Hormone-free birth control options are both effective and affordable. Below are six commonly used methods.

1. Diaphragm

The diaphragm is a small, flexible silicone cup inserted into the vagina to cover the cervix. It is essential to put spermicide on the diaphragm and along its edges before inserting it.

According to Planned Parenthood, the diaphragm is 94% effective if used correctly every single time, but the real-life accuracy rate is around 88%, meaning 12 out of 100 women still get pregnant using the diaphragm. The reason for this is that many people do not follow the instructions correctly — diaphragms work best when used with spermicide.

Diaphragms must be prescribed and fitted by a doctor, but are effective immediately. Each one is reusable for up to 2 years and if inserted correctly, neither partner should feel it during sex.

A diaphragm does not, however, protect against STDs and cannot be used during a woman’s period.

2. Cervical cap

A cervical cap is a small silicone cup inserted into the vagina to cover the cervix, kind of like a smaller version of the diaphragm. The only cervical cap available in the U.S. is under the name FemCap.

The failure rate for the FemCap (according to the Association of Reproductive Health Professionals) is 14% in women who have never given birth and 29% for those who have had a vaginal delivery.

The cervical cap does not contain hormones, can be inserted before sex, and can be reused for up to 2 years. Similar to the diaphragm, the cap should always be used with spermicide, requires a prescription, must be fitted by a doctor, and cannot be used during periods.

3. Spermicides

Spermicides are placed in the vagina before sexual intercourse to stop sperm from entering the uterus and are available in creams, gels, and suppositories.

Spermicides, when used alone, have a failure rate of 28%, according to the American Pregnancy Association. When used with other methods, however, such as the diaphragm or cervical cap, it is more effective.

Spermicides are easy to use, do not require a prescription, and are inexpensive. Some women might experience side effects, however, such as irritation and allergic reactions.

4. Male and female condoms

The male latex condom is the best protection against STDs and is also very effective in preventing pregnancy by physically keeping semen from entering the vagina. When condoms are used correctly, they are 98% effective in preventing pregnancy, but in reality, are only about 85% effective.

The male condom is easy to use, inexpensive, easily accessible, and does not require a prescription. They are not, however, as effective as some other methods of birth control, and must be used every single time two people have sex. Some people are allergic to latex, while some couples find condoms make sex less enjoyable by limiting sensation or requiring more lubricant. (When using a lubricant with condoms, remember to choose a water-soluble or silicone one, since oil-based lubricants can break down latex condoms.)

The female condom is a strong, thin protective covering with a ring on each side to hold it in place and can protect against both pregnancy and STDs. When the female condom is used correctly, it is 95% effective in protecting against pregnancy, but in reality that number is more like 79%.

The female condom contains no hormones, is available without a prescription, and is inexpensive (though it unfortunately usually costs twice as much as male condoms). A female condom can be inserted up to 6 hours before sex, can be used by people who are allergic to latex, and can be used with lubricants. Some people find the outer rings of the female condom to be irritative, and many people claim that it reduces feeling.

5. The sponge

The sponge is made of plastic foam and contains spermicide; it is inserted into the vagina before sex and has a nylon loop for easy removal afterward. It is also conveniently available at most drug stores and does not require a prescription.

The sponge works by covering the cervix so no sperm can enter; it also releases spermicide to immobilize sperm.

According to the Association of Reproductive Health Professionals, the birth control sponge is least effective in women who have previously been pregnant. In women who have never been pregnant, the failure rate is 9% when used correctly each time, and 12% with regular use. For women have been pregnant before, the failure rate is 20% with accurate use, and 24% with regular use.

The sponge also comes with an increased risk for yeast infection and toxic shock syndrome, and should not be left in the vagina for more than 30 hours in total. Vaginal dryness and allergic reactions are common side effects.

Also, each sponge can only be used once. After removal, throw it in the trash — do not flush it down the toilet.

6. ParaGard

In the U.S., this non-hormonal intrauterine device (IUD) is available under the brand name ParaGard. According to the Association of Reproductive Health Professionals, it has a very low failure rate of only 0.8%.

The ParaGard is hormone-free and can prevent pregnancy for up to 10 years. It takes only a few minutes for a doctor to insert the device into the uterus. Once in place, the thin copper wire releases small amounts of copper to prevent sperm from passing through the cervix.

The ParaGard is a good option for women who do not want to worry about daily or weekly birth control birth reminders or do not want to use hormonal birth control. This method is completely reversible and can be removed by a doctor at any time if a woman decides she wants to get pregnant.

ParaGard does not protect against STDs and side effects include cramping, heavy periods, and spotting between periods.