There are a lot of birth control methods available besides the pill (Mirena, diaphram, Etc.) but if you are interested in a natural, hormone-free approach without having to mess around with condoms all the time, I HIGHLY suggest reading "Taking Charge of your Fertility" by Toni Weschler. It is a really really informative book about tracking your ovulation cycle naturally using several of your body cues as well as your basal body temperature so you know the two to three days a month to avoid unprotected intercourse. I know it might sound like a lot of work/trouble (it did to me at first), but once you get the system down it is almost efforless and surprisingly highly effective. Anyway, I just wanted to let you know that there is a hormone-free, effective way to manage your fertility that isn't as permanent as getting your tubes tied. No matter what method you decide to use, don't get the surgery unless you are absolutely SURE. Take Care!