Is Hormone-Free Birth Control as Effective as the Pill? We Asked a Gynecologist

The pill, the patch, the shot…we’ve tried a handful of hormone birth control options, and while we love the whole not-getting-pregnant thing, we’re not so thrilled about the side effects (ugh, bloating and mood swings). But what about the options that don’t rely on hormones? There are a few other alternatives to condoms out there, but is hormone-free birth control for women effective? We asked Raquel Dardik, M.D., a gynecologist and clinical associate professor of obstetrics and gynecology at NYU Langone Health, for the facts.

If you’re one of the nine million-plus women currently taking a birth control pill with hormones, you might be hearing about options that are hormone-free for the first time. After all, outside of condoms and sterilization (and abstinence, of course), the only forms of non-hormonal birth control currently available to women are the diaphragm, sponge and copper IUD.

How it works: You have to first be fitted for a diaphragm by an OB/GYN before you can start using one to make sure it can do its job of blocking sperm from entering the uterus and fallopian tubes, Dr. Dardik says. When it’s the correct size and shape for your body, it creates a barrier against sperm. They're easy to insert, so women can take them out and put them in at home, by themselves, all the time—to varying degrees of efficacy.

Effectiveness: Human error comes into play with a diaphragm and it’s considered to be 88 percent effective for this very reason. It can slip out of place when you’re moving around and can shift with even slight weight loss or gain. 

The downside: Diaphragms are not popular. Fewer than one percent of women use them today, even though they’re a hormone-free option that can be used for up to two years. They also have to be inserted every single time you have sex, must remain in place for six hours after having sex and can’t stay inside your body for longer than 24 hours. Honestly, it’s just too much math for us. Diaphragms can become more effective if used with spermicide, but that gel can be quite irritating to your skin and vagina and can increase your odds of STIs. Ehh, we're gonna pass.

How it works: The sponge and the diaphragm are similar in a lot of ways: The sponge—which you've likely heard of thanks to Elaine on Seinfeld—covers up your reproductive bits and makes it so that sperm cannot get to or fertilize your eggs. (Add spermicide and it will also kill sperm that gets near it.) "You don’t need a prescription for the sponge, and it can be bought over the counter at pharmacies," Dr. Dardik informs us. 

Effectiveness: The sponge is also not super effective and only works about 75 to 88 percent of the time.

The downside: It relies on spermicide to do its job—which can cause pain and discomfort for you. A sponge can also slip out of place easily and it’s nearly impossible to tell if you’ve put it in correctly. They can be a little tricky to remove, too, and have an unfortunate reputation for being wet and messy—something you don’t necessarily want to worry about taking care of right after sex. 

How it works: This birth control method is, surprisingly, a bit of a mystery to doctors. “The copper IUD mechanism of action is not fully understood,” Dr. Dardik says, “but it is thought to work by making the uterine lining and uterine environment inhospitable for implantation.” In a nutshell, this means that the copper somehow makes a woman’s uterus attack sperm and unable to grow a fetus. (Whoa, that’s pretty cool.)

Effectiveness: The copper IUD can also prevent pregnancy for up to 12 years and is over 99 percent effective.

The downside: There’s always some risk involved when having either a copper or regular (read: hormonal) IUD inserted. It could cause pain, cramping, spotting and irregular periods, but most of these symptoms go away within three to six months. An IUD can also become expulsed, meaning it slips out of place and might not be as effective at preventing pregnancy, but this is rare and only happens to less than one percent of women, according to Dr. Dardik.

Our clear winner for a hormone-free birth control option that doesn’t come with terrible side effects or wishy-washy effectiveness is the copper IUD. “This non-hormonal option works well for patients who do not desire the side effects that many hormonal methods can cause,” Dr. Dardik says. Talk to your doctor about your own personal experience with different forms of birth control and see if you’d like to make the switch.