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Hormonal Birth Control Methods (Non-Pill Options)

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on July 31, 2022.

Non-Pill Options

Birth control pills are so popular: they're easy, convenient and affordable. But the pill may not be an option for every woman desiring contraception.

Some women may prefer a method that does not involve remembering to take a daily pill. Other women may not be able or want to use estrogen in birth control pills for health reasons or because they are breastfeeding. Some women just prefer not to take a daily pill. For these women, there are other options that provide convenient pregnancy protection.

Non-pill hormonal birth control options include:

Review each product individually for a full listing of uses, warnings, and side effects.

Advantages of Non-Pill Birth Control

  • Convenient pregnancy protection.
  • No need to remember to take a daily pill.
  • A high level of contraceptive effectiveness; progestin-only forms may have slightly lower effectiveness.
  • Some methods, such as the IUD, last for 5+ years (the non-hormonal copper IUD, or ParaGard, can last up to 10 years).
  • Progestin-only forms may be used by women who are breastfeeding or cannot use estrogen due to health reasons. Estrogen can slow down milk production during breastfeeding.

Warnings for Birth Control

Hormonal birth control should NOT be used by women who have a history of breast cancer, endometrial or cervical cancer, undiagnosed vaginal bleeding, liver tumors or disease, increased clotting or stroke risk, or if pregnant.

Smoking increases the risk of serious heart side effects when using a combined estrogen and progestin birth control, including the ring or the patch. Combination estrogen and progestin birth control should NOT be used (is contraindicated) in women over 35 years of age who smoke due to an increased risk of serious side effects, such as heart attack, blood clots, and stroke.

Women of any age should avoid combination hormonal birth control if they have a history of:

  • Uncontrolled high blood pressure
  • Chest pain
  • Diabetes with kidney, eye, nerve, or blood vessel damage
  • Breast cancer or any cancer that is sensitive to female hormones
  • Severe headaches
  • Allergies to any ingredients in their birth control.
  • Unexplained vaginal bleeding
  • Currently pregnant
  • Heart disease, heart attack, problems with your heart valves
  • Liver disease
  • Blood clots
  • Conditions that increase blood clotting
  • Stroke.

Cardiovascular risks increase with age, weight, family history of heart disease, and number of cigarettes smoked per day. Women should talk to their healthcare professional about their cardiovascular risk before deciding which birth control method to use.

The pill, patch, vaginal ring, IUD, implant or birth control shot do not protect against any form of sexually transmitted disease (STD), including HIV and AIDS. A male latex or female condom should be used in combination with other birth control options if protection against STDs is needed.

Let your physician know if you have migraine headaches when discussing birth control options. You may need to avoid hormonal birth control if you have certain kinds of severe migraine headaches.

Certain medicines may make birth control less effective; check with your pharmacist or doctor for possible drug interactions with all prescription, over-the-counter (OTC), and herbal or dietary supplement medicines you take.

Breastfeeding mothers should avoid the estrogen in combined hormonal birth control as it may reduce milk supply. Birth control options for breastfeeding women include:

  • Intrauterine device (IUD)
  • Progestin only pills (“mini-pills”)
  • Contraceptive implant
  • Birth control shot

Common Side Effects

  • Spotting between periods
  • Possible weight gain
  • Breast swelling or tenderness
  • Nausea or upset stomach
  • Mood changes vaginal infections and irritation, vaginal secretion, headache, weight gain, and nausea.

Serious Side Effects

  • Blurred vision
  • Severe stomach pain
  • Severe headache
  • Swelling or pain in the legs
  • Chest pain, heart attack, blood clots, stroke.

Other warnings and side effects exist for individual birth control options. It is important to review the specific consumer information for your birth control of choice and discuss any questions or concerns with your healthcare provider.

Tell your healthcare provider about all other medications you take, including prescription, over-the-counter, vitamin and herbal supplements. Certain medications may make birth control less effective. Be sure to have a complete drug interaction review each time you start a new medication.

Hormonal Birth Control Options (Non-Pill)

Generic Name Proprietary Name Details
etonogestrel and ethinyl estradiol vaginal ring
  • Vaginal ring you insert yourself and wear continuously for 3 weeks, then remove for 1 week to allow period (withdrawal bleeding).
  • Remove the ring 3 weeks after insertion on the same day of the week AND at the same time of day; replace with a new ring each month.
  • NuvaRing costs roughly $170 per month (cash) but insurance may cover. EluRyng costs about $60 per month. A generic option is also around $60.
  • 99% effective if always used correctly. In reality, about 91% effective. Staying on schedule with insertions/removal increases effectiveness.
  • Common side effects include vaginal infections, irritation or secretion.
etonogestrel subdermal implant

  • Progestin-only implant.
  • Healthcare provider-inserted matched-sized rod placed under the skin of upper arm.
  • Replace after 3 years, but may be removed at any time; do not use if pregnant.
  • Effective for 3 years; 99% effective; not known if equally effective in very overweight women (>130% of ideal body weight).
  • If at any time you cannot feel the implant, contact your doctor and use a non-hormonal method of contraception (such as condoms) until you see your doctor.
  • About $1000 per implant but lasts for 3 years; insurance may cover, but you may have addition fees for implant insertion. No generic option available.
  • Can cause shorter, longer or irregular periods, or spotting between periods; may lighten or eliminate periods.
ethinyl estradiol and segesterone
  • Estrogen and progestin vaginal ring that can be inserted and removed by a woman herself.
  • Is left in place for 21 days and removed for 7 days each cycle (withdrawal bleeding occurs during the 7 days). Same ring is used to prevent pregnancy for up to one year.
  • Annovera is 97.3% effective in preventing pregnancy when used as directed.
  • Annovera costs over $2,000 but only needs replacement once per year. Most insurance will cover under ACA. Manufacturer may offer additional savings, if needed. No generic available.
  • Annovera has not been adequately evaluated in women with a body mass index (BMI) greater than 29 kg/m2.
  • Do not refrigerate or freeze Annovera.
levonorgestrel intrauterine device (IUD)
  • Healthcare provider-inserted progestin-only IUD; inserted within 7 days of menses onset. Your healthcare provider can remove your IUD at any time.
  • Replace IUD after - 6 years for Liletta; 5 years for Mirena or Kyleena; 3 years for Skyla.
  • $500-$1000 per IUD; no generic available yet.
  • Very effective, 99% effective if used as directed; may lighten or eliminate periods, or make them more heavy in the first 3 to 6 months.
  • If a period is missed, promptly be evaluated for pregnancy.
  • Use non-hormonal back-up method (such as a condom) if you cannot locate threads for IUD; contact doctor to check placement.
  • Risk of ectopic pregnancy, including the loss of fertility with IUD.
  • Do not use if: pregnant, unexplained vaginal bleeding, liver disease, breast cancer, pelvic infection, cancer of the uterus or cervix, large fibroid tumors, infection in the cervix.
medoxyprogesterone acetate injection
  • Injection of progestin-only hormone given every 12 to 14 weeks (subQ form) or every 13 weeks (IM form).
  • Use for longer than 2 years not generally recommended due to effect on bone mineral density.
  • Costs $50 to $100 per injection; generic may be available.
  • May lighten or eliminate periods.
  • 99% effective if used as directed.
  • Do not use if pregnant, breast cancer, at risk for bone fractures, taking aminoglutethamide.
  • May initially cause irregular bleeding.
norelgestromin and ethinyl estradiol transdermal patch
  • Apply 1 patch once a week (on the same day every week) for the first 3 weeks, then use no patch in week 4 to allow menstruation (withdrawal bleeding). Repeat this each month.
  • 99% effective if used correctly; may be less effective in women who weigh over 198 lbs. (90 kg). Do not use if BMI ≥30 kg/m2.
  • May result in lighter periods and less cramping.
  • Cost is roughly $50 per month (for 3 patches), but insurance will most likely cover (per ACA). Manufacturer may offer additional savings.
  • Can cause skin irritation.
  • Stop use if pregnancy should occur.
  • If a patch is partially or completely detached for ≥ 24 hours, apply a new patch and start a new cycle. Use a back-up contraception for the 1st week of the new cycle.
levonorgestrel and ethinyl estradiol transdermal patch
  • Low-dose combined hormonal contraceptive patch for birth control.
  • Twirla is used for women with a BMI < 30 kg/m2 and for whom a combined hormonal contraceptive is appropriate.
  • Do not use in women with a BMI > 30 kg/m2 due to reduced effectiveness and a higher risk for clots. Twirla has reduced effectiveness in women with a BMI in the range 25 to 30 kg/m2.
  • Twirla should not be used in women over 35 years old who smoke.
  • Apply one patch every week for three consecutive weeks. No patch is worn during the 4th week (when withdrawal bleeding is expected.)
  • Patch can be worn on the abdomen, buttock, or upper torso (excluding the breasts).

See also

Sources

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer