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Hormonal Birth Control Methods (Non-Pill Options)

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Feb 13, 2024.

Which hormonal birth control can I use if I don't want to use the pill?

Birth control pills are popular - they're easy, convenient and affordable. But not every person may want to risk remembering to take a daily pill to prevent pregnancy. The good news is there are other convenient hormonal birth control options that are very effective including the birth control patch, shot, implant, intrauterine device (IUD) or the vaginal ring.

Non-pill hormonal birth control options include:

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

Advantages of using birth control that is not a daily pill

Warnings and side effects for hormonal birth control

Some females may not be able to use non-pill forms of birth control that contain hormones. For example, hormonal birth control may not be suitable for females with a history of:

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. This risk increases with your age and the number of cigarettes you smoke. 

You should talk to your healthcare professional about your heart risks 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 infection (STI), including HIV and AIDS. A male latex condom 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 may need to avoid the estrogen in combined hormonal birth control as it may reduce milk supply, especially before the milk supply is established. Birth control options for breastfeeding women include:

You can usually start using these options right after giving birth.

Non-pill options that may be most effective and safe for women with obesity or who are overweight may be the birth control shot, an IUD (levonorgestrel or copper) or the contraceptive implant. 

Common side effects

Serious side effects

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. Let your healthcare provider know if you are being treated for Hepatitis C virus.

For a complete list of severe side effects, please refer to the individual drug monographs. 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.

Hormonal Birth Control Options (Non-Pill)

Generic Name Proprietary Name / Generic Availability 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 $400-$500 per month (cash price for 3 rings) but online discounts may be available or insurance / Medicaid typically cover. Generic options are around $142.
  • 99% effective if always used correctly. In reality, about 91% effective. Staying on schedule with insertions and removals 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 your upper arm.
  • Replace after 3 years, but may be removed at any time; do not use if pregnant.
  • Effective for 3 years; 99% effective; may be less effective overweight women.
  • 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 $0 to $2,200 per implant but lasts for 3 years; insurance or Medicaid will probably cover, but you may have addition fees for implant insertion or removal. 
  • Can cause shorter, longer or irregular periods, or spotting between periods; may lighten or eliminate periods.
ethinyl estradiol and segesterone
  • Combination estrogen and progestin vaginal ring that can be self-inserted and self-removed.
  • 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 (thirteen 28-day cycles). Replace after one year of use.
  • Annovera is about 97% effective in preventing pregnancy when used as directed.
  • Annovera costs over $2,400 but only needs replacement once per year. Insurance or Medicaid typically covers cost. Manufacturer may offer additional savings for copays, if needed. 
  • Annovera has not been adequately evaluated in overweight or obese women with a body mass index (BMI) greater than 29 kg/m2. Speak with your doctor if you have concerns.
  • Do not refrigerate or freeze Annovera.
levonorgestrel intrauterine device (IUD)

Generic options not available.
  • 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 8 years for Liletta or Mirena; after 5 years for Kyleena; after 3 years for Skyla.
  • Costs $0 to $1300 per IUD nut insurance or Medicaid typically pays.
  • 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 or test 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 or progestin-sensitive cancer, pelvic infection, cancer of the uterus or cervix, large fibroid tumors, infection in the cervix.
  • Not for use as an emergency contraceptive, per manufacturer.
medoxyprogesterone acetate injection
  • Injection of progestin-only hormone given every 12 to 14 weeks (subcutaneous injection form) or every 13 weeks (intramuscular injection form).
  • Use for longer than 2 years not generally recommended due to effect on bone mineral density.
  • Costs $50 to $100 per injection; insurance or Medicaid typically pays.
  • May lighten or eliminate periods.
  • 99% effective if used as directed.
  • Do not use if pregnant, history of blood clots, blood vessel disease in brain, history of breast cancer, liver disease, at risk for bone fractures, undiagnosed vaginal bleeding, allergy to medicine.
  • May initially cause irregular bleeding patterns.
norelgestromin and ethinyl estradiol transdermal patch
  • Xulane, Zafemy
  • generic options available.
  • Combination hormone patch with an estrogen and progestin.
  • 98-99% effective if used correctly; may be less effective in women who weigh over 198 lbs. (90 kg). If you weigh more than 198 lbs, talk to your healthcare provider. Do not use if BMI ≥30 kg/m2.
  • 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. 
  • Only wear one patch at a time. Make sure you remove your old patch before applying your new one.
  • 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 or longer, apply a new patch and start a new cycle. Use a back-up contraception (condom) 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 blood 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).

 

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Sources

Further information

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

Medical Disclaimer