Contraceptive methods are designed to prevent unwanted pregnancy. With the right contraception you can have sex without the worry of getting pregnant or getting someone else pregnant. There are many different methods and it's important to find what is right for you. Natural family planning methods should be taught by an expert and when used correctly can be up to 99 per cent effective in preventing pregnancy.
To help you make an informed choice about contraception, Dr Juliet McGrattan offers her expert advice on natural family planning:
What is natural family planning?
Using natural family planning for contraception is also known as fertility awareness. This form of contraception involves being able to identify the signs and symptoms of fertility during your menstrual cycle.
Once you can identify the phases during your cycle when you are most fertile, as well as well as when you are less fertile, you can time your sex to avoid or plan a pregnancy.
How does natural family planning work?
Natural family planning involves observing and understanding the changes that happen in your body throughout the menstrual cycle.
There are three fertility indicators and monitoring these can help you identify your most fertile time:
The length of your menstrual cycle.
Your body temperature.
Cervical secretions (mucus discharge).
What happens during the menstrual cycle?
The average length of the menstrual cycle is 28 days. Day 1 is the first day that period bleeding begins and day 28 is the day before the next period starts. Normal cycles can be shorter or longer than this and may also vary from month to month. The menstrual cycle is controlled by hormones including the female hormones progesterone and oestrogen. During the cycle the body prepares for potential pregnancy:
❤️ The first half of the cycle is called the follicular phase during which a follicle develops in the ovary.
❤️ An egg is released from the mature follicle around 10-16 days before the start of the next period. This is called ovulation and this is the most fertile time in the menstrual cycle. Sometimes a second egg is released within 24 hours of the first.
❤️ Mucus in the cervix helps to protect the uterus from infection. Around ovulation it changes to become more slippery and allow sperm to pass through the cervix and reach the egg.
❤️ The lining of the uterus becomes more bulky as it thickens up in preparation for a pregnancy.
❤️ If the egg isn't fertilised by sperm then there is no pregnancy. The uterus doesn't need its thick lining and it comes away as period blood. The cycle then starts again.
💡 Some women may experience ovulation-related pain, also known as mittelschmerz, to one side of their lower abdomen and occasional mid-cycle spotting.
How to track ovulation
Each menstrual cycle has approximately eight or nine fertile days. Accurately identifying the time of ovulation is the key to natural family planning. You need to prevent sperm reaching the egg. Sperm can survive in a woman's body for up to seven days. After ovulation an egg survives for 24 hours so be aware you are fertile for a week before ovulation.
Some women may experience some light bleeding (spotting) or one-sided abdominal pain when they ovulate. This pain is called mittelschmerz.
Monitoring the three fertility indicators mentioned above can help you to work out when your fertile time is:
• The calendar method
This method involves using your past menstrual cycles to estimate the time of ovulation. You need to make a detailed note of your periods for at least 12 months. Each month, you should note the number of days between starting one period and the next. Work out the shortest interval between your periods. This is your shortest cycle. Subtract 20 days from this to find the first fertile day.
⚠️ Don't use the calendar method alone to work out when your fertile time ends. It is the least reliable fertility indicator for this. Using two or more indicators is more effective.
• Monitoring basal body temperature
Body temperature is influenced by the hormones oestrogen and progesterone and it varies slightly throughout the menstrual cycle. Just after ovulation, body temperature rises a little. Monitoring your body temperature at the same time every day can help you determine when your fertile time ends.
You need to use an accurate digital thermometer to monitor your basal body temperature. Check your temperature on waking, before you get out of bed. Do it at the same time each day and before you have your morning coffee or breakfast. If this isn't possible then do it after you have rested for at least three hours.
Body temperature will rise by about o.2 degrees centigrade at ovulation. So, when you have three days in a row of temperatures that are higher than all the previous six days, then you can assume the ovulation has taken place and as the egg will only survive around 24 hours, the fertile time has ended.
If you are unwell with an infection this can affect your body temperature so your readings will be less accurate and shouldn't be relied upon for contraception.
• Tracking changes in cervical mucus
You can use your cervical mucous as an indicator of your fertility. It changes throughout the menstrual cycle and can help to indicate the start and end of your fertile time. In the same way that body temperature is influenced by oestrogen and progesterone, cervical mucous is affected by hormonal changes too. Both the amount and type of mucous will vary at different times of the month.
You can use fertility charts or apps to record your indicators and determine your fertile time.
Cervical discharge during your cycle
It takes time and practice to get to know and monitor your cervical secretions. First thing in the morning or when you go to the toilet you can check your mucous. You may need to gently insert your finger into your vagina to remove a little. The discharge does vary from woman to women and from month to month so take your time to get used to what is normal for you.
Here are some of the changes you will notice:
When a period ends you may have little or no cervical mucous and your vagina can feel dry.
During the follicular phase, in the lead up to ovulation, the level of oestrogen in the body rises. You will notice your discharge increasing in amount and becoming quite sticky. This mucous is usually cream or white in colour. Your fertile time is beginning.
When the discharge becomes clearer, and more slippery and stretchy, this is a sign that ovulation is about to happen. The mucous can look like raw egg white. You are at your most fertile.
After ovulation the cervical secretions change again. They become thicker and more sticky. When this has been the case for three days in a row then your fertile time has ended.
How reliable is natural family planning?
The effectiveness of any contraceptive is dependent on your age, how sexually active you are and how well you follow the instructions on how to use the contraceptive.
However, the effectiveness of natural family planning depends on many variables, such as:
❤️ Which fertility indicator tracking method you use.
❤️ How regular your menstrual cycle is.
❤️ How reliably you track your menstrual cycles.
❤️ If you have unprotected sex near to when you were ovulating.
When used correctly natural family planning can be up to 99 per cent effective. If you are inexperienced with monitoring fertility indicators than the chances of getting pregnant increase. Encouraging your partner to become familiar with the tracking of fertility can make it a more effective method of contraceptive - monitoring correctly and consistently is vital.
It's important to see a specialist natural family planning teacher as this makes the method more effective. Using more than one fertility indicator will also increase the effectiveness of the method.
⚠️ Using condoms as well as monitoring fertility indicators if you do not wish to get pregnant is also an option, and helps protect against STIs.
Natural family planning advantages
Fertility awareness and tracking your menstrual cycle as a form of contraception has the following advantages:
✔️ Natural family planning is hormone-free.
✔️ Natural family planning is safe to use, has no side-effects and can be stopped immediately if you decide to have a baby.
✔️ Natural family planning helps you recognise normal and abnormal vaginal discharge and makes you more aware of your fertility, so you can avoid a pregnancy or plan for a pregnancy better.
✔️ Natural family planning is acceptable to all faiths and cultures.
Natural family planning disadvantages
Natural family planning methods have a higher failure rate than other methods, especially if you are not familiar with how to monitor your fertility indicators. It also comes woth the following disadvantages:
✖️ Natural family planning won't protect you against sexually transmitted infections; you'll still need to use condoms for that.
✖️ You need to track your menstrual cycles for at least six months before using natural family planning as a reliable method of contraception. You must be fully confident about how to monitor fertility indicators.
✖️ You need to keep daily logs to know when you are fertile.
✖️ Changes in your life, such as increased stress, travelling long distances, illness or lifestyle changes may affect your menstrual cycle, making it harder to track the fertility indicators.
✖️ If you have irregular periods then natural family planning may not be suitable for you.
⚠️ You should always use a condom during sex in the most fertile phase of your menstrual cycle if you do not wish to get pregnant.
Sexual health resources
For further advice and information on choosing the right contraceptive for you, try one of the following:
Ask your GP for advice.
Find a sexual health clinic near you.
Find contraceptive services near you.
Use the FPA my contraceptive tool.
Call the National Sexual Health Line: 0300 123 7123.
Last updated: 23-12-2020
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