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What are my options for birth control if I don’t want to take the pill?

What are my options for birth control if I don’t want to take the pill?

If you’re looking for safe, effective contraception but a daily pill just isn’t for you, don’t worry. You’ve got plenty of options, with and without hormones — and one of them even lasts up to 10 years.

There’s the diaphragm, a barrier method you insert before sex. And the implant, a LARC (long-acting reversible contraceptive) that keeps you protected for up to 3 years. Then there are the vaginal ring and birth control patch, which require less fuss than the daily pill but are as convenient to get. You’ve likely heard of the IUD, which lasts for 5 or 10 years depending on the one you pick. And we’re just getting started. Read on to learn about non-pill options for women, and discover which is best for your needs and lifestyle.

Daniel Atkinson
Medically reviewed by
Daniel Atkinson, GP Clinical Lead
- Last updated August 02, 2022
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Medically reviewed by
Dr Daniel Atkinson
GP Clinical Lead
on August 02, 2022.
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  • IUS
  • IUD
  • Injection
  • Implant
  • Diaphragm
  • Natural Family Planning
  • How effective is it? More than 99%
  • How long does it last? Up to five years (depending on the brand)
  • Do you need an appointment? Yes
  • How effective is it? More than 99%
  • How long does it last? Up to ten years (depending on the brand)
  • Do you need an appointment? Yes
  • How effective is it? More than 99%
  • How long does it last? 13 weeks
  • Do you need an appointment? Yes for Depo-Provera, no for Sayana Press
  • How effective is it? More than 99%
  • How long does it last? Up to three years
  • Do you need an appointment? Yes
  • How effective is it? 92-96% when used with spermicide
  • How long does it last? Needs inserting each time you have sex
  • Do you need an appointment? No
  • How effective is it? 76-88% for 'typical' use
  • How long does it last? Can be used indefinitely
  • Do you need an appointment? No

Mirena and hormonal IUDs

There are two types of IUD: hormonal (like Mirena) and non-hormonal (like the copper IUD). So how does the Mirena work? The Mirena IUD — sometimes called an IUS for intrauterine system — is a T-shaped piece of plastic that’s inserted into your uterus. Like other hormonal birth control, it then releases hormones that keep you from getting pregnant. Mirena hormones include progestin but not oestrogen, and they’re released locally versus throughout your whole body like with the pill, which usually means fewer side effects.

Mirena insertion can be painful for some women, and your doctor might advise you to take a painkiller before your fitting appointment, or apply some numbing gel before insertion. For others, it’s about as uncomfortable as getting a pap smear. Mirena is more than 99% effective against pregnancy, and you can get pregnant immediately after Mirena removal. There are also some studies showing that it can last up to 7 years even though it’s only approved for 5 years, which would make it the longest-lasting hormonal IUD.

Mirena isn’t the only hormonal IUD available. In the UK, you can also get Kyleena, Levosert and Jaydess.

Kyleena vs Mirena

Kyleena is a newer hormonal IUD to hit the market, so it’s got a few advantages over the Mirena. For one, it’s smaller, which should make insertion less painful. It’s also got less progestin: 19.5mg compared to the 52mg in Mirena. Fewer hormones can help with side effects, but it also means that losing your period won’t be as likely as it is with the Mirena IUD.

Jaydess

Like Mirena and Kyleena, the Jaydess IUD uses the same progestin to prevent pregnancy: levonorgestrel. Mirena has the most levonorgestrel and lasts the longest, whereas Jaydess has the least at only 13.5mg — it also only protects you for 3 years. Jaydess is smaller than Mirena, which can make it a better choice for women who haven’t had children yet, and the lower hormone dose can mean fewer side effects. The trade-off is getting it switched out more often.

What are the pros?

The IUD is one of the most effective types of contraception. In fact, the effectiveness of hormonal IUDs like Mirena is over 99%. The periods you get with Mirena should get lighter over time, and stop completely for many women. And the Mirena can help with issues like endometriosis.

How long does Mirena last?

Mirena is licensed for 5 years, but studies have shown it’s safe and effective for 7 years. Leading up to this time, though, you might notice a few symptoms of the hormones in your Mirena running out. This will usually feel like your period before you had the Mirena inserted: PMS, a heavier cycle or more cramping. If you think you’re experiencing signs of your Mirena wearing off, you should talk to your doctor or gynecologist. Even if it’s still effective, they might be able to recommend something to make you more comfortable.

Mirena for menopause

The Mirena IUD can be used as birth control until you reach menopause, which is usually around age 50. But it’s possible to use Mirena when you’re over 50 as the progestin component of HRT. HRT, or hormone replacement therapy, alleviates some symptoms of menopause. Taking estrogen with Mirena is necessary if you are using it for HRT.

Because Mirena can keep you from having a period and a sign of menopause is not having a period for 12 months, it can be challenging to know when to remove your IUD as you get older. Talk to your doctor or gynaecologist if you have your Mirena at age 50. They’ll be able to do a blood test to check your hormone levels and see if you’re experiencing menopause.

What are the cons?

Shortly after you’ve gotten your Mirena, you may experience some random bleeding. There’s no way to stop Mirena spotting besides waiting it out, but that shouldn’t take longer than a few months. You might also experience some other Mirena side effects, like headache or mood changes. These can happen with any hormonal birth control.

The “Mirena crash” describes a series of anecdotal side effects after Mirena removal. These include mood changes, nausea, acne, headache, depression or anxiety, hair loss and a lower sex drive.

Like with all IUDs, there is also the possibility of your IUD moving out of place — although this is very unlikely. If your Mirena IUD has moved out of place, symptoms can include pain, heavy bleeding, abnormal cramping. You or your partner might also be able to feel the IUD. Normally, you should only be able to feel the strings but not the actual device.

Non-hormonal IUDs: the copper IUD

The non-hormonal IUD, also called the copper IUD, is a t-shaped piece of plastic like its counterpart the hormonal IUD. The difference is that it’s got copper wire coiled around it and doesn’t contain any hormones. So how does the copper IUD work? The magic is in the copper, which is toxic to both sperm and eggs.

The copper IUD effectiveness is over 99% when inserted correctly, and it’ll keep you safe from pregnancy for 10 years. That makes IUD birth control the longest-lasting contraceptive.

What are the pros?

The biggest pro to the copper IUD is how long it lasts: up to 10 years. That’s longer than any other method of birth control besides something permanent like sterilisation. It’s also very effective and doesn’t contain any hormones.

You can get the copper IUD for free on the NHS.

How long does a copper IUD last?

The copper IUD is approved for 10 years, but there have been studies that show it can last up to 12. Talk to your doctor or gynaecologist about how long they recommend you leave your IUD in for.

What are the cons?

The main downside to using the copper IUD is the same as the upside: it doesn’t contain any hormones. If you don’t do well with the hormones in other birth control, the copper IUD is a great option because of how long it lasts — the only other non-hormonal options are things like condoms or natural family planning, which require more maintenance and aren’t as effective. However, the lack of hormones also means you don’t get the benefits of hormonal birth control like lighter periods. While the Mirena can make your period go away entirely, periods on the copper IUD are often longer and heavier. Another con to the copper IUD is that the fitting and insertion can be painful for some women.

The birth control injection

If you want a set-it-and-forget-it birth control that’s a little bit less long-term than the implant or IUD, the contraceptive injection is a great option. It lasts for 8 or 13 weeks (depending on the type you choose) and is more than 99% effective. It is usually injected into your arm but if you prefer, it can be injected into the buttocks. The injectable contraceptive names available in the UK are Depo-Provera (Depo for short), Noristerat and Sayana Press.

Depo-Provera

The original and most well-known birth control shot is Depo-Provera. It lasts for 13 weeks and releases progestin, a synthetic version of the female hormone progesterone, into your bloodstream. You can’t inject it yourself, so you’ll need to visit your doctor each time.

Sayana Press

A newer progestin-only birth control shot is Sayana Press, which is injected into your thigh or stomach. It’s so new, in fact, that it might not be available at your GP surgery — but it’s good to ask. Like Depo-Provera, Sayana Press lasts for 13 weeks. It works similarly and even has similar side effects. The big difference is you’ll be taught how to give yourself the injection, so you don’t have to make an appointment every time you need a top up. 

Noristerat

Noristerat is a progestin-only contraceptive injection that lasts eight weeks. It’s considered a short-term contraceptive, meaning you’ll only get a prescription for a short time — like if your partner just had a vasectomy or if you’re being immunised against rubella. Noristerat is also prescribed for women who are breastfeeding.

The active ingredient in Noristerat is the progestin norethisterone, so it’s similar to mini-pills like Noriday. If you’re looking for a progestin-only birth control with a longer-lasting prescription than Noristerat, Noriday is a great option.

What are the pros?

One of the pros of getting the contraceptive injection is that it lasts 3 months. That makes it the longest-lasting birth control that’s not a LARC (long-active reversible contraceptive) like the IUD. It’s also progestin-only (perfect for women who can’t have oestrogen-based birth control) and can help with your period. Best of all, the birth control injection has no cost when you use the NHS.

What are the cons?

The cons to birth control injections are similar to other methods of hormonal birth control. It doesn’t protect you against STIs and you might experience side effects like headache, mood changes and acne. These symptoms of injection should eventually become less bothersome or go away, but it’s possible they’ll continue as long as you have the injection.

The contraceptive injection can also change your period, and how this happens can be a bit unpredictable. Many women find that their periods become lighter and shorter or stop altogether, but it’s possible yours might become irregular or heavier. It can also take a long time for your period to get back to normal once you stop taking the shot.

Another downside is that you usually have to go to your doctor to get the injection, although you can ask to be taught to use Sayana Press at home. However, even if you do need to make the trip, it’s only every three months.

How long does it take to get periods after stopping the injection?

It can take up to a year to get your first period after stopping Depo-Provera or other birth control injections. You’re still able to get pregnant during this time, so it’s important to use another type of birth control if you want to stay protected.

Does the contraceptive injection help acne?

Although the injection can help with cramps and lighten your flow, it’s unlikely to help with acne. In fact, acne is listed as a possible side effect of Depo-Provera. There are other birth control methods that are better at treating acne, including some pills like Cimitz and Marvelon that are approved for the purpose. 

Is there a male version of the birth control injection?

There’s no men’s injectable birth control yet, but one is in the works. Vasalgel, also called the male birth control gel, is a polymer gel injected into the vas deferens, blocking the flow of sperm. It’s kind of like a vasectomy but a little bit less intense.

Non pill contraceptives

The birth control implant

Unlike with the pill, there aren’t a lot of arm implant birth control brands to choose from. Nexplanon is the name of the only birth control implant approved in the UK.

Here’s how the birth control implant works: it releases the hormone progestin into your body like a mini-pill does, but without the daily hassle. You’ll need a doctor or gynaecologist to insert or remove the birth control implant and it’ll protect you for 3 years, though there are some studies showing it can remain effective for up to 5 years.

Although it’s a long-active reversible contraceptive (LARC), the rod implant isn’t the most long-term birth control. It doesn’t protect you for quite as long as an IUD, though it lasts much longer than the injection.

Birth control implant insertion is quick and relatively painless. Only 5.2% of patients said they experienced pain at the insertion site during a clinical trial. After numbing the skin of your non-dominant upper arm, the healthcare provider will create a small incision and insert Nexplanon. Removal and replacement of the birth control implant is easy too.

What are the pros?

Wondering about the pros and cons of the birth control implant? The primary pro is how long it lasts, as well how effective it is (more than 99%). It only contains one hormone (a progestin) so is a great choice for women who don’t do well on oestrogen. Like the hormonal IUD, it’ll also make your period lighter — some women stop getting their period altogether.

More good news: you can get the implant birth control for free on the NHS. So if you’re in the UK, the cost of the birth control implant is nothing to worry about.

What are the cons?

There aren’t too many disadvantages to the birth control implant. Like any medication, it does come with a few possible side effects. After having the birth control implant inserted, you might notice symptoms like headache or changes in mood. It’s also possible to experience spotting while on the birth control implant, though your period will usually go away entirely after the first year of having it.

You might bruise after getting the birth control implant, but your healthcare provider will give you a pressure dressing to wear for the first 24 hours to help prevent this.

A few medications don’t play nice with Nexplanon. The epilepsy medication Topamax can lower the effectiveness of your birth control implant. What about antibiotics and the birth control implant? Most are fine to take but rifampicin-like antibiotics can also lower the effectiveness, so you should use a back-up birth control method like condoms while you finish your course.

And like all other LARCs, Nexplanon doesn’t protect you against STIs.

Does the implant cause acne?

The Nexplanon implant can cause acne. It’s listed as one of the common side effects, but that doesn’t mean you’ll experience it. In clinical trials, a little over one in ten women said they had acne after taking Nexplanon, but only one in 100 stopped using the implant for that reason.

Can you get an implant that lasts for longer?

Wish your birth control implant was more permanent? Good news. Although Nexplanon is only licensed to be used for 3 years, studies have shown that it can stay effective for up to 5 years.

The birth control diaphragm

The diaphragm is a barrier method of birth control that you put inside your vagina before sex. It’s a small latex cup that covers your cervix, physically keeping sperm away, and is best used alongside a spermicide. You might need to visit a GP surgery, pharmacy or sexual health clinic to receive a supply of barrier method contraception, but if you take good care of a diaphragm, it can be reused for up to two years.

Inserting the diaphragm is a bit like putting in a menstrual cup. Here’s how to use diaphragm birth control:

  • Fill the cup part of the diaphragm with a bit of spermicide
  • Pinch the diaphragm in half and slide it inside your vagina
  • Check the position and make sure you can feel your cervix through it
  • Apply spermicide inside your vagina

You should leave it in for at least six hours after sex.

What are the pros?

Unlike condoms (both male and female), diaphragms aren’t disposable — you can keep using it over and over for up to two years. They’re convenient as well. Your diaphragm is portable and you can insert it before sex so you’re not interrupting the action to fumble inside your bedside drawer. Perhaps the biggest pro is that it’s hormone-free, so there aren’t any side effects.

What are the cons?

At 92-96% effective when used correctly with spermicide, diaphragms don’t offer the most protection when compared to other contraceptive methods. Additionally, they don’t protect against STIs. Female condoms, a different barrier method for women, do protect against some STIs, but the effectiveness is even lower at 79%.

Is there a male version of the diaphragm?

Sort of. The diaphragm is a barrier method of birth control, meaning it creates a physical barrier between sperm and your uterus. Condoms are a barrier method that men can use, so they’re probably the closest there is to an equivalent.

Natural family planning

Also known as the rhythm method or the fertility awareness method (FAM), natural family planning is a non-hormonal birth control option that’s very effective if you do it right — and very ineffective otherwise.

Natural family planning involves monitoring three different indicators of your own fertility and then avoiding sex on your most fertile days, which occur around ovulation. You’ll need to track the length of your menstrual cycle, which is easy enough, but also do daily body temperature readings and analyse any changes to your cervical mucus. It can take a few months to get the hang of and we recommend visiting your doctor or gynaecologist to get a few pointers with the cervical mucus bit, so you know what to look for.

What are the pros?

The pros to natural family planning are that there aren’t any hormones involved, and the only thing you need to pay for is a thermometer (which you likely own already). If you use all three FAMs, natural family planning can be up to 99% effective.

What are the cons?

The cons to natural family planning are that the effectiveness is only 76-88% if you measure only one of the three indicators. It also doesn’t protect against STIs and isn’t reliable for the first few months, so you’ll need to use a second birth control like condoms or the pill.

What other non-pill methods are there?

There are a few non-pill methods that we haven’t covered here. In terms of ease-of-use and longevity, they’re somewhere between the pill and a more long-term solution like the implant or IUD. We’re talking about the vaginal ring and birth control patch.

The contraceptive patch is a birth control you wear on your skin and change once a week. It tends to be a combined type of birth control, meaning it contains both oestrogen and progestin.

If you don’t want to insert, inject or swallow anything, the patch is the birth control for you. The main downside is that it only lasts a week, which makes it the least long-term solution after the daily pill.

The vaginal ring protects you from pregnancy for a full month, which isn’t bad for something you can do yourself at home. You insert it into your vagina for three weeks and then take it out for a week before inserting a new one. Using the contraceptive ring for the first time can be tricky, so we do recommend visiting your doctor or gynaecologist once to learn the ropes.

Like the patch, the ring is a combined birth control and has both oestrogen and progestin hormones. It’s more than 99% effective when used correctly. And because the ring lasts a month, it’s the most long-term method you don’t need a doctor to insert or inject.

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