What’s the Difference Between Hormonal vs Non Hormonal Birth Control?

Written by Dr. Erica Montes

Hormonal birth control includes those methods that have estrogen and progesterone or progesterone alone. They suppress your natural female hormone levels which prevent ovulation or increase cervical mucus with some progesterone only methods. These include oral contraceptives, long-acting reversal methods such as the contraceptive implant or intrauterine devices, a vaginal contraceptive ring, contraceptive patch, or injection. Nonhormonal birth control options involve no hormones and can include one intrauterine device that is made of copper, barrier methods such as condoms, diaphragms, or cervical cap, sterilization, and newer options that make the vagina more acidic leading to a hostile environment for sperm.

What are the different forms of birth control?

Oral contraceptives can be combination pills with estrogen and progesterone or progesterone only pills (POPs). They have to be taken daily to be effective. Effectiveness is usually about 93% but can decrease with user error.

The contraceptive ring is also about 93% effective. You leave it in for 3 weeks and take a break for a week. It's nice since you don't have to think about it everyday but don't forget to take it out! There are two types- one which is a new ring every month and one that you use this schedule as mentioned but you use the same ring for a year.

The intrauterine device has progesterone only options at varying doses. It can be painful to place but your doctor can guide you on options to help with pain. It is nice since they last for several years depending on which one you choose.

The arm implant is easy to place, can sometimes be a little difficult to remove, but is very effective and lasts for 3 years.

The injection is given every 3 months, and is also one of the most effective forms but after stopping it, it can take up to a year for your body to start having regular cycles again and be able to conceive. The patch is changed every week, can cause some skin irritation and may not be well absorbed in some patients who are overweight.

Barrier methods are nice since they are used at the time of intercourse but they have less effectiveness and you have to be good about using it everytime. Sterilization is a permanent method that requires surgery. It is a nice birth control option if you don't desire future fertility and want a non-hormonal method. Remember though that a vasectomy for your partner is easier to perform and just as effective.

Pros and Cons of hormonal and non hormonal birth control

A pro about hormonal birth control is that they are effective. Hormonal IUDs offer long-term protection, they can be used for other gynecological conditions such as PCOS- making bleeding more predictable, less acne, endometriosis, heavy menstrual bleeding caused by fibroids. They can improve anemia or low blood counts from heavy bleeding, decrease the risk of uterine and ovarian cancer. It allows you to take control of your reproductive health and not rely on less effective methods.

Cons could be from the lowering of your natural hormones leading to some side effects such as irregular bleeding, low libido, vaginal dryness, fatigue, and acne depending on the progesterone you are using. Also some progesterone only birth control methods can lead to ovarian cyst formation which can be temporary but can cause some pain at times. Sometimes when you try a hormonal method you may have to switch to another one depending on your symptoms. If you think you may be experiencing side effects from your hormonal contraception, talk to your doctor so you can see what options you have.

Non-hormonal options offer no change in bleeding pattern, effective especially if you consider sterilization, you don't have to worry about potential hormonal side effects.

Cons of non-hormonal options are potentially less effective as hormonal methods so you have to be diligent with use and may decrease spontaneity of intercourse since you have to think about it right before.

What are possible side effects of hormonal and non hormonal birth control and at what point should women look for an alternative?

Side effects of hormonal birth control include irregular bleeding, nausea, acne, mood swings, low libido, vaginal dryness, possible hair loss and fatigue. This is due to the lowering of your natural hormone levels of estrogen and testosterone decreasing with estrogen and progesterone combination methods. Still, with these possible side effects, not everyone experiences these and it also depends on the dosages you are getting. It is good to talk about any side effects you are having to see if you would do better with a different birth control pill, intrauterine device instead of a pill, or maybe the hormonal contraceptive vaginal ring is better for those with nausea since it is absorbed through the vagina and not taken orally.

If any of the above symptoms are severe, affecting your quality of life, or not improving the symptoms you have related to a gynecological condition such as fibroids, PCOS or endometriosis which can sometimes have improvement in symptoms using some hormonal methods, then talk to your doctor right away. You don't have to be miserable just to stay on the same method.

Side effects of hormone free birth control include heavier periods with the copper IUD, allergic reactions to certain types of condoms such as latex. Also because they can possibly be less effective there is a possible need to use Plan B or another emergency contraception if for example the male condom broke or you forgot to use your barrier method. There is a possibility of regret with sterilization since more doctors are removing the tubes completely. This can actually decrease your risk of ovarian cancer but the only way to conceive would be with assisted reproduction such as IVF if you want to have babies after sterilization.

For young women who are struggling with acne or PMS but are not sexually active, some combination birth control pills can help for how to balance hormones. There are certain progesterones included in these pills that are known to possibly minimize mood changes and acne. Still, a healthy lifestyle especially during the luteal phase or right after ovulation can help to reduce mood swings and there are always topical medications and women’s health supplements that can help with acne that may not require a birth control method.