Hormone-free contraception: How to use contraception without hormones
Non-hormonal contraception includes a range of methods, such as condoms, that prevent pregnancy without the use of hormones. These methods do not interfere with the body’s hormonal balance and offer an alternative for those who wish to avoid the side effects of hormonal contraceptives. However, even with non-hormonal contraception, protection against sexually transmitted infections (STIs) is crucial, as many of these methods do not provide STI protection. In this article, we will present various non-hormonal contraceptive methods and examine their advantages and disadvantages. Having access to this information can help individuals make more informed decisions that support both their health and well-being.
Table of Contents
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Why are more and more women avoiding hormonal contraception?
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Do non-hormonal contraceptives protect against sexually transmitted infections?
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What exactly is the Pearl Index?
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What are the alternatives to hormonal contraception?
Why are more and more women avoiding hormonal contraception?
The decision not to use hormonal contraceptives is often a highly individual one. Many women are concerned about physical side effects such as weight gain and headaches, and worry about long-term health risks like blood clots and breast cancer. Mental health also plays a role, as symptoms such as low mood and mood swings can occur. Hormonal contraceptives can also affect sexual well-being, with many women reporting a decreased libido. Concerns about long-term fertility and the fear of unknown side effects from new contraceptive methods are additional reasons why women seek hormone-free alternatives (Guen et al, 2021).
Do non-hormonal contraceptives protect against sexually transmitted infections?
Not all non-hormonal contraceptives provide protection against sexually transmitted infections (STIs). While condoms—both male and female—are highly effective at protecting against many STIs, other methods like copper IUDs or natural methods do not offer such protection. STIs can cause a wide range of symptoms in both men and women, from mild signs such as itching or rashes to serious health issues like HIV. For 2020, the WHO estimated 374 million new infections with one of the four major STIs: chlamydia (129 million), gonorrhea (82 million), syphilis (7.1 million), and trichomoniasis (156 million) (WHO, 2023). Therefore, if you choose a non-hormonal contraceptive method, you should also take appropriate precautions against STIs, especially if you have multiple sexual partners, are in an open relationship, or are starting a new relationship. Regular STI testing and open communication with your partner about sexual health and contraception are essential for responsible sexual health practices (CDC, 2023).
Want to gain insight into your own health?
At-home sexual health tests, such as those offered by Homed-IQ, provide a convenient and discreet way to regularly monitor your health. With tests like the Comprehensive STI Test, Basic 4 STI Test, or the Syphilis Test, you can easily test for multiple or individual STIs without scheduling a doctor’s appointment. Regular testing is an important part of preventive healthcare and helps detect and treat infections early.
What exactly is the Pearl Index?
The Pearl Index is a metric used to evaluate the effectiveness of contraceptive methods. It indicates how many out of 100 women will become pregnant within one year of using a particular method. A low Pearl Index indicates high effectiveness, while a high one indicates lower effectiveness. However, the Pearl Index is often calculated under ideal conditions and does not account for user error in daily life. As a result, the real-world effectiveness of contraceptive methods may be lower than the Pearl Index suggests. For example, the Pearl Index for male condoms ranges from 2 to 12, meaning that 2 to 12 out of 100 women may become pregnant in a year using condoms alone. Copper IUDs have a very low Pearl Index, often below 1, while the index for coitus interruptus is much higher, typically between 18 and 22 (Trussell& Portmann, 2013).
What are the alternatives to hormonal contraception?
When choosing the right contraceptive, many factors need to be considered. These include your personal health, lifestyle, tolerance, as well as the effectiveness and safety of the method. It’s also important to consider whether protection against STIs is provided. If you are unsure which method suits you best, it’s always advisable to consult a doctor for an informed decision tailored to your needs.
Barrier methods
Barrier methods work by physically preventing sperm from entering the uterus and thus preventing pregnancy. The most common barrier methods include condoms and diaphragms.
Condoms are usually made from latex, polyurethane, or other synthetic materials. External condoms (commonly known simply as condoms) are rolled over the erect penis. Internal condoms, also known as "female condoms," are inserted into the vagina. Both types are effective at preventing pregnancy and STIs when used correctly.
| Advantages | Disadvantages |
|---|---|
| Provide protection against most STIs | Can cause allergies or irritation (e.g., latex allergy) |
| No long-term side effects or hormonal influence | Must be used correctly with every act of intercourse, which can be seen as inconvenient |
| Easily available and generally inexpensive | Can break or slip, increasing the risk of pregnancy or STIs |
| Do not require a prescription | May reduce sensation during intercourse |
Diaphragms are soft, silicone domes inserted into the vagina to cover the cervix. They must be used with spermicide to be effective and should remain in place for at least six hours after intercourse. Diaphragms come in various sizes and need to be fitted by a healthcare provider.
| Advantages | Disadvantages |
|---|---|
| No effect on hormonal balance or fertility | Must be inserted before each intercourse |
| Reusable and eco-friendly | No STI protection |
| Can be inserted just before intercourse | Requires correct insertion for effective protection |
| May cause discomfort or allergic reactions in some women | Must be fitted by a healthcare provider |
Source: NHS,2022
Coitus interruptus
Coitus interruptus, also known as "withdrawal," is one of the oldest methods of contraception. The man withdraws his penis from the vagina before ejaculation to prevent sperm from entering (CDC, 2023).
| Advantages | Disadvantages |
|---|---|
| Free method | Very low reliability |
| No impact on hormones or fertility | No STI protection |
| Requires significant self-control and discipline from the male partner |
Intrauterine contraceptives
Intrauterine devices (IUDs) are small devices inserted into the uterus to prevent pregnancy. There are hormonal and non-hormonal types. Non-hormonal IUDs, typically made with copper, impair sperm mobility and are ideal for long-term contraception. These devices require medical consultation and are not suitable for all women. Variants include (Cleveland Clinic, 2022):
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Copper IUD: T-shaped device wrapped in copper wire.
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Copper chain (GyneFix): Flexible chain of copper cylinders.
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Copper pearl ball (IUB): Flexible frame forming a ball inside the uterus.
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Copper-T with gold or silver core: For improved tolerance and reduced inflammation.
| Advantages | Disadvantages |
|---|---|
| Long-lasting and highly effective (up to 10 years) | Insertion/removal must be done by a professional |
| Low maintenance after insertion | Can cause heavier periods and cramps |
| Fertility returns upon removal | No STI protection |
| No daily attention required | Rare risk of uterine perforation or displacement |
Source: NHS, 2021
Chemical contraceptives
These work by immobilizing or killing sperm, reducing their ability to fertilize an egg. They are applied just before intercourse.
Examples:
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Spermicidal creams and gels
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Contraceptive foam
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Vaginal suppositories
| Advantages | Disadvantages |
|---|---|
| Easy to use, no prescription needed | Lower effectiveness than other methods |
| Immediate protection | No STI protection |
| No long-term body effects | Possible allergic reactions or irritation |
| Hormone-free alternative | Must be used before each intercourse |
Sources: IQWiG, 2006; Sullivan, 2021
Natural methods
Natural methods rely on understanding your body and cycle. They help avoid or achieve pregnancy by identifying fertile days through:
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Basal body temperature
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Cervical mucus observation
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Menstrual cycle tracking
| Advantages | Disadvantages |
|---|---|
| No medication or procedures | Lower reliability if not applied precisely |
| No side effects or hormonal influence | Requires detailed body awareness and discipline |
| Promotes understanding of your body | No STI protection |
| Cost-effective | Less effective with irregular cycles |
| Involves both partners | Can limit spontaneity |
Sterilization
Sterilization is a permanent contraceptive method for men (vasectomy) and women (tubal ligation or removal). In a vasectomy, the vas deferens are cut so sperm no longer enter the semen. In women, the fallopian tubes are blocked or removed. This method is very effective but provides no STI protection. It is chosen by people who are certain they do not want children. Since it is usually irreversible, the decision must be carefully considered (Mayo Clinic, 2023).
Summary
Choosing a non-hormonal contraceptive method can help you avoid the side effects of hormonal options. It is also essential to consider STI protection, as not all methods provide it. Each method has its own pros and cons, and your decision should be based on your personal health and family planning goals. Being well-informed is the key to choosing the method that best fits your lifestyle and needs.
