When it comes to choosing your birth control, thankfully, you’ve got options. Around 60% of U.S. women of reproductive age are currently using some form of contraception–anything from a daily hormonal pill to a rubber condom. The decision about which method to use is a personal one, based on preference, lifestyle, and medical history. No two contraceptive methods are equally effective, so it’s crucial to talk with your doctor to determine what makes sense for your life.
That’s not to say you can’t do your own research and come prepared to your appointments, especially as new options hit the market–like Phexxi, a non-hormonal birth control gel for pregnancy prevention that was recently approved by the FDA (and is expected to become available to women in September of 2020). This is big news for women looking for a new method of birth control, especially if hormonal methods just aren’t cutting it.
“Many women have cycled through numerous contraceptive options and still have not found the right fit for their sexual or reproductive needs, so clearly there remains an unmet need for new, non-hormonal contraceptive options,” explains Michael A. Thomas, M.D., chair of the Department of Obstetrics and Gynecology at the University of Cincinnati College of Medicine, who was an advisory doctor on the Phexxi clinical trials. And while Phexxi is by no means a perfect solution for everyone, it does provide a new alternative for women to consider.
Hormonal vs. Non-Hormonal Birth Control
The pill remains the favorite birth control method out there, used by 25% of contraceptive users in the U.S. The hormonal IUD is another popular choice (11%), followed by the injectable, patch, or implant. Hormonal contraceptives work by stopping ovulation, which prevents an egg from being released from the ovaries each month. For many women, this means their periods go away or become significantly lighter and less painful.
Another advantage of taking hormonal birth control is that you have no interruption from sexual activity. You don’t have to think twice before doing the deed about whether you’re protected from pregnancy. But–and this is a big one!–these hormonal methods do not protect against sexually transmitted infections, so if you’re with a new partner and you haven’t both been tested for STIs, you should still rely on barrier methods (i.e. condoms) to protect your health.
All this said, some women cannot or don’t want to use hormonal birth control. There are plenty of reasons for this, Dr. Thomas explains, “including personal preference, family planning, risk of side effects associated with hormones, or a negative physical reaction to the hormones.” Poll your group of girlfriends, and chances are they’ll each have a different story about which birth control they like best. Serious side effects are uncommon with hormonal birth control, but some women may experience headaches, nausea, mood changes, or skin irritation. If you have a pre-existing condition like high blood pressure or blood clots, your doctor may recommend a non-hormonal option, such as a barrier method or a copper IUD.
“The best birth control method for a patient depends on many factors—such as ease of use, potential side effects, cost, someone’s reproductive plans and menstrual cycle, and how important it is for them not to get pregnant,” notes Courtney Benedict, associate director of Medical Standards Implementation at Planned Parenthood Federation of America (one of Planned Parenthood’s affiliates was also involved in the Phexxi clinical trials). She explains that the best-case scenario is for women to have a multitude of safe and effective options to choose from.
How Phexxi Works
Phexxi is a short-term and fast-acting contraceptive that comes in gel form. Using an applicator, you insert it into your vagina up to one hour before sex and use it again before each subsequent round (if you’re feeling extra frisky). In a clinical trial with 1,384 participants, Phexxi was 86% effective at preventing pregnancy, putting it roughly on par with the effectiveness of a condom. For comparison, the pill is 91% effective, and the IUD is 99% effective.
If you want to feel more secure–because let’s be real, a 15% chance of pregnancy is not a comforting stat when you’re trying to avoid conceiving–you can combine Phexxi with a diaphragm or condom to provide another layer of protection. If you need STI protection, you’ll want to use a barrier method anyway: “While Phexxi helps to prevent pregnancy, it’s important to keep in mind that it does not offer protection against sexually transmitted infections,” Benedict says. “Patients who choose Phexxi as their birth control method should still use condoms to protect themselves from STIs.” Potential side effects of Phexxi include vaginal burning, itching, or discharge, though these are typically mild if they occur.
Dr. Thomas explains that this new option represents an important step forward in the field of contraception. “Many of my patients have cycled through numerous contraceptive options and still have not found the right fit for their sexual and reproductive needs,” he says. If that’s you, too, don’t give up. Keep doing your research and working with your doctor to figure out a solution.
“It’s critical that all people—no matter who they are, where they live, or how much money they make—have access to the full range of birth control methods,” Benedict explains. Only you can know what makes the most sense for you.