Uses, Risks, and Benefits of Non-Pill Options

You don’t have to take a pill every day. There are birth control methods that last weeks, months, or even years with little effort on your part – and no surgery. They are safe and effective for most healthy women.

Which one is best for you?

“The best method of contraception for any woman is the method that she’s going to use correctly and consistently,” says Elizabeth Micks, MD, MPH, an acting assistant professor of obstetrics and gynecology at the University of Washington Medical Center.

Find out what’s available, what’s involved, and how well each one works.

The IUD

This is a small, T-shaped device that your doctor places inside your uterus, or womb, after giving you a checkup. It can stay there for 3 to 10 years, depending on its type.

Once the IUD is in place, you don’t have to do anything else to prevent pregnancy. They are 20 times more effective than pills, patches, or rings. Fewer than 1 in 100 women get pregnant during their first year on the IUD.

Your doctor can easily remove it if you decide you’d like to get pregnant or you no longer want to use it.

Hormonal IUDs are plastic and release the hormone progestin. This thickens the mucus in your cervix (lower part of your uterus), which keeps sperm from entering. It also thins the walls of your uterus. This keeps a fertilized egg from attaching to it, which is a part of pregnancy.

Four brands of hormonal IUD are available:  Kyleena, Liletta, Mirena, and Skyla. All rely on the same drug, called levonorgestrel. Liletta and Mirena last 6 years. Kyleena releases the lowest dose of hormones for the longest amount of time. It lasts 5 years. Mirena can also reduce heavy menstrual bleeding up to 90% after the first 6 months.

“It’s so effective in treating women with heavy bleeding, painful periods, even women with endometriosis [a disorder of the uterus], fibroids [noncancerous tumors], and other problems,” Micks says.

The drawback for some women is getting through those first 6 months. “Hormonal IUDs can lead to a lot of irregular bleeding in the beginning, which for a lot of women is really not acceptable,” Micks says. “Women do not like spotting (light bleeding between periods).”

Copper IUDs are hormone-free. Copper works like a spermicide and prevents sperm from fertilizing an egg. If an egg does become fertilized, it can prevent implantation of an embryo.

Women who want a hormone-free form of contraception (meaning less potential side effects) often choose these devices. Hormone-free birth control, though, does not have the same effect on your menstrual cycle.

“It’s not true for all women, but in general, periods may be a bit heavier and crampier with the copper IUD,” Micks says. “It’s not a method that we would choose in a woman who is already having heavy periods.”

Birth Control Implant

Your doctor inserts this small, thin, and flexible plastic rod into your arm. It’s the size of a matchstick. Like a hormonal IUD, the implant releases progestin into your body. It works for up to 3 years, and your doctor can remove it any time before that.

Like IUDs, implants are 20 times more effective than pills, patches, or rings.

Some women have irregular bleeding during the first 6 to 12 months. For most, periods get lighter and happen less often.

“What comes with the implant is that it’s very unpredictable,” Micks says. “Some will stop having periods, but some will have quite a bit more bleeding.”

With her patients, Micks says, “if they don’t see themselves wanting to get pregnant within a year, then I recommend that they do an IUD or an implant,” she says. “They can have it taken out any time, even a day later, a month later, whenever.” 

A study in Finland showed that providing for free long-acting reversible contraception (LARC) like the IUD or implants resulted in more LARC use and fewer abortions in the community. 

The Shot (Depo-Provera)

This method protects against pregnancy for 3 months at a time. It uses progestin to do that.

Only 1 in 100 women who get the shot every 12 weeks will get pregnant. For those who don’t get their shot on schedule, 6 out of 100 will get pregnant.

Similar to other progestin methods, the shot can cause irregular bleeding during the first year. About half of women will have fewer and lighter periods after that. Others may have spotting or heavier, longer periods.

The shot can cause bone thinning, which stops after the injection wears off. For this reason, women at risk for osteoporosis should use a different form of birth control.

If you want to use the shot for more than 2 years, you should talk to your doctor about the risks and the benefits of continuing it. Women with breast cancer and those who take some medications for Cushing’s syndrome (a disease from being exposed to high levels of the hormone cortisol) also should not get it.

Some women might not want the shot because it requires going to a doctor’s office every 3 months. In some parts of the U.S., women can get a prescription for an injection they give themselves. If giving yourself a shot makes you squirm, find out if there are convenient places to get it — such as a local health center — before you decide.

If you want to get pregnant within the next year, you might consider other methods of birth control. It can take 10 months or more to become fertile again after you stop the shot.

Combination Birth Control

Like most birth control pills, the patch and the ring prevent pregnancy with the hormones progestin and estrogen. You use the patch and the ring for 3 weeks, then stop for 1 week. During this “week off,” you get your period. Some women who want to stop their periods completely don’t take a week off.

Women who take the fourth week off often get lighter periods with less symptoms.

You must change your patch or ring on time. Nine out of 100 women who don’t use them as directed get pregnant.

Like the pill, both the patch and the ring can raise your risk for blood clots. They’re not recommended for women with risk factors for stroke, blood clots, or heart disease, such as women over 35 who smoke.

The patch is a thin, beige, plastic sticker that you wear on your skin at all times for a week. You stick it on the outside of your upper arm, your back, your behind, or your stomach. You replace the patch every week for 3 weeks, then typically take a week off.

Some women complain that the patch falls off or irritates their skin where it’s applied.

The ring is another option. Sold under the name Annovera or NuvaRing, it is small ring that you insert in your vagina, similar to a tampon. You leave it in for 3 weeks. After that, you take a week off to allow you to experience a period. With Annovera, you then reinsert the ring. With NuvaRing, you insert a new ring.

It is possible for the ring to fall out before it’s time to change it. If that happens, just rinse it and put it back in. If it’s broken, you should insert a new one.

The patch and the ring are not as effective as the pill, IUDs, implants, or shots. But some women still use the patch and the ring, Micks says, because they feel more in control of a method they can stop at any time without a doctor visit.