Alice Queen used oral contraceptives for years, but they caused her “intense pain and swollen breasts all the time,” she says. Eventually, she switched to non-hormonal birth control options.
Hormonal birth control like oral contraceptives, the NuvaRing (a vaginal ring) and hormonal intrauterine devices (IUD) work to avert pregnancy by preventing you from ovulating and by changing the cervical mucus and lining of the uterus to be less hospitable to a fertilized egg. Unfortunately, these treatments can come with a host of side effects. You might consider non-hormonal options, if you have “a history of clotting (deep vein thrombosis), migraines with aura [or] elevated blood pressure, or if you don’t like how you feel on hormones,” says Christine Greves, MD, OB-GYN, at Orlando Health Winnie Palmer Hospital for Women & Babies.
Pregnancy prevention is not the only reason people use hormonal birth control. It may be prescribed to help treat polycystic ovarian syndrome (PCOS), early symptoms of menopause or acne, for example. In those cases, the hormones are key to the treatment’s efficacy. [Listen to our Power to the Patient podcast about one woman’s journey treating her PCOS with and without birth control.]
If your goal is to avert a pregnancy, there are non-hormonal options available. IUDs with copper instead of hormones have been around since the 1980s. In 2020, the Food and Drug Administration (FDA) approved the vaginal gel Phexxi for birth control. Even without hormones, these options can produce side effects. Here’s what you need to know about them.
How They Work: Copper interferes with sperm’s ability to swim to an egg. The copper IUD retains its ability to prevent pregnancy for more than a decade, but can be removed at any time if you want to change birth control methods or decide you want to get pregnant.
Possible Side Effects: Upon insertion of the device, you may feel cramps and pain immediately. To treat pain, you can use over-the-counter treatments such as nonsteroidal anti-inflammatories (NSAIDs) like Advil, or acetaminophen (Tylenol), or you can ask your physician to prescribe stronger pain medications. In rare cases, the IUD can damage the uterus wall, and you’ll need to have the device surgically removed.
After any initial pain eases, you may experience more bleeding or pain during your period for the first three to six months. This, too, should decrease over time.
Queen says she was bedridden for two days after having the IUD inserted. “Strong pain killers and determination helped me through, but I won’t lie, I was very tempted to get it removed,” she says. After two days, the pain lessened, though her next two periods were heavier and more painful than usual.
“Once the pain subsided, heavier periods were manageable for me. And the fact that I did not have sore and swollen breasts was a positive trade-off,” she says. In addition to heavier periods, some patients experience breakthrough bleeding between periods.
It’s also possible for the IUD to get infected, usually within the first month. This can cause symptoms like abdominal pain, foul-smelling discharge and fever. @Wealthyoptimist explains that she had to have hers removed after a serious infection spread to her blood.
@wealthyoptimist⚠️My HORRIBLE Copper IUD experience! (Full story up now on my TikTok) ⚠️ #copperiud #iudexperience #fyp #GoBoldColorista #sepsis #birthcontrol #nhs♬ original sound – Sarah Hall
@wealthyoptimistCopper IUD horror story UPDATE ‼️ #copperiud #iudexperience #iudremoval #pelvicinflammatorydisease #ovariancystawarness #fyp♬ original sound – Sarah Hall
Lastly, while the copper IUD is more than 99% effective, a small number of women may become pregnant while using it. These women are at a heightened risk of experiencing a dangerous ectopic pregnancy, one in which the fertilized egg implants itself outside the uterus.
Removal: When you want to stop taking oral contraceptives, you simply stop taking them. However, to cease using an IUD, you need to have it removed by your healthcare provider. Once it’s out of your body, your period and fertility will immediately go back to normal. The extraction process should be very quick, as a physician or nurse grasps the device’s strings and gently pulls it out.
@jennifersharkReply to @allietee IUD out! #iud #iudremoval #larc #paragard #mirena #midwife #midwifelife #MakeMomEpic #mirena #liletta #birthcontrol #contraception
When the IUD came out, some patients on Twitter described extremely painful experiences without anesthesia and little or no other pain relief. Some said cramping and pain continued after the removal.
Not only was the pain intolerable but it felt wildly violating. I nearly passed out and when I got home just burst into tears for hours and hours. I thought my pain was unusual bc I didn’t have it inserted during my period until I spoke to many others with similar experiences💀
— Kate L (@badbratsy) July 10, 2021
However, others, like Harmony Major, who had her IUD in for 15 years, said they “barely felt” the removal. Queen had a similarly uneventful extraction. She received general anesthetic and said removal was “a breeze. . . It really made me think that the insertion should also have been under some sort of anesthetic – I find it hard to believe that option is not offered more often!”
Phexxi is a gel that you apply using a tamponlike applicator up to an hour before sex. On its own, it is 86% to 93% effective, but it can also be used with other birth control methods like condoms and oral contraceptives.
How it Works: Semen raises the pH of the vagina, making it less acidic and more welcoming to sperm. Phexxi brings the pH back down to its normal acidity, making it harder for sperm to swim toward an egg. “Sperm cannot thrive in the acidic pH environment,” says Aparna Sridhar, MD, a gynecologist at David Geffen School of Medicine at the University of California, Los Angeles (UCLA). “This is a completely non-hormonal option.”
Possible Side Effects:
“The most common side effects are vaginal itching, yeast infection, urinary tract infection, vaginal discomfort, vaginal discharge, bacterial vaginosis and vaginal burning. Also, the male partner may have genital itching, pain or burning,” says Greves.
There are several other options that can be used in conjunction with or in lieu of the method, above.
You can use barrier methods like condoms, diaphragms and birth control sponges, which physically block sperm from staying in your body and finding an egg to fertilize. These can be used along with hormonal birth control, Phexxi, spermicides and IUDs. Pay attention to the materials the devices are made of. Some people are allergic to latex, the plastic that most condoms are made from, and some come with lubrication or other coatings that may irritate your skin.
For those looking for a long-term, or even permanent, form of birth control, there are surgical procedures for both men and women. Men can undergo vasectomies, a procedure in which the tubes that carry sperm out of the scrotum are cut so sperm cannot leave the body. Women can have a tubal ligation, in which the Fallopian tubes are disconnected from the uterus, making it impossible for an egg to get from the ovaries to the uterus to be fertilized. These are minor surgical procedures, but come with the usual risks, such as negative reactions to anesthesia.
If you’ve recently given birth and are breastfeeding your infant regularly every four to six hours, your body won’t release an egg. If an egg isn’t released, it can’t be fertilized. Like oral contraceptives, this strategy is about 98% effective. Be aware that this method works only for six months and only if you’re feeding your baby a strict diet of your breast milk. That means, no formula.
Similar to Phexxi, you apply spermicide with your fingers or an applicator before having sex. The chemical makes it difficult for the sperm to move, and the gel itself can serve as a barrier to your cervix.