For some people, hormonal birth control is not an option. They may simply want to avoid hormones, do not want to deal with side effects, have health concerns, or are breastfeeding.

This article explores 10 types of hormone-free birth control options and their efficacy.

This article talks about perfect and typical use of birth control. Perfect use describes how effective a form of birth control is if everyone uses it exactly as instructed every time they have sex. Typical use describes how effective a form of birth control is if a person sometimes uses it as instructed but may also use it irregularly or imperfectly.

Even with perfect use, contraception is not 100% effective. People should discuss birth control options with a healthcare professional to find the right option for them.

Barrier methods of birth control prevent sperm from entering the uterus. These methods are only used during sexual intercourse and people should use these correctly every time they have sex.

Some barrier methods can be purchased in drug stores, whereas others need to be prescribed by a healthcare professional.

Barrier methods have fewer side effects compared to hormonal birth control options.

Diaphragm

The diaphragm is a small, flexible cup made of silicone. A person inserts the diaphragm into their vagina to cover the cervix. It is essential to put spermicide on the diaphragm and along its edges before inserting it.

According to Planned Parenthood, a nonprofit organization specializing in sexual healthcare in the United States, the diaphragm is 94% effective if used correctly every single time.

However, the real-life accuracy rate is around 88%, which means 12 people out of 100 will still get pregnant using the diaphragm.

Diaphragms work best when used with spermicide.

Most diaphragms are prescribed and fitted by a doctor but are effective immediately. A person can use reusable devices for up to 2 years. If inserted correctly, neither partner should feel it during sex.

Diaphragms are most often prescribed and fitted by a healthcare professional. However, one-size diaphragms that fit most people are also available.

Diaphragms should be used with spermicide and should remain in place for 6 hours after sex, but not for more than 24 hours. If a person has sex again during the 24 hours, they should reapply spermicide and then wait another 6 hours before removing the diaphragm.

A diaphragm does not protect against sexually transmitted diseases (STDs) and individuals cannot use them during their period.

Cervical cap

The cervical cap is a small silicone cup that a person inserts into their vagina, fitting over the cervix. It is similar to the diaphragm but smaller. The only cervical cap available in the U.S. is available under the brand name, FemCap, which comes in three sizes.

According to Planned Parenthood, the failure rate for the FemCap is 14% in people who have never given birth and 29% for those who have had a vaginal delivery.

The cervical cap does not contain hormones and can be inserted before sex. A person can use the same cap for up to 2 years. People should always use spermicidal gel with the cervical cap to ensure its protective qualities. Much like the diaphragm, it requires a prescription, a doctor must fit it, and is not suitable for use during periods.

As with the diaphragm, the cervical cap should be left in place for 6 hours after sex. Unlike the diaphragm, the cervical cap can stay in longer, up to 48 hours total. A person does not need to reapply spermicide again if they have sex more than once during this timeframe.

Spermicides

Spermicides are placed in the vagina before sexual intercourse to stop sperm from entering the uterus. They are available in creams, gels, and suppositories.

Spermicides have a failure rate of 21% with typical use, according to the Centers For Disease Control and Prevention (CDC). However, effectiveness increases when used with other methods, such as the diaphragm or cervical cap.

This method is easy to use, does not require a prescription, and is inexpensive. Some people might experience side effects, such as irritation and allergic reaction.

Learn more about some of the best spermicides here.

Male and female condoms

The male latex condom is the best way to guard against STDs.

It is also effective in preventing pregnancy by keeping semen from entering the vagina.

According to Planned Parenthood, when people use condoms correctly, they are 98% effective in preventing pregnancy.

But in reality, condoms are about 85% effective, meaning about 15 people out of every 100 might get pregnant.

The male condom is simple to use and safe. It is also convenient, inexpensive, easy to source, and does not require a prescription.

Condoms are not as effective as some other methods of birth control, and people need to use them every single time they have sex. Some individuals are allergic to latex, and some people find condoms make sex less enjoyable by limiting sensation or requiring more lubricant. When people are using a lubricant with condoms, they should choose a water-soluble or silicone variety, as oil-based lubricants can break down latex condoms.

The female condom is a strong, thin protective covering with a ring on each side to hold it in place. It can protect against pregnancy and STDs.

According to Planned Parenthood, when people use the female condom correctly, it is 95% effective in protecting against pregnancy. However, for most people, the rate is 79%, which means 21 of 100 people will get pregnant each year using this method.

The female condom contains no hormones, is available without a prescription, and is inexpensive. A person can insert the female condom up to 6 hours before sex, individuals who are allergic to latex can use them, and they are suitable for use with lubricants.

However, the outer rings of the female condom may irritate, and many people feel it reduces feeling. Female condoms usually cost twice as much as male condoms.

The sponge

The sponge is made of plastic foam and contains spermicide. A person inserts it into their vagina before sexual intercourse, and has a nylon loop for easy removal afterward. It is available at most drug stores and does not require a prescription.

The sponge prevents pregnancy by covering the cervix so that no sperm can enter. It also releases spermicide to immobilize sperm.

According to Planned Parenthood, the birth control sponge is least effective in people who have previously been pregnant.

In people who have never been pregnant, the failure rate is 9% when used correctly each time, and 12% with regular use. For people who have been pregnant before, the failure rate is 20% with accurate use and 24% with regular use.

The sponge carries an increased risk for yeast infection and toxic shock syndrome and should not be left in the vagina for more than 30 hours in total. Vaginal dryness and allergic reactions are common side effects.

A person can only use each sponge once. After removal, they should throw it in the trash and flush it down the toilet.

Phexxi

A newer non-hormonal birth control method is a prescription vaginal gel under the brand name Phexxi.

According to Planned Parenthood, Phexxi is put into the vagina up to an hour before having sex using a prefilled applicator. It starts working immediately and is effective for up to 1 hour. It is not effective if a person uses it after having sex.

Phexxi prevents pregnancy by lowering the pH level in the vagina. This makes it difficult for sperm to move, decreasing the chance for sperm to meet the egg.

With perfect use, Phexxi is 93% effective. However, it is 86% effective with typical use. A person should make sure to follow the instructions closely. Phexxi is suitable for use with some other birth control methods, such as condoms or a diaphragm.

It is important to note that this method does not protect against STDs.

However, it is safe to use while breastfeeding.

There are some side effects associated with Phexxi, including:

A person should consult their doctor for further information.

There are some long-term and permanent non-hormonal options that are safe and effective for most healthy people.

ParaGard

In the U.S., this non-hormonal intrauterine device (IUD) is available under the brand name Paragard. According to Planned Parenthood, it has a low failure rate of 0.1% if inserted within 5 days after having unprotected sex.

Paragard is hormone-free and prevents pregnancy for up to 12 years. It takes only a few minutes for a doctor to insert the device into the uterus. Once in place, the thin copper IUD causes an inflammatory reaction inside the uterus that prevents sperm from reaching the egg.

Paragard is a good option for people who do not want to worry about daily or weekly birth control birth reminders or do not want to use hormonal birth control. This method is completely reversible and can be removed by a doctor at any time if a person decides they want to get pregnant.

Paragard does not protect against STDs. Side effects include:

Sterilization

For people who want a permanent birth control method, sterilization may involve surgery that is difficult to reverse. Sterilization will not protect against STDs. For females, the surgical procedure is tubal ligation, and for males, vasectomy surgery provides permanent sterilization.

When done correctly, these methods are highly effective in preventing pregnancy.

Another method of sterilization was available in the U.S. under the brand name Essure. It is a uterine device that does not require surgery, is hormone-free, and fitted in the doctor’s office without general anesthesia.

The Essure device is a tiny spring-like device that the doctor inserts through the vagina to each fallopian tube. The mesh substance of Essure inflames the fallopian tubes, causing permanent scarring and blockage of the tubes over time.

According to the United States Food and Drug Administration (FDA), Essure should not be available for implantation in the U.S. However, people who have been using the device as birth control successfully can continue to do so.

While barrier methods and long-term birth control are popular options in the U.S., some people prefer alternative hormone-free birth control, such as the withdrawal method:

Withdrawal method

The withdrawal method is the oldest form of birth control, but it is not the most effective. Withdrawal involves a person pulling their penis out of the vagina before ejaculation.

According to Planned Parenthood, with perfect use the method is 96% effective. However, this is a difficult method to use perfectly, and typical use is 78% effective. This means around 1 in 5 people who use this method will become pregnant.

Natural family planning

Some people may wish to try natural family planning or fertility awareness methods. It involves tracking the menstrual cycle to work out when a person is ovulating. While a person is ovulating, they should use barrier methods if they wish to prevent pregnancy.

According to Planned Parenthood, there are three main methods:

  • Temperature: A person takes their temperature every morning.
  • Cervical mucus: A person checks their vaginal discharge every day.
  • Calendar: A person records their menstrual cycle on a calendar.

A person can use one or more of these methods — a combination of all three is the most effective. Failure rates are between 12–24% depending on which method a person uses, and failure rates are lower if a person uses a combination.

Natural Cycles has FDA approval, which is an app a person can use for fertility awareness.

However, it is important to note that natural family planning can be difficult, and it may be better for a person to consider a more effective method.

A person may wish to consider the following when choosing a non-hormonal birth control method:

  • How much does it cost?
  • How long does it last?
  • Does it require a prescription?
  • How effective is it?
  • Does it protect against STDs?
  • How much do efficacy rates vary between perfect and typical use?
  • Are there any side effects?
  • Is it easy to use long term?

Deciding on a birth control method is a personal choice. Each person should consider how birth control fits into their lifestyle and pick a method that is effective, safe, and convenient. It is also important to consider some methods that reduce the risk for STDs.

People may also consider consulting their doctor for further advice.