Non-Hormonal Contraceptives: Are They as Effective as Their Hormonal Counterparts at Preventing Pregnancy?
By Shannon Farley
Many women do not like adding additional hormones to their bodies to prevent getting pregnant. Luckily, there are non-hormonal options for women and couples who want to prevent pregnancy without adding hormones. Non-hormonal contraceptives rely on changing behaviors or using methods that block the sperm from reaching the egg. However, the concern is that the non-hormonal contraceptives are not as effective at preventing pregnancy. Fortunately, there are non-hormonal methods that are equally as effective as hormonal methods for preventing pregnancy.
As close to the effectiveness of abstinence as possible, while still having sex!
Vasectomy and tubal ligation are almost 100 percent effective measures of non-hormonal contraception available to men and women who do not plan to have any more children. During a vasectomy, the vas deferens is cut and is blocked with cauterization or clips. A tubal ligation involves blocking the fallopian tubes via cauterization, rings or clips. Both procedures can be conducted as outpatient procedures, and recipients are both capable of sexual intercourse whenever they feel ready. Because sperm are still in the vas deferens when vasectomy occurs, couples should be sure to use contraceptives for at least 15 to 20 ejaculations after a vasectomy. Both procedures can be reversed, but it is expensive and the success rate is inconsistent.
Another very effective method of pregnancy prevention is the copper intrauterine device, or IUD. ParaGard is the copper IUD brand that is available in the United States. IUDs are inserted into the uterus by a healthcare professional. Once in place, the copper begins to make changes to the environment of the uterus. These uterine environmental changes prevent the sperm from reaching the egg. There is also a theory that the IUD alters the lining of the uterus, but it has not been proven yet. Both of these functions result in close-to-perfect pregnancy prevention. Once an IUD is in place, a woman should have the IUD checked to make sure it is still in place after her first period and at least by the third month. While IUDs usually stay in place, the IUD can be pushed out by a woman’s period. Women should check tampons and pads to make sure that the IUD is not lost. The copper IUD can be used for up to 12 years; however, it can be removed by a healthcare professional any time a woman decides she would like to become pregnant.
Methods that are fairly effective when used correctly but if not the chances of pregnancy are as high as 1 in 4!
Male and female condoms are the only methods of contraception that also prevent sexually transmitted infections as well. Male condoms are placed on the tip of the erect penis, and then the tip of the condom is pinched to create a reservoir for the ejaculate and then rolled down the penis for immediate use. Female condoms are inserted into the vagina, closed end first, and positioned as far up in the vagina as it will go. They can be inserted up to eight hours before having sex. Both condoms can be removed right after sex and discarded. If used correctly, male condoms are effective in 98 out of 100 uses. However, most people do not use condoms perfectly, so the realistic effectiveness is closer to 85 out of 100 uses. If female condoms are used perfectly, they work 91 percent of the time, yet with normal use, which is usually far from perfect, they work 79 percent of the time.
The diaphragm is another barrier method of contraception. The diaphragm is a small, flexible cup made from latex that is pinched together by the user and inserted into a woman’s vagina. It blocks the cervix physically. A woman has to see a doctor to get a diaphragm. The doctor will perform an examination; decide what size diaphragm is needed; and, then give instruction on how to use it. Because it is not always an exactly perfect fit, it must be used with spermicide to kill any sperm that may get by it. If diaphragms are used correctly every time, just six out of 100 will get pregnant. Yet with non-perfect use, 16 percent of women will get pregnant.
There are other barrier methods of contraception like the cervical cap and the sponge. The cervical cap is similar to the diaphragm. It is a small silicon cup that fits over the cervix and is used with spermicide and requires a doctor’s examination. There are two types of caps: one has to be fitted to each woman and is called the FemCap. And the other is a one-size fits all called Lea’s shield. However, both types of caps work better on women who have never given birth. With the one-size fits-all cap, more spermicide must be added to the vagina before each additional round of sexual intercourse. After intercourse is over, both caps should be left in place: the FemCap for a minimum of six hours and Lea’s shield for at least eight hours. Overall, cervical caps should not be worn for no longer than two days. Perfect cap use will result in 91 percent effectiveness, and non-perfect use will be 80 percent effective. The effectiveness decreases if the woman has given birth vaginally; with perfect use, there is still a 26 percent failure rate and with non-perfect use the failure rate is 40 percent.
Is he sponge-worthy? In 1994, the Today Sponge was taken off the market because the factory was non-compliant. Instead of fixing the problems, the company stopped selling the product. In 2005, the sponge came back on the market, manufactured by a new company. The sponge is made of polyurethane and contains a spermicide. The sponge is round and has a little dimple to fit over the cervix. It is for one-time use, but can remain useful for 24 hours and multiple bouts of sexual intercourse. To use the sponge, just get it wet, squeeze it once, and insert it into the vagina and make sure the dimple fits onto the cervix. The sponge should be left in place for at least six hours after the last sexual intercourse. If a woman uses the sponge perfectly, she has a 9 percent chance of pregnancy; however, with regular non-perfect use, she has a 20 percent chance of pregnancy. Women who have been pregnant double their chances of getting pregnant when using the sponge, 20 percent for those with perfect use and 40 percent for those without perfect use.
The rhythm method or fertility awareness-based methods do not rely on barriers to prevent pregnancy but rather on knowing when a woman is ovulating and avoiding sexual intercourse during ovulation. A woman can get pregnant during 7-8 days of the month. These days are the five days before ovulation, the day of and up to a couple days after ovulation. Sperm can live inside a woman’s body for about 6 six days and an egg can live for about a day after ovulation. To utilize this method of birth control, a woman needs to be aware of her fertility cycle to know when five days before ovulation most likely will occur. Of course, you can still have sex during this week, but if you want to prevent pregnancy it would be a smart idea to use some other form of contraception. The failure rate of using fertility awareness methods is between 12 and 25 percent for inconsistent use. For couples who practice it faithfully, the chance of pregnancy decreases.
Thirty percent chance of getting pregnant, better than Russian Roulette!
Many couples choose to use the withdrawal method of contraception. The withdrawal method involves the man pulling his penis out of the woman’s vagina before he ejaculates to avoid pregnancy. This is the least effective method of pregnancy prevention. For couples who practice this method to perfection, the failure rate is approximately 4 percent and for normal people who forget sometimes the failure rate is more like 27 percent. Another risk factor for this method is that some men release pre-cum which may contain sperm, so even if the withdrawal occurs properly, the pre-cum can result in a pregnancy too.
Spermicide is another method of contraception that carries a fairly high chance of pregnancy when used alone. Spermicide should always be used with diaphragm and cervical caps, and can also be used with both male and female condoms. Spermicides come in a variety of forms such as gels, creams, foams, films and suppositories. Spermicides are inserted into the vagina right before sex and they block the path of the sperm to the cervix. They prevent the sperm from moving, so they are incapable of fertilizing any eggs. With perfect spermicide use, the chance of pregnancy is only 15 percent, whereas with non-perfect use the chance of pregnancy while using spermicide as contraception is 29 percent.
Something new for permanent birth control!
There is a fairly new permanent method of female sterilization called microinserts. Also know as Essure, it consists of two small metal coils wrapped around a mesh of polyethylene terephthalate fibers that expand when put into the fallopian tubes and cause the tissue to become inflamed. They are put near the attachment point of the tubes with the uterus. The irritation to the tubes causes tissue to grow and within 3-6 months the tubes are completely blocked. This procedure is not reversible. While a woman is waiting for the blockage to complete, another form of contraception should be used. After three months have passed from insertion of the the microtubules, the woman needs to be checked to make sure the blockage was successful. Because this procedure is so new, there is no accurate data on the effectiveness or side effects yet.
Which one’s for you?
The most effective non-hormonal contraceptives are male vasectomy, female sterilization and the non-hormonal IUD. The mid-level effectiveness of non-hormonal contraceptives are condoms, both male and female, diaphragm, cervical cap, sponge, and what is commonly referred to as the rhythm method. The lowest level of effectiveness of non-hormonal contraceptives are the withdrawal method and spermicide alone. Of course, only condoms are effective in preventing the spread of sexually transmitted infections such as HIV and Chlamydia.