Birth control pills are one very common method of preventing unwanted pregnancies. However, standard birth control pills do contain estrogen. Some women would prefer to avoid taking estrogen for birth control. They may have side effects from it, or they may be concerned about potential health effects of taking estrogen, such as an increased risk of blood clots and even breast cancer.

For those who would prefer to avoid taking estrogen, what are the options for birth control? Are there any estrogen free birth control options?

Birth control options without estrogen

There are actually quite a few different options for non estrogen birth control. Some of these use other types of hormones, but not estrogen; others are entirely hormone-free.

Birth control pills without estrogen

Currently, there are no hormone free birth control pills. Scientists are working on developing these for both men and women, but none of them are now approved for use. However, for those who prefer to avoid estrogen, there are birth control pills that use only progesterone and not estrogen. This is known as the “mini pill.” Progesterone acts to thicken the cervical mucus so that sperm can’t enter. It also thins the lining of the uterus, so that it can’t support a pregnancy. In addition, progesterone partially suppresses the release of eggs from the ovaries.

The mini pill needs to be taken every day at approximately the same time in order to be effective. This can be difficult for many women to achieve. The mini pill is also less effective at preventing pregnancy than the combination birth control pill (which contains both estrogen and progesterone).

Birth control implants and injections

For those who want a more convenient option than the mini pill, there are also other birth control options that use only progesterone. One of these is the implant. This is implanted under the skin of the upper arm, and releases progesterone slowly into the bloodstream. It acts much like the mini pill, but women don’t have to remember to take it each day. However, they will need to get the implant replaced after five years, or it will lose effectiveness. If a woman does decide that she wants to get pregnant, she will need to have the implant removed.

There are also long-acting injections of progesterone. These are needed four times per year. This is somewhat less convenient than an implant, but the injection is easier to reverse. If a woman decides that she’s ready to have kids, she can simply stop getting the injections and her fertility will return within a few months.

IUDs

The intrauterine device, or IUD, is another estrogen free birth control option. This is a small device that’s placed in the uterus. There are two main types of IUDs. One of these contains progesterone, which it slowly releases into the tissues of the uterus. This works in much the same way as other progesterone-based options. Once implanted, it’s highly effective at preventing pregnancy for up to five years.

The other type is a copper IUD, which contains no hormones. The copper changes the fluids of the cervix, uterus, and fallopian tubes, making it difficult for sperm to swim through in order to reach the egg and fertilize it. The copper IUD is highly effective at preventing pregnancy for ten years after insertion.

Barrier methods

Another option for non estrogen birth control is a barrier method. The male condom is the most effective, but other options also exist, including the female condom, diaphragm, cervical cap, and sponge. Barrier methods have the huge advantage that they can prevent STDs along with pregnancy; other methods of birth control don’t help to prevent STDs.

However, as a pregnancy prevention method, condoms and other barrier methods are not the most effective options. Some people choose to use condoms along with another birth control option, to get more effective contraception along with STD protection. Barrier methods also have to be used correctly every time you have sex, so they’re not very convenient for many people.

Spermicides

Spermicides are chemicals that kill sperm. These can be used along with barrier methods, or can be used alone. The spermicide is placed into the vagina (as close to the cervix as possible) before having sex. Some condoms come already treated with spermicides. Spermicides are not particularly effective when used on their own, although using them along with barrier methods increases the effectiveness.

There is also another type of contraceptive vaginal gel, known by the brand name Phexxi, which was approved by the FDA in 2020. This isn’t a spermicide; instead, it works by lowering the pH of your vagina, so that sperm have a hard time swimming through. Although the mechanism of action is different, the use is similar. You need to put the gel into your vagina before having sex, and it must be used every single time you have sex.

Cycle tracking

Another natural birth control method that women can use is to closely track your menstrual cycle. This allows you to determine which days you could potentially be fertile; on those days, you would either avoid having intercourse or use a barrier method to prevent pregnancy. On days when you’re not fertile, you can have unprotected sex. This is sometimes known as the “rhythm method.” Although some women simply use a calendar for tracking, the method is more effective if you measure things like basal body temperature and the consistency of your cervical mucus in order to more accurately predict ovulation.

Cycle tracking methods are only effective if you’re diligent about using them. In addition, because a woman’s menstrual cycle can vary from month to month, the calculation of the fertile period may not always be accurate, which can lead to unwanted pregnancies.

Surgical sterilization

For those who are certain that they never want to have another child, surgical sterilization options are also available. These include tubal ligations or tubal removal for women, or vasectomies for men. This method of birth control does require surgery, but is highly effective at preventing unwanted pregnancies. It’s also permanent, so it’s only suitable for those who are certain that they will never want any more children.

Preventing STDs along with pregnancy

When it comes to your sexual health, contraception is one very important consideration, but it’s also important to think about STDs. Most birth control methods (whether they use estrogen or not) don’t do anything to prevent the spread of infections. Condoms are the only method that prevents both pregnancy and STDs. Other types of birth control do prevent pregnancy, but you can still get STDs while using them.

You can’t necessarily rely on asking your partners about their symptoms. Even if they answer honestly, many STDs cause no symptoms in a large proportion of people with the infection. This is why it’s important to get regular testing to ensure that you don’t have any undetected STDs.

In order to get the testing that you need, one option is to visit your regular doctor or an STD clinic. For more privacy and convenience, some people prefer to order a home test kit. You take samples yourself at home, and then mail these to a medical laboratory, where they’ll be tested. You’ll then get your results online within a few days. For many people, this option removes some of the common barriers that may cause them to avoid STD testing, allowing them to protect their sexual health.