Non-hormonal contraception

Published by Bupa’s Health Information Team, September 2011.

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

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

About non-hormonal contraception

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 by either stopping sperm from fertilising an egg, or by preventing a fertilised egg from attaching to the lining of your womb (uterus).

There are three main methods of non-hormonal contraception: barrier methods, the intrauterine device (IUD) and natural family planning. The intrauterine system (IUS) is different to the IUD. The IUS is a contraceptive device that is placed in the womb. It can also help women who suffer from very heavy periods (menorrhagia).

Barrier methods

These are physical barriers that stop the 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).

A male condom is made of thin rubber (latex) or plastic (polyurethane) and is 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. For example:

• 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, as these can weaken the latex and cause it to tear
• you should 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. Ask your pharmacist or GP for advice.

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

Diaphragms and caps

Diaphragms and caps 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 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 so you can have a diaphragm or cap fitted that is right for you. Your GP or nurse 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 at any time before you have sex. But if you have sex three hours or more after fitting it, you should apply some more spermicidal cream. You will need to leave the cap or diaphragm in place for at least six hours after you’ve had sex.

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

• don’t use it during your period and never use it without a spermicide
• have it refitted or checked by your GP or nurse after a pregnancy, abortion or 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, as these can weaken the latex or silicone and cause it to tear
• you should 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 between four and eight 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

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 one or two threads that hang down from your womb and into the upper part of your vagina.

The IUD is designed to prevent sperm meeting the egg and to stop a fertilised egg attaching to the lining of your womb. The main advantage of an IUD is that once fitted, and as long as it remains in place, it can be left 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. For example, it:

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

The rhythm method

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

The rhythm method works by observing and recording your body’s natural signs, such as body temperature, mucus from your cervix and the time 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, urine or saliva.

There are several things you need to be aware of when using the rhythm method. For example:

• 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 rhythm method varies in how effective it is. If used correctly, only one 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.

For more information about the rhythm method, speak to your GP or nurse.

The withdrawal method

This involves withdrawing the penis before ejaculation (coitus interruptus). It’s not considered a method of contraception because it’s unreliable. But if used correctly, it can help reduce the chance of pregnancy – however, there is always the risk sperm may have leaked out of the penis before ejaculation. It can also be a cause of sexual frustration because it means ‘pulling out’ at the last moment.

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. Ask your GP or family planning clinic for more advice.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.