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Non-hormonal contraception

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

If you're a woman of childbearing age, almost any time you have sex without using contraception there is a chance you might get pregnant.

Non-hormonal contraception can prevent you from getting pregnant. It can either stop sperm from fertilising an egg, or prevent a fertilised egg from attaching to the lining of your womb (uterus).

The main methods of non-hormonal contraception are barrier methods and the intrauterine device (IUD). The intrauterine system (IUS) is different to the IUD. The IUS is a hormone containing contraceptive device similar to the IUD that is placed in the womb. It can also help women who suffer from heavy periods (menorrhagia).

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  • Barrier methods Barrier methods

    These are physical barriers that stop sperm from entering the womb.

    Condoms (male and female)

    Condoms act as a barrier to sperm to prevent pregnancy and also protect both partners against sexually transmitted infections (STIs). They may be used specifically to protect against STIs, even if you are using other forms of contraception.

    A male condom is made of thin rubber (latex) or plastic (polyurethane). It’s used by rolling it onto an erect penis before making contact with the vaginal area.

    A female condom is a thin, soft, polyurethane pouch that is fitted inside the vagina before the penis makes contact with the vaginal area. It’s held in place with a ring that lies outside the vagina.

    There are several things you need to be aware of when using condoms.

    • If you're using a latex condom, don’t use medicated creams or gels, or oil-based lubricants such as petroleum jelly or baby oil. These can weaken the latex and cause it to tear.
    • Always check a used condom for leaks and tears before throwing it away.

    If you notice a tear, or think the condom has leaked or slipped during sex, you may wish to use emergency hormonal contraception. Contact your pharmacist or GP for advice.

    Even if used according to instructions, each year two in 100 women will get pregnant when their partner is using a male condom. Up to five in 100 women will get pregnant when using a female condom correctly. Always read the instructions that come with the condoms. If condoms aren’t used correctly, the failure rate is much higher – up to one in five women will become pregnant.

    Diaphragms and caps

    Diaphragms and caps are made of latex or silicone. These 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 STIs.

    Diaphragms and caps come in different shapes and sizes. Diaphragms are usually dome-shaped and fit in the vagina; caps are smaller and fit over the cervix.

    If you want to try this form of contraception, visit your GP or family planning clinic. Your GP or nurse can help you get a diaphragm or cap fitted that’s right for you. He or she will teach you how to put it in and check it’s positioned correctly.

    The cap or diaphragm needs to be put into place before you have sex. You must use a spermicidal cream with this form of contraception. You can put the cap or diaphragm in up to three hours before you have sex. You need to leave it in for six to eight hours after sex. If you have sex again during this time you should apply more spermicidal cream without removing it, by using an applicator.

    There are several things you need to be aware of when using a diaphragm or cap.

    • Don’t use it without a spermicide.
    • Have it refitted or checked by your GP or nurse after a pregnancy, miscarriage or abortion. You should also have it checked if you noticeably gain or lose weight – more than 3kg (seven pounds).
    • Don’t use medicated creams or gels, or oil-based lubricants such as petroleum jelly or baby oil. These can weaken the latex or silicone and cause it to tear.
    •  Always check for tears before putting it in place.

    If you see a hole or tear in your diaphragm or cap, you must throw it away and get a new one. Even if used correctly, each year around six in 100 women will get pregnant when using a diaphragm or cap. Always read the instructions that come with the diaphragm or cap. If a diaphragm or cap isn’t used correctly, the failure rate is much higher.

  • IUD Intrauterine device (IUD)

    The IUD (also known as the coil) is a small plastic and copper device that is fitted into your womb by a GP or nurse. It has threads that hang down into the upper part of your vagina. These help to check that it’s still in place and are used for its removal.

    The IUD can prevent sperm meeting the egg and stop a fertilised egg attaching to the lining of your womb. The main advantage of an IUD is that once fitted, it can be left in place for five to 10 years. An IUD doesn’t protect against STIs.

    There are several things you need to be aware of when using an IUD.

    • Having an IUD protects you from getting pregnant as soon as it’s fitted.
    • It’s not hormonal, so won’t affect your weight.
    • It can make your periods heavier and/or more painful, although this may improve over time.
    • An IUD can increase your risk of pelvic infection in the first three weeks after having it fitted, particularly if you’re at risk of STIs.
    • It can damage or go through (perforate) your womb or cervix when it’s fitted, but this is rare.
    • It can sometimes be pushed out by your womb or it can move – your GP or nurse will teach you how to feel for the threads to check it’s positioned correctly.

    The IUD is very effective and fewer than two in 100 women using it will get pregnant over five years. If you do get pregnant while using an IUD, there is a small risk that you may have an ectopic pregnancy. This is when pregnancy occurs outside the womb, for example in one of the fallopian tubes.

    If your periods are heavy, your GP or nurse may advise an alternative type of coil called the intra-uterine system (IUS). This releases a hormone called levonorgestrel to thin the lining of the womb. For more information about the IUS, see Hormonal contraception.

  • Natural family planning Natural family planning

    Fertility awareness

    This involves planning when to have sex based on your menstrual cycle to reduce the chances of becoming pregnant. To be as effective as possible, this method should be taught by a trained health professional.

    Fertility awareness means noticing and recording your body’s natural signs of ovulation. These include body temperature, mucus from your cervix and the timing of your menstrual cycle. Fertility monitoring devices can help to measure these signs – you can buy these from a pharmacy. They work by recording changes in your temperature, or hormones in your urine or saliva.

    There are several things you need to be aware of when using natural family planning.

    • It limits you from having sex at certain times of the month.
    • You need to monitor your body’s natural signs on a daily basis.
    • Illness, lifestyle, stress and age (particularly when approaching the menopause) can interfere with your body’s natural signs, making them difficult to interpret.
    • It doesn’t protect you against STIs.

    The fertility awareness method varies in how effective it is. If used correctly and consistently, between one and nine in 100 women will get pregnant each year. However, it can be difficult to get the method right and if sex is timed incorrectly, the risk of pregnancy is high. Typically 25 women out of 100 become pregnant using this method alone.

    For more information, speak to your GP or nurse.

    Sterilisation

    Both men and women can have operations to permanently prevent fertilisation. Women can have their fallopian tubes cut or blocked, and men can have a vasectomy to stop sperm being present in the semen.

    Sterilisation is only recommended if you and your partner are sure you don’t want to have any, or more, biological children as it’s considered irreversible. Ask your GP or family planning clinic for more advice.

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  • FAQs FAQs

    How long can I leave a diaphragm or cap in for?

    Answer

    This depends on the exact type you’re using. Some can be left in place for up to 30 hours and others for up to 48 hours.

    Explanation

    Diaphragms and caps must be left in place for at least six hours after you’ve had sex to be effective. This allows the spermicide enough time to kill any remaining sperm and prevent them from entering your cervix (neck of the womb).

    You can leave a diaphragm or cap in for longer than the minimum of six hours. This can be up to 30 hours for those made of latex and up to 48 hours for those made of silicone. You should check the information leaflet that comes with your diaphragm or cap to find out the maximum recommended time for your particular device. This can differ between products.

    You can put the diaphragm or cap in place up to three hours before you have sex. However, you need to remove it at least once within the maximum stated time. You should wash it in mild soap and water, dry it and store it in a cool place before you next put it back in.

    How often will I need to get a new diaphragm?

    Answer

    You may need a new diaphragm if you gain or lose weight, if you become pregnant or if you have a miscarriage or abortion. You also need to look out for holes or puckering in the latex.

    Explanation

    Your GP or nurse should check the fit of your diaphragm if you gain or lose more than 3kg. You may also need a new one after a pregnancy, even if you had a miscarriage or an abortion.

    Check your diaphragm regularly to make sure it’s still in good condition. Do this by holding it up to the light and stretching it (being careful not to damage the rubber with your fingernails or jewellery). If there are any holes or puckering, or you can’t return it to its normal shape, visit your GP or clinic to get a replacement. A change in colour of the rubber is quite normal and doesn’t make it less effective.

    I’m thinking of having an IUD fitted, but will my partner be able to feel it during sex?

    Answer

    No, your partner won’t be able to feel the IUD during sex. However, your partner may feel the threads attached to the IUD. If this happens, see your GP.

    Explanation

    The IUD has one or two threads that hang down from your womb and into the upper part of your vagina. These threads help you to check the IUD hasn’t slipped or moved. Your GP or nurse will teach you how to feel for the threads to make sure the IUD is still in place. You will usually be asked to do this several times in the first few weeks after having an IUD fitted and then after each period.

    Rarely your partner may be able to feel the threads of the IUD during sex. If this happens, make an appointment to see your GP and get them checked.

    Is the withdrawal method considered a method of contraception?

    Answer

    The withdrawal method isn’t considered a method of contraception.

    Explanation

    The withdrawal method involves the man withdrawing his penis before ejaculation (coitus interruptus). It’s not considered a method of contraception because it’s unreliable. There is a risk that sperm may leak out of the penis before ejaculation. It can also be a cause of sexual frustration because it means ‘pulling out’ at the last moment.

    But if used correctly, it can help reduce the chance of pregnancy. Out of every 100 women using this method perfectly every time they have sex, 4 will become pregnant in a year. This rate is much higher if it is not done perfectly every time – around 27 out of every 100 women.

    What is a spermicide?

    Answer

    A spermicide is a chemical that kills sperm.

    Explanation

    The most common type of chemical used as a spermicide is nonoxinol-9. It’s most commonly available as a gel. Spermicidal foam, cream, sponges or pessaries (tablets inserted into the vagina) are also available.

    A spermicide isn’t a reliable method of contraception on its own and doesn’t protect you against sexually transmitted infections (STIs). However, a spermicide is recommended for use with a diaphragm or cap to increase their effectiveness. You usually need to smear the spermicidal cream or jelly onto the diaphragm or cap before you fit it into place.

    You can buy spermicides from a pharmacy without a prescription.

    Should I use a spermicide with a condom?

    Answer

    No, you don’t need to use a spermicide with a condom.

    Explanation

    At one time, it was widely recommended to use a spermicide with a condom. However, this advice has now changed – if used correctly, condoms should give enough protection without the need for a spermicide.

    Spermicidal-lubricated condoms are now being phased out as research has shown that spermicidal condoms (containing the spermicidal chemical nonoxinol-9) offer no additional benefits and may be less effective against STIs.

  • Resources Resources

    Further information

    Sources

    • Contraception. Medscape. www.emedicine.medscape.com, published 11 November 2013
    • Contraception. Map of Medicine. www.mapofmedicine.com, published 18 October 2013
    • Contraception – barrier methods and spermicides. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published June 2012
    • Contraception – IUS/IUD. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published June 2012
    • Long-acting reversible contraception. National Institute for Health and Care Excellence (NICE), April 2013. www.nice.org.uk
    • Fertility awareness‒based methods of contraception. The Merck Manuals. www.merckmanuals.com, published June 2013
    • Contraception – natural family planning. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published June 2012
    • Overview of contraception. The Merck Manuals. www.merckmanuals.com, published June 2013
    • Freundl G, Sivin I, Batar I. State-of-the-art of non-hormonal methods of contraception: IV. Natural family planning. Eur J Contracept Reprod Health Care 2010; 15(2): 113–¬23. doi: 10.3109/13625180903545302 
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