So you don’t want to get pregnant—but you also don’t want to use hormonal birth control. Your reasons may vary: Progestin-only pills, for example, can make acne worse. Your doctor may discourage combination pills, which contain progestin and estrogen, if you have a blood-clotting disorder, migraines, or high blood pressure. And certain hormonal contraceptives have been known to cause irregular periods and mood changes. You could rely on the pull-out method. Or use an app to track your fertility and not have sex on your most fertile days. The thing is, neither of those methods is super effective. Here are half a dozen nonhormonal birth control options that are worth considering if you want to avoid both pregnancy and hormones (and pregnancy hormones!).
This tiny T-shaped device is implanted in your uterus, usually in under five minutes, where the copper it’s wrapped in causes a reaction that makes it difficult for sperm to get to the egg. Nonhormonal IUDs may make your periods worse for the first three to six months. With that said, they’re more than 99 percent effective (in part because you can’t forget to, um, implant an IUD), and the one-and-done method lasts for up to 12 years.
There are actually two kinds of condoms: The ones that go on penises (typically called plain old condoms), and internal, or “female,” condoms that go inside your vagina. Both are the only forms of birth control that protect against both pregnancy and STDs by creating a physical barrier that keeps sperm from getting to the egg. (There’s one exception: Condoms can be made from latex, plastic, or lambskin, and lambskin condoms have tiny holes that allow bacteria and viruses to pass through.) About 15 out of 100 people who use condoms and only condoms will get pregnant each year, and that number goes up to 21 with internal condoms.
The Swiss army knife of the birth control world, spermicide can be used alone (though you have a 28 percent chance of getting pregnant that way), with condoms, or with diaphragms or cervical caps (more on those soon). It uses chemicals to slow down sperm and block them from reaching your cervix. It’s convenient, it’s inexpensive, and—since you put it in before you start getting down—it doesn’t interrupt sex. Because the most effective spermicides contain at least 100 milligrams of nonoxynol-9, an ingredient that can irritate your vagina, spermicide may increase your risk for STDs by making it easier for infections to enter your body.
Like spermicide, contraceptive gel goes in your vagina. You can insert it up to an hour before sex, using a prefilled applicator you slide in like a tampon. And you can combine it with condoms or diaphragms (getting there, promise!). Unlike spermicide, however, it’s made of lactic acid (yes, the stuff in yogurt), citric acid (found in citrus fruits), and potassium bitartrate (aka cream of tartar, for you bakers out there). It works by lowering the pH of your vagina—which normally goes up to a 7 or 8 out of 14 during sex—to its normal pre-sex range of between 3.5 and 4.5, making it harder for sperm to move around. It’s about 86 percent effective, and it doesn’t have nonoxynol-9 in it, so it doesn’t increase your risk of STDs. Because side effects include urinary tract infections, it’s not recommended for women with a history of UTIs.
Remember those rubber popper toys that flip high in the air when you turn them inside out? A diaphragm kind of looks like that. You fill it with spermicide or contraceptive gel, pinch it in half, then push it as far back as it can go in your vagina—where it covers your cervix to keep sperm out—up to six hours before having sex. You leave it there for at least six hours (but no more than 24) postcoitally. The cons: Putting it in takes a little practice, and you may need a new diaphragm if you get pregnant or your weight fluctuates by 10 or more pounds. On the plus side, it’s 88 percent effective, portable, and reusable. There’s also a newer, one-size-fits most diaphragm that looks a little bit like a baby bathtub. It has different instructions for use—so read the instructions!—and is slightly less effective at preventing pregnancy.
Shaped like a sailor’s, ahem, cap, the silicone cervical cap works much like a diaphragm, preventing pregnancy—but only when used with spermicide—by suctioning to your cervix to keep sperm from entering the uterus. The main differences are that it’s smaller, you can leave it in for up to two days, and you’ll need a new size after you’ve been pregnant, whether or not you give birth. It’s also slightly less effective: 86 percent for people who have never given birth, and 71 percent for those who have.