidle, whod had a bad experience with the copper IUD in the past, decided to track her cycle. But nine months after having Della, she was pregnant again. I cried when I found out, she said. I was terrified. I had a child I needed to stay alive for.
Twidle calls herself one of the lucky ones, since her heart stayed strong enough to support pregnancy. But had things taken a turn, Twidle was prepared to get an abortion to stay alive.
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How Does It Work
Phexxi is a contraceptive gel consisting of three active ingredients: lactic acid, citric acid, and potassium bitartrate.
To understand how it works to help prevent pregnancy, lets go back to the acids and bases of high school chemistry class. The vagina is naturally acidic, with a pH around 4. Semen is basic, with a pH around 7.5.
Normally when semen enters the vagina, it temporarily causes the pH to become more basic to ensure the survival of sperm. However, the three ingredients in the gel keep the vagina acidic. This helps immobilize sperm to keep them from swimming up the vaginal canal and through the cervix to reach and fertilize an egg. The gel also coats the cervix, which may prevent sperm from reaching the uterus.
How Long Does Birth Control Take To Work
Another benefit is that it can be safely used for up to 10 years and can be removed at any time. If your IUD expires, but you still dont want to get pregnant, you can have it replaced. People who want to avoid unnecessary hormones can benefit from a copper IUD because there are no added hormones .
While effective at preventing pregnancy, copper IUDs are not without some side effects or downsides. Some people report increased menstrual pain and bleeding early on, but this tends to decrease over time . There is a chance that the IUD can come out shortly after being placed, but your provider can place a new one for you. Lastly, IUDs do not protect against STIs like HIV, herpes, chlamydia, etc.
Although not technically a hormone-free form of birth control, its worth mentioning hormonal IUDs. They contain a form of progesterone that is only released into the uterine tissue . The hormones cause changes in the uterus lining that prevent implantation and thicken the cervical mucus. These factors create a barrier to fertilization .
Hormonal IUDs only last 36 years, depending on the dose, and are slightly more effective at preventing pregnancies than copper IUDs. However, you may experience hormonal side effects like headaches, breast tenderness, and mood changes .
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Side Effects Of Hormonal Birth Control Can Include:
- Being over 35 years old
If you don’t have any of these conditions, Ross says hormonal birth control is an equally viable option for you, as it is not inherently unhealthy. There are also low-dose and ultra-low-dose forms of hormonal birth control available, which may be another alternative for you.
Note: Hormonal birth control methods do not protect against sexually transmitted infections . Barrier methods like condoms can help prevent STIs, although the only reliable way to prevent them is to abstain from sexual activity.
Whats The Best Birth Control
The best birth control is the one that most effectively prevents pregnancy and fits with your lifestyle. Generally, a male condom plus another form of birth control is the most effective way to prevent pregnancy.
What’s “best” among birth control methods differs from person to person. What’s right for you may not be right for everyone. And your needs may change over time.
Hereâs what to think about when choosing a kind of birth control:
- How fail-proof do you need your protection plan to be?
- How much does the cost matter?
- How important is your privacy?
- Do you have a regular partner whose needs you care about?
- Do you need to protect against sexually transmitted diseases ?
- How much effort do you want to make to prevent a pregnancy?
- If you’re a woman, does it matter if your period is affected?
- Will you someday want to have a child?
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There Isnt A Right Age If Youre Ready Youre Ready
Theres no right age to start having sex, whether thats solo or partnered.
Some people have sex as teenagers, others wait until their twenties, and others choose to be celibate forever and theres nothing wrong with that. Its your choice!
Choosing to have sex is a personal decision, and its up to you whether you want to or not. Just remember to practice enthusiastic consent when youre with your partner and take measures to prevent unwanted pregnancy and sexually transmitted infections .
Does Birth Control Raise My Risk For Health Problems
It can, depending on your health and the type of birth control you use. Talk to your doctor to find the birth control method that is right for you.
Different forms of birth control have different health risks and side effects. Some birth control methods that increase your risk for health problems include:
- Hormonal birth control. Combination birth control pills and some other forms of hormonal birth control, such as the vaginal ring or skin patch, may raise your risk for blood clots and high blood pressure. Blood clots and high blood pressure can cause a heart attack or stroke. A blood clot in the legs can also go to your lungs, causing serious damage or even death. These are serious side effects of hormonal birth control, but they are rare.
- Spermicides . Spermicides that have nonoxynol-9 can irritate the vagina. This can raise your risk for getting HIV. Use spermicides with nonoxynol-9 only if you are in a monogamous relationship with a man you know is HIV-negative. Also, medicines for vaginal yeast infections may make spermicides less effective.
- Intrauterine devices . IUDs can slightly raise your risk of an ectopic pregnancy. Ectopic pregnancies happen when a fertilized egg implants somewhere outside of the uterus , usually in one of the fallopian tubes. An ectopic pregnancy is a serious medical problem that should be treated as soon as possible. IUDs also have a very rare but serious risk of infection or puncture of the uterus.
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Can You Make Contraception Part Of Your Daily Routine
If you’re a well-organised person with a reasonably regular routine, you have a wide choice of contraception.
This is because you’re less likely to forget about your contraception by forgetting to take a pill or reapply a patch, for example.
You may want to use a method that you only need to use when you have sex, such as the male or female condom, or you may prefer a method that you need to take every day, such as the pill.
Or you may want to consider methods like the patch, injection or implant, which you do not need to use every day or each time you have sex.
The list below shows how often you need to use, replace or take each contraceptive method.
Once you have looked at the list, ask your GP or a doctor or nurse at your local clinic for more details.
Methods used each time you have sex:
Methods taken on a daily basis:
- the pill , but there are some types of 21-day pill where you have a week “off” each month
Methods replaced every week:
Natural Birth Control: Does It Work
If youre looking for a 100% effective method for preventing pregnancy, theres only one way to go: abstinence. Some couples choose abstinence, which means refraining from sexual intercourse for religious, cultural, or medical considerations. Although not always the popular choice, abstinence is the most effective way to prevent pregnancy and reduce exposure to STIs.
Outercourse is another form of natural or non-hormonal birth control method. It encompasses all sorts of sexual activities, like kissing, masturbation, handjobs, etc., that dont involve penile penetrationno penetration means no pregnancy. However, this method does not necessarily protect against STIs.
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How Effective Is Phexxi Compared To Other Forms Birth Control
According to data cited by the FDA, Phexxi is about 86% percent effective with typical use. . Planned Parenthood says this means about 14 in 100 women who use Phexxi will become pregnant.
That’s much less effective than the implant, an IUD, or male or female sterilization, which has about a 99% effectiveness, per the CDC. Even with typical use the patch, the ring, the shot, and the Pill-which range from 91%-94% effective-are all also more effective than Phexxi.
Instead, the new birth control method is more on par with other non-hormonal methods like male and female condoms, diaphragms, spermicides, and the sponge, at preventing pregnancy. Worth noting: The CDC calls these methods “less effective” than their counterparts.
Planned Parenthood also says you can use Phexxi with plastic or latex condoms for extra protection against pregnancy as well as STDs. Phexxi can also be used with a diaphragm as well as some other types of hormonal contraceptives, like the patch, Pill, or shot. You should not, however, use Phexxi with a vaginal ring.
How Effective Is This Type Of Birth Control
FDA approval for this product is based on a multisite study that enrolled sexually active women ages 18 to 35 . Women who participated had regular menstrual cycles and a single male partner. They agreed to just use Phexxi for birth control except for morning-after, emergency birth control, if necessary and engage in heterosexual intercourse at least three times during each cycle throughout the study.
Results collected over seven cycles show that nearly 14% of 1,183 women who completed the study became pregnant.
Overall, the efficacy rate of Phexxi is 86% for typical use.
Phexxi can be combined with some other forms of birth control to increase the odds of preventing pregnancy. Compared with other nonhormonal birth control methods it seems to be more effective at preventing pregnancy than withdrawal natural family planning barrier methods such as condoms and diaphragms and most spermicides . However, as a nonhormonal option, the copper intrauterine device is far more effective.
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Types Of Nonhormonal Birth Control
- What is it? A saucer-shaped silicone cup that you put into your vagina to block semen from entering your womb. You must be fitted for a diaphragm at first by your doctor.
- How well does it work? If you use the diaphragm correctly and add spermicide, you have a 6% chance of getting pregnant after a yearâs use. But the odds double if you donât always use it or donât use it exactly right, the way a typical person does.
- Pros and cons. You can carry your diaphragm and put it in just before you have sex. Itâs reusable for 12 months. If you decide you want to start a family, stop using it. A diaphragm wonât protect you from STDs. You have to leave it in for at least 8 hours after sex. You also may be more likely to get vaginal or urinary tract infections. Learn about the best ways to prevent a UTI.
Outercourse and the pull-out method
Natural family planning
How Does Birth Control Work
Birth control works to prevent pregnancy in different ways, depending upon the type of birth control you choose:
- Female or male sterilization surgery prevents the sperm from reaching the egg by cutting or damaging the tubes that carry sperm or eggs .
- Long-acting reversible contraceptives or “LARC” methods prevent your ovaries from releasing eggs, prevent sperm from getting to the egg, or make implantation of the egg in the uterus unlikely.
- Short-acting hormonal methods, such as the pill, mini-pill, patch, shot, and vaginal ring, prevent your ovaries from releasing eggs or prevent sperm from getting to the egg.
- Barrier methods, such as condoms, diaphragms, sponge, cervical cap, prevent sperm from getting to the egg.
- Natural rhythm methods involve avoiding sex or using other forms of birth control on the days when you are most fertile .
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What Are The Best Birth Control Options That Arent Hormonal
I need a contraceptive that isn’t hormonal. I’m allergic to condoms. I’ve heard a copper IUD can be painful or dangerous. What are my options?
If hormones arent your thing, you still have a few birth control options. But first, when you say youre allergic to condoms, are you sure youre not just allergic to latex? There are condoms made from a few different materials out there, like polyurethane and polyisoprene. If you havent tried those yet, its worth finding out if they work for you because condoms are not only a great non-hormonal birth control option, but they also help protect you from STDs.
The copper IUD is the most effective and convenient of the non-hormonal options. Like all birth control methods, it has some risks, but overall its really safe. In terms of pain, you may have some pain when you get it put in, but that goes away pretty quickly. Some people have heavier periods or worse period cramps with the copper IUD, but that also tends to taper off over time. Talk with your doctor or nurse about the copper IUD to find out if its right for you.
The diaphragm, the cervical cap, and the sponge are also solid non-hormonal options, but theyre a little more high maintenance than other methods. They require that you take care of your birth control in the time right before you have sex, which isnt for everyone.
The Most Accessible Method: Condoms
Condoms are probably the most accessible form of birth control to you. They can be bought online or at a supermarket. And, unlike most forms of contraception, you dont need a prescription.
Unless you have an allergy to latex or the lubricant commonly found on condoms, the side effects are usually pretty rare and mild.
A big advantage of using condoms is that they can also reduce your risk for contracting a STI.
They can also be used alongside other birth control methods, like an IUD and the pill, further reducing your chance of unwanted pregnancy.
However, in order for condoms to be effective, they need to be used correctly and consistently and its not always as easy as it looks. Even if you do use condoms correctly, theres a chance theyll break.
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Diaphragm And Cervical Cap
Unintended pregnancy in one year of use: 17% typical use, 16% perfect use .
Diaphragms and cervical caps are barrier methods that are both placed over the cervix and used with spermicide . Cervical caps are smaller than diaphragms and fit tightly around the cervix . Diaphragms stay in place by sitting behind the pubic bone . Diaphragms and cervical caps do not protect against STIs . Both are available in the USA with a prescription.
An OBGYN, nurse practitioner, doctor or midwife puts the diaphragm or cervical cap in the first time to pick the right size. The healthcare provider inserts the index and middle finger into the vagina to feel where the device sits . Only use water-based spermicides or lubricants when using a diaphragm and a cervical cap . Oil-based products can cause a cervical cap or diaphragm to break down .
There is also a one-size-fits-all diaphragm, Caya . A healthcare provider may have you insert Caya during the visit and then perform a pelvic exam to make sure that it was placed in the right position . Water-based spermicide should also be used with Caya .