The natural option

While natural family planning can help to prevent pregnancies, it's not as effective as other forms of birth control.

A number of birth control methods are available for women, but is there a natural alternative? We examine the natural family planning method–which is based on your menstrual cycle–and ask if it can prevent unwanted pregnancies.

Natural family planning is a form of birth control that's based on your menstrual cycle. It's also called the "rhythm method" or "fertility awareness." Instead of using other birth control methods–such as the cervical cap, condoms or contraceptive pills–this is a natural alternative, and means you and your partner choose not to have sex during the "fertile" period (when there's more chance you can become pregnant).

Natural family planning–is it the right choice?

Natural family planning is a useful form of birth control, and can help avoid unwanted pregnancies. It's safe and low cost; however, it does depend on:

• You having a regular menstrual cycle
• You having an intimate knowledge of your menstrual cycle. You need to be able to recognize the signs of ovulation
• You not having sex during the fertile period, or the use of an additional birth control method (for example, a condom)

Can I become pregnant?

While natural family planning can help to prevent pregnancies, it's not as effective as other forms of birth control. Even with perfect use, studies show that one in four women who use the natural family planning method becomes pregnant!

You and your partner could find it hard (or even impossible) to follow the rules of natural family planning. There's a limited time when sex is "safe"–10 or 11 days each month.

How does the natural family planning method work?

You have two ovaries, one on each side of the uterus. Each month, one of the ovaries releases an egg. This is called ovulation. Usually, this occurs 12-14 days before the start of the menstrual period.

You can become pregnant if you have sex around the time of ovulation. This is because when your partner ejaculates (orgasms), he releases sperm into the vagina, which then travel into the fallopian tubes. If a sperm meets an egg in the fallopian tube, fertilization can occur.

Natural family planning helps you and your partner to find out when you're in this fertile period (in other words, when there's more of a chance that you can become pregnant). During this time, you and your partner must not have sexual intercourse. Of course, if you and your partner choose to have sex, another birth control method is needed.

The "fertile period"
For most women, an egg is released almost two weeks before the next expected menstrual period. This is, of course, an estimated period of time. The different natural family planning methods (see below) can help you and your partner to find out when ovulation occurs.

The "safe period"
The safe period is when sex is least likely to lead to pregnancy. It varies between the different methods of natural family planning; however, it's often a couple of days after ovulation until the start of the menstrual period.

Natural family planning options

Before you and your partner decide on a natural family planning method, ask your doctor, nurse or a trained counselor for more information. There are five methods of natural family planning:

Basal body temperature method
For most women, there's an increase in basal body temperature just after ovulation.

To use the basal body temperature method you need to take your temperature each morning before rising, and record it in a graph. After a couple of months, you'll be able to see when there has been an increase in body temperature, and this signals that ovulation occurs. For the basal body temperature method to work, you must take your temperature each morning. But, be careful–fever, restless sleep or variable work schedules can change the temperature readings!

When you and your partner use this method to prevent pregnancy, you should not have sex from the end of the menstrual period until three days after the increase in body temperature.

Ovulation/cervical mucus method
The ovulation method is based on how much mucus is produced in your cervix. Women learn to recognize changes in cervical mucus around the time of ovulation. To do this, you must check the mucus on a regular basis–look for how much mucus there is, and how it feels.

For most women, the vagina is dry just after the menstrual period. A sticky mucus then appears. Before ovulation, the mucus becomes wet and slippery. The last day of wetness, called the "peak" day, often occurs at the same time as ovulation. Afterwards, the mucus becomes thicker or disappears.

The safe period is the 10 or 11 days at the end of this mucus cycle, and the dry days, if any, that occur just after the menstrual period. The fertile period starts with the first signs of mucus and continues until four days after the peak day. Don't forget, during the menstrual period, there's still a chance you can become pregnant. This is because mucus production can overlap the menstrual period, which creates an ideal place for sperm to live. An experienced user of the ovulation method should be able to detect if this happens. The ovulation method has advantages over the basal body temperature method because it doesn't require a thermometer or graphs. However, false readings can be produced by a vaginal infection, sexual excitement and the use of certain medications.

Symptothermal method
The symptothermal method combines the basal body temperature and ovulation methods, and uses other signs of ovulation. These include:

• Abdominal pains or cramps
• Spotting
• Changes in the position and firmness of the cervix

The symptothermal method is more effective than the basal body temperature and ovulation methods because it uses a number of signs (rather than just one).

Calendar method
The calendar method is also called the "rhythm method." To use this method, you need to record each day of your menstrual cycle for six months. It's then possible to calculate your fertile period.

A menstrual cycle is counted from the first day of menstrual bleeding (Day 1 of the menstrual cycle), to the first day of the next menstrual period. A normal menstrual cycle is about 28 days, but it can range from 23 days to 35 days.

The first day of the fertile period (remember–if you do not want to become pregnant this is when you and your partner should not have sex) is found by subtracting 18 days from the length of the shortest menstrual cycle. The last day of the fertile period is found by subtracting 11 days from the longest menstrual cycle.

For example, during the past six months, a woman's shortest menstrual cycle could be 25 days, and her longest menstrual cycle could be 35 days. To calculate her fertile period:

• Subtract 18 days from the shortest menstrual cycle (25 days) = 7
• Subtract 11 days from the longest menstrual cycle (35 days) = 24
• This means the first day of her fertile period is Day 7. The last day of her fertile period is Day 24. Therefore, the woman should not have sex between Day 7 and Day 24 in her menstrual cycle.

However, because the calendar method doesn't take into account day-to-day physical changes, it's not as reliable as the other natural family planning methods.

Lactational amenorrhea (for moms with young children)
Lactational amenorrhea means, when you're breastfeeding, you usually don t have your menstrual period. Ovulation and menstruation are postponed because levels of a certain hormone, prolactin (which causes lactation), are increased.

To use the lactational amenorrhea method, you must be breastfeeding. The time between each feed should not be longer than four hours during the day, or six hours at night. Remember, the more your baby feeds, the less chance there is that ovulation and menstruation will return.

This method is most effective during the first six months of exclusive breastfeeding (this means formula milk isn t used). But pregnancies can occur. If menstruation does not return after you stop breastfeeding, see your doctor to find out if you are pregnant.

Finally…

Natural family planning is an alternative to other forms of birth control, and can help you and your partner to avoid unwanted pregnancies. It's ideal if you choose not to use contraceptives (cervical cap, condoms or pills) for religious reasons. However, the natural family planning method is not as effective as most other forms of birth control. It also doesn't protect you from sexually transmitted diseases (STDs). It's therefore best to use the natural family planning method with other forms of birth control, just to be on the safe side!