11 Nonhormonal Birth Control Options You Need to Know About

Birth control comes in many different forms. In the U.S., over 88% of women between 15 to 44 years old have used some type of birth control. Many people want reliable options for family planning, whether for a short time or long term. 

In 1960, the FDA approved the first oral hormonal birth control pill. Within 2 years, millions of women were taking it. Since then, many other hormonal options — like some intrauterine devices (IUDs) and implants — have been introduced. But hormonal birth control isn’t right for everyone. 

The “right” birth control varies from person to person — and it may change at different points in your life. If hormone-based birth control options aren’t right for you, here are the most up-to-date options of nonhormonal birth control methods. 

What is nonhormonal birth control?

There are many birth control options that don’t have hormones. Some need a prescription from a healthcare professional, like a diaphragm. You’ll also need to visit a healthcare professional if you want a copper IUD or a sterilization procedure. 

But there are also over-the-counter (OTC) options, like condoms, that you can buy without a prescription. These, along with lifestyle methods like natural family planning, are more affordable, but they take more time and are less effective than other methods. 

It’s important to know that only condoms help protect against sexually transmitted infections (STIs). So if you’re using another method, it’s a good idea to also use condoms to stay protected from STIs.

Here are 11 nonhormonal birth control options to consider.

1. Phexxi

In 2020, the FDA approved Phexxi, a new nonhormonal birth control option. Phexxi is a gel that you insert into your vagina within 1 hour of having sex. The gel keeps your vaginal pH acidic. The acidic environment, along with the thickness of the gel, slows down sperm, making it harder for it to reach and fertilize an egg. 

The formulation of Phexxi is different from spermicide. It contains lactic acid, citric acid, and potassium bitartrate instead of the common spermicide ingredient nonoxynol-9 (N-9). 

EXPERT PICKS: WHAT TO READ NEXT

• Birth control pill alternatives: Long-acting methods like IUDs, implants, and more offer reliable protection without the hassle of remembering to take a daily pill.

• Are IUDs safe for teens? Yes, they’re safe. Experts recommend IUDs as one of the safest and most effective forms of birth control. Find out why.

• Side effects of nonhormonal birth control: Even though they don’t use hormones, some nonhormonal methods can still have side effects. Here’s what you need to know about copper IUD side effects.

Phexxi comes in a box of 12 prefilled applicators. Each applicator holds a 5-g dose. You need to use one dose before you have sex each time. 

• Effectiveness: 79% to 86% 

• Price: Low cost or free with health insurance

2. Cervical cap

A cervical cap is a silicon covering for your cervix. You insert it before sex, and it can stay in place for up to 2 days. The cap works as a barrier to keep the sperm from reaching the egg. It’s most effective when used with a spermicide. 

Not all cervixes are the same size, so a healthcare professional recommends the correct size and writes a prescription for it. After getting a prescription, you can get the cervical cap at a pharmacy:

• Effectiveness: When used with spermicide, it’s 71% to 86% effective 

• Cost: Anywhere from free to $275, including the cost of the exam.

3. Diaphragm

Diaphragms are very similar to cervical caps, but they’re larger. A diaphragm is a soft, shallow cup made of silicone that you insert into your vagina to cover your cervix. It acts as a barrier between the sperm and your egg. For the best protection, use this birth control option with a spermicide:

• Effectiveness: 88% when used with spermicide

• Cost: Free to $75, depending on your insurance and where you live 

4. Copper IUD

Intrauterine devices (IUDs) are T-shaped devices that a healthcare professional, like a gynecologist, inserts into your uterus. These IUDs use copper, not hormones, to create a toxic environment for sperm:

• Paragard has been available in the U.S. for decades. It can last up to 10 years.

• Miudella is a newer IUD that contains half the amount of copper as Paragard. It was FDA approved in February 2025 and can be used for up to 3 years.

There are other types of IUDs, but these are the only nonhormonal options. Nonhormonal IUDs may cause heavier or longer menstrual bleeding than hormonal IUDs, although this may improve with time: 

• Effectiveness: IUDs are over 99% effective

• Cost: The cost depends on your insurance and which type of IUD you choose

5. Condoms (external and internal)

Condoms are great for protection against both pregnancy and STIs, and there are plenty of options. 

Internal condoms (female condoms) are made of nitrile (a soft plastic) and polyurethane. These materials form a pouch, which is inserted into your vagina and acts as a protective barrier:

• Effectiveness: 79% with real-world use

• Cost: Free (at some family planning centers) to $3 each

External condoms can be made of latex, plastic, or lambskin. They’re placed over the penis to create a similar protective barrier. Unlike other types of condoms, lambskin condoms don’t offer protection against STIs:

• Effectiveness: 87% with real-world use

• Cost: Free (at student health or family planning centers) to $2 each

6. Contraceptive sponge

Another OTC, hormone-free birth control option is the contraceptive sponge (birth control sponge). The sponge is inserted into your vaginal canal before sex. Like the diaphragm and cervical cap, it acts as a barrier between your cervix and the sperm. The sponge also contains spermicide:

• Effectiveness: 78% to 86% with real-world use

• Cost: $10 to $20 for a 3-pack

7. Spermicide

Spermicide is a nonhormonal birth control option that’s available without a prescription at most drugstores. The active ingredient in spermicide prevents sperm from moving. It doesn’t kill the sperm, but it slows it down or stops it from reaching an egg. But it can cause vaginal irritation. 

Spermicide comes in different forms (like gel, cream, and foam) and is inserted into the vagina before sex. Be sure to read the instructions on the label, as the timing for use may differ. Like Phexxi, you need to reapply it before each sexual encounter: 

• Effectiveness: 78% with real world use

• Cost: $1 to $3 per dose

8. Natural family planning/fertility awareness

This birth control option is a lifestyle where you track your ovulation to know when your ovaries release an egg (ovulation). The days around ovulation are when you’re most fertile, so you can either avoid sex during these days or use another form of birth control. There are different ways to track your fertility signs. Some of the most common ways are: 

• Monitoring your body temperature in the morning and before bed

• Observing cervical mucus changes

• Calculating your menstrual cycle with a monthly calendar

This method doesn’t have any side effects, but it requires more effort and planning: 

• Effectiveness: 66% to 86% with real world use

• Cost: none

9. Pullout or withdrawal

Just as the name suggests, this birth control method involves pulling the penis out of the vagina before ejaculation. This keeps the semen away from your vagina and egg. This method requires consistency and self-control because the penis must be withdrawn before ejaculation every single time. This method isn’t very effective against preventing pregnancy and doesn’t protect against STIs:

• Effectiveness: 78% 

• Cost: none

10. Tubal ligation and removal

Tubal ligation or removal are surgical procedures for people with female reproductive organs. The fallopian tubes carry eggs from your ovary to your uterus, so cutting or removing them is a permanent option to prevent pregnancy. There are two different types of procedures: 

1. Tubal ligation: This procedure cuts, closes, or removes part of your fallopian tubes. 

2. Tubal removal (bilateral salpingectomy): This procedure completely removes both fallopian tubes.

This method of contraception isn’t reversible, so it can’t be undone. It was previously thought that sterilization was the most effective form of contraception, but recent data suggests that may not be the case:

• Efficacy: 97% 

• Cost: This can be a costly procedure — up to $6,000 — but many insurance plans will cover all or part of the cost. 

11. Vasectomy

A vasectomy is a procedure that blocks the vas deferens tube, which carries sperm out of the penis. In many cases, a healthcare professional can do a vasectomy in their office using either an incision or a no-cut method. This is a safe and effective option for permanent, nonhormonal birth control. It can be reversed in some cases, but it’s not guaranteed.

• Effectiveness: Over 99%

• Cost: Around $1,000, or less with insurance

How to choose the right nonhormonal birth control

With so many options, it can feel overwhelming to pick a nonhormonal birth control method. But there are resources and people who can help you find the best choice for you. Your women’s health or primary care provider is a great place to start this discussion. If you don’t have one, consider these options:

• Local health department

• Free or low-cost clinics, like Planned Parenthood

• Title X family planning clinics

• Your local pharmacist

• Student health centers

You’ll want to think about your short- and long-term pregnancy goals. If you plan to become pregnant in the future, you might want an option that you can use in the short term. But if you’re trying to avoid pregnancy for decades (or even the rest of your life), a longer-term solution may be the right fit for you. 

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Written by:

Meredith Grace Merkley, DO, FAAP

Dr. Merkley is a licensed, board-certified pediatrician who has over a decade of experience working in community health. She is currently a National Health Services Corp scholar, and is serving as the medical director of a school-based health clinic at a federally funded health center.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

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.

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