Birth control without hormones?

July 30, 2010 4:05 PM

I hate the idea of taking hormonal BC. Am I crazy, and what are my other options?

Quick stats: 20, never been pregnant and never want to be, no health problems, not on medications, never used any birth control besides rubbers.

I want a back-up method of birth control. Most girls I know are on the pill or the ring or whatever, but I hate the idea of taking hormones because:
1. I am a light/social smoker.

2. My sex drive is already on the low side, so I'd rather not screw with it.

3. I am pretty happy with my current menstrual cycle (pretty regular, not too heavy, almost no PMS symptoms). And this is going to sound pretty weird, but around ovulation I get this boost of energy and productivity where I'm more creative and get a lot done AND always have the best sex. I don't want to lose my awesome days of the month!

4. I read all these studies about the effects on hormonal BC on attraction and they scare me. Women on the pill prefer different and more feminine men, apparently. I don't want to become less attracted to my great and not very feminine boyfriend because my body thinks it's pregnant.

My other options seem to be:
1. Cervical caps and diaphragms - are these horribly out of date? Never heard of anyone using one
2. Sponge - sounds pretty awful/gross/like it would give me infections
3. Copper IUD - this sounded great to me, but apparently it rejects a lot in young women who haven't given birth?
4. Rhythm Method - not a fan because it would mean not having sex during awesome ovulation days

Please tell me if I am being stupid for not wanting to take hormones. My friends think I am mad and should just quit smoking and get my ass on the pill like everyone else. Advice on my non-hormonal options also appreciated. I'm not even sure where to get these, or how I would explain to a doctor. I live in Canada, by the way.

posted by anonymous to Health & Fitness (42 answers total)

You should HBC shop. Different pills with different hormone cocktails have different effects on people.

Personally, I've never experienced any ill effects from my HBC, but this is a case where YM-will-most-certainly-V. If, after several months and several different kinds of pill you're completely unsatisfied, I would revisit this question.

As a data point, my boyfriend gets a 5 o'clock shadow within an hour of shaving, and I think he's super hot.
posted by phunniemee at 4:23 PM on July 30, 2010

I personally hated being on hormonal birth control as well. You're not stupid at all...it's unnatural and just doesn't agree with some people, simple as that. I honestly feel that being on the pill/ring for a total of about 1.5 years many years ago caused some semi-permanent changes in my body, and I wish I had never tried them at all.

My recommendation would be the Fertility Awareness Method because if you do it correctly *and* you're using condoms, it's pretty foolproof as far as birth control methods go. But if you don't want to be deprived on sex on certain days, that's out. I've known women who loved the IUD and some who hated it--you won't know unless you try. If you don't like it you can easily have it removed.

There really is no perfect method of birth control, unfortunately. It's frustrating if you hate hormones but also want to be responsible. Sigh!
posted by tetralix at 4:23 PM on July 30, 2010 [3 favorites]

You're already using condoms in a relationship, and you don't mention that they're causing any particular hassles for either of you. Why not just keep doing that? Just because most people start using the pill once they're in a long-term relationship, doesn't mean you have to.
posted by 8k at 4:30 PM on July 30, 2010

You're not stupid, but like all things medical, you really have to weigh the benefits vs. the drawbacks. A lot of times, very rare things get reported to the point that they sound like they're happening to everyone. Also know your source -- some people don't want women to enjoy reproductive freedom and will say just about anything. If you decide to give it a go, be prepared to switch brands if you do get side effects.
posted by sageleaf at 4:32 PM on July 30, 2010

Mirena! (It's an IUD but not copper, with a low level of local hormone.) Love it. LOVE IT. No side effects, except for no periods, which is an awesome side effect. Though not everyone gets that one. And you don't have to worry about it but once every five years.
posted by rabbitrabbit at 4:33 PM on July 30, 2010

Are people reading the question? She doesn't want to *stop* taking condoms, she wants an additional method of BC.

I have friends who use cervical caps/diaphragms. They might be out of date(?) but my friends are happy with them.
posted by gaspode at 4:39 PM on July 30, 2010

You left out:
5. Condoms

I believe the OP is saying that condoms are her current primary method of BC, and she is looking for options for a backup method to use with them.

You're not crazy for not wanting to deal with hormones which do mess with a lot of women (although I have never had any side effects from the pill that I've noticed). Being nervous about possible side effects is very reasonable, actually. But I think the number one best thing to have when choosing BC methods is an obgyn that you feel comfortable with that you can take some time to go over your reservations, needs, and wants and that can give you more personalized info and choices than anyone else can. I would go looking for one of those, honestly, before looking for anything else.

Women on the pill prefer different and more feminine men, apparently. Really? This sounds strange and unlikely...is it that test where women in different phases of their cycle smell undershirts with men's sweat on them and say which ones they like the best?
posted by frobozz at 4:40 PM on July 30, 2010

It is totally normal to not want to be on hormonal birth control. The diaphragm is not out of date at all, and remains an awesome thing. Any good gyn should know about it -- and if you don't have a good gyn, perhaps you are close to one of the Canadian Planned Parenthood affiliated clinics. They can definitely help you there.
posted by shamash at 4:41 PM on July 30, 2010 [2 favorites]

Expulsion rates with Paraguard (the copper IUD) are not particularly high in nulliparous women -- just higher than they are in women who have given birth. And if you check on it (easy enough) monthly, you don't have to worry about that. It's an uncommon enough issue that it would be foolish to rule it out just because of that. Yeah, insertion sucks, and yeah, you'll probably have shitty cramps for the first couple of months, but seriously, it rocks: 12 years of exceptionally effective, thought-free contraception. Dirt cheap on a monthly basis even if you pay full price -- and I found that my county (US) health department offered them on a sliding scale, so I paid about $75, so you might look into that too.
posted by amelioration at 4:41 PM on July 30, 2010 [1 favorite]

I've said it before and I'll keep saying it: Modern Copper IUDs are safe and effective for most women, including those who have not given birth. The rejection rate is slightly higher for nulliparous women, but not high enough to contraindicate their use. Copper IUDs can make periods heavier and more painful, so they're not recommended for women who already have problems with heavy bleeding.

Some doctors are reluctant to offer IUDs to young women, especially those who aren't in committed (read: married) relationships. This isn't strictly because it's not safe; rather, rejecting young, single women has historically been an easy way to rule out those women whom doctors believe to be at highest risk of contracting STDs. The WHO guidelines used to caution against (not prohibit) giving IUDs to single women under 25, specifically because of the risk of STDs; this guideline has changed and now no age restrictions on their use.

That said, avoiding STDs is important, because contracting one while you have an IUD puts you at much higher risk of pelvic inflammatory disorder (PID). But if you can account for your own STD risk, say, by always using condoms and by making your partner aware of how serious the consequences of infidelity could be, there's no clinical reason for a doctor to refuse you an IUD. If you're denied, try another doctor. I had to go to an abortion clinic for mine, because my regular doctor didn't carry the appropriate insurance for the procedure.

As an anecdote, I got mine when I was 22. I got a bit of a lecture about STDs, and the doctor tried to nudge me towards getting a Mirena, but when I made the reasons my decision clear, he agreed. Getting it inserted was painful, and when I get it replaced I'll probably choose twilight sedation rather than local anaesthetic. But it's given me years of cheap, trouble-free contraception, and I wouldn't change it for the world.
posted by embrangled at 4:43 PM on July 30, 2010 [3 favorites]

You can totally do a diaphram or cervical cap in addition to the condoms. They're not foolproof on their own, but as an additional method, they sound great!
posted by wyzewoman at 4:47 PM on July 30, 2010

If you know you never want to be pregnant, obviously it would be best just to be sterilized and not have to worry anymore. Good luck, however, finding anyone who will do it at your age. (I couldn't, and now in my old age don't want to bother because I take hormonal BC to suppress menstruation.) A friend of mine had the Essure method, which seems easier than tubal ligation.
posted by LadyOscar at 5:04 PM on July 30, 2010 [1 favorite]

You are not crazy. You're allowed to choose your method of birth control, and if hormonal birth control makes you uncomfortable, you're not alone.

A lot of the alternate methods have been covered in this thread, but there's also the Lea Contraceptive.

(That same website lists all the different forms of BC, and also how/where to get them, and for how much.)
posted by Ouisch at 5:08 PM on July 30, 2010

I'm not even sure where to get these, or how I would explain to a doctor. I live in Canada, by the way.

Oh, and re: this -- all you have to do is go to your family doctor and tell her/him you're interested in non-hormonal birth control. Really not a lot of explanation necessary. Doctors are there to help you, not to be an obstacle you have to leap over in order to get a prescription for birth control. And for methods like IUD, you'll need a prescription. For a cervical cap/diaphragm, you'll need a fitting as well. Apparently the Lea Contraceptive requires neither of these.
posted by Ouisch at 5:12 PM on July 30, 2010

(Also consider just adding spermicide to your condom routine. Okay I really will stop posting now.)
posted by Ouisch at 5:16 PM on July 30, 2010

I actually love the Today Sponge, which I get automatically shipped monthly through their website. They're not nearly as messy as they seem, and though I'm really prone to UTIs, I haven't gotten one during the year I've used them. Easy to insert, easy to remove, no hormones, and you can use them for up to 36 hours.
posted by Viola at 5:30 PM on July 30, 2010 [2 favorites]

seconding what shamash said - you're not crazy to want to avoid the hormones - they can have subtle and insidious side effects - and if you can go to a planned parenthood clinic, do it. they are super knowledgeable and very understanding. If you are close to toronto, there is the Bay centre for birth control - also great. the awesome thing about going to a clinic that specializes in birth control is thet they know everything, and dealing with sexual issues if what they do everyday, so there's no weirdness or embarassment.
posted by 5_13_23_42_69_666 at 5:38 PM on July 30, 2010

I didn't much care for the diaphragm, and the sponge isn't bad but at the time I was looking for a non-hormonal option they weren't being made. What I used and really liked were the vaginal contraceptive films.
posted by lemniskate at 5:55 PM on July 30, 2010

I don't think you're crazy--I really dislike the idea of hormonal birth control too (and I've tried so many kinds of it and they all made me gain weight and get depressed: everybody's body is different).

What about condoms with spermicide?
posted by millipede at 5:56 PM on July 30, 2010

You should give the IUD a second look. I was in pretty much the exact same place as you, though I had to go the no-HBC route for medical reasons, and got my copper IUD at 20. I won't lie, insertion was hell and for the first year and a half or so my cramps went from nonexistent to I-want-to-die. But I was very bad at pain management so it doesn't have to be that bad (ibuprofen + heat = problem solved). Now, 3 years out, my cramps are back down to normal levels. But that's really the only drawback of the IUD, and every month when I was in agony and vowing to get it removed the math never really worked out -- 8 hours of pain a month was much better than any of the other alternatives.

In addition, the copper IUD doesn't mess with your cycle. You will most likely still get your awesome ovulation days.
posted by lilac girl at 6:08 PM on July 30, 2010 [1 favorite]

Today sponges sound like exactly what you want. They rock. There is a reason there was a whole episode of Seinfeld lamenting when they were temporarily off the market. Not gross at all. And will be cheap to try them out and see if you like them!
posted by selfmedicating at 6:16 PM on July 30, 2010 [1 favorite]

I think those are all great reasons not to use HBC. I've been using a diaphragm for years, and it's very easy to deal with. The last time I filled my prescription for a diaphragm, the pharmacy had to special order it, which was annoying, but you can still get them. Of course quitting smoking is a good idea but you should do it when you're ready -- not for HBC.
posted by runtina at 6:19 PM on July 30, 2010

Everyone has different experiences with hormonal forms of birth control. You just have to know your body well enough to be able to figure out if things change and take action if they do. I've been on the pill since I was 17, so almost 15 years now. There's been stretches where I haven't taken it, and I can tell that the side effects are all positive for me. It smooths my skin and I have much less acne, my sex drive is up, my periods are very light and I have no PMS symptoms or cramps (both of which are awful when I'm not on the pill), and I find that I am less fatigued at certain times of the month.

When I first started on the pill I had the same feelings as you about hormonal birth control, but there was nowhere that would give me an IUD at the time. I'm very glad I tried it and even though I've had to switch (first from Ortho Tri-Cyclen to the Lo version, because a gyn said the regular was far too many hormones for someone my size, and then from Lo to Lutera because I noticed some mood symptoms around my period that I wasn't happy with), even at the worst it still was better than nothing at all. And now I'm very happy on my pill and dread ever going off it.

Bottom line, birth control is a very personal decision. Good on you for exploring your options. I would, however, remember that the studies you've read (I've read many of them too) are often overblown and sensationalized in the media. The one you refer to on women's preference for feminine men is merely based on theory, not actual research. Become a critical consumer of media stories on science--pay attention to sample sizes, methods of measurement, and interpretations made by the proponents of the research. You'll often see that these stories are not quite what they seem at first.
posted by Fuego at 6:25 PM on July 30, 2010 [1 favorite]

1) you are not crazy.
2) If you're looking for anectdata on other forms of birthcontrol, I ***HATE*** my Mirena. But maybe other people have had better experiences with it.
3) Don't forget to check out the Nuva Ring. It's a compromise between IUD & hormonal. My understanding is it uses far less hormone than traditional methods, since the hormone is provided directly where needed, instead of ingested. I was extremely happy with the results, although I normally don't do well, with hormone-based treatments. Alas, my insurance has lapsed & I can't currently afford it.
posted by Ys at 6:34 PM on July 30, 2010

I wouldn't put too much stock in either the sex drive issue or "this study says women on hormonal birth control prefer X" sorts of things.

It is questionable as to whether hormonal birth control really causes a decrease in sex drive. Even if it's possible, every woman's side effects are different, so you may not have that anyway. Also, even if you do get that particular effect, your doctor may be able to tweak around with your prescription and find something that works for you.

In terms of the studies that show x, y, or z - it is really negligible how much this sort of thing affects any particular woman. It's certainly highly unlikely that you would stop being attracted to your boyfriend or anything like that. Don't let weird behavioral studies scare you.

Re your original question - diaphragm? Though I don't know if a diaphragm is recommended for use alongside condoms. Copper IUD?

I used Nuvaring for a year and have nothing but lovely things to say about it. YMMV on all things birth control related, of course.
posted by Sara C. at 6:55 PM on July 30, 2010 [1 favorite]

Right now am a very happy user of the ring, but I have a pretty good disposable income so I can afford the $50 a month.

I really think whatever you heard about changing attraction with hormones is way overblown. Think of how huge a number of women use hormonal BC, and most of us still love our husbands and boyfriends, yes, even the manly ones. :-)

I enjoyed Mirena but to me, it was not the same as the ring in terms of being just a 'local effect'. The ring has never given me side effects (neither did pills), but those are combined estrogen/progestin methods, and the Mirena is just levonorgestrel, a progestin. I gained a bit of weight with Mirena (have to admit though I really wasn't trying to be too healthy, and it was only about 5-10 lbs), and my skin got a bit unpredictable - not like I had acne, but I was about 25 yrs old and had always had good skin, and at that time I started getting pimples here and there. It also would give me twinges of pain if I moved around, like a pinch to my uterus. All those were fairly small deals, and I loved the fact I didn't have to remember anything and it was so cheap, but I also got a few rogue hairs in locations that made me sad (i.e. nipples, chin)! There are only like 5 of them, but they are dark so very irritating. I wanted the Mirena because I hate having my period, I feel crummy for about 3 days when I have it, but I think given the tradeoffs, I would go with a Copper IUD next time.
posted by treehorn+bunny at 7:08 PM on July 30, 2010

You are absolutely not crazy for not wanting to ever try hormonal birth control. It is really, really stupid that men never have to make decisions like this, and that women are just expected to put hormones in their bodies on a regular basis. I was on the pill for several years and did not realize until after I stopped taking it how much it had fucked with my body. It gave me monthly migraines, lowered my sex drive, and gave me atrocious PMS, among other things.

I second everyone who recommends the copper IUD or the Today sponge. The copper IUD doesn't reject much more frequently in women who haven't had kids and that is no reason not to give it a shot. I was 22 and never pregnant when I had mine inserted, still have it a year later. I have tried both, and I think you may prefer the Today sponge, simply because it works well in conjunction with condoms and requires no painful insertion procedure. It is neither awful nor gross, and if it does give you an infection, you can always stop using it. You should at least give it a try.

Cervical caps and diaphragms are very similar to the sponge, but require prescriptions. You can get the Today sponge over the counter so it sounds like the more logical choice for you.
posted by Lobster Garden at 8:14 PM on July 30, 2010 [1 favorite]

I should also add that the skill of the person doing the insertion has a lot to do with whether or not the IUD gets expelled, so if you go that route, make sure you choose a doctor who has done many, many successful insertions before.
posted by Lobster Garden at 8:17 PM on July 30, 2010

women are just expected to put hormones in their bodies on a regular basis

For what it's worth, anyone who lives in the affluent West and eats meat or dairy products puts hormones in their bodies on a regular basis.

Hormonal birth control isn't clear-cut BAD because "ohnoez, hormones!" Different women will react to different prescriptions/methods differently. And AFAIK the pill, ring, mirena, etc. are still fully approved by regulatory bodies worldwide, including the FDA, as being perfectly safe.

I think if OP has concerns about it for whatever personal reasons, that's fine, and nobody should be forced to take a medication she doesn't want. But let's not get too hyperbolic about this.
posted by Sara C. at 8:27 PM on July 30, 2010 [3 favorites]

If you are in Toronto -- I highly recommend the Bay Centre for Birth Control, if it is still there. They are experts, and will be able to discuss all the alternatives with you.

An IUD with hormone (aka Mirena in the US, an Intra-Uterine System in the UK, don't know what they are calling it in Canada) is an excellent form of birth control even for nulliparous women. The hormone is low enough to not have the effects that other hormonal birth control methods have, but counter-acts the effects an IUD without hormone can have. So, instead of a heavier period and increased cramping, most people have a light to non-existent period and no cramping.
posted by jb at 8:32 PM on July 30, 2010

I should have looked at the middle of the thread -- the Bay Centre is still there, and apparently the IUS is also called Mirena in Canada. In the UK, it was free, but apparently it is relatively expensive here. But certainly doesn't have the cramping issues of a copper IUD (actually, can eliminate existing cramps, without affecting ovulation, since you still ovulate while using an IUD).
posted by jb at 8:39 PM on July 30, 2010

A good friend got an IUD in college and had it until she was ready to have kids. No problems with the IUD, no problems getting pregnant once she got it out. She was always very happy with it. I think you should keep it on your list of options.

And: "And this is going to sound pretty weird, but around ovulation I get this boost of energy and productivity where I'm more creative and get a lot done AND always have the best sex. I don't want to lose my awesome days of the month!"

This isn't weird at all. And I still got a similar energy boost while on the pill. (There's still a CYCLE of hormones, it's just not exactly the same as it was.) On or off birth control, I put off annoying projects for those days. :D (In fact, I missed my mid-cycle boosts while pregnant!) While I don't think you should try the pill if you don't want to, it's hard to know how you'll react to the pill UNLESS you try it -- you may get none of the side effects you fear, or you may get all of them (and of course there are tons of different formulations). Which it's still fine not to want to experiment with, of course.
posted by Eyebrows McGee at 8:54 PM on July 30, 2010

You're not crazy. I had terrible side effects with HBC - depression, endless crying, wrecked libido, etc - and went off it for good a few years ago. Now I use condoms exclusively.

The scariest part of HBC side effects is how hard it can be to identify that the HBC is really what's causing them. You start thinking about all the environmental things that could be getting to you instead, and then whoops!, it's three years later and you happen to go off it and are shocked to realize you suddenly have your life back. Or maybe that's just me (and apparently Lobster Garden).

If you absolutely feel that you need a back-up, I do hear good things about IUDs. Even the Mirena is supposed to be fairly low-impact for many women, though given my history of extreme sensitivity to hormone alterations, I personally wouldn't touch it with a ten foot pole.

Diaphragms/sponges/films all pretty much work by creating a barrier of spermicide, which I think nowadays is always nonoxynol-9. This causes yeast infections in many women, but not all. It's pretty easy to test - does using condoms with spermicidal lube give you yeast infections? If not, you should be good to go!

Sponges and films are definitely still in use - not too long ago, I had a gentleman caller request that I use a sponge or film as back-up. He had brought both and was very patient while I looked at the packages to identify the active ingredients (sadly, both contain yeast infections for me). (I rejected the back-ups for my health's sake, and told him that I wouldn't be offended if he preferred to avoid PIV sex since I couldn't use birth control other than condoms, and also that my endocrinologist is pretty sure I don't ovulate regularly anyway. He found that comforting enough. I love men who communicate well in bed.)
posted by Eshkol at 9:24 PM on July 30, 2010 [1 favorite]

For all the negatives about hormonal birth control, it's also important to note that it significantly protects against ovarian cancer, even if you just take it a few years. It's also effective enough that you could use it alone without condoms, assuming your all tested and ready to go.
posted by yarly at 9:47 PM on July 30, 2010

The scariest part of HBC side effects is how hard it can be to identify that the HBC is really what's causing them. You start thinking about all the environmental things that could be getting to you instead, and then whoops!, it's three years later and you happen to go off it and are shocked to realize you suddenly have your life back. Or maybe that's just me

me too - I won't use them again.
posted by 5_13_23_42_69_666 at 1:06 AM on July 31, 2010

I haven't read through all the comments, but I'm chiming in in favour of the copper IUD. Having struggled with hormonal birth control for five years and finally given up on it three months ago, I wish I'd got mine sooner!

It has slightly worsened my period pains but this is very manageable. I think if you're happy with your menstrual cycle, it shouldn't give you any trouble. (Mine was all over the place before I went onto the pill, was forced into a routine for years and is now settling back into some kind of cycle. Still worth it for not being on the pill.)

Of course you might be one of those women whose body *loves* the pill and who finds the right one for her straight off - but it often takes a few tries, and you shouldn't rule out the copper IUD as an option.
posted by daisyk at 1:26 AM on July 31, 2010

Another (enthusiastic!) vote for the sponge. It's not gross and has never caused me any infections. I've never had any problems with it whatsoever.
posted by Eumachia L F at 3:02 AM on July 31, 2010

I had the IUD put in during my early 20's and have never had any trouble with it, apart from some really nasty cramps immediately afterwards and worse-than-usual cramps for the first year or so. Hormonal birth control for me was just a nightmare, so i can definitely see why you'd like to avoid it!
posted by ukdanae at 5:23 AM on July 31, 2010

I am just an anecdote, not a scientific study. Each of 3 different pill formulations I used had a noticeable effect on my personality and my sense of smell. Yes, smell: the sense that means the most to me in terms of physical attraction to potential sex partners. It was frightening (and in retrospect enlightening) to find that my body responded differently to the same individuals depending on what hormones I was or wasn't putting into it.

The Canadian Federation for Sexual Health may have a member clinic near you. The staff and volunteers at sexual health clinics can give you good facts to help you make the choice that's right for you.

At this point in my life (over 40, youngest child was at that point in middle school) I've opted for tubal ligation. The freedom to not worry about pregnancy as a result of sex is great.
posted by thatdawnperson at 6:44 AM on July 31, 2010

I had exactly the same concerns as you when I started shopping around for secondary birth control. I knew full well I wasn't going to give up my very light social smoking habit, but the risk was still enough to put me off most oral contraceptives. I looked into IUDs (both Mirena and the copper variety) but even with insurance, the out of pocket cost was going to be pretty high. In the end I decided to give the pill a try, but I went with the progestin-only pill or mini-pill. YMMV, but here's what's happened since I started taking mine:

-no change to my (short, light, non-crampy) period
-no change to my sex drive
-no weight gain
-no mood swings or emotional side effects
-I still ovulate, like clockwork, in exactly the same fashion as before
-still think my boyfriend is super hot
-not pregnant

I know this isn't how it goes for everyone, and I've heard some horror stories about adjusting to the mini pill, but I couldn't have been happier with the results I got. They're not nearly as popular as the combined pill, but the risks of taking estrogen really scared me off.
posted by kella at 7:53 AM on July 31, 2010

Sara C., I am not being hyperbolic. Hormonal birth control can cause many problems and have serious side effects, and many women are pressured into taking the pill because it is just expected (the OP herself says her friends keep telling her to take it). It is hardly the same as drinking milk or eating meat, so please do not pretend that these things are in any way similar.
posted by Lobster Garden at 3:22 PM on July 31, 2010 [4 favorites]

That last comment came across as a bit bitchy, so I should amend it by saying that if a woman feels hormonal birth control is right for her, she should, of course, go for it. And it's good to have a lot of different birth control options. I just feel that many women are pressured into taking hormones when perhaps it's not best for them, due to ignorance of other options (as the OP's question demonstrates).
posted by Lobster Garden at 4:41 PM on July 31, 2010