Hormonal birth control isn't working for me. What are my options?

If you're shopping for alternatives to the pill and other forms of hormonal birth control, you're not alone. An astonishing 70% of women who've used the pill said they'd stopped taking it in the last three years or thought about switching methods, per a recent survey.

Side effects were the chief reason most women cited for quitting the pill, according to a separate survey of 3,616 women. Some 69.6% of respondents said the pill erased their sex drive, 53.6% complained of weight gain, and 51.9% said they suffered from moodiness and depression while on the pill. Many of these women switched to non-hormonal methods: 30% opted for a copper IUD, and 9% switched to a Fertility Awareness-based Method (FABM), with 6.2% of respondents opting for the Symptothermal Method (sign up here for FABM free educational email series to learn more).

Now, this isn’t to suggest the pill is harmful, and we can’t ignore the fact it remains wildly popular among the vast majority of women. Lest we forget, 4 in 5 sexually active women go on the pill at some point in their lives (1). 

Still, if you're troubled by hormone-related side effects or just exploring your options, we've put together a helpful guide on the top non-hormonal options out there (Note: You don't get STI protection with most of these methods, so you'll want to pair them with condoms if you and your partner aren't exclusive). 

We also point you to resources to learn about the various types of FABMs, including the Symptothermal Method. 


Intrauterine device (IUD)

An IUD is a small, T-shaped piece of plastic inserted into your uterus. If you're trying to avoid hormones, a copper IUD might work for you. With a failure rate of less than 1% (2), it’s nearly perfect at preventing pregnancy. 

Copper IUDs offer years of protection—at least 10 years or more (2). The devices don't affect ovulation but instead work by triggering a reaction in your uterus that's toxic to sperm and interferes with implantation. If you want to get pregnant, you can have the IUD removed at any time, and it won't mess with your fertility.

The downside? Copper IUDs are associated with a variety of side effects, including longer, heavier, and more painful periods (2). 


Diaphragm

A diaphragm is a dome-shaped cup made of silicone. You insert it into your vagina, where covers your cervix to block sperm from reaching your uterus. With perfect use, about 6 out of 100 women get pregnant with this method in a year (3).

You need to get fitted for a diaphragm by a medical professional and use spermicide with the diaphragm for maximum pregnancy prevention. You'll also need to leave it in place for 6 hours after sex for it to be most effective (which is kind of a hassle and the reason why 47% of women in a survey said they ditched this method) (3).


Condom

Condoms have been around since the dawn of time and remain one of the most popular forms of birth control. They're easy to use, come in countless sizes and shapes, with various kinds of lubrication, and offer the benefit of safeguarding against most STIs. With perfect use, condoms are 98% effective (4).


Female condom

Female condoms work the same way as a traditional condom, keeping your partner's sperm in the condom and away from your uterus — and protecting you from most STIs. You insert the condom in your vagina anytime before sex. Like male condoms, female condoms have minimal side effects, plus the ringed opening of the female condom may even stimulate your clitoris. Pregnancy rates range from 5% with perfect use up to 21% with typical use (5).


Cervical cap

The cap is a slim silicone cup that looks like a sailor's cap. It covers your cervix to keep sperm out of your uterus. The only brand of cervical cap available in the U.S. today is the FemCap (6). It can be inserted 6 hours before sex and must be left in place 6 hours afterward. Your chances of pregnancy with this method range between 13 and 32% (6). As with a diaphragm, you'll need a prescription from a medical professional and need to use spermicide with the cap for maximum effectiveness.


Sponge

The sponge is a plastic foam circle around two inches across with a loop on one side. You insert it in front of your cervix and can wear it up to 24 hours before having sex (7). The sponge works in two ways: It blocks your cervix to keep sperm out of your uterus, and it continuously releases spermicide. Its failure rate ranges from 12-24% (7).


Fertility Awareness-Based Methods (FABMs)

FABM is an umbrella term for methods that rely on your body's fertility cues to identify your fertile window — so you can avoid sex or use condoms during that time. These cues include cervical mucus, basal body temperature, and the position of your cervix.

However, it’s a mistake to lump FABMs in with all the other (like rhythm or calendar) methods to avoid pregnancy. Why? Because tracking your fertility cues offers the unique advantage of putting you in tune with your body. FABMs provide insight into hormonal imbalances or unusual fluctuations, which empowers you with knowledge to discuss any changes you've noticed with your doctor. 

If you're curious about FABMS, here's a great resource to read up on the most effective FABMs. You also can hear first-hand from other women who’ve switched from hormonal contraception to FABMs by going here.


References


  1. https://www.guttmacher.org/fact-sheet/contraceptive-use-united-states
  2. https://www.uptodate.com/contents/intrauterine-contraception-background-and-device-types?search=copper%20iud&source=search_result&selectedTitle=1~50&usage_type=default&display_rank=1#H4226625111
  3. https://www.uptodate.com/contents/pericoital-contraception-diaphragm-cervical-cap-spermicide-and-sponge?search=diaphragm&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1
  4. https://www.uptodate.com/contents/male-condoms?search=female%20condom&topicRef=5471&source=related_link#H175230645
  5. https://www.uptodate.com/contents/female-condoms?search=female%20condom&source=search_result&selectedTitle=1~127&usage_type=default&display_rank=1
  6. https://www.uptodate.com/contents/pericoital-contraception-diaphragm-cervical-cap-spermicide-and-sponge?search=diaphragm&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H3911714417
  7. https://www.uptodate.com/contents/pericoital-contraception-diaphragm-cervical-cap-spermicide-and-sponge?search=diaphragm&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H3367616990

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