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 15 to 44 years old have used some sort of birth control in their lifetime. This means that most people need to make a decision about which birth control to use. 

The “right” birth control varies from person to person. And the “right” birth control for you 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 are your options for nonhormonal birth control?

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

The good news is that there are many options for birth control that don’t contain hormones. Nonhormonal birth control options include prescription medications, over-the-counter (OTC) options, surgical procedures, and natural family planning.

Prescription nonhormonal birth control options

There are three nonhormonal birth control options that require a prescription from a medical provider. It’s important to know that these options do not protect against sexually transmitted infections (STIs) and should be used with condoms.

Phexxi

In 2020, the FDA approved Phexxi, a new nonhormonal birth control option. This contraceptive is a gel that you insert within 1 hour of having sex. The gel helps to keep the vaginal pH acidic. The acidic environment is not livable for the sperm, so it will not reach and fertilize the egg. 

The formulation is different from spermicides because it contains lactic acid, citric acid, and potassium bitartrate instead of nonoxynol-9 (N-9). This has been found to be less damaging to vaginal cells. 

Phexxi is 79% to 86% effective. The Affordable Care Act covers it, and it will be low cost or free with other health insurance. The prescription comes in a box of 12 prefilled applicators that have a 5-gram dose. You need to use one dose before each sexual encounter. 

Cervical cap    

A cervical cap is a silicon covering for the cervix. The cap is inserted before sex and can be left in for up to 2 days. It provides a barrier so that the sperm can’t reach the egg. It’s most effective if used with a spermicide. Together, their effectiveness against pregnancy is 71% to 86%. 

Not all cervixes are the same size, so a healthcare provider must size the cervix and write a prescription for the correct size. After getting a prescription, you can get the cap at a pharmacy.     

Diaphragm

Diaphragms are very similar to cervical caps, except they’re larger. A diaphragm is a shallow cup made of soft silicone, and it covers the cervix when inserted into the vagina. The diaphragm acts as a barrier between the sperm and the egg. 

For the best protection, use this birth control option with a spermicide. When used together, the efficacy is 87%. Depending on which brand you chose, you may need to get fitted for a diaphragm. 

Paraguard IUD

This type of hormone-free birth control is an IUD, which is a small and flexible T-shaped plastic device with a copper wrapping. Sperm avoids copper, so when the IUD is in place, the sperm can’t swim to the egg and will not fertilize the egg.  

A healthcare provider inserts the IUD into the uterus through the cervix. There are other types of IUDs, but this is the only nonhormonal option. This form of nonhormonal birth control has an amazing efficacy rate of 99% and lasts for up to 10 years. 

Over-the-counter nonhormonal birth control options

OTC nonhormonal birth control options can be used by themselves or along with other options, which make them work even better.  

Condoms (external and internal)

Condoms are great for protection against both pregnancy and STIs. And they’re very affordable. Internal condoms (female condoms) have a nitrile (soft plastic), non-latex cover and outer ring as well as a polyurethane inner ring that forms a pouch. This is inserted into the vagina and acts as a protective barrier. 

External condoms can be latex, plastic, or lambskin. They're placed on the outside of the penis to provide a similar barrier. Unlike other types of condoms, lambskin condoms don’t offer protection against STIs.

Contraceptive sponge

Another great hormone-free birth control option is the contraceptive sponge (birth control sponge). Similar to the diaphragm and cervical cap, the sponge acts as a barrier between the cervix and the sperm. 

The soft, plastic sponge contains a spermicide and is inserted into the vaginal canal before sex. Just like we discussed above, though, this birth control option does not protect against STIs, so it’s recommended that you use a condom to provide extra protection. 

Spermicides

Spermicide is a nonhormonal birth control option that is available without a prescription. It stops the sperm from reaching an egg. It’s a gel that is inserted into the vagina before sex. It works by creating a more acidic environment within the vagina so the sperm can’t function. 

The main ingredient in spermicide is nonoxynol-9, which is different from Phexxi, the new nonhormonal birth control gel. This birth control option does not protect against STIs. 

Lifestyle options

Lifestyle options are a form of birth control that can be time intensive. They’re also less effective than other methods if not used correctly and consistently. But, if this is the option you prefer, there are many resources and medical providers available to help you. 

Natural family planning/fertility awareness

This birth control option is a lifestyle where you track your ovulation so that you know when your ovaries release an egg (ovulation). There are different ways to track fertility signs. Some of the most common ways are: 

• Monitoring your body temperature in the morning and before going to bed

• Observing cervical mucus changes

• Calculating your menstrual cycle with a monthly calendar

This method can be less effective than other methods. But there are resources that can help. 

Pullout/withdrawal

Just like it sounds like, this birth control method is where the penis is pulled out of the vagina before ejaculation. This keeps the semen away from the vagina and the egg. This method requires consistency because the penis must be withdrawn before ejaculation every single time. This method is not very effective against preventing pregnancy and does not protect against STIs.   

Surgical nonhormonal birth control options

Surgicalbirth control options are more expensive than the other nonhormonal birth control methods. Unlike other options, surgical methods are permanent.

Tubal ligation and removal

Tubal ligation or removal are surgical procedures for people with uteruses. These are permanent options to prevent pregnancy. There are two different types of procedures: 

• Tubal ligation: Thiscuts, closes, or removes part of the fallopian tubes. 

• Tubal removal (bilateral salpingectomy): Thiscompletely removes both fallopian tubes.

This is a permanent method of contraception and is a good option for anyone who doesn’t want to get pregnant in the future. This can be a costly procedure  — up to $6,000 — but many insurances will cover all or some of the cost. It’s a very effective method of nonhormonal birth control, but it does not protect against STIs. 

Vasectomy

A vasectomy is a procedure that blocks the vas deferens tube, which carries sperm out of the penis. A healthcare provider can do a vasectomy in their office with an incision or a no-cut method. 

This is a safe and effective option for permanent nonhormonal birth control. The procedure is less expensive than a tubal ligation or removal, costing on average about $1,000. The success rate for vasectomies is also very high, at 99.7%. There is a low risk of complications. 

How to choose the right nonhormonal birth control

With so many options, it can feel overwhelming to pick a nonhormonal birth control. But there are resources and people who can help you find the best options for you. Your healthcare provider is a great place to start this discussion. 

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

Why trust our experts?

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:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

Reviewed by:

Adriena Beatty D.O., MBA, CPE

Adriena Beatty, DO, MBA, CPE, is an Army veteran and board-certified obstetrician and gynecologist with over 20 years of experience. She is a graduate from Tuskegee University with a degree in chemical engineering and chemistry.

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