Non-hormonal contraception: copper coils and more

There are hormonal and non-hormonal contraceptives. Non-hormonal contraceptives do not affect a woman’s hormonal balance, which is why they’re so popular. There are various methods of non-hormonal birth control: 

• Intrauterine contraception: this is a form of long-term non-hormonal contraception. A doctor places a non-hormonal contraceptive such as the copper coil into the uterus. It stays there for three to five years.
• Natural birth control: with this method of non-hormonal contraception, women monitor their menstrual cycle and the changes in the body that are associated with it. Specific indicators allow them to detect their fertile days.
• Mechanical contraceptives: this non-hormonal method of birth control forms a sort of barrier in the body, preventing sperm from reaching the egg cell. Mechanical contraceptives include diaphragms and condoms.
• Permanent contraception: this includes sterilisation. This is an option where couples do not plan on having any more children.
• Chemical contraceptives: these non-hormonal contraceptives consist of spermicides. These are substances that kill sperm in the vagina. Spermicides are available in the form of suppositories that the woman inserts into her vagina before intercourse.
  

The copper coil is the non-hormonal alternative to the hormonal coil, making it a popular choice with many women. How does it work? The gynaecologist inserts the T-shaped copper coil into the uterus, where it takes effect. The coil releases copper ions, which reduces the mobility of the sperm. The copper coil also has another function: it affects the mucous membrane of the cervix and the uterus. This makes it difficult for the egg cells to implant. Likewise, using a non-hormonal coil makes it more difficult for sperm to penetrate the uterus.

The Pearl Index for the copper coil is between 0.4 and 1.0.

Advantages and disadvantages of the copper coil

The copper coil offers the following advantages: 

• Low cost: the copper coil is associated with minimal cost – e.g. in comparison to the frameless copper IUD.
• Less hassle: the non-hormonal coil is associated with minimal effort. It usually stays in the uterus for five years.
• Emergency contraception: the copper coil is suitable for use as emergency contraception. A gynaecologist can insert it up to five days after unprotected sex. There is the option of leaving the copper coil in the uterus for ongoing protection afterwards.
• Minimal side effects: unlike hormonal contraception, the copper coil doesn’t cause any loss of libido. It doesn’t cause any nausea, mood swings or weight gain either.

The copper coil also has the following disadvantages:

• Heavier periods: in some cases, this contraceptive causes women to experience heavier and more painful periods.
• Expulsion: in 2 to 5% of cases the copper coil slips out in the first year. In such cases it no longer prevents pregnancy. That is why you should check regularly to see whether the copper coil is sitting in the correct position. Ideally, ask your gynaecologist how often this should be checked. Do you use a menstrual cup? This may increase the risk of your copper coil falling out. 
• Increased risk of inflammation in the pelvis: this risk relates primarily to girls and young women and the risk is greatest the first month after the copper coil is inserted. Frequent intercourse, particularly with alternating sexual partners, increases the risk. Seek medical attention if you experience pain in the lower abdomen, fever, pain during sex, heavy vaginal discharge or unusual vaginal bleeding.
• Spotting: the copper coil may potentially cause spotting in the first few months in particular.
• Injuries: in some rare cases, minor injuries may be sustained in the uterus or the cervix during the insertion of the copper coil.
• Pain during insertion: some women find it painful when their gynaecologist inserts the copper coil. Medication to widen the cervix or anaesthesia will alleviate the pain in most cases. 
  

The frameless copper IUD consists of a nylon thread that is just a few centimetres long. Four to six small copper sleeves are threaded onto this thread. Like the copper coil, the frameless copper IUD emits copper ions for contraceptive effect.

The Pearl Index for this non-hormonal contraceptive is 0.1 to 0.8. 

Frameless copper IUD: the advantages and disadvantages

Like the copper coil, the frameless copper IUD doesn’t generally have any side effects. Occasionally menstruation can be heavier and more painful than before the IUD was inserted. Minor injuries may be sustained during insertion of the frameless copper IUD too, but these are rare. The insertion and removal of the frameless copper IUD is painful for some women. For that reason, there’s the option of inserting it under local anaesthetic.

The IUB Ballerine is another non-hormonal contraceptive. It has a diameter of 1.5 centimetres and consists of a wire on which 17 copper beads are threaded. Recent studies show that the IUB Ballerine has a frequent tendency to slip out of place. For this reason, experts do not recommend the IUB Ballerine. 

Another non-hormonal method of birth control is natural birth control, also referred to as NFP birth control. NFP stands for natural family planning. This is where you forego using any chemical, hormonal or mechanical contraceptives or contraceptives that are inserted into the uterus and instead pay attention to your body’s changing physiological signs during your cycle. These include body temperature as well as changes in cervical mucus.

The symptothermal method can help you to determine the fertile and infertile days in your cycle – either to prevent pregnancy or to increase the chances of it. The symptothermal method combines the temperature method, the cervical mucus method and other cycle observations. With practice, this natural contraception method is very reliable. However, symptothermal contraception involves focusing intensively on your body and your cycle. This is time-consuming and sometimes very demanding.

Used correctly throughout, symptothermal contraception has a Pearl Index of 0.3 to 2.3. Used alone, the temperature method achieves a Pearl Index of 1 to 10, and the cervical mucus method an Index of 5 to 35.

Note: Use a barrier method of contraception if you have sexual intercourse during your fertile days – such as condoms, diaphragms or spermicides.

Below we outline the three cornerstones of the symptothermal method:

Observing your cycle

Follow your natural cycle (without hormonal contraception). Your cycle begins on the first day of your menstrual period, and ovulation takes place approximately in the middle of the cycle. Write down on a cycle sheet how your body changes over the course of the cycle. Take note of your cervical mucus and body temperature in particular. You should also keep track of when you’re stressed, sick, or when you’re travelling. All of this affects your cycle. 

Check your cervical mucus

Cervical mucus is a fluid that many women perceive as a form of discharge. Its primary job is to close the cervix. This prevents any germs from penetrating the uterus. How do you check cervical mucus? Simply remove the mucus from the vaginal entrance or cervix, rub it between your thumb and index finger, and then pull your fingers apart. You can tell whether you are in your fertile or infertile phase depending on the texture of the mucus: on your infertile days, the mucus is thick and lumpy. Before ovulation, it is milky and sticky. During your fertile days, the mucus is clear, and a thread is formed when you pull your fingers apart.

Important: check your cervical mucus every day.

Measure your temperature

Measure your body temperature daily and write it down. Use a thermometer that shows your temperature with two digits after the decimal point. Your temperature is at its lowest during ovulation. It rises by 0.2 to 0.4 degrees Celsius one to two days after ovulation. Your infertile days usually begin on day three after this rise in temperature. These last until your menstrual period.

Important: take your temperature immediately after waking up, even before you get up (basal body temperature). 

Symptothermal method: the advantages and disadvantages

Like the other natural contraceptive methods, the symptothermal method does not affect the body. It is also cost-effective. However, since the body’s temperature fluctuates – for example due to stress, certain medications, alcohol consumption or time differences – it isn’t always easy to clearly determine the fertile days.

The diaphragm is a form of mechanical contraception. Visually, this non-hormonal contraceptive resembles a small, flexible cap made of silicone or latex. It prevents sperm from entering the uterus. Women who use a diaphragm for contraception use it every time they have sexual intercourse. There are different models of this non-hormonal contraceptive. It is therefore only safe if an experienced specialist – for example a midwife – adapts the diaphragm to your body. They will also show you how to insert it, check the correct fit and remove it again. Ideally, they will also check every one to two years whether the diaphragm still fits. Make an appointment at a doctor’s office, family planning centre or women’s health centre to find out which model is right for you.

The Pearl Index fluctuates between 1 and 20 for this non-hormonal contraception. Properly adapted and used appropriately, the diaphragm offers a certain degree of contraceptive reliability. Contraceptive protection generally improves with the right size and experience using the diaphragm.

Diaphragms: the advantages and disadvantages

The diaphragm offers various advantages as a non-hormonal contraceptive. It is cost-effective and flexible to use. You only use it when you have sexual intercourse. Another advantage for many women is that the diaphragm is inserted before sexual intercourse, not just before climaxing. In addition, a diaphragm has a shelf life of one to two years.

In the beginning, it may be difficult to insert the diaphragm correctly. Experienced advisors can provide you with guidance on this. 

The femidom is a condom for women. It consists of a plastic tube that is about 18 centimetres long. The tube is open at one end and closed at the other. There is a plastic ring at both ends. Insert the femidom with the closed end. The open end remains outside the vagina in front of the labia majora.

The femidom has a Pearl Index of 5 to 25.

Advantages and disadvantages of the femidom

The femidom is the only contraceptive for women that protects against sexually transmitted diseases. One disadvantage is that using it requires a little practice. In addition, the femidom may slip during sexual intercourse. Due to its high Pearl Index, the femidom is considered an unsafe contraceptive.

Condoms are a non-hormonal contraceptive for men. Most condoms are made of latex. However, there are also variants made of polyurethane or polyisoprene. The tip of the condom is slightly rounded, allowing it to catch the man’s sperm.

Important: make sure you use the right size. If the condom is too big, it may slip. If it is too small, it may burst. You should also ensure you don’t open the packaging of the condom with sharp fingernails or your teeth, so you do not damage it.

The Pearl Index for this non-hormonal contraceptive method is 0.4 to 12.

Condoms: the advantages and disadvantages

Condoms protect against sexually transmitted diseases. They are easy to use and do not affect hormonal balance. Some find the condom uncomfortable during sexual intercourse.

Sterilisation is a suitable form of contraception if you have completed your family planning. This is because it is not always reversible. During male sterilisation (vasectomy), a doctor severs the sperm duct. During female sterilisation (tubal sterilisation), a doctor blocks the fallopian tubes. Alternatively, they disconnect them. Sterilisation for men is generally less risky and easier than for women.

Both forms of sterilisation have a Pearl Index of 0.1.

Advantages and disadvantages of sterilisation

Sterilisation does not affect the sex life of the man or woman and provides very reliable protection against unwanted pregnancy. However, it involves surgery and offers no protection against sexually transmitted diseases.

It is possible to reverse sterilisation (refertilisation). Whether or not a pregnancy occurs after refertilisation is dependent on several different factors: the time between sterilisation and refertilisation, the age of the woman and the quality of the sperm.

Spermicides are a simple method of non-hormonal contraception. They contain substances that kill the sperm in the vagina. They are available in suppository, gel or cream form. Spermicides work immediately after insertion.

Spermicides have a Pearl Index of 3 to 21.

Advantages and disadvantages of spermicides

Spermicides are easy to use and can be used as needed. Occasionally, however, side effects can occur – such as irritation of the vagina or penis – increasing the risk of infections. Spermicides do not offer any protection against sexually transmitted diseases either. They also do not protect against unwanted pregnancy as reliably as the copper coil, for example. That is why it is best to combine spermicides with other methods such as condoms for better protection.

If consultation does not serve to diagnose or treat an illness, the costs of consultations are not covered by health insurance. Basic insurance and supplementary insurance do not generally provide benefits for non-hormonal or hormonal contraceptives.

Non-hormonal contraceptives offer you many options for safe contraception. Find out about the different methods and choose the method of non-hormonal contraception that suits you best. Your gynaecologist will assist you in this.

Tip: The independent advisory service appella.ch will help you to find a specialist centre in your area.