Key Takeaways
- Wer auf hormonelle Verhütung verzichten möchte, steht vor einer großen Auswahl an hormonfreien Alternativen.
- Die Alternativen unterscheiden sich in der Art ihrer Anwendung und Sicherheit.
- In diesem Artikel stellt Dr. med. Rieke Hermann, Ärztin für Gynäkologie die verschiedenen hormonfreien Verhütungsalternativen vor und beschreibt ihren individuellen Verhütungsschutz.
In recent years, attitudes toward hormonal contraceptive methods have changed significantly. The pill has increasingly come under criticism, and many patients now seek safe, hormone-free alternatives. In this blog article, Dr. Rieke Hermann, gynecologist, presents different hormone-free contraceptive methods and describes their individual effectiveness. Since contraceptive counseling always involves personal and individual circumstances, the decision should always be made together with the treating physician.
Hormone-Free Contraceptive Methods
Barrier Methods
Condom
The condom is probably the best-known contraceptive method for men*. It prevents sperm from entering the uterus and fertilizing the egg. As the only contraceptive method, it also offers some protection against sexually transmitted infections.
Diaphragm
The diaphragm is a flexible ring covered with silicone or latex, inserted deep into the vagina before intercourse together with a spermicidal gel. It prevents contact between the penis and cervix, acting as a barrier for sperm.
Surgical Methods
Vasectomy
In a vasectomy, the man’s* vas deferens are cut so that no sperm can enter the ejaculate.
Sterilization
In female* sterilization, the fallopian tubes are cut so sperm and egg can no longer meet.
Intrauterine Device (IUD)
The most commonly used hormone-free intrauterine device is the copper IUD. Alternatives such as the copper chain or copper ball work according to the same principle and differ only in form. All intrauterine devices are inserted through the vagina into the uterus. A local reaction in the endometrium and the sperm-killing effect of copper ions prevent both fertilization and implantation of the egg.
Natural Family Planning
All methods of natural family planning are based on observing one or more body parameters to determine fertile and infertile days in the menstrual cycle.
Symptothermal Method
This method determines both ovulation and the fertile phase, as well as monitoring the second half of the cycle. It is based on continuous measurement of basal body temperature and observation of cervical mucus and the cervix.
Temperature Method
This method identifies the beginning of the second half of the cycle and thus the post-ovulation phase. Basal temperature is measured before getting out of bed. It is lower in the first half of the cycle (before ovulation) and rises in the second half, until menstruation.
Calendar Method
In this method, ovulation and the fertile phase before it are calculated based on cycle length. Since menstruation (in a healthy cycle) occurs 12–14 days after ovulation, the fertile window can be estimated.
Coitus Interruptus
In coitus interruptus (“withdrawal”), the man* ejaculates outside the vagina and vulva. The penis is withdrawn before ejaculation, preventing sperm from reaching the egg.
How to Measure the Reliability of Contraceptives
The Pearl Index is often used to measure contraceptive effectiveness. It is an international standard indicating how many sexually active women* become pregnant within one year using a given method. It is calculated for 100 women* using the same method for one year. Results are given for both perfect use and typical use. A lower Pearl Index means higher effectiveness.
Example: A Pearl Index of 1–3 means that 1 in 100 women with correct use, and 3 in 100 with typical use, become pregnant within a year.
Which Hormone-Free Contraceptive Is the Most Effective?
Here is an overview of the hormone-free methods described above with their Pearl Index:
| Hormone-Free Method | Pearl Index |
|---|---|
| Condom | 2–12 |
| Diaphragm* | 6–14 |
| Copper IUD | 0.3–0.8 |
| Symptothermal method | 0.4–1.8 |
| Temperature method | 3.8–20 |
| Calendar method | 9–30 |
| Coitus interruptus | 4–18 |
*When used together with a spermicidal gel.
From the table, it is clear that the most effective hormone-free method is the copper IUD. However, insertion is a minor procedure not tolerated by every woman*, and it often has side effects that many do not wish to accept. With correct use, the symptothermal method is comparably effective, can be learned quickly, and can be integrated into everyday life without side effects.
For Whom Is the Symptothermal Method Not Suitable?
The symptothermal method requires motivation to engage actively and consistently with one’s menstrual cycle. Measuring basal temperature, observing cervical mucus, and possibly checking the cervix should be practiced for several cycles to reliably predict the fertile phase. For women with very long or irregular cycles, evaluation can be difficult. During puberty and perimenopause, cycles without ovulation, very late ovulation, or fluctuations in basal temperature are more common. For this reason, the method is not recommended under age 18 or during hormonal transition phases. Other factors such as lack of sleep, illness, stress, or an unhealthy lifestyle can also cause fluctuations in the temperature curve or prevent regular documentation. For contraception, the symptothermal method also requires an additional method, such as a condom or diaphragm, during fertile days, or abstinence during that time. Importantly, the method does not protect against sexually transmitted infections, and—as with all contraceptives—pregnancy cannot be ruled out 100%.
Which Method Works Best When Trying to Conceive?
Not only for contraception, but also for conception, it is important to recognize fertile days. Fertile days begin up to five days before ovulation. The symptothermal or temperature method can be very helpful for identifying this period. Shortly before ovulation, cervical mucus changes in quality, and the cervix becomes softer and shifts position. On the day of ovulation, or at the latest the following day, basal temperature rises, confirming ovulation.
Dr. Hermann’s Conclusion on the Symptothermal Method:
In conclusion, I can say that the symptothermal method can be a good solution for many women seeking safe, hormone-free contraception. The key requirement is motivation to engage with one’s body and cycle. Beyond contraception and family planning, I see a major advantage in helping women reconnect with themselves and recognize irregularities in their cycles early on. Since not every method suits every woman, individualized counseling by a gynecologist is especially important.
Medically Reviewed
This text was created by medical editors on the basis of specialist medical literature and current studies. Our aim is to work scientifically, identify sources and regularly check that the content is up to date.
References & Literature
- Pro Familia, der Bundeszentrale für gesundheitliche Aufklärung und der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe.
