Phexxi™: A Safer Option for Perimenopausal Birth Control?

Tara is a 38-year-old woman who is at “a pivotal reproductive point” in her life. Her periods are starting to become a bit longer and heavier. She is well aware that perimenopause is likely to be just around the corner. 

Her two children are no longer in the “baby phase” at ten and seven years old and part of her enjoys the freedom from diapers and sleepless nights. But there’s that little voice in the back of her head that says, “What if we tried for #3?” 

Her husband has made up his mind. He would be willing to go in for a vasectomy tomorrow, but Tara is not ready to make that final decision. Up till now, they have been practicing “natural family planning,” but Tara is frustrated with the “mind game” she feels monthly when her period is a little bit late. 

It is a transitional problem many women, like Tara, deal with during the perimenopausal years.

Her online research shows her options, such as the birth control pill, IUD, condoms, or natural family planning. As a Savvy Sister, she also knows the hormones in birth control pills are not the safest choice for perimenopausal females. And condoms… not her favorite choice. 

Then, a new result, Phexxi ™, pops up in her results. 

A non-hormonal vaginal gel? How does that work?

What is Phexxi™?

The FDA recently announced its approval of  Phexxi™ (lactic acid, citric acid, and potassium bitartrate), a birth control vaginal gel. It is the first in its class, as it is a “non-hormonal, on-demand, vaginal pH regulator.” 

Understanding Vaginal pH

pH is a measure of how acidic or alkaline a substance is. The scale runs from 0 to 14. A pH of less than 7 is considered acidic, and greater than 7 is basic. 

The pH of your vagina (acidic or alkaline) plays a vital role in how “healthy” your vagina is. A slightly acidic environment (pH less than 5) allows healthy, beneficial bacteria to grow. Anytime this environment is compromised, unhealthy bacteria can take over. You can read more about that here.

If your vagina is too acidic, it won’t cause disease, but it can interfere with fertility. During sex, the pH of the vagina raises (sperm like an alkaline environment) to a level around 7 or 8. 

Phexxi™ is a vaginal pH regulator that prevents pregnancy by keeping an acidic pH during sex, thereby decreasing the motility of sperm. 

How Do I Use it?

  • Insert the pre-filled, single-use applicator into the vagina immediately before sex. It can also be applied one hour before sex, but never after. It won’t work after sex. 
  • Of note, it must be reapplied every time you have sex. If you have sex again within the hour, you must use another application.

A Gel? How is it Different From Spermicide?

Phexxi™ has some similarities to a spermicide, which works by blocking the entrance to the cervix and slows sperm down, but it works differently by changing the pH of the environment. Usually, spermicides are combined with other barrier methods, such as a condom or diaphragm. 

Is it Effective?

Phexxi™ has an 86% effectiveness rate of preventing pregnancy. Evofem, the manufacturer of Phexxi™, claims that with the perfect technique, it can be as high as 93%.

Of note, Phexxi™ has been shown to increase sexual satisfaction with some women, as it increases vaginal lubrication.

What Are the Potential Side Effects?

  • The most common side effects are burning, itching, and an increased risk of urinary tract infections (UTIs). For this reason, women with a history of UTIs should avoid the use of this product.
  • Per the manufacturer, the burning and itching do decrease with each consecutive cycle of use.

How Much Does This Cost?

Phexxi™ will come with a list price of $250-275 for a box of 12 without insurance.

When is it Available?

It is expected that Phexxi™ will be available in early September.

An Important Advance for Perimenopausal Females

There have been a limited number of birth control options for women over the past two decades. Many women, like Tara, struggle to find an ideal contraceptive that meets both sexual and reproductive needs during the perimenopausal years. The introduction of non-hormonal Phexxi™ expands the limited selection of safe choices for birth control during perimenopause.

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Dr. Anna Garrett is a menopause expert and Doctor of Pharmacy. She helps women who are struggling with symptoms of perimenopause and menopause find natural hormone balancing solutions so they can rock their mojo through midlife and beyond. Dr. Anna is the author of Perimenopause: The Savvy Sister’s Guide to Hormone Harmony. Order your copy at

Dr. Anna is available for 1-1 consultations. Find out more at

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