Not So Hot on Hormonal Birth Control? There Are (Lots of!) Other Options

By | March 15, 2019

Theoretically, there’s an ideal birth control option for every person (though maybe none of them are totally perfect just yet). You want to get your contraception in the form of a daily pill? Go for it! Rather baby-proof your uterus by getting a shot every three months? Yup—that exists! Or if you prefer to ward off unwanted pregnancy without any hormones, you can do that, too.

There are reasons for using a hormonal method, like if you want to skip your period entirely, clear your skin, or make your cramps less intense. But hormones are tricky because you can’t really know how your body is going to react to them until you try. There are potential side effects, and maybe you just don’t want to deal with all that. Totally fair! Thankfully, other options exist.

But wait, before we get to the list below, let’s just be clear that there is no medically necessary reason to forgo hormones, according to Robin Watkins, a women’s health nurse practitioner and director of health care at Power to Decide. “This is a myth that probably comes from when hormonal birth control first came out in the sixties and the high levels of hormones caused some side effects that were pretty unpleasant,” Watkins says. “We’ve since moved on to birth control that has five-times less hormones in it and people are no longer having those symptoms. So there’s no medical basis for needing to ‘take a break’ from hormonal contraception.”

Ultimately, the kind of birth control you use is your choice. Whether you’re looking to switch it up or you’re shopping for the first time, here’s a basic guide to all the hormone-free options out there.


Copper IUD

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Several other IUDs—like the Mirena, Liletta, and Kyleena—use a combination of hormones to prevent pregnancy, but the copper IUD (called the ParaGard) does the same thing, just without the chemicals. According to Planned Parenthood, the copper in the ParaGard changes the way sperm travels and makes it so they can’t swim and reach an egg. And if sperm can’t reach the egg, then a pregnancy can’t form. Think of it as an MPV goalie at the gateway to your uterus.

How effective is it?

Super effective. Because the ParaGard is inserted by a physician and then just chills in your body after that (for up to 12 years), there’s no real margin of error. The ParaGard is more than 99 percent effective.

What does it cost?

With employer-based insurance and the Affordable Care Act, the copper IUD is free. According to Bedsider, a birth control education network from Power to Decide, the full price ranges from $ 500-739 without insurance—a high upfront cost, but over time, it’s about $ 62 per year. At a low-cost clinic you may be able to spend less.

How do I get it?

Either make an appointment with your gyno or GP, visit Planned Parenthood, or head to another local clinic that provides birth control. The health care provider will consult you about the IUD insertion process and then usually they’ll set up a second appointment for the actual procedure—it’s quick and can be done right there in the office. But if getting to the doctor more than once is hard for you, call ahead and ask the clinic you’re planning to go to if they have the ParaGard in stock and whether they can insert same-day.

External condom

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Ruban Chamorro

Essentially the OG of birth control, the external condom is wildly popular, inexpensive, generally easy to access, and one of the methods that also protects against STIs. This variation is meant to be worn over a penis to keep sperm from ever hitting your vagina and protect both partners from swapping any infections they may have. External condoms come in literally hundreds of options, but the only thing that really matters is that the one you’re using fits properly (SNUG), is compatible with any lube you’re using (oil-based lubes and latex do not mix), and isn’t a million years old (yes y’all, these do expire).

How effective is it?

With perfect use, condoms are 98 percent effective. But perfect use and typical use are two different things, so for most people, the effectiveness rate is actually somewhere around 85 percent. Still good—and protecting against STIs is a huge bonus—but that means on average 15 out of every 100 people who use condoms as their only form of birth control get pregnant.

What does it cost?

Fancy condoms with all the textures and special effects can be pricier, but generally, condoms are $ 1-2 a pop. And they’re easy to find for free at most health clinics (including the one on campus if you’re a student).

How do I get it?

In a perfect world, all birth control would be as easy to get as condoms are. You can find these at most convenience and drug stores, order them online, and even grab ’em for free at most health clinics and in communal bowls at (good) bars. Just triple-check the expiration date when you’re picking up a freebie at a public place—you never know!

According to our survey with Power to Decide, the answer is B. Read more in our January investigation on why condom use is down.

Internal condom

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The overlooked companion to the external condom, this variation is meant to be worn inside a vagina and protects against pregnancy and STIs by trapping sperm. It’s a bit floppy and odd-looking, but if your partner is anti-condom for whatever reason, this is a good alternative barrier method.

How effective is it?

With perfect use, internal condoms are also 95 percent effective at preventing pregnancy. But once again, people aren’t perfect. Typical use puts these around 79 percent effective, according to Planned Parenthood. Most people like to combine these with spermicide (more on that later), which ups the effectiveness substantially because you’re combining two methods.

What does it cost?

The only brand of internal condoms available in the United States is the FC2, which costs about $ 29 for a 12-pack. You may also be able to get them for free at a local health clinic.

How do I get it?

The FC2 Condom can be ordered online directly from the website without a prescription, or you can pop by a local clinic or Planned Parenthood to pick some up (potentially at a lower cost).

Cervical cap

This is exactly what it sounds like—a tiny cap you plop onto your cervix that works to prevent pregnancy by physically blockading your uterus. It’s cute because it looks like a lil hat, if that’s what you’re into!

How effective is it?

According to Planned Parenthood, this method is best for people who’ve never given birth (because pregnancy changes the state of your cervix a bit). With perfect use, the cap is 86 percent effective. That drops to about 71 percent effective if you’ve given birth. It’s somewhat difficult to use correctly, only because it involves a bit of finagling around deep inside your vagina.

What does it cost?

The only brand of cervical cap available in the United States is the FemCap. With insurance and the ACA, it’s free. If you don’t have insurance, Planned Parenthood says the exam needed to get the cap (it’s prescription-only) can be free or cost you up to $ 200. The cap, without insurance, retails for $ 89, or a two-pack for $ 130. You should be able to get it at a lower cost through Planned Parenthood or another low-cost clinic.

How do I get it?

You need a prescription for the FemCap, and your doctor will do a quick exam to check your cervix and prescribe you the correct size. Make an appointment with your gyno or GP, or visit a local clinic and call ahead to check that they have the FemCap available (they should!).

Spermicide

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John FrancisGetty Images

Though you may have never actually noticed it, spermicide is lurking on the shelves in most drugstores, just waiting to be squeezed out of its lil tube and into your vagina to prevent pregnancy. This old-school contraceptive is a gel or cream that contains chemicals that slow sperm down so it can’t reach an egg. It’s usually used with something else, like an internal condom, diaphragm, or cervical cap, but can also be used on its own.

How effective is it?

Spermicide can be tricky to use perfectly, so typical use is about 71 percent effective, according to Planned Parenthood. It’s best to pair this with another method for better prevention.

What does it cost?

A good thing about spermicide is that it’s relatively easy to find over-the-counter, and costs about $ 3 per dose. It comes in a kit containing multiple does.

How do I get it?

Spermicide is available at most drugstores and at local health clinics.

Diaphragm

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John FrancisGetty Images

If you’ve ever watched ’90s television, you’ve heard of the diaphragm. It was Carrie Bradshaw’s preferred birth control method (that once famously got stuck in her vagina), and yes, the diaphragm does still exist today—though it’s much less popular than it once was.

How effective is it?

With perfect use, the diaphragm is 94 percent effective, according to Planned Parenthood. Once again, no one is perfect, so typical use for diaphragms is 88 percent effective.

What does it cost?

Like the cervical cap, you have to get an exam to be fitted for the diaphragm, which means that, all-in, it costs between $ 0-250 (depending on your insurance). You have to use spermicide inside your diaphragm in order for it to work, so add another $ 10 to the cost for that.

How do I get it?

Once you have a prescription from a nurse or doctor, you can pick up a diaphragm at most pharmacies, drugstores, or health centers. And while you’re there, make sure to pick up some spermicide, too. Crucial!

The sponge

No, this is not a tiny piece of the thing you use to do the dishes. Made of soft plastic, the sponge is another old-school option that sits deep in your vagina and has spermicide in it. Like the cap and diaphragm, it physically blocks your uterus and has the added bonus of the spermicide to prevent pregnancy.

How effective is it?

The sponge is best for people who’ve never given birth because the effectiveness drops significantly if you have. With perfect use, it ranges from 80-91 percent effective. With typical use, this puppy is about 88 percent effective. Planned Parenthood recommends pairing this with another method, like a condom.

What does it cost?

The only sponge available in the United States is the Today Sponge. You don’t need a prescription for it and can buy it over-the-counter for about $ 15. It may also be available at a lower cost or for free at your local health center or Planned Parenthood.

How do I get it?

This is another option that you’ve probably been overlooking during your drugstore runs—it’s available straight off the shelves in most pharmacies.

Tubal ligation

Better known as “getting your tubes tied,” tubal ligation is the only permanent, irreversible hormone-free option on this list. It’s highly effective and involves a very safe outpatient surgical procedure (meaning you’ll be knocked out with anesthesia) where a doctor closes or blocks your fallopian tubes. The outcome? Eggs can no longer travel down from your ovaries and chill out, waiting to be fertilized by sperm. Cool.

How effective is it?

Because there’s no room for user error and a doctor performs the procedure, tubal ligation is super effective—more than 99 percent. That’s great, but remember: this is permanent. Tubal ligation is an option for people who are totally chill with not getting pregnant, ever.

What does it cost?

With employer-based insurance and the ACA, tubal ligation is free. If you don’t have insurance, Planned Parenthood says the cost can reach up to $ 6,000—which is steep, even for a lifetime of birth control. Depending on your income, you may be able to get a tubal ligation for less at a low-cost clinic.

How do I get it?

You’ll make an appointment with you gynecologist or GP and let them know you want to have your tubes tied, and then schedule a separate appointment for the procedure itself. Some people decide to go ahead and do this right after giving birth or having an abortion, and your doctor should be able to accommodate that request on the fly (since you’re already there). Certain states have age restrictions or waiting periods for tubal ligation—the office you call will be able to tell you more when you ask.

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