Hormonal vs Non-Hormonal Birth Control: Which is For Me?

How Does Birth Control Work?

Birth control methods work through various mechanisms to prevent pregnancy. The primary pathways involve either preventing the sperm from fertilizing the egg or creating an unfavorable environment in the uterus for pregnancy. These mechanisms can be categorized into hormonal and non-hormonal methods.

Non-hormonal birth control methods primarily focus on preventing the meeting of sperm and egg. They employ physical barriers or substances that hinder the movement or survival of sperm. Examples include barrier methods such as condoms, cervical caps, diaphragms, and contraceptive sponges.

On the other hand, hormonal birth control methods exert their effects through the use of synthetic hormones. These methods work by

• preventing the release of an egg from the ovaries (ovulation),
• altering the cervical mucus to inhibit sperm penetration,
• thinning the uterine lining to prevent implantation of a fertilized egg, or a combination of these actions.

Hormonal birth control options include combination pills, patches, intravaginal rings, progestin-only pills, injections, implants, and hormonal intrauterine devices (IUDs).

Read more about Types of Birth Control

Types of Non-Hormonal Birth Control

There are three main categories of non-hormonal birth control: "natural" methods, barrier methods, and surgical options.

Natural" Methods

Withdrawal: This method involves removing the penis before ejaculation to prevent sperm from entering the vagina
Fertility Awareness: Monitoring and tracking menstrual cycles to determine the fertile window and avoiding sexual activity or using other birth control methods during that time

Pros

• Free of cost
• Does not require any tools before or during sexual activity.

Cons

• Among the least effective birth control methods
• Difficult to use effectively
• Does not protect against sexually transmitted infections (STIs)

Barrier Methods

Condoms: Male condoms cover the penis, while female condoms are inserted into the vagina
Cervical Caps/Diaphragms: These are placed over the cervix to block sperm from entering the uterus
Contraceptive Sponges: These contain spermicide and cover the cervix

Pros

• Inexpensive and easy to use
• Male and female condoms provide protection against STIs

Cons

• Must be applied every time you have sexual activity
• Barriers can break, reducing effectiveness
• Cervical caps and diaphragms require a prescription

Intrauterine Device (IUD)

Copper IUD: This non-hormonal device is inserted into the uterus by a healthcare provider. It releases copper, which creates an inflammatory environment and impairs sperm function.

Pros: No need to remember to use any devices before or during sexual activity

Cons

• Expensive upfront cost
• May increase menstrual cramps and bleeding
• Does not protect against STIs
• Insertion can be painful

Surgery

Vasectomy (for males) and sterilization (for females): These surgical procedures provide long-lasting contraception. Vasectomy can be reversible, but female sterilization is not.

Pros: Long-lasting and no need to remember to use any devices before or during sexual activity

Cons

• Expensive
• Female sterilization is not reversible
• Does not protect against STIs

Types of Hormonal Birth Control

Hormonal birth control methods offer a wide range of options to suit individual needs. There are two main types: combination and progestin-only. Combination hormonal birth control combines estrogen and progesterone, while progestin-only methods do not contain estrogen. These categories can be further divided into six major types:

Combination Pill

Pros: Inexpensive, easy to take

Cons: Must be taken daily

Combination Patch

Pros: Inexpensive, easy to apply (once per week)

Cons: Need to remember to change it weekly, not discreet

Combination Intravaginal Ring

Pros:Inexpensive, requires insertion only once per week

Cons: Need to remember to change it weekly, may cause a sensation of a "foreign object"

Progestin-Only Injection

Pros: Lasts for 13 weeks

Cons: Relatively more expensive, may take several months for fertility to return

Progestin-Only Arm Implant

Pros: Lasts for 3 years

Cons: Relatively more expensive, requires a procedure for insertion and removal

Progestin-Only Intrauterine Device (IUD)

Pros: Lasts for 3-6 years, can improve painful or heavy menstruation

Cons: Higher upfront cost, insertion can be painful for some individuals

With different costs and durations of use, there is likely a hormonal birth control method that can suit almost everyone's preferences. When used correctly, all hormonal birth control methods are highly effective. Methods requiring user intervention, such as the patch, pill, and ring, have a typical effectiveness rate of 91-99%, while the perfect use can achieve over 99% effectiveness. Longer-term methods like the implant, injection, and IUD are all more than 99% effective.

Who Can Use Each Method?

Most non-hormonal methods can be used by anyone without significant contraindications. However, the copper IUD has a specific list of contraindications that should be considered.

It is not recommended to use a copper IUD if you:

• Are pregnant
• Have uterine abnormalities
• Have pelvic inflammatory disease
• Have postpartum/postabortal endometritis
• Have uterine/cervical cancer
• Have undiagnosed vaginal bleeding
• Have Wilson's disease
• Have a copper allergy
• Have a cervical infection

On the other hand, hormonal birth control methods have a broader range of contraindications. It is generally not advised to use hormonal birth control if you:u

• Are pregnant
• Have a history of breast cancer
• Have undiagnosed vaginal bleeding
• Are within 6 weeks of delivery*
• Are a smoker and older than 35*
• Have uncontrolled high blood pressure or diabetes*
• Have a history of blood clots*
• Have heart disease*
• Have migraine headaches (with aura)*

*Note: These contraindications are specific to combination birth control methods containing estrogen. Progesterone-only birth control methods may typically be safe for individuals with these conditions.

These contraindications are primarily due to the risks associated with the hormones present in hormonal birth control. Individuals with these conditions may be at an increased risk of adverse events such as blood clots if they were to use hormonal birth control. It's essential to discuss your medical history and any potential contraindications with a healthcare provider who can guide you towards the most appropriate birth control method for your specific circumstances.

Side Effects

Among non-hormonal methods, only spermicides and the copper IUD are associated with side effects. Spermicides can cause tingling or burning sensations in the vagina and may even increase the risk of urinary tract infections. Copper IUDs, while effective, can have unpleasant side effects such as heightened menstrual cramps and increased bleeding.

In general, hormonal birth control methods are more likely to have side effects due to the introduction of hormones into the body. Some common side effects associated with hormonal contraceptives include:

• Acne
• Irregular periods (spotting or missed periods)
• Headaches
• Nausea

It's important to note that the specific side effects can vary depending on the type and formulation of the hormonal method used. For example, birth control patches may cause irritation at the application site, and some individuals may experience discomfort during the insertion of an IUD.

Cost

When it comes to birth control, there are various options available, each with its own cost implications. Natural methods are the least expensive as they are free, but they tend to be less effective. Barrier methods, such as condoms or diaphragms, are the next affordable option. The cost of barrier methods depends on how frequently you engage in sexual activity since they need to be used each time you have intercourse.

Hormonal contraceptives come in a range of costs. For instance, birth control pills can be as low as $20 per month, although prices may vary depending on the brand and insurance coverage. Long-acting methods like the intrauterine device (IUD) can cost closer to $1000, but they provide effective contraception for several years, which may make them cost-effective in the long run.

Surgical options such as vasectomy or sterilization are the most expensive choices. These procedures require medical intervention and are typically considered permanent forms of contraception. The cost of surgery varies depending on factors such as the healthcare provider, location, and insurance coverage.

With a variety of options available, you have the freedom to choose a method that aligns with your lifestyle and meets your specific needs.

Which One Is Better?

This question has a different answer depending on your own personal preferences. However, there are a number of things to consider, which are outlined here. It’s important to note that the only methods of birth control that prevent against STIs are male and female condoms. It is therefore recommended to always use condoms in addition to whichever other method of birth control you use, for best protection against both pregnancy and STIs.

Prices mentioned in this article are based on average retail price at major box chain pharmacy in the U.S. as of May 31, 2023.