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

Below is information on eight types of hormone-free birth control options, which are both effective for pregnancy protection and affordable.

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

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

1. Diaphragm

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The diaphragm cup does not release hormones, but must be used with spermicide.

The diaphragm is a small, flexible cup made of silicone. A woman inserts the diaphragm into her vagina so that it covers 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 percent effective if used correctly every single time.

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

The reason for a reduced effective rate is that many people do not follow directions precisely every time they have sex. Diaphragms work best when used with spermicide.

Diaphragms must be prescribed and fitted by a doctor but are effective immediately. Each reusable device can be used for up to 2 years. If inserted correctly, neither partner should feel it during sex.

A diaphragm does not protect against sexually transmitted diseases (STDs) and cannot be used during monthly periods.

2. Cervical cap

The cervical cap is a small silicone cup that a woman inserts into her vagina, fitting over the cervix. It is like the diaphragm but smaller. The only cervical cap available in the U.S. is available under the brand name, FemCap.

The failure rate for the FemCap is 14 percent in women who have never given birth and 29 percent for those who have had a vaginal delivery, this according to Association of Reproductive Health Professionals.

The cervical cap does not contain hormones and can be inserted before sex. The same cap can be used up to 2 years. Women should always use spermicidal gel with the cervical cap to ensure its protective qualities. Much like the diaphragm, it requires a prescription, must be fitted by a doctor, and cannot be used during periods.

3. 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 28 percent, this according to the American Pregnancy Association. However, when used with other methods, such as the diaphragm or cervical cap, effectiveness increases.

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

4. Male and female condoms

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Condoms can help to prevent the spread of STI’s, unlike other forms of non-hormonal birth control. However, they are not the most effective form of birth control.

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 condoms are used correctly, they are 98 percent effective in preventing pregnancy.

But in reality, condoms are about 85percent 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 get hold of, and does not require a prescription.

Condoms are not as effective as some other methods of birth control, and they need to be used every single time two people have sex. Some people are allergic to latex, and some couples find condoms make sex less enjoyable by limiting sensation or requiring more lubricant. When using a lubricant with condoms, choose a water-soluble or silicone one, 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 the female condom is used correctly, it is 95 percent effective in protecting against pregnancy. For most people, however, the rate is 79 percent, which means 21 of 100 women will get pregnant each year using this method.

The female condom contains no hormones, is available without a prescription, and is inexpensive. A woman can insert the female condom up to 6 hours before sex; it can be used by people who are allergic to latex and can be used with lubricants.

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

5. The sponge

The sponge is made of plastic foam and contains spermicide. A woman inserts it into her 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 the Association of Reproductive Health Professionals, the birth control sponge is least effective in women who have previously been pregnant. In women who have never been pregnant, the failure rate is 9 percent when used correctly each time, and 12 percent with regular use. For women have been pregnant before, the failure rate is 20 percent with accurate use, and 24 percent 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.

Each sponge can only be used once. After removal, throw it in the trash — do not flush it down the toilet.

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

6. ParaGard

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ParaGard is a non-hormonal IUD, and can work for up to 10 years.

In the U.S., this non-hormonal intrauterine device (IUD) is available under the brand name ParaGard. According to the Association of Reproductive Health Professionals, it has a low failure rate of 0.8 percent.

The ParaGard is hormone free and prevents pregnancy for up to 10 years. It takes only a few minutes for a doctor to insert the device into the uterus. Once in place, the thin copper wire releases small amounts of copper to prevent sperm from passing through the cervix.

The ParaGard is a good option for women 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 woman decides she wants to get pregnant.

ParaGard does not protect against STDs. Side effects include:

  • cramping
  • heavy periods
  • spotting between periods

7. 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 women, the surgical procedure is a tubal ligation, and for men, vasectomy surgery provides permanent sterilization.

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

There is a newer method of sterilization available to women in the U.S. — under the brand name, Essure. It is a uterine device that does not require surgery, is hormone-free, and is 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 one report in the European Journal of Obstetrics & Gynecology and Reproductive Biology, pregnancy was less than 2 for every 1,000 procedures. After placement of the device, some women may have changes in their periods, cramping, and allergic reactions to the metal in the device.

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

8. Withdrawal method

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

Regular use of this method has a failure rate of 18 to 19 percent, this according to the American Pregnancy Association.

Deciding on a birth control method is a personal choice. Each woman should consider how birth control fits into her 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.