Don’t Want to Take the Pill? A Guide to 7 Birth Control Alternatives

The most common types of birth control are surgical sterilization (such as “getting your tubes tied”) and birth control pills (“the pill”) — and for good reason. They’re very effective. But they’re not for everyone. Sterilization is convenient but permanent. And the pill needs to be taken at the same time, every day, which can be tough to remember. Plus, the side effects of the pill can be hard to manage for some people.

Luckily, there are many alternative forms of birth control. There are options that you use just when you need to, like Phexxi gel or the diaphragm. Others, like IUDs (intrauterine devices), implants, and injections, need to be done by a healthcare professional. There are also in-between options that you can apply yourself every month, like contraceptive rings and patches.

With so many options, there’s sure to be a method of birth control that’s right for you.

Types of birth control alternatives

There are plenty of options if you’re interested in contraception that doesn’t involve the pill or surgery. They vary in terms of ease of use, effectiveness, and length of protection against pregnancy.

Before we take an in-depth look at each one, here’s an overview of the different options:

• Long-acting, reversible contraceptives (LARCs): These methods include implants and IUDs. They’re the most effective and easiest to use, and they can last for years. Your healthcare professional has to place an IUD or implant, but then you don’t need to do anything afterwards. There are both hormonal and nonhormonal options.

• Injections: The Depo-Provera (medroxyprogesterone) injection isn’t quite as error-proof as LARCs, but it requires less monitoring than the options you place yourself.

• Patch and ring: These options contain hormones and are more convenient than a daily pill. But, in order to have your best chance of avoiding unplanned pregnancy, you need to remember to switch them out.

• As needed: The cervical cap, diaphragm, spermicide, and Phexxi (lactic acid/citric acid/potassium bitartrate) are used before sexual activity. They are nonhormonal, prescription forms of birth control that require more work on your part. Generally speaking, they aren’t as effective as the other methods, so consider using them with another form of birth control. Condoms also work as-needed, without a prescription.

Just remember that regardless of which type of birth control you choose, they don’t protect against sexually transmitted infections (STIs), like gonorrhea or HIV. Only condoms can give that kind of protection.

Comparing nonpill birth control alternatives

Here’s a quick comparison of prescription birth control methods that are not the pill.

Below are more details about seven birth control alternatives to the pill.

1. Nexplanon implant

The contraceptive implant (Nexplanon) is a thin, plastic rod that’s inserted under the skin in your arm. It releases the hormone etonogestrel (a progestin), which helps prevent ovulation (release of an egg by an ovary).

EXPERT PICKS: WHAT TO READ NEXT

• Side effects of hormonal birth control: You may know about changes to your period, but it’s important to be aware about these less common side effects, as well.

• Are IUDs safe for teens? Yes. In fact, IUDs are recommended by experts as one of the safest and most effective forms of birth control. Find out why.

• Nonhormonal birth control options: Learn more about nonhormonal methods like condoms, copper IUDs, and more.

It also prevents pregnancy by thickening the mucus in the cervix (where the vagina meets the uterus). This makes it harder for a sperm to reach an egg (fertilization) in case ovulation does occur. It also thins the lining of the uterus, making implantation more difficult. 

Benefits

The implant can help with symptoms related to endometriosis or your period. It’s safe if you’re  breastfeeding.

Side effects

The most common side effect is irregular bleeding, and there’s no way to predict how or if your period will change. Other possible side effects are related to hormones. They include headaches, breast tenderness, and worsening acne.

Risks

There’s an increased risk of blood clots in people who smoke. Regarding breast cancer risk, the evidence is mixed. Some research suggests progestin-only birth control such as the implant may also raise the risk of breast cancer in some people. But other studies didn’t find such a link. 

You shouldn’t get an implant if you are pregnant or have:

• Breast cancer (current or past)

• A current or past blood clotting problem

• Liver disease

• Unexplained vaginal bleeding

2. Intrauterine devices

IUDs are T-shaped contraceptive devices that are placed in the uterus to prevent fertilization of an egg by sperm. There are two types of IUDs: copper (nonhormonal) and hormonal. And they work a little differently.

Copper IUD

The copper IUDs (Paragard and Miudella) are hormone free. They release copper ions, which are toxic to sperm. This makes it difficult for sperm to move and enter the uterus. Miudella contains less copper than Paragard but can’t stay in as long.

Hormonal IUD

The other IUDs release levonorgestrel, a progestin. This thickens the cervical mucus, making it difficult for sperm to reach the uterus. It also helps prevent ovulation and thins the lining of the uterus.

You have a few different types to choose from:

• Skyla

• Mirena

• Kyleena

• Liletta

Getting an IUD placed

You’ll need to see a healthcare professional in a clinic or outpatient setting to have an IUD placed. This procedure lasts only a few minutes, but it’s uncomfortable and even painful.

The IUD has strings attached to it. Your healthcare team will ask you to “check your strings” about once a month. You simply insert a clean finger into your vagina, and you should feel the strings at your cervix. This is an important check to be sure the IUD hasn’t moved out of place.

If you have an IUD and want to get pregnant, or if you have side effects from it (see below), know that an IUD can be removed at any time. Simply contact your healthcare team for a quick visit.

Benefits

IUDs are linked to a lower risk of endometrial cancer. Within 6 months of getting a hormone-releasing IUD, many women report having lighter or no periods. They can lessen pain related to menstruation and endometriosis. And they’re safe to use immediately after giving birth or having an abortion. The Paragard copper IUD can be used as emergency contraception if placed within 5 days of unprotected sex.

Side effects

Possible side effects of the hormone-releasing IUDs include breast tenderness, mood changes, and headache.

Possible side effects of the copper IUD include:

• Anemia

• Backache

• Painful or heavier menstruation

• Pain with sex

• Irregular periods

• Vaginitis

Risks

There are a few rare risks to know about with IUDs:

• Ectopic pregnancy: Getting pregnant with an IUD isn’t likely. But, if it happens, the pregnancy is more likely to be ectopic. This means the fertilized egg grows somewhere other than the uterus, usually in the fallopian tube, and it’s a surgical emergency.

• Expulsion: This is when the IUD makes its way out of the uterus. The risk is less than 2% if it’s placed 4 or more weeks after giving birth. But the risk increases for IUDs placed closer to birth, especially vaginal birth. An expulsion might not cause symptoms, or it could result in cramps, pain with sex, or irregular bleeding.

• Perforation: This is when the IUD punctures the wall of the uterus. It’s very rare. Many times there are no symptoms with perforation. Other times, it may cause pelvic or abdominal pain and abnormal bleeding. Depending on where it is, it may need to be surgically removed.

The risks of expulsion and perforation are why it’s important to check for your strings regularly. If you can’t find them, or if you have any symptoms out of the ordinary, contact your healthcare team to have a second look.

You shouldn’t get either IUD if you are pregnant or have:

• An STI

• Pelvic inflammatory disease

• Cervical or endometrial cancer

• Unexplained vaginal bleeding

You shouldn’t get the hormone-releasing IUD if you have breast cancer (current or past) or liver disease.

3. Depo-Provera injection

Depot medroxyprogesterone acetate (DMPA) is a progestin-only contraception. It’s given by injection every 3 months (4 times per year). The brand name is Depo-Provera, and it’s sometimes known as the “Depo shot” or the “birth control shot.” A healthcare professional can give you the shot, or you can self-administer it at home.

It prevents pregnancy by thickening the cervical mucus and preventing ovulation.

Benefits

A benefit of DMPA is that it can help with pain related to endometriosis. Long-term use can lower the risk of endometrial cancer. It’s also safe right after giving birth and while breastfeeding.

Side effects

The most common side effect is irregular bleeding. Other side effects include the usual hormone-related ones, such as breast tenderness and mood changes. Unlike most hormonal birth control methods, DMPA can also cause weight gain. Because it’s an injection, you could experience pain, bruising, or skin changes at the injection site.

Risks

Using hormonal contraceptives increases the risk for blood clots (see below). DMPA has been linked to lower bone mineral density. Experts aren’t sure if this leads to a higher risk of fractures. This change in bone density is reversible after the injections are stopped. But it should still factor into your birth control decision.

You shouldn’t get DMPA if you are pregnant or have:

• Breast cancer (current or recent)

• Diabetes with complications

• Heart disease

• Liver disease

• Lupus

• History of stroke

• Unexplained vaginal bleeding

4. Patch

The patch (Xulane, Twirla) contains estrogen and progestin, which are released through the skin into the body. It prevents pregnancy by inhibiting ovulation, thickening the cervical mucus, and thinning the uterus lining. But the combination of the two hormones is more effective at preventing ovulation than progestin-only formulations.

You apply 1 patch to your body once a week for 3 weeks, making sure to remove the old patch before applying a new one. It’s a good idea to change the spot where you apply the patch to prevent skin irritation from the adhesive on the patch. On week 4 of your cycle, don’t apply a new patch. You’ll get your period during this off week.

Benefits

Hormonal contraceptives like the patch can help symptoms related to periods or endometriosis. They can also make your periods lighter.

Side effects

Possible side effects include:

• Headache

• Skin irritation

• Breast tenderness

• Nausea

• Spotting

Studies suggest that people who use the patch may be more likely to stop using it due to side effects than people who use the pill.

Risks

Using hormonal contraceptives increases the risk for blood clots (see below). Some evidence suggests that patches don’t work as well at protecting against pregnancy in women with high body fat.

Don’t use the patch for at least a few weeks after giving birth or if you are currently pregnant. Also avoid the patch if you have any of the following:

• Blood clots (current or past)

• Body mass index (BMI) of 30 or greater

• Breast cancer (current or past)

• Diabetes with complications

• Gallbladder disease

• Heart disease

• High blood pressure that isn’t well managed with treatment

• Liver disease

• Certain people with lupus

• Migraine with aura

• Stroke

If you are older than 35 years and have the following, don’t use the patch:

• Smoking 

• Diabetes with or without complications

• Migraines 

5. Ring

Contraceptive rings (NuvaRing and Annovera) are flexible rings that contain estrogen and progestin. The different brands work similarly.

You insert the ring into your vagina, where it releases hormones. It stays in place for 21 days at a time. You don’t need to remove it for sex. After 21 days, you remove the ring for 1 week, during which time you will most likely have a period. Then you either insert a new ring (if you’re using NuvaRing) or reinsert the same ring after cleaning it (if you’re using Annovera). An Annovera ring provides enough hormonal medication for 13 menstrual cycles (about 1 year).

Benefits

Benefits of the ring are similar to those of the patch.

Side effects

Possible side effects include the usual ones, like headache and breast tenderness. But the ring may also cause vaginal irritation and discharge. Studies suggest that people who use the ring might have fewer side effects and thus be less likely to stop using it than people who use the pill.

Risks

See below for more information on the risk of blood clots with hormonal contraceptives.

Don’t use the ring for at least a few weeks after giving birth or if you are currently pregnant. Avoid using the ring if you have any of the following:

• Blood clots (current or past)

• Breast cancer (current or past)

• Diabetes with complications

• Gallbladder disease

• Heart disease

• High blood pressure that isn’t well managed

• Liver disease

• Certain people with lupus

• Migraine with aura

• Stroke

If you are older than 35 years and have the following, don’t use the patch:

• Smoking 

• Diabetes with or without complications

• Migraines 

6. FemCap and diaphragm

The cervical cap (FemCap) and diaphragm are reusable pieces of silicone that you insert into your vagina to cover your cervix before you have sex. These are known as “barrier methods” because they serve as a physical barrier that prevents sperm from reaching the uterus. They should be used with spermicide, which slows down sperm and makes it harder for them to reach an egg.

They don’t contain hormones, but they both require a prescription. Cervical caps are smaller in size than diaphragms and can be left in place longer.

Like most contraceptives, the cervical cap and diaphragm work best when they’re used correctly. For barrier methods, that means using them every single time before sex. Keep in mind that they need to be left in place for at least 6 hours after sex. They can be hard to use correctly, especially at first, and they’re more effective for people who have never given birth.

Benefits

Barrier methods are convenient in that you can carry them with you. They’re also an option for people looking for a nonhormonal contraceptive option.

Side effects

Spermicide is the most likely culprit of side effects. It can contribute to vaginal irritation and even allergic reactions. Spermicide may also increase the risk of urinary tract infections (UTI) and HIV infection.

Risks

If your body changes, like experiencing weight changes or after having a baby, you’ll probably need a new size of cervical cap or diaphragm. There’s a small risk of toxic shock syndrome with caps and diaphragms, so don’t leave one in for more than 24 hours. And don’t use it while you have your period.

7. Phexxi gel

Phexxi is the first contraceptive gel of its kind. The FDA approved it in mid-2020. It contains lactic acid, citric acid, and potassium bitartrate. It works by keeping the pH in the vagina low enough so sperm can’t move well. It doesn’t contain hormones or spermicide.

You need a prescription to get it, and it comes in a prefilled applicator, sort of like a tampon. It’s meant to be applied to the vagina within 1 hour before each sexual encounter.

Benefits

It’s easy to use and doesn’t contain any hormones. And you can use it with other types of contraception, except the ring.

Side effects

Phexxi gel may feel messy, although it’s meant to be less messy than traditional spermicide. Side effects reported with Phexxi use include:

• UTI

• Yeast infection

• Burning, itching, and pain of the vulva and vagina

Risks

Very rarely, women using Phexxi experience serious UTIs or kidney infections. You also have to remember to use it in order for it to be effective.

How to choose the best birth control option for you?

With all of these options for contraception (and more over-the-counter (OTC) options), it might be hard to know how to choose. First, speak to your healthcare professional about your options. They can help you narrow it down based on whether you have any medical conditions to consider or if you take any medications.

Then, think about things like convenience, affordability, and efficacy. As you choose your birth control method, consider what’s most important to you:

• Lifestyle: Are you OK with remembering to replace a patch or ring? Or would you rather use a form of birth control that lasts longer?

• Hormones: Are you sensitive to hormones, or do you want to avoid them? Or are you looking for a hormonal birth control that will help with painful periods?

• Affordability: Do you have insurance or want to avoid a large upfront cost?

Which forms of birth control are covered by insurance?

Keep in mind that the Affordable Care Act (ACA) says that healthcare plans must cover contraception prescribed by a healthcare professional. This includes all FDA-approved options, including the ones mentioned here. If you have coverage, and your healthcare team prescribes birth control, you shouldn’t be charged for the contraception or for a copay.

Note that employers may opt out of this policy if they have a “religious or moral objection” to providing coverage for contraception to their employees. Be sure to check your plan for more information.

How to save on nonpill birth control

If you are uninsured, underinsured, or want to go outside your insurance plan, alternative forms of birth control can still be an option. Here are some ways to save on nonpill birth control:

• Save with GoodRx: GoodRx can help you save a significant amount off the retail price of many of these options, and it’s easy to use. Just search GoodRx to find coupons for the lowest prices near you.

• Save with copay savings cards: Many manufacturers offer copay cards to help reduce the cost of medications. Usually, you must have commercial insurance to be eligible for these. For example, you may be able to get Annovera for as little as $0 using a savings card from the manufacturer. Check the GoodRx page for your birth control or visit the manufacturer’s website to see if this option is available.

• Save with patient assistance programs: Many manufacturers offer their medications at reduced cost through patient assistance programs. For example, Bayer offers assistance for their IUD Mirena for qualifying individuals. Visit the manufacturer’s website or ask your healthcare team to see what options are available.

• Visit a free clinic: Clinics like Planned Parenthood or ones that participate in the federal 340B program may offer alternatives to oral birth control at a reduced cost. You can also search for a Title X family planning clinic near you.

A note on birth control risks

Last but not least, it’s important to know that there are some medical risks linked to the use of hormonal contraceptives — not just the pill.

Risk of blood clots

Some types of hormonal birth control (including the ring, patch, and injection) increase the risk of blood clots. The risk is higher if you’re older than 40 years, smoke, or have certain medical conditions.

Risk of breast cancer

Use of hormonal birth control has been linked with a slightly higher risk of breast and cervical cancer. The risk is very small, and it likely goes away after birth control use is stopped. The exceptions are implants and injections, which don’t appear to increase the risk of breast cancer at this time.

It’s also important to note that hormonal birth control lowers your risk of other cancers, such as endometrial, ovarian, and colorectal cancers.

When choosing a form of contraception, it’s best to weigh all the pros and cons — not just these risks — to choose what’s best for you.

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Written by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

Reviewed by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined her interests in clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

Reviewed by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

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