11 Non-hormonal birth control methods and how they work

This article is also available in Spanish.

1. The copper IUD 

The first option on our list, the copper IUD, also known as the copper coil, is the only long-acting non-hormonal option out there. This t-shaped piece must be inserted by a healthcare professional and can sit in the uterus for as long as ten years. It prevents pregnancy in two ways: by creating a hostile environment in the female reproductive tract stopping sperm survival, and by preventing the implantation of a fertilized egg cell. 

The copper IUD is highly effective at preventing pregnancy, in fact, it’s more than 99% effective with both typical and perfect use. One of the reasons it’s so effective is that it requires little work from the user after it’s inserted, it can just sit there and do its thing without you having to think about it. 

One of the great things about this method is that it can also be used as emergency contraception if fitted for up to five days after having unprotected sex. Some people who use this method of birth control may get unpleasant side effects such as heavier or longer periods, spotting between periods, or worse period pain. It’s also common to experience some pain or cramping during the fitting and in the days after.

Pros: Highly effective. Doesn’t require any work once fitted. Can be used as emergency contraception. 

Cons: Invasive. Requires a professional to fit and remove. Can have side effects, such as heavier or longer periods. Doesn’t protect against STIs.

2. The male condom (external condom)

When it comes to alternatives to hormonal contraceptives, most of us are familiar with condoms. The most common type of condom is the male condom, also known as the external condom which is worn on the penis to prevent pregnancy.

This male birth control option is pretty easy to get hold of, you don’t need a prescription and you can buy condoms, in most supermarkets, drug stores, and pharmacies, and you can often find them in bathroom vending machines, or available for free from sexual health clinics. Prefer not to leave the house to buy your contraception? No stress. You can also buy condoms online. If you have an allergic reaction to latex, it’s also possible to buy latex-free condoms. 

When it comes to effectiveness, this method is 87% effective with typical use and 98% effective with perfect use. A type of barrier method, condoms work by stopping the sperm and egg cell from meeting and this method also helps prevent the spread of sexually transmitted infections (STIs). Condoms can be used on their own or with another birth control method to add another layer of protection. 

Pros: Easily accessible (no prescription needed). Offers protection from STIs. 

Cons: Needs to be used every time you have sex. Costs money. Can take time to get used to using.

3. The female condom (internal condom)

The female/internal condom is similar to the external condom, except this barrier birth control method is worn inside the vagina. Although you don’t need a prescription to access this method, female condoms are a bit harder to get hold of. You can buy them online, or over the counter in some pharmacies. 

When it comes to effectiveness, the internal condom is 79% effective with typical use and 95% effective with perfect use. While these numbers are lower than the male condom effectiveness rate, some people prefer to use the internal condom as it puts the user in control. While we may more commonly think of the external condom, both male and female condoms can be used to protect against STIs.

Pros: No prescription needed. Protects against STIs.

Cons: Requires input from the user. Not as easy to buy as the male condom.

4. Diaphragms & cervical caps 

Diaphragms are another type of barrier method. Made of silicone, the diaphragm sits inside the vagina covering the cervix where it stops sperm cells from getting to the egg cell. Keep in mind that while this is a barrier method - diaphragms do not protect from STIs as condoms do. 

The diaphragm needs to be left in place for at least six hours after sex, and in order to be most effective, the diaphragm should be used with spermicide. This is a type of cream or gel that contains a chemical that when inserted into the vagina stops sperm from swimming so it can’t reach the egg cell. Diaphragms are 83% effective with typical use and 84% effective with perfect use. Diaphragms may not be a suitable option to you if you regularly get urinary tract infections.

Cervical caps are similar to diaphragms but are shaped a bit differently. Where a diaphragm is disc-shaped, the cervical cap looks more like a sailor’s hat. These also are more effective when used with spermicide but can be left inside the vagina for longer (up to two days after sex). 

You can get your hands on a diaphragm or cervical cap at a pharmacy, drugstore, or health center, but you’ll need a prescription to get one. There are different sizes of diaphragms so a healthcare professional will need to fit you for one and show you how to use it before you can get started. Diaphragms are covered by insurance and are available for free in the UK on the NHS.

Pros: Insert it any time before you have sex (more spermicide should be used if it’s more than three hours prior). You can use the same one for a year before it needs to be replaced.

Cons: Requires fitting. Requires a prescription. Does not protect against STIs.

5. Fertility awareness-based methods (FABM)

Our next option isn't just one method, in fact, fertility awareness is a broad category that includes a range of natural family planning methods such as the rhythm method, calendar methods and temperature-based methods. These methods rely on getting to know your fertility indicators, or by counting days to work out your own fertile window.

Take the Standard Days Method, a type of calendar method. This requires users to abstain from sex on days 8-19 of the menstrual cycle. As with other FABMs, the Standard Days Method requires users to practice this method for at least three months before it can be relied upon as birth control. With typical use, the Standard Days Method is 88% effective with typical use and 95% with perfect use.

One of the main reasons people choose to use these sorts of methods is because they offer a natural way to not get pregnant. They don’t involve invasive procedures, using barrier methods, creams or putting anything else in or on your body. However, they do require daily dedication and knowledge to use. For example, if you choose to measure cervical mucus as a fertility indicator, you need to learn about the different types of mucus and how they change throughout the cycle.

Pros: No prescription needed. Non-invasive. No side effects. 

Cons: 3-6 month monitoring period before you can use. Requires daily work. Does not protect against STIs.

6. The Natural Cycles app

In 2018, Natural Cycles became the first birth control app to be FDA cleared in the US. Like some fertility awareness-based methods, NC° Birth Control uses your body temperature and menstrual cycle data to work out your fertile window. However, unlike traditional FABM and other tracking apps, the app uses an algorithm that learns the pattern of your cycle and does the calculations for you. This method is 100% hormone-free and is popular with users who’ve previously used hormonal birth control methods (such as the birth control pill) but didn’t get along with the side effects.

The algorithm works out your daily fertility status and based on your history and temperature for that day gives you either a red or a green day. On green days you’re not fertile and can have sex without using protection. On red days there’s a risk you’re fertile and you need to either use condoms or abstain from penetrative sex. 

With typical use, this method is 93% effective, and it’s 98% effective with perfect use. Natural Cycles, does not require a prescription for you to use it and is available with a monthly or yearly subscription (includes a free thermometer). You can order it online or buy NC° Birth Control in select pharmacies. We’re working hard to ensure that NC° Birth Control is covered by insurance. Did you know you can get your Natural Cycles subscription reimbursed with an FSA or HSA account? 

Pros: Prescription-free. Non-invasive. No side effects. Less daily work than traditional FABMs.

Cons: Doesn’t protect against STIs.

7. Contraceptive gel (Phexxi)

Phexxi is a new method in the form of a contraceptive gel. It’s not the same as a spermicide, but is used in a similar way - it’s inserted into the vagina before sex and it stops sperm cells from reaching an egg cell by lowering the pH in the vagina. To use Phexxi you’ll need a prescription. 

Used perfectly, Phexxi is 93% effective, with typical use it’s 86% effective at preventing pregnancy. It should be inserted immediately or up to one hour before sex - and must be used every time. You can also use Phexxi alongside some hormonal methods, but not the vaginal ring.

There are a few reported side effects from using this contraceptive gel, including vaginal burning and discomfort, increased chance of yeast infections, and bacterial vaginosis. Phexxi is also not recommended for those who are prone to urinary tract infections.

Pros: Insert it up to an hour before sex. Works with other types of contraception such as a diaphragm.

Cons: Prescription required. Some people may experience side effects.

8. The pull-out method 

When it comes to preventing pregnancy, the pull out method, also known as the withdrawal method, has been around for a long, long time. However, just because it’s tried and tested, doesn’t mean it’s the best way to not get pregnant. When it comes to failure rates, this method is 96% effective with perfect use and only 80% effective with typical use. 

The pull out method works by removing the penis from the vagina before ejaculation. This can be tricky to time and even if it is done perfectly there is still a risk of pregnancy as there is still sperm present in pre-ejaculate and there’s a risk of pregnancy if only a small amount of sperm gets in the vagina. 

Pros: Free. Can be used with another form of contraception, such as condoms.

Cons: Hard to time, less effective than other methods.

9. Breastfeeding as birth control (LAM)

Did you know that breastfeeding can also stop you from getting pregnant? This method is called lactational amenorrhea (or LAM for short). This option is suitable for those who’ve just given birth and are breastfeeding full time This means you’re only feeding your baby breast milk and the gaps between feeds are no longer than four hours during the day and six hours at night. 

Following these guidelines you can use breastfeeding as contraception for up to six months - or until your period returns. Used in this way breastfeeding is about 98% effective at preventing pregnancy. Breastfeeding naturally stops your body from ovulating, meaning you’re not fertile during this window. 

Keep in mind that this is only a temporary option you can use soon after you’ve been pregnant, and you’ll need to find another method after 6 months or as soon as your period has returned. Due to the way the menstrual cycle works, you’ll ovulate before you get your first period back, which means you may be fertile before you know you are, so it’s important to follow the guidelines of LAM to use it effectively. 

Pros: Free. Convenient if you’re already planning to breastfeed full time.

Cons: Requires daily dedication. Only works for a short period of time.

10. Vasectomy (male sterilization)

This is a surgical procedure that involves cutting or sealing the tubes that carry sperm. This method is more than 99% effective at preventing pregnancy and should be considered permanent (although it is possible to successfully reverse a vasectomy in some circumstances). 

Depending on your age and other factors (such as whether you have children or not) you may need to undergo counseling before you can get a vasectomy.

The procedure itself is quick and while you may experience some mild discomfort you’ll be able to return to work after a day or two. After the procedure, you’ll need to use another method of contraception for several months to make sure there’s no residual sperm left in the tubes - you’ll be asked to provide a sample between 8 and 16 weeks to check the procedure has worked. Physiologically there are no changes to sex drive or hormone levels.

Pros: Highly effective. Long-term option. Quick procedure.

Cons: Permanent.

11. Female Sterilization (tubal ligation)

As with a vasectomy, female sterilization is more than 99% effective and a long-term option. The procedure is a bit more involved than with male sterilization and in some cases requires a general anesthetic. The procedure works by permanently blocking or sealing the fallopian tubes. This procedure is sometimes called tubal ligation, or colloquially known as having your 'tubes tied'.

While it’s safe to have sex as soon as you feel ready after the operation, it’s not effective immediately, you’ll need to have something called a hysterosalpingogram performed after 3 months to confirm the permanent sterilization has worked, so it’s important to use another method until that time. 

Pros: Highly effective. Long-term option. 

Cons: Permanent. The procedure is not as quick and easy as with male sterilization. 

Ready to go hormone-free?

Thanks for checking out our 11 types of non-hormonal birth control - we hope you know a bit more about natural family planning and the options available to you. If you’re thinking about switching to contraception it’s always a good idea to talk to your reproductive healthcare professional to get a good idea of all your options. They will be able to provide counseling and patient education to help you make an informed choice.

Natural Cycles is the first FDA cleared birth control app, putting the power of your cycle in your hands. Hormone-free and non-invasive, why not find out if Natural Cycles could work for you today?