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Non-hormonal contraception

Published by Bupa's health information team, November 2009.

This factsheet is for women who are using non-hormonal contraception, or anyone who would like information about it.

Non-hormonal contraception prevents pregnancy without using hormonal treatments such as the contraceptive pill.

About non-hormonal contraception
Types of non-hormonal contraception
Questions and answers
Related topics
Further information
Sources

About non-hormonal contraception

Up to seven in every 10 women of childbearing age can become pregnant if they don't use contraception.

Non-hormonal contraception can prevent you from getting pregnant by either stopping sperm from fertilising an egg or preventing the implantation of a fertilised egg into the lining of the womb (uterus).

Types of non-hormonal contraception

The main methods are:

barrier methods
intra-uterine devices and systems (IUDs and IUSs)
natural family planning (NFP)

Barrier methods

These are physical barriers that stop the sperm coming into contact with the egg and so prevent fertilisation.

Condoms

Condoms can help to prevent pregnancy and also protect both partners against many sexually transmitted infections (STIs).

Spermicidal condoms (containing nonoxinol 9) offer no additional benefits and may be less effective against STIs.

If you're using creams or pessaries (dissolvable tablets that you insert into the vagina) in your genital area, speak to a family planning doctor or nurse or a pharmacist as these could affect a condom and break it down. Oil-based lubricants such as petroleum jelly or baby oil can also cause the latex to break down. Water-based lubricants won't affect condoms so are a good alternative.

Male condom

A male condom is a thin sheath, usually made out of latex, that is rolled onto an erect penis before sexual contact. If you're allergic to latex, there are alternatives such as polyurethane condoms.

After sex, check the condom for leaks and tears before throwing it away - don't flush condoms down the toilet.

If you do see a tear or think the condom hasn't worked, you may wish to use emergency contraception (the 'morning after' pill). Ask your family planning doctor or nurse or a pharmacist for advice.

If you follow the instructions in the information leaflet in the packet, male condoms are very effective. Each year two in every 100 women could get pregnant if their partner uses a condom.

Female condom

A female condom is a thin, soft polyurethane pouch that is fitted inside the vagina before sex. It has an inner ring that goes into the upper part of the vagina and an outer one that should be visible.

If the instructions are followed correctly, each year five in every 100 women could get pregnant using female condoms. If it's not used correctly, the failure rate is much higher.

The diaphragm and cap with spermicide

The diaphragm and cap are made of latex or silicone and are inserted into the upper part of the vagina to cover the cervix (neck of the womb). They act as a barrier to sperm to prevent pregnancy but don't protect against most STIs. You must use a spermicidal cream with the cap or diaphragm.

Caps and diaphragms are available in several types and sizes. If you're going to try this form of contraception, visit your GP or family planning doctor or nurse so one can be fitted for you. He or she will ensure it's the right size and is positioned correctly.

After the initial fitting, you can put the cap or diaphragm in place yourself before you have sex. You can put it in at any time before you have sex but if you have sex three hours after fitting it, apply some more spermicidal cream. It's important to leave it in place for at least six hours after sex.

Don't use diaphragms or caps during your period.

After pregnancy or if you noticeably put on or lose weight - more than 3kg (seven pounds) - it's important to contact your GP, family planning doctor or nurse to check whether you need a different type or size of cap or diaphragm.

Diaphragms and caps are made of latex or silicone so they can break down and fail if you use oil-based lubricants and medicated creams or gels. Ask your family planning doctor or nurse or a pharmacist for advice when using medicines or lubricants in the genital area.

If used correctly, six women out of 100 who use a diaphragm could get pregnant each year. Out of 100 women using the cervical cap, nine could get pregnant each year. This rises to 20 in 100 if you have had a baby.

Spermicides

Spermicides are creams, gels, sponges or pessaries that contain a chemical that kills sperm. They can increase the effectiveness of certain barrier methods of contraception such as a diaphragm or cap. However, they don't provide reliable contraception when used alone and don't protect you against STIs.

You can buy spermicides from a pharmacy without a prescription.

The IUD or coil

The intra-uterine device (IUD) or coil is a small plastic and copper device that is fitted into the womb by a doctor or nurse. It's designed to prevent sperm meeting the egg and stop an egg settling in the womb. An IUD doesn't protect against STIs.

The main advantage of a coil is that, once fitted, and as long as it remains in place, it can be left for five to 10 years. Coils are very effective and only one woman out of 100 using them could get pregnant each year.

However, there are some disadvantages to the IUD. Copper coils can make your periods heavier and/or more painful, although this may improve over time. If your periods are heavy, your GP may advise a different type of coil called the intra-uterine system (IUS). This releases a hormone to thin the lining of the womb.

Another disadvantage is that you are at an increased risk of pelvic infection in the three weeks following insertion of an IUD, particularly if you're at risk of STIs. Rarely, a coil might go through (perforate) the womb or cervix when it's fitted.

If you do get pregnant while using a coil, there is a small risk of an ectopic pregnancy. This is when pregnancy occurs outside the womb, for example in one of the fallopian tubes.

Ask your GP or family planning clinic for more advice on the advantages and disadvantages of this method.

The IUS

The intra-uterine system (IUS) is a small T-shaped plastic frame that is fitted inside your womb by a doctor or nurse. The stem of the 'T' has a small reservoir that contains a hormone called levonorgestrel.

The IUS works by making it difficult for an embryo to implant in your womb. It can also thicken the mucus that your cervix produces and this can help prevent sperm from entering your womb. An IUS doesn't protect against STIs. The IUS is equally effective as the IUD.

The IUS is usually fitted within seven days after the start of your last period. This is when the womb lining is at its thinnest and so the IUS can be immediately effective as a contraceptive. If your IUS is fitted after the seventh day you will need to use other forms of contraception for seven days.

The IUS can be left in your womb for up to five years.

The disadvantages are similar to those of the IUD with respect to ectopic pregnancy and pelvic infection. The hormone in an IUS may lead to side-effects such as mood swings or breast tenderness. However, it can also make your periods lighter so you may wish to try it if you have heavy periods.

Natural family planning (NFP)

This involves reducing the chance of becoming pregnant by planning when to have sex around your monthly cycle. To be as effective as possible, natural family planning (NFP) should be taught by an experienced NFP teacher.

NFP works by observing and recording your body's natural signs on each day of your menstrual cycle. The main signs are recording your body temperature, monitoring cervical secretions and calculating how long your menstrual cycle lasts.

Fertility monitoring devices can help to measure these signs - you can buy these from a pharmacy. They work by monitoring changes in temperature, urine or saliva.

NFP varies in how effective it is. If used correctly, between one and nine in every 100 women using this method can get pregnant each year. However, NFP can be difficult to get right and the number of women who get pregnant while using it can be as high as 25 in 100.

Withdrawal

This involves withdrawing the penis before ejaculation. It's not considered a method of contraception because it's so unreliable - sperm can leak out of the penis before ejaculation and cause pregnancy.

Sterilisation

Both men and women can have operations to permanently prevent fertilisation. This is only recommended if you and your partner are sure you don't want to have any, or more, children.

Ask your GP or family planning clinic for more advice.