What birth control has no hormones?
Last updated September 3, 2026.
The copper IUD is the only hormone-free method in the top effectiveness tier: 0.8% typical-use failure, up to 10 years, zero hormones. Below it, hormone-free options trade effectiveness for control: external condoms (13% typical failure) and internal condoms (21%), the diaphragm (17%) and cervical cap (22%) with spermicide, fertility awareness (2 to 23%, entirely discipline-dependent), spermicide alone (21%), withdrawal (about 22%), and permanent sterilization via tubal surgery (0.5%) or vasectomy (0.15%). Two notes that matter for choosing well. Only condoms also protect against STIs, so they pair with everything. And the copper IUD's side effect is menstrual: heavier flow and stronger cramps, worst early on. If hormone-free is a hard requirement and pregnancy prevention is the priority, the copper IUD is the answer; if it is a preference with flexibility, a conversation about low-dose or progestin-only options is also worth having with your clinician.
What to do
- Copper IUD first: the only hormone-free method that beats the pill.
- Condoms regardless: the sole hormone-free tool that also covers STIs.
- Barrier methods need spermicide: diaphragm and cap only work properly with it.
- Fertility awareness needs rigor: 2% failure with expert tracking, 23% without.
- Permanent is an option: vasectomy (0.15%) is the simplest hormone-free permanent route.
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