Female Contraception

Description

Alternative Names

Natural Family Planning Methods

Natural family planning contraceptive methods include those that do not require medication, physical devices, or surgery to prevent pregnancy.

Cycle-based fertility awareness methods rely on tracking the changes in the body that signal fertility. A woman is only fertile during part of the menstrual cycle. By monitoring certain changes in her body, a woman can more or less predict the fertile phase and abstain at that time. She can also use barrier methods if she isnt prohibited by religious beliefs. The Catholic Church, for example, generally approves most natural family planning methods.

Monitoring Basal Body Temperature. To determine the most likely time of ovulation and therefore the time of fertility, a woman is instructed to take her body temperature, called her basal body temperature. This is the bodys temperature as it rises and falls in accord with hormonal fluctuations.

• Each morning before rising, the woman takes her temperature with a specialized basal body thermometer and marks the result on a graph-paper chart. (Of interest is a wrist watch-like device under investigation that measures skin changes to predict ovulation.)
• The woman also notes the days of menstruation and sexual activity.
• The so-called "fertile window" is six days long and starts five days before ovulation and ends the day of ovulation.
• The chances for fertility are considered to be highest between days 10 and 17 in the menstrual cycle (with day 1 being the first day of the period and ovulation occurring about two weeks later). It should be noted, however, that a 2000 study reported that only 30% of women were fertile within that period of time. In the study, women had a 10% chance of ovulating on each day between day 6 and 21. Researchers who conducted the study suggested that each woman track the length of her cycle, which in the general population of women actually runs between 19 and 60 days. A long cycle, for example, suggests a delayed ovulation date.
• Immediately after ovulation, the body temperature increases sharply in about 80% of cases. (Some women can be ovulating normally yet not show this temperature pattern.)

By studying the temperature patterns after a few months, couples can begin to anticipate ovulation and plan their sexual activity accordingly. Couples must try to avoid becoming fixated on the chart, however, in scheduling their sexual activity. Spontaneity can be lost, and the stress on the relationship can be quite severe, possibly impeding fertility.

Home Monitoring System. A number of home test kits may help couples determine times of fertility. Not all are available in the US.

• Some test kits monitor reproductive hormone levels in the urine (e.g., Persona, Clear Plan).
• Other devices (e.g., Lady Comp, Bioself) measure basal body temperature.
• Yet another approach (PFT 1-2-3 Kit, Maybe Baby, Fertility Tracker, and Ovu-Tech) employs a pocket microscope to examine crystals of dried saliva, which would indicate the presence of hormones associated with fertile days.

No comparative studies are available on these tests and there is little evidence to determine their reliability. None are reliable enough to be used for complete contraception. Manufacturers of Persona, for example, claim failure rates of 6%.

Cervical Mucus Method. A much more reliable method (also called the ovulation method) requires a woman to take a sample (by hand) of her cervical mucus every day for a least a month and to record its quantity, appearance, feel, and to note other physical signs connected with the reproductive system. Cervical mucus changes in predictable ways over the course of each menstrual cycle:

• Six days before ovulation, mucus is affected by estrogen and becomes clear and elastic. Ovulation is likely to occur the last day that mucus has these properties.
• Right after ovulation, mucus is affected by progesterone and is thick, sticky, and opaque.

Once a womans individual pattern is understood, analyzing cervical mucus can provide a highly accurate guide to fertility.

Creighton Model. The Creighton Model is a variation of the cervical mucus method. When used precisely, pregnancy rates have been reported to be less than 1%, although given the likelihood of errors, the annual failure rate is about 3% to 4%. It is an intensive program involving both the couple and a trainer. Having a regular cycle is not necessary for success. The woman learns when she is most likely to be ovulating, when she is likely to conceive, and to determine if her reproductive system is functioning normally or abnormally. It requires a trained instructor, however, and the program is not yet available everywhere.

Prolonged Breastfeeding (The Lactational Amenorrhea Method). Breastfeeding often delays the onset of ovulation and menstruation for about six months. A technique called the Lactational Amenorrhea Method (LAM) has been devised to allow women to rely on breastfeeding for natural family planning. New mothers are candidates for LAM if their periods have not returned after delivery. They must be breastfeeding the baby on demand, day and night, without regularly substituting other liquids or foods in the babys diet.

The risk for pregnancy with this method is less than 2% in the early months, although by six months after birth it increases to over 5%. The return of menstruation indicates the return of fertility. Bleeding or spotting during the first 56 days is not considered menstruation. After that, two or more consecutive days of bleeding are usually an indicator that periods have returned. Ovulation can occur before menstruation resumes, although it is less likely within six months of delivery (particularly if the mother is intensively breastfeeding).

Candidacy for Natural Family Planning

Because of the high risk for pregnancy, natural family planning methods are recommended only for those whose strong religious beliefs prohibit standard contraceptive methods. Couples who are not guided by religious authority, but who simply want a more natural sexual life, should use a barrier contraceptive during the fertile phase and no contraception during the rest of the cycle. To be effective against pregnancy, cycle-based methods require not only training, commitment, discipline, and perseverance, but also the cooperation of the male partner. Cycle-based methods are not recommended for women unless they are in a stable, monogamous relationship, and can count on their partners willing participation.

Advantages of Natural Family Planning

Many couples, especially older ones, who have used these methods for a while and are strongly motivated, are able to successfully incorporate fertility awareness into their lives. For those with strong religious beliefs, natural family planning allows them to have a fulfilling sexual life yet still adhere to the rules of their church.

Disadvantages and Complications of Natural Family Planning

Couples who adopt a cycle-based approach to pregnancy avoidance must often abstain from sex or substitute other kinds of sexual intimacy for vaginal intercourse. Some couples find this self-denial and the need for vigilant tracking of the cycle difficult and stressful for the relationship. Failure rates are high with natural family planning, although newer methods, such as the Creighton Model, are reporting very effective results. The risk for sexually transmitted diseases is also of particular concern, because such methods offer no protection against infection and religious beliefs usually preclude barrier protection.