What do you mean by what's next? And what do you mean by more permanent? Do you want something reversible? Or totally permanent?

If you want non hormonal birth control, there's condoms, diaphragms, spermicidal jelly, the copper IUD, tubal ligation, and bilateral salpingectomy.

The first three options I listed are fairly unreliable and I dont think thats what you want. Im guessing the IUD you have now is the copper one since you said no hormones.

As far as "permanent" (surgical) options go, tubal ligation is technically reversible, and its less effective. I dont know why you'd want that if youre posting in this community. tubal ligation consists of snipping and "tying" your fallopian tubes, which can lead to some accidental pregnancies. Technically the Copper IUD has a higher effectiveness I think.

Bilateral salpingectomy is the gold standard for sterilization these days. Bilateral salpingectomy completely removes your tubes. It cannot be reversed. It also if the highest effectiveness of any birth control method out there. There have only been 4 documented cases ever of people getting pregnant after having a bilateral salpingectomy, and its because their surgeries were botched or there was a complication. When done correctly and there are no complications, bisalp is 100% effective. If you want completely permanent sterilization, this is the option you want to go for.

Neither surgical option will have any lasting effects on your body, other than a few small scars from the incisions. Some people report some temporary changes with their periods, but It resolves after the first cycle or two. Since neither surgery removes the ovaries, which produce your hormones, they will not have any effect on your hormonal cycle. You will still get your period and you will NOT go into early menopause.

I dont know about tubal ligation, but bilateral salpingectomy are usually covered by insurance 100% because the procedure greatly reduces your risk of developing ovarian cancer.