What are the best non-hormonal options for birth control?

Question

Hello doctor,

I am 33 and have been using contraceptive gel for the past four months because I can not take birth control pills due to a history of blood clots. My doctor recommended this Phexxi gel as a non-hormonal option, but I am having so many problems with it.

The gel causes intense burning and irritation every time I use it, and my partner complains about the burning sensation too. Now I have what looks like a yeast infection with thick white discharge and terrible itching, but the test came back negative for yeast.

Used the contraceptive gel before sex last week and ended up with UTI for the third time. My urine culture showed E. coli, and I am on antibiotics again. The pH of the gel is supposed to prevent pregnancy, but I think it is messing up my natural vaginal pH and causing all these infections. Also, the application is really messy and kills the mood completely.

I am in a committed relationship, and we want reliable birth control, but this contraceptive gel is causing more problems than it is solving. I already had DVT in my leg two years ago, so estrogen birth control is not an option. What other non-hormonal contraceptive options do I have? I really need something that actually works without constant infections.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I can understand your concern.

Barrier methods (with or without spermicide) - You could consider these if you want on-demand contraception, though they are less reliable than IUDs. These include-

1. Condoms (for both male and female):

Effectiveness: 85% (typical use).
Pros: STI (sexually transmitted infection) protection is widely available.
Cons: May break or slip, can reduce sensation.
Avoid additional spermicides (like Nonoxynol-9), since they can worsen vaginal irritation and increase UTI risk.

2. Diaphragm or cervical cap:

Used with spermicide, but many spermicides irritate similarly to what you experienced with Phexxi.
You could try a non-spermicidal diaphragm (e.g., Caya diaphragm with lactic acid–free lubricant), but effectiveness is moderate (~88%). You need to consult your medical physician and a consultant gynecologist.

3. Progestin-only options (if your DVT (deep vein thrombosis) risk allows):

While combined (estrogen-containing) pills are unsafe for you, some progestin-only methods can sometimes be considered case-by-case if your medical physician and gynecologist agree.
Progestin-only pill (Norethindrone or Drospirenone-based).
Levonorgestrel IUD (includes Mirena, Kyleena): These are hormonal but locally acting, with minimal systemic absorption; often considered acceptable in patients with prior DVT depending on risk profile.
If your DVT was provoked (e.g., surgery, immobilization, pregnancy-related), your doctor might reassess whether a local progestin IUD is permissible; these are much less likely to affect clotting than estrogen pills.

I hope this helps.

Kindly follow up if you have more concerns.

Thank you.