The Anti-Hormone Guide To Birth Control

There are tons of birth-control options out there. They run the gamut from hormonal (the pill, NuvaRing) to as natural and non-hormonal as can be (withdrawal; Natural Family Planning). It may seem, at times, like hormonal methods are the ones hogging the most media buzz. But nowadays, more and more women are choosing to go in the other direction. In light of the recent lawsuits against the manufacturer of NuvaRing, the low-but-present risk of serious complications with hormonal birth control is in the news.
If you find yourself questioning what lies on the other side of the hormonal divide, we've done the research for you. With the help of some experts, we investigated the best contraceptive choices out there for women who want their birth control without the hormones, if you please. Ahead, take a peek at everything from diaphragms to the pullout method. And learn which — if any — of these options might work best for you.
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Despite the high success rate and longtime number-one rock-star status of the pill, lately more women are choosing to forgo the potential risks and side effects of hormonal birth control altogether. (See the NuvaRing disaster — the hormonal contraceptive's manufacturer, Merck, is the target of approximately 3,500 lawsuits after the drug reportedly triggered blood clots among thousands of users). Whether it's because they're freaked out by the horror stories or simply tired of irritating side effects like fatigue and mood swings, more women are embracing a more natural approach to birth control, opting for methods like the copper IUD, the pullout method, and Natural Family Planning.
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That’s not to say that the pill doesn’t work or that it didn’t, in many ways, revolutionize women’s sexual freedom. It’s still the number-one contraceptive in America for good reason: It works. According to the Centers for Disease Control, typical use failure rate for combined oral contraceptives is 9%. The pill has also been incredibly popular because, at the time of its FDA approval in 1960, there was a dearth of non-barrier-method options. The pill gave women control and convenience. As Dr. Vanessa Cullins, Vice President for External Medical Affairs, Planned Parenthood Federation of America, notes, “It was much more reliable than, say, withdrawal. And, of course it is reversible.”
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So, how exactly does the hormonal contraception work? Dr. Cullins explains: “[It] works two ways: It thickens the cervical mucus, thereby preventing the sperm and the egg from getting together and uniting, and it also prevents ovulation.” But the pill — and its contemporary contraceptive cousins, like the NuvaRing, Ortho-Evra patch, and Depo Provera shot — can pose a range of side effects and risks; some mild, some more serious. The most commonly reported side effects include, well, feeling like you’re pregnant — nausea, mood swings, breast tenderness, bloating, fatigue, and what Cullins describes as “not feeling like your normal self.” Some of the nastier (but less common) adverse effects are pulmonary embolisms, blood clots in legs, blood clots in lungs, heart attack, and stroke.
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For women who prefer their B.C. without hormones, there are, thankfully, more non-hormonal options than ever. One that's been getting lots of buzz in recent months is withdrawal (a.k.a. the pullout method). This old-school, less-than-scientific method — in which pregnancy is potentially averted by the man “pulling out” before ejaculating — is gaining in popularity. One recent study found that one in three young women aged 15 to 25 rely on withdrawal as their primary form of birth control, and that about 21% of them became unintentionally pregnant (compared with just 13% of women using different B.C. methods).

Dr. Cullins notes that though using withdrawal as one’s primary birth control method is “much better than no method at all,” it isn’t as effective as other forms, and it should only be considered an option when you have “nothing else to use.” In typical use, she says, about 27 out of 100 women will become pregnant each year using withdrawal, though if your partner is super experienced at it, withdrawal “can be [up to 90%] effective for prevention of pregnancy.”

Some men do produce a small amount of pre-ejaculate before ejaculating. Studies on whether this liquid contains sperm are inconclusive — with some studies finding no sperm and others finding live sperm in the substance. It should be noted that pre-ejaculate likely does contain the HIV virus in HIV-positive men. The withdrawal method does not protect against STIs and should be used with a partner you trust and only after you've both been tested.
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Barrier methods such as condoms, diaphragms, and the cervical cap are more reliable for preventing pregnancy, and spermicide can be used to help boost their efficacy even more. The old-fashioned, inexpensive male condom is “anywhere from 85% to 98% effective,” says Dr. Cullins, and it has another major thing going for it: It protects against STIs. Condoms, of course, don’t have many (if any) side effects, though people with latex allergies generally can’t use them (they should try plastic and polyurethane condoms instead).
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The diaphragm ($15 to $75) — a silicone cup inserted into the vagina before sex to block the sperm from reaching the uterus — has, when always used as directed, a 6% rate of pregnancy. Though it's waned in popularity in recent years, it's still a solid option for women looking for a self-controlled non-hormonal choice. The somewhat similar cervical cap (or FemCap; $60 to $75) — a thimble-size silicone cup inserted over the cervix up to six hours before intercourse — is more effective for women who haven’t been pregnant before. Among that group, 14% became pregnant; among women who had previously had children, the pregnancy rate rose to 29%. The main disadvantage of all the above barrier methods is that they require forethought — you (obviously) have to put them in, or on, before getting busy. Plus, the diaphragm and cervical cap can take some practice to pull off, and women must learn how to properly insert and remove them in order for them to work.
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There’s no “practice” to be had when choosing the copper IUD (ParaGard) as your contraceptive method — the small T-shaped copper device is a “set it and forget it” type of BC that has to be professionally inserted and removed. Dr. Cullins notes that it’s “as effective as sterilization or permanent birth control — over 99% effective.” It can also be left in for up to 12 years (seriously, set it and forget it!). Costing anywhere from $500 to $900, the ParaGard is a pricier option, though it's pretty cost-effective considering how long it can be left alone to do its thing. Some of the copper IUDs reported side effects are bleeding, cramping, pain during sex, and vaginitis (inflammation of the vagina).
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Unsavory side effects like vaginitis are nowhere to be found when using one of the most natural BC methods around: Natural Family Planning. In NFP, or fertility awareness methods, a woman uses various strategies to help track her monthly fertility pattern and her ovulation — the release of an egg — to prevent (or achieve) pregnancy. She relies on her knowledge of her menstrual cycle to determine when it’s safe to have protection-free intercourse, and when to abstain altogether. Some of the strategies include the “Temperature Method” (taking your temperature every day before you get out of bed; your body temperature is lower during the first part of your cycle and usually rises a bit after ovulation); the “Cervical Mucus Method” (checking the daily changes in your cervical mucus; usually, you’ll have the most mucus just before ovulation, and be most fertile then); and the “Calendar Method” (keeping a chart of the length of each menstrual cycle to determine when you’re most fertile — it’s slightly confusing, but more details are here). Simcha Fisher, author of The Sinner's Guide to Natural Family Planning, says NFP "requires some discipline and self-sacrifice," but is the only birth control method she trusts that "doesn't treat fertility like a disease." She says NFP is "completely healthy for your body and can actually help you understand your body better."
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According to Dr. Vanessa Cullins of PPFA, natural family planning can be a great choice “if a woman and her partner have the patience to learn [NFP] and to adhere to the rules.” Dr. Cullins says it’s “anywhere from 75% to 99% effective,” but the method’s efficacy “depends on how well-versed the person is in it and sticks to the rules.” That’s the key point to remember about NFP — it can work wonders, but it requires significant time, effort, and practice. It also doesn’t protect against STIs, and isn’t recommended for women with irregular periods. Ultimately, there’s no one-size-fits-all approach when it comes to something as personal and individual as birth control — one woman’s negative side effect could be another woman’s “no big deal.” Plus, what a woman wants from her contraception shifts and evolves as she does, depending on her age, her relationship status, and when — or whether — she wants to have children. Unsure which option is best for you? Check out Planned Parenthood’s simple “My Method” birth control widget to help learn about all your choices.
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