Non-estrogen birth control: Minipill and other non-hormonal options

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What is the mini pill?

Unlike the more common combination birth control pill (otherwise known as ‘the pill’), the mini pill only contains synthetic progesterone rather than both synthetic progesterone and estrogen. The synthetic version of the natural female sex hormone progesterone is called progestin, which is why the mini pill is also known as the progestin-only pill or (PoP).

This non-estrogen birth control pill thickens the mucus in the cervix, which makes it harder for sperm to get to the uterus. It also thins the lining of the uterus, so a fertilized egg can't attach there. [1] 

With typical use, the mini pill is 93% effective at preventing pregnancy. With perfect use, that effectiveness rate goes up to 99%. [2] Keep in mind that using a method perfectly includes following all guidance correctly, including taking the pill at the same time each day and storing it as instructed. 

The mini pill doesn't protect against sexually transmitted infections (STIs), so you'll need to use condoms or other barrier methods to reduce your risk of getting an STI.

Because the mini pill doesn't have estrogen, it doesn't increase your risk of blood clots or deep vein thrombosis like some other birth control pills can. [1] That may mean that if you can’t take regular birth control pills for ones of these reasons, the mini pill could be a good option for you if you still want to take an oral contraceptive.

Mini pills can be taken immediately following childbirth, even while breastfeeding, and they can be a good choice for those who are looking to get pregnant again in the not-too-distant future. 

How to start taking the mini pill

The mini pill is the first hormonal birth control pill available over the counter in the U.S. While some UK pharmacies also sell it over the counter — you can also get the mini pill via prescription. 

While this non-invasive contraceptive method is widely available, it's still advisable to consult a healthcare professional before and during your use of the mini pill. As a hormonal medication, the mini pill requires consistent and accurate use to remain effective.

To start taking the mini pill, you must take it at the same time every day. Consistency is key —— missing or delaying doses, even by just a few hours, can reduce the mini pill's effectiveness and lead to unintended pregnancy. 

If you do miss a dose, don’t worry. Just take the pill as soon as you remember, even if that means taking two pills in one day. However, if you miss a pill by more than three hours or are inconsistent with dosing, you'll need to use a backup birth control method or abstain from sex for at least two days. [1]

For optimal effectiveness, begin taking the mini pill on the first day of your period. If you start at any other point in your cycle, you'll need to use a backup contraceptive method for the first two days.

Are there side effects with the mini pill?

As with any form of hormonal birth control, there is the possibility of side effects. While most of the time, these side effects are mild or go away on their own, talk with a pharmacist or doctor if you experience severe or increasing side effects. 

Common side effects of birth control pills without estrogen typically include:

• Irregular or unpredictable bleeding 
• Breast tenderness 
• Nausea 
• Mood swings
• Headaches 
• Weight changes
• Acne
• Increased hair growth

Whether or not the mini pill is a good choice for you may also depend on your health history. Individuals with a history of breast cancer, unexplained vaginal bleeding, liver tumors, jaundice, hepatitis, liver disease, or cirrhosis should generally avoid taking the mini pill. [3]

Why choose a birth control method without estrogen?

There are a few reasons why you might want to consider birth control pills without estrogen. From a medical standpoint, there are several instances when you will be recommended to choose a birth control method without estrogen, including if you are:

• Over the age of 35 and a smoker 
• Obese
• Taking certain medications
• Affected by medical conditions such as problems with circulation
• Prone to a certain type of migraine (with with symptoms such as vision changes before a headache) [4]

For others, the decision to choose birth control without this hormone might be because of unwanted hormonal birth control side effects or may be a lifestyle change motivated by the desire to go completely hormone-free. 

Whatever the reason, if you’re considering switching birth control methods, it’s worth having a frank discussion with your doctor about your contraceptive options. There are several birth control methods without estrogen, so it’s important to talk to your healthcare provider to find the best method for you.

More progestin-only methods

When it comes to non-estrogen birth control, you’re not limited to the mini pill. There are a few more progestin-based options you can also consider, including:

The progestin shot

Birth control shots (also known by the brand names Depo-Provera and Sayana Press) are convenient and longer-lasting birth control methods. You only need to get an injection once every few months, making it a hassle-free option for those who don’t want to take a pill every day. 

The injection is given in fleshy parts of the body, such as the buttocks, thighs, upper arms, or abdomen. It’s usually administered by a healthcare professional, but in some cases, you might be able to do it yourself at home. 

The shot is 96% effective with typical use and more than 99% effective with perfect use and can be given at any time during your cycle, provided you’re not pregnant. If you get the shot within the first five days of your cycle, you’ll be protected from getting pregnant straight away. However, if you have the injection on another day of your cycle, you’ll need to use a backup method of birth control, like condoms, for seven days to protect against pregnancy. [5]

The progestin implant

The progestin implant (known by the brand name Nexplanon) is a small rod that is inserted in the upper arm by a healthcare provider. [6]

As with the shot, the progestin implant continuously releases progesterone into the body for up to three years. Thus, preventing pregnancy. 

If you struggle to take a birth control pill at the same time every day, an implant that lasts for three years might be a good option for you. You won't have to worry about a daily pill. After a quick procedure to insert the implant, you'll be all set for three years. When the three years are up, you'll need to have the implant removed or swapped for a new one.

The progestin IUD

There are two types of IUDs, the hormonal IUD (only containing progesterone) and the hormone-free copper IUD. The progestin IUD (intrauterine device) is a small T-shaped device inserted into the uterus that releases progestin, providing contraceptive protection for three to five years, depending on the specific brand. 

Unlike birth control pills that needs to be absorbed into the bloodstream, the progestin IUD works directly in the uterus. This localized action is thought to reduce the risk of systemic side effects — however, more research is needed to confirm this. [7]

IUDs are highly effective at preventing pregnancy. In fact, they are more than 99% effective in both Perfect and Typical Use, as there is very little work required from the person using the method. [8] You can have an IUD fitted at any time during your cycle, provided you’re not pregnant. 

Keep in mind that you may experience some initial discomfort and cramping during and after an IUD fitting. 

Hormone-free birth control options

If you’re considering saying goodbye to hormones altogether, the good news is that there are more natural and non-hormonal methods available than ever before, including: 

Natural Cycles birth control app

Natural Cycles is a completely hormone-free birth control method that’s based on the science of your cycle. Simply measure your temperature most days, and the Natural Cycles app will let you know your fertility status.

Your body temperature changes throughout your cycle based on whether you’re ovulating or not, meaning your temperature can be used to detect ovulation and identify your fertile window. By identifying temperature shifts the app can learn the pattern of your unique cycle. 

The app gives you a daily fertility status: on Green Days you’re not fertile, but on Red Days you must either avoid sex or use protection, like condoms.

Unlike traditional family planning methods, Natural Cycles does not require a monitoring period, although the app will likely give you more Red (fertile) Days at the start until it gets to know you. With perfect use, Natural Cycles is 98% effective and it’s 93% effective with typical use.

Natural Cycles doesn’t have any side effects and doesn’t require a prescription. It’s important to be aware that your data can be affected by external factors such as if you’re hungover, unwell, stressed, or if you’re traveling and your sleep cycles are affected. While this doesn’t make Natural Cycles less effective, it may lead to more Red Days.

Copper IUD

The copper IUD is a type of non-hormonal IUD that works by releasing copper ions into the womb. As a result, it is harder for sperm to survive and survive and reach an egg. [9]

This type of non-hormonal birth control is also a highly effective method of emergency contraception. If the copper IUD is inserted within five days of unprotected sex, it is more than 99% effective at preventing pregnancy. If inserted after ovulation, the copper IUD can also stop the implantation of an egg cell. [10]

This form of contraception can provide protection against pregnancy for up to 12 years after insertion, making it a convenient choice for women who prefer a low-maintenance birth control method. 

A healthcare professional can also easily remove it if you decide you want to become pregnant or no longer want to use the method for other reasons.

There are some side effects associated with the copper IUD, and some individuals may experience increased menstrual cramping and heavier periods, especially in the first 3-6 months. Additionally, because the IUD is embedded into the uterus, there is a slight risk of pelvic infection during the first few weeks after insertion, and you may experience increased cramping or bleeding during each period. [11]

Barrier methods

Preventing pregnancy and protecting against STIs can be done by using barrier methods of contraception, including condoms, diaphragms, and cervical caps. With these methods, sperm is physically blocked from reaching the uterus, creating a reliable barrier between the egg and sperm. 

One of the advantages of barrier methods is their accessibility and affordability. They are widely available without a prescription, and condoms can often be obtained for free at clinics. Additionally, condoms offer the best protection against STIs during sexual activity. 

When individuals use barrier methods correctly and consistently, they can be highly effective in preventing pregnancy. Condoms are 98% with perfect use. But typical use reflects how the method is more commonly used, and for condoms this is 87%. Typical use reflects all kinds of use cases, including condoms breaking. [12]

Some individuals may also have allergies or sensitivities to the materials used in barrier methods, such as latex. Therefore, it's essential to find the right type of barrier method that suits your needs and preferences.

Surgical procedures

Surgical birth control methods (sometimes referred to as sterilization) offer a permanent solution for individuals who do not want or no longer wish to have children. 

A tubal ligation (also known as getting your tubes tied) is a surgical procedure that involves blocking or sealing the fallopian tubes. This prevents sperm from reaching the eggs, thus effectively preventing fertilization. [13]

Another surgical procedure that can be used to prevent pregnancy is a hysterectomy, which involves removing the internal female organs responsible for reproduction. A total hysterectomy involves removing the uterus and cervix, while a partial hysterectomy removes only the uterus. Nonetheless, both result in the inability to carry a pregnancy. [14]

A vasectomy for men is similar to having your tubes tied for women. This procedure prevents sperm from reaching an egg for fertilization. [15]

While there are procedures available to reverse vasectomies or tubal ligations, they are considered permanent forms of birth control as success rates for reversal can vary. 

All of these procedures are typically performed under anesthesia in a hospital or clinic. They are generally safe, but like any surgery, they carry some risks, such as bleeding, infection, or damage to surrounding organs. 

Get to know your options

At Natural Cycles, we’re passionate about birth control choices and believe everyone should have access to a range of options, including hormonal and non-hormonal contraceptives. Our birth control app is the first of its kind to be FDA Cleared in the US and learns the pattern of your unique cycle to prevent pregnancy naturally. If you’re looking for a hormone-free birth control method, why not find out if Natural Cycles could work for you?