Contraception without the pill

Index

The pill: increasingly unpopular

According to a study by the Federal Center for Health Education, the popularity of the pill is declining. This trend is particularly evident among younger women between the ages of 18 and 29. This not only has to do with the fact that the pill is a hormone preparation, the daily intake is also often perceived as annoying. Some women also have to give up the pill for medical reasons. Fortunately, there are a variety of highly effective alternatives available to those looking to prevent.

Important to know

Before we introduce you to the 6 safest alternatives to the birth control pill, we would like to point out a few important things to you:

No contraceptive is 100% safe.
Women over 40 and smokers are at higher risk of side effects from hormonal contraceptives.
The 6 contraceptives presented here do not protect against sexually transmitted diseases. If necessary, you should also use condoms or wipes.

The Pearl Index stands for security

The Pearl Index is used to indicate how safe a contraceptive is. Example: If 100 women use a method for 1 year and 5 women become pregnant during this time, the Pearl Index is 5. The following therefore applies: the lower the index, the safer the method. The pill has a Pearl Index of 0.1 to 0.9. That means: out of 1,000 women between 1 and 9 women become pregnant in the course of a year despite contraception.

Alternatives to the pill: which contraceptive method should I choose?

This question can only be answered individually. The answer depends, for example, on how old you are, what your health is like and how much money you can or want to spend. We introduce you to 6 options that you can get prescribed by the doctor. You can get a comprehensive overview of all contraceptive options in our overview article on contraceptives .

1. Contraceptive patch

How it works The small patch releases the hormones estrogen and progestin. (All hormonal birth control methods are based on synthetic estrogen and/or progestin.)
Application It is easy to use: the patch is applied to a clean and dry area of skin 3 times in a row for 7 days each time. After that there is a 1 week break. Bleeding usually starts at this time.
Benefits The patch can make bleeding more regular, lighter and less painful. Since the hormones enter the bloodstream through the skin, the liver is less stressed than with the pill.
Disadvantages The patch is visible on the skin. Some women experience skin irritation, nausea, breast tenderness, headaches, or mood swings. The patch may fall off or the woman may forget to change it. If this is noticed, condoms should also be used as protection.
Pearl-Index 0,72–0,9

2. Contraceptive ring

How it works The small, flexible plastic ring is placed in the vagina. There it releases estrogen and progestin. The hormones enter the blood via the vaginal mucosa and inhibit ovulation.
Application The vaginal ring is inserted by the woman herself for 21 days. This is followed by a 7-day ring break, during which withdrawal bleeding occurs. A new ring is then inserted. The ring cannot be felt during sex.
Advantages The vaginal ring only needs to be inserted once a month. Unlike the pill, it works even if the wearer is vomiting or diarrhea. Bleeding may be more regular, lighter, and less painful.
Disadvantages Inserting and removing the ring hygienically requires some practice. It can lead to inflammation in the vaginal area. In addition, the risk of a blood clot is increased. A few women feel the ring as a foreign body. The possible side effects correspond to those of the contraceptive patch. In addition, the ring can be forgotten or fall out at the wrong time.
Pearl-Index 0,4–0,65

3. Contraceptive sticks

How it works The birth control rod is an implant about 4 cm long. The small, flexible rod is placed under the skin on the inside of the upper arm and only releases progestin.
Application In an outpatient procedure, the contraceptive stick is inserted by the doctor under local anesthetic. It protects against unwanted pregnancy for about 3 years. After that, it must be removed or changed by the doctor.
Pros This contraceptive method is very safe. The progestogen dosage is low, estrogen is not administered at all. The wearer of a contraceptive stick does not have to worry about contraception for 3 years.
Disadvantages The contraceptive stick can lead to irregular bleeding or bleeding between periods and a reduced libido. Nausea, acne, weight gain, and mood swings can also occur.
Pearl-Index 0,1

4. 3-month injection

How it works The woman is given an injection of progestin. This suppresses ovulation and also makes the cervical mucus more impermeable. This makes it difficult for sperm to enter the uterus.
Application When visiting a doctor, the progestin is injected into the buttocks. The effect lasts about 8 to 13 weeks.
Advantages The name says it all: The injection only has to be used every 3 months. She is estrogen free. The woman does not have to carry any foreign body in or with her. Vomiting or diarrhea do not affect the reliability of the method.
Disadvantages In contrast to implants, the progestin depot created by the injection cannot be removed. Of course, this is unfavorable when side effects such as irregular bleeding, reduced libido, nausea, acne, weight gain or mood swings occur. Long-term use increases the risk of osteoporosis. In addition, a woman’s fertility can be impaired for a long time after stopping the injection.
Pearl-Index 0,2–1,4

5. Hormonal IUD

How it works The IUS is a small, T-shaped device made of plastic. It continuously releases progestin into the uterus.
Application The gynecologist inserts the hormone spiral into the uterine cavity, usually during the menstrual period, because the cervix is then dilated. The hormone spiral is effective for about 3 to 5 years. The removal is also done by the doctor.
Advantages Application errors are practically impossible with the hormone spiral. In addition, the wearer is very reliably protected against unwanted pregnancy for a long time, and it is estrogen-free. After the removal of the hormone spiral, pregnancy is usually possible again quickly.
Disadvantages Insertion can damage the uterus. It is rare, but not impossible, for the hormonal IUD to fall out. This is most likely to happen shortly after onset, either during menstruation or after childbirth. In addition, irregular bleeding and abdominal or pelvic pain may occur.
Pearl-Index 0,16

6. Copper IUD (hormone free)

How it works The copper spiral consists of plastic and copper. It does not require any hormones at all: the copper prevents the sperm cells from moving and ensures that a fertilized egg cell cannot implant itself in the uterus.
Application Like the hormone IUD, the copper IUD is inserted into the uterus by the gynecologist in a sterile environment and later removed. The wearing time of a copper spiral is between 3 and 5 years.
Advantages Since the copper IUD does not contain any hormones, the woman’s natural menstrual cycle is not affected. The copper coil can be worn for several years and is one of the most reliable contraceptive methods. After their removal, pregnancy can quickly occur.
Disadvantages The disadvantages are the same as with the IUS. In addition, heavy, long-lasting and painful menstrual bleeding can occur.
Pearl-Index 0,3–0,8

Not recommended: Unsafe alternatives to the pill

In addition to the 6 contraceptives mentioned above, there are other tools available for women who want to prevent pregnancy. We name them here for the sake of completeness, but we tell you very clearly that they are significantly less reliable than, for example, the pill. In addition, they are quite cumbersome to use.

Femidom (“female condom”), Pearl Index 5-25
Diaphragma, Pearl-Index 1–20
Portiokappe, Pearl-Index 6
Contraceptive Cream, Pearl Index 3-21
Contraceptive suppositories, Pearl Index 6-21

And what about male contraceptives? Condoms (Pearl Index 2-12) and sterilization (Pearl Index 0.1) are still the only ways in which men can actively prevent themselves. Women should not engage in coitus interruptus, i.e. pulling the penis out of the vagina shortly before ejaculation – this method has a Pearl Index of 4-18.

Your birth control method = your decision

You should decide for yourself which contraceptive method is best for you in consultation with your gynaecologist. If you have specific questions about which birth control methods are right for you, you can also video chat with a doctor at Med-Healths. Our doctors also issue follow-up prescriptions for existing pill prescriptions.