Gynecology And Obstetrics-

Hormone-free contraception

What does hormone-free contraception mean?

Many couples are looking for alternative methods of contraception because of concern about complications from hormonal contraceptives or personal rejection of them.

There is a wide range of options, with most contraception methods affecting the woman herself. The advantage of hormone-free methods is that they do not interfere with the natural female cycle.
Many non-hormonal contraceptive methods provide good protection against pregnancy when used correctly, but they often require practice and patience.
A medical consultation can therefore be recommended.
The conventional condom and the vasectomy, i.e. the surgical sterilization of men, are options for the partner to prevent pregnancy.

What hormone-free contraception methods are there?

There are numerous methods of contraception that do not require an external hormonal supply.
These, too, are very safe in many cases, whereby the right protection is always associated with correct handling:

symptothermal method:

With the help of the symptothermal method, the fertile days can be found out via the basal temperature and the consistency of the cervical mucus.
Contraceptive Computer:

It is similar with the contraceptive computers, which collect the measured values themselves, record the monthly cycle and show in color when unprotected sexual intercourse can take place. Some contraceptive computers also include the consistency of the cervical mucus in their analyzes.
Billing method:

As part of the so-called billing method, women can also examine their own mucus to determine whether it is fertile or not.
Barrier Methods:

In addition, there are so-called barrier methods that prevent semen from entering the uterus.
These include the conventional condom, the female condom, the diaphragm and the cervical cap.

You might also be interested in: Put the condom on properly
Intrauterine devices:

In addition, intrauterine devices, including the copper coil and chain, prevent invading sperm from fertilizing the egg.
If fertilization nevertheless took place, implantation of the fertilized egg cell is made more difficult.

Please also read our detailed article on this: GyneFix® copper chain

The condom

The condom is the only contraceptive that offers protection against pregnancy as well as against sexually transmitted diseases.
This applies to both the male and female variant.

The condom is a barrier method of contraception. This prevents sperm from entering the woman's vagina and uterus.
A condom usually consists of extremely thin latex, although products made of polyurethane are also available for allergies.

If the man is not circumcised, the foreskin must first be slicked back before putting on the condom. The condom is then rolled over the erect penis, taking care to leave the small prefabricated tip at the tip of the condom free and not to pull it over the penis as well.
This tip serves as a reservoir for the seminal fluid that escapes during orgasm and is therefore important to prevent the condom from bursting due to insufficient space.

After sexual intercourse, the condom is removed from the still stiff penis, and this should be done after the member has been pulled out of the vagina.
This prevents the semen in the condom from leaking into the vagina. '
Due to the thin nature of condoms, they are usually barely noticeable during sexual intercourse. A prerequisite for this, however, is the optimal fit of the condom, which is why the correct size must be selected according to the length and thickness of the limb when buying.

The safety of the product can be severely impaired if oils or fatty creams are used as lubricants, as the condom material becomes porous and can tear more easily.
Therefore, if necessary, only lubricants that are designed for the use of condoms should be used.

You might also be interested in: Put the condom on properly
The spermatic duct valve is a new invention for male contraception.
Read our article on this:
The spermatic duct valve - an evolution in contraception?

The female condom

A female condom acts as a mechanical barrier to sperm penetration. This traps the semen before it enters the uterus. A female condom consists of a thin plastic sleeve that has an open and a closed end.
The ends are stabilized by means of flexible rings.
This is to prevent the hose-like female condom, which is closed on one side, from collapsing and slipping in its seat.

Proper use consists in inserting the condom with the closed side first into the vagina deep enough to cover the cervix.
Lubricants can be helpful here.
The open end of the female condom protrudes from the vaginal canal and covers the outer labia. On the one hand, this guarantees easier insertion of the male genitals and, on the other hand, prevents the condom from slipping into the vagina.

After intercourse, the female condom can be removed from the vagina with a twisting motion. The rotation closes the condom, which prevents the sperm from running out.

When used properly, the female condom, like the male condom, is a fairly safe method of contraception.
In addition, the transmission of sexually transmitted diseases can be prevented.
The correct placement of the female condom in front of the cervix is important for the safety of the contraceptive method, which is why its use requires some practice.

The copper chain (e.g. GyneFix)

The application and mode of action of the copper chain, trade name Gynefix ®, is similar to the copper spiral.
The copper chain is also one of the intrauterine devices. This contraceptive consists of small tubes made of copper that are strung like a chain on a flexible thread. The length of the chain and the number of copper elements depends on the size of the uterus.
It is usually inserted into the uterus by the gynecologist during the menstrual period and, if properly seated, is fixed there with a knot.

The mode of action of the copper chain is based on the fact that the mobility of the sperm is reduced by the emission of copper ions and these usually perish.
This reduces the likelihood that the sperm will be able to fertilize the egg. If fertilization could still take place, the chain also acts as a foreign body in the uterine cavity, which makes it difficult for the egg cells to implant in the uterine wall.
In some cases, this mechanism is also used for emergency contraception, if the copper chain is inserted as soon as possible after unprotected sexual intercourse, thus preventing implantation. The copper chain thus has two anti-pregnancy principles.

As a rule, the chain can remain in the body for up to five years and is removed from the uterus using the retrieval thread after the time has elapsed or, if desired, earlier.
Since the copper chain is still a relatively new procedure, not all gynecologists are familiar with the correct handling and are more familiar with inserting the copper spiral.
Therefore, information should be obtained beforehand which gynecologist in the area will carry out this type of procedure.

Please also read the detailed article on the subject: GyneFix® copper chain

The spiral

The IUD as a method of contraception is available in two forms, with the hormonal and non-hormonal variants being differentiated.
The IUD is one of the intrauterine devices.
The hormone-free method is the copper coil:

This consists of two short and one longer plastic sticks, which are reminiscent of the letter T in their shape. The name-giving copper wire is wrapped in a spiral on the longer plastic rod. A retrieval thread is also attached for later removal of the IUD.
The gynecologist inserts the copper coil into the uterus via the cervix, usually during menstrual bleeding, in order to use the natural, easy opening of the cervix during the period for the procedure.

In the uterus, the coil has a movement-inhibiting effect on penetrating sperm, so that the way to the egg is more difficult.
In addition, if the egg cell is fertilized anyway, it prevents it from implanting in the uterus. This happens because the spiral stimulates a foreign body and also represents a mechanical obstacle to implantation.

The IUD can remain in the uterus for up to five years, or it can be removed earlier by a doctor using the retrieval thread if desired or if there are complications.
In addition, the position of the copper IUD should be checked at regular intervals via ultrasound examinations, usually every six months.

You might also be interested in: What does the IUD cost? or the insertion of the IUD

Temperature method

The temperature method is a natural form of both contraception and family planning. The woman's fertile days are determined by means of the morning wake-up temperature, the so-called basal temperature.
Only those thermometers with at least two decimal places are suitable for this purpose, as the hormonally controlled temperature changes are very small.
In addition, the measurement must be made at the same time and on the same part of the body in order not to falsify the results.

About one to two days after ovulation, the basal temperature increases by a few tenths of a degree, at least by 0.2, due to the influence of the hormone progesterone.
If the values remain elevated for at least three days compared to the temperature of the previous six days, the infertile phase begins in the monthly cycle and pregnancy is unlikely until the beginning of the period.
From the start of menstruation until the temperature rises again for at least three days, you should either refrain from sexual intercourse or use alternative methods of contraception, such as a condom.

If used correctly, the temperature method can be a very reliable means of contraception. However, the temperature should be recorded in writing for a few cycles in order to determine the individual cycle duration. Additional contraceptive measures are recommended during this time. In addition, some factors can influence the measurement result.
These include:

Alcohol consumption,
Lack of sleep and
Disturbed sleep rhythms due to jet lag or shift work.

Some women combine temperature measurement with an evaluation of the uterine mucus, the so-called billing method, to make the contraceptive method more secure.
Both procedures combined are also known as the symptothermal method.

Billing method

The billing method is a natural method of contraception and family planning.
To determine the fertile days, the consistency of the cervical mucus is compared every single day, as it is subject to hormonal influences.

After ovulation, the mucus becomes tough and thick.
It forms a real plug in the cervix to catch the rising sperm.
This is the infertile phase when intercourse is unlikely to result in pregnancy.
In the course of the process, the mucus becomes more liquid again and shortly before ovulation reaches a "spinnable" state, that is, it forms threads between the fingers when the fingers spread.
If the cervical mucus is thin, additional prevention should be used.

On its own, the billing method is not very reliable.
In combination with the basal temperature measurement, the safety of contraception can be increased significantly. It is then the so-called symptothermal method.

Contraceptive computer

Nowadays, numerous manufacturers offer contraceptive computers which, based on the measurement of body signals, can calculate when the risk of pregnancy through unprotected sexual intercourse increases or when the probability is low.

The underlying principle of the contraceptive computer is usually similar to the basal temperature method or the symptothermal method.
This means that both the basal body temperature and, in some models, the nature of the cervical mucus are measured. However, this is not determined manually and by thermometer, as is the case with the classic application principle, but the device takes over the task independently.

Some models use ovulation tests instead of cervical mucus, i.e. testing the time of ovulation, in their calculations.
By evaluating and collating the measurement results, there is a cycle-dependent release of infertile days, which are often displayed in green on the computer, on which unprotected sexual intercourse can take place without the risk of pregnancy.
Conversely, the fertile days are usually marked in red, on which either sex should be avoided or alternative contraceptive methods should be used.

Persona contraception monitor

The Persona Contraception Monitor is one of the hormone-free contraception methods. It is a set consisting of a touchscreen monitor and urine measuring sticks.

On the first day of the period, a new cycle is set up on the monitor, in which the time of the menstrual period is entered. In addition, the woman can independently set an individual six-hour time window in which the regular measurements are carried out on the following test days. The first time it is used, more measurements must be taken, usually sixteen, so that the meter can learn about the woman's cycle. In the following months, eight measurements per cycle are sufficient. The days on which the measurements should be carried out are shown in orange on the monitor.

The result of the measurement then determines whether unprotected sexual intercourse can take place or should be prevented on the day of measurement. To carry out the measurement, the test strip must be held in the urine stream for three seconds or in a container filled with urine for fifteen seconds. Morning urine is the most informative. After the test strip is soaked in urine, it is inserted into the test slot of the monitor. This calculates the level of the hormone estrogen and the so-called luteinizing hormone (LH). A signal is given after the analysis. The days on which unprotected intercourse can take place are then marked in green on the monitor, whereas the time in which additional contraceptive precautions should be taken to avoid pregnancy is shown in red.

The precondition for safe contraception with the Persona contraception monitor is a regulated cycle, which must not be shorter than 23 days and not longer than 35 days.
In addition, the individual suitability for using the Persona contraception monitor should be checked beforehand by consulting the doctor or obtaining product information.
There are some factors that can influence the reliability of the method and should therefore be excluded beforehand.

Lea

Lea is one of the barrier methods of contraception that prevent the penetration of sperm into the uterus and thus prevent the subsequent possible fertilization of the egg cell.
The Lea contraceptive is a silicone cap of uniform size with a handle, which is inserted deep into the vagina and placed over the cervix. There it sucks itself through the creation of a negative pressure when used correctly, which prevents the Lea contraceptive from slipping during sexual intercourse.
In order to increase the reliability of the method, the silicone product is coated with a spermicide.
In 2014 the product was withdrawn from the German market.

The contraceptive methods with a similar principle of action include the diaphragm and the FemCap®, a further development of the previously available cervical caps.
The shape of the diaphragm is similar to a cap, as it is a round or oval spring ring covered with silicone.
It is also inserted deep into the vagina and should sit in front of the cervix and completely cover it.
In contrast to the Lea contraceptive, there are several sizes available that must be adapted to the individual female anatomy in order to prevent slipping during sexual intercourse. It is therefore advisable to have the size adjusted by a specialist.

Correct use of the FemCap® also depends on choosing the right size.
This is a cap that is arched like a dome and has a handle for removal after sexual intercourse. It is placed over the cervix and adheres there like the Lea contraceptive via a negative pressure.
Both the diaphragm and the FemCap® should always be used in conjunction with a gel, which on the one hand reduces sperm mobility and on the other hand forms an additional mechanical barrier.

NFP - Natural Family Planning

NFP stands for natural family planning and comprises those methods that determine the fertile days of women through the body's own signals and changes.
The knowledge about this can then be used either for pregnancy planning or its contraception by having sexual intercourse timed according to the results. On the fertile days, if contraception is desired, sexual intercourse is either avoided or additional contraception.

The NFP methods include, for example, the temperature method, also known as the basal temperature method.
If this is combined with the billing method, which is also part of the NFP, which observes the nature of the cervical mucus, it is called the symptothermal method.
Depending on the definition, this can also include manual palpation of the consistency of the cervix, which is subject to cyclical fluctuations.

When used correctly, NFP methods can reliably prevent pregnancies. They offer an option of contraception that is completely free of side effects.

However, some disruptive factors can influence the natural rhythm of the body and thus impair the accuracy of the measured values. In addition, all NFP methods require practice and should take place over several monthly cycles before the results can be reliably accessed.
Only with precise knowledge of your own cycle and correct handling can additional contraception be dispensed with on the infertile days determined.

coitus interruptus

Coitus interruptus, i.e. interrupted sexual intercourse, is a very unreliable and therefore not recommended form of contraception.

This involves pulling the penis out of the vagina just before the man's orgasm, causing the ejaculation to take place outside the vagina.
If this method is used correctly, most of the sperm cells will not get into the woman's body, but small amounts of semen can come off before the actual climax and thus reach the uterus.

In addition, coitus interruptus requires good body knowledge and strict self-control on the part of the man in order to pull the member out of the vagina at the right moment before orgasm. This may not always work and the seminal fluid reaches the uterus unhindered.

What is the respective Pearl Index like?

The Pearl Index shows the number of pregnancies in one hundred women over a period of one year using the chosen method of contraception. This is a guideline for reliability.
The lower the Pearl Index, the safer the method is classified.

The portio cap has a pearl index of 6,
the diaphragm assumes values between 1 and 20,
the female condom is between 5 and 25 and
the condom for men between 2 and 12.
The basal temperature method has a pearl index of 0.8 to 3,
in the symptothermal method it is 0.3 and
about 15 for the billing method.
The copper chain has a pearl index of 0.1 to 0.5,
while the copper spiral has a pearl index between 0.3 and 0.8.

The stated values may vary depending on the literature source used.

What are the respective costs?

As a rule, non-hormonal contraceptive methods are not part of the range of services offered by health insurance companies, which is why the costs have to be borne by yourself.
When deciding on a particular method of contraception, it may be worthwhile to compare prices beforehand, as there are sometimes large price differences that apply to the same method of contraception and sometimes even to the same product.

The most expensive non-hormonal contraceptive methods include the contraceptive computer, the copper chain and IUD:

The contraceptive computers cost between 100 and 350 euros, depending on the provider and model used.
The Persona contraception monitor costs around 80 euros, with an additional 10 euros a month for the urine measuring strips, which can only be used once.
The copper IUD can cost between 150 and 300 euros, whereby the price usually includes the consultation, the gynecological examination, the product itself and the insertion of the IUD.

Read more detailed information on this in the article: What does the IUD cost?
The copper chain usually costs around 200 - 350 euros.

The barrier methods are usually cheaper:

The FemCap® and the diaphragm are available for around 50-60 euros, plus the cost of a sperm-inhibiting gel at regular intervals and depending on use.
The cost of the female condom and the male version depend on the package size.
Usually packs with a larger number of condoms are cheaper per unit.

The condom for women costs between 8-12 euros in a pack of three. In addition, there are often shipping charges because the product is not available in stores.

The range of conventional condoms is much larger, which is why the price varies a lot and depends on the brand. A piece costs between around 20 cents and 1.20 euros.

Latex-free condoms are usually a bit more expensive, which means that the unit price is around 1.10 euros.

The application of the basal temperature method and the symptothermal method costs the one-time purchase price of a thermometer, which measures the body temperature with at least two decimal places.