Natural Family Planning (NFP) – Fertility Awareness Methods

Fertility awareness, natural family planning or the rhythm method, are ways to track your ovulation so you can avoid pregnancy. There are a few different NFP methods which, when used together, can have a success rate of over 90% in avoiding pregnancy. The most effective way to go about NFP is to get an understanding of the methods involved and working with a nurse, counsellor or a doctor who can give inputs on how to use them correctly.

What is Natural Family Planning?

Natural family planning is a method of birth control which is done without the use of drugs or devices. The method involves understanding the menstrual cycle and related bodily functions to determine the days on which the woman is most likely to conceive. Since it is a collection of methods that involves an understanding of the body’s natural functioning, it is also called fertility awareness. NFP birth control works by plotting the days of the month when the woman is most fertile and keeping a record of it every month. It also pays attention to fertility signals of the body such as cervical secretions, body temperature and hormone variations to determine when it is safe to have unprotected sex or even have sex to conceive.

Why it is Done

Fertility awareness allows a woman to predict when she is likely to ovulate during the month. That information can be used in two ways:

1. To Become Pregnant

Couples who are trying to conceive stand their best chances when they have unprotected sexual intercourse close to the days of ovulation.

2. To Avoid Pregnancy

NFP can be used as a method of birth control by couples when faced with any of the following situations:

• Religious beliefs impose a prohibition on the use of existing methods of birth control.
• Preference for natural methods of family planning.

Note: Two things the couple should be willing to do when opting for NFP are: to abstain from having sex during the ovulation days, and tracking the woman’s entire menstrual cycle every month.

Effectiveness of Natural Family Planning

The effectiveness of natural family planning depends on how well couples understand the methods involved and how well they use it.

In couples who use NFP to avoid pregnancy, fewer than 5 women out of 100 get pregnant in the first year of perfect use. Perfect use refers to using the method correctly and consistently throughout the menstrual cycle of the woman. With typical use, that is the way the average person does this incorrectly or inconsistently, the pregnancy rates go higher. With typical use in the first year, 12- 24 couples out of a 100 get pregnant.

Natural family planning methods work well when they use multiple methods together to track ovulation and the menstrual cycle. It’s also better to have guidance from a counsellor, doctor or a nurse who understands the methods well and gives you instructions on how to use the methods correctly. Also, NFP doesn’t work well for women who don’t track their fertility signs regularly or have irregular menstrual cycles.

How to Prepare for Natural Family Planning

If NFP is used as a method of birth control then the woman needs to find her pattern of ovulation. This can be done by keeping a good record of three or four menstrual cycles. It is important, however, to know that NFP works mostly with women who have regular menstrual periods.

To measure body temperature, a basal body thermometer needs to be purchased from a drugstore or a family planning clinic. It can show even the smallest variation in temperature of the body, unlike the standard thermometer, and comes in handy while using the temperature method. The couple must be willing to do the NFP methods together and decide to abstain from sex or use a barrier contraceptive on the woman’s fertile days. The couple must also be willing to have an unplanned pregnancy in case NFP is the only method of birth control they have opted for.

Natural Family Planning Methods

The first task in natural family planning is awareness and familiarisation with the menstrual cycle and charting the fertility pattern. The menstrual cycle, on an average, lasts between 28 to 32 days and can be divided into different phases.

• Day 1 of menstrual flow is when the cycle begins and typically lasts for three to five days.
• By Day 7 an egg is preparing to be released by one of the ovaries for fertilisation by the sperm.
• On a 28 days menstrual cycle, the days 11- 21 is when hormones secreted in the body cause the ovary to release an egg; a process known as ovulation.
• During this window which lasts for 12-24 hours, the egg travels through the fallopian tube towards the uterus. If the sperm penetrates the egg during this time, the fertilised egg will move down and attach itself to the uterus lining and begin to grow. If fertilisation doesn’t occur, the egg breaks apart.
• By day 28, if there is no fertilised egg implanted in the uterine wall, hormone levels drop, causing the uterine lining to shed, which leads to the menstrual flow.

It is important to note that the first phase of the menstrual cycle (before ovulation) differs in all women and can even vary from month to month. Typically, the number of days before ovulation range between 13 to 20 days. The last half of the cycle after ovulation is similar for every woman on an average because there are around 12-16 days from the day of ovulation to the start of their next period.

Once you are familiar with your cycles, the following fertility awareness methods can be used to predict ovulation:

1. Calendar (Rhythm) Method

A meticulous record-keeping of the menstrual periods for 6 to 8 months is needed to use this method successfully. Observe if the menstrual cycle is regular and how many days it lasts and write it down on a natural family planning calendar. If the cycle is 28 days long and regular, then ovulation is most likely to occur 14 to 15 days after the menstrual bleeding starts.

– How is It Done?

To find the length of the cycle, mark day 1 as the first day of your period. Then, mark the day 1 of the next period. Counting the number of days between the first days of each period gives the length of the cycle. Make a note of the longest and the shortest menstrual cycle over a period of 8 months.

To figure out the first day that you are likely to be fertile, subtract 18 from the number of days in the shortest menstrual cycle. The result gives you the first fertile day after your menstrual bleeding starts. As an example, if the shortest menstrual cycle lasts for 26 days, subtract 18 from 26, which gives 8. Therefore your first fertile day would be on the 8^th day after the menstrual bleeding starts.

The last day when you are likely to be fertile can be found by subtracting 11 from the number of days in the longest menstrual cycle. The resulting number gives you your last fertile day after your menstrual bleeding starts. For example, if your longest menstrual cycle is 30 days long, subtract 11 from 30, which gives 19. Therefore your last fertile day would be on the 19^th day after the menstrual bleeding starts.

– Result

• If you intend to get pregnant, have sexual intercourse every day or every other from your first to the last fertile day.
• To avoid pregnancy, abstain from sex on the fertile days or use another form of birth control during that period. Considering the above example, the fertile period is from day 8 to day 19. Therefore, use protection or abstain during these days.

– What Affects the Method?

This method won’t work with irregular, long or short menstrual cycles. Also, breastfeeding for more than 6 months and supplementing breastfeeding with bottle-feeding affects the method.

2. Standard Days Method (SDM)

The SDM is similar to the calendar method and the simplest of all the fertility awareness methods. To use this, you need an app or Cycle Beads, which is a special string of beads made just for SDM. Cycle Beads have 33 beads that are coloured mostly in brown and white and have one red bead to indicate the first day of your period. A darker brown bead in between also tells you if your cycle is shorter than 26 days. A black rubber ring is used to move from bead to bead.

– How is It Done?

The day 1 of your period, move the rubber ring to the red bead on the Cycle Beads. Each day is counted as one bead. All brown beads are days when you are least likely to become pregnant; these are your natural family planning safe days. All the white beads are days when you are most likely to become pregnant. The dark brown bead indicates day 26. The last brown bead before the red one is day 32.

– Result

Unprotected sex can be had on days 1-7. On days 8 to 19 avoid sex or use other methods of birth control, and from day 20 to the end of the cycle, you can have unprotected sex.

– What Affects the Method?

It is important that your menstrual cycle is always regular. If you have more than one cycle that is shorter than 26 days or longer than 32 days, this method is not suitable as birth control.

3. Cervical Mucus Method (Billings Method)

This method helps you predict when you are going to ovulate by observing and tracking the changes in your cervical mucus that comes out as a vaginal discharge throughout the cycle. Throughout the menstrual cycle the cervical mucus changes in colour, texture and amount especially around ovulation.

– How is It Done?

Examine your cervical mucus each day by putting one finger into your vagina and noting down the amount and colour of the mucus. Also, look for how thin or thick it is and its “stretchiness” by placing a drop of it between the index finger and the thumb. Spread the fingers apart and see how much it stretches.

Just after your periods, there won’t be much cervical mucus. It could be thick, sticky and cloudy. As you approach ovulation, the number of mucus increases and it is also thinner and clearer. Before the ovulation, it may stretch to about 2.5 cm before breaking.

– Result

To get pregnant, have sexual intercourse from the days you notice the mucus becoming clear and stretchy until the day it becomes sticky and cloudy. To avoid pregnancy, use other forms of birth control during the days when the mucus is clear and stretchy. The 2- day method can also be used; ask yourself: Did I have secretions yesterday? Did I have secretions today? If ‘yes’ is the answer to both the questions, you are most likely fertile.

– What Affects the Method?

This method will not work well if you douche, use vaginal lubricants, are breastfeeding, have a vaginal infection or are close to menopause.

4. Basal Body Temperature (BBT) Method

The body temperature changes by a tiny bit throughout the menstrual cycle and can be detected by a special ovulation thermometer. They can show temperature variations to up to a tenth (0.1) of a degree and can be used to predict when you are ovulating.

– How is It Done?

Take temperature readings of your body just after you wake up for several months before engaging in any activity, eating or drinking. Use the ovulation thermometer to take the temperature measurement either orally or rectally. Ensure to use the thermometer in the same location every day and leave it in place for a full 5 minutes to get an accurate reading. Write down the reading, clean the thermometer and put it away. Record the temperature on a chart or a graph every day to observe the trend of the basal body temperature. Ovulation usually causes the BBT to go up by 0.4 degrees Fahrenheit or 0.2 degrees Celsius and stay high for over a week.

– Result

If you want to conceive, have sexual intercourse every day or on alternate days from your first fertile day until 3 days after the BBT rises. To avoid pregnancy use another form of birth control on these days. Keep in mind that after your BBT rises and stays high for 3 full days, your fertile period is over and the temperature on these 3 days would be higher than any other days in your cycle.

– What Affects the Method?

Conditions such as fever, stress, travelling and taking medicines such as aspirin affect this method. Inconsistent measuring such as taking the thermometer out too soon and taking the temperatures at different times of the day also leads to inaccuracy.

5. Combined (Symptothermal) Method

The combined method uses some of the other methods done all at once to predict the most fertile days in your cycle.

– How is It Done?

You can begin by checking your basal body temperature, the changes in the cervical mucus and a hormone test. If the results of all the tests converge toward ovulation, watch for secondary signs such as breast tenderness, abdomen pain and mood swings.

– Result

Along with the tests that indicate ovulation, watch for symptoms such as breast pain and an increase sexual desire. As only one of the ovaries releases an egg in each cycle, you would notice pain on only one side of the belly. Called ‘mittelschmerz’, it can be sharp or dull and occurs on the side of the ovary which releases the egg.

– What Affects the Method?

Any changes to the results of one of the tests can also change the result of the combined method.

6. Hormone Monitoring

The changes in hormones during ovulation can be monitored using ovulation predictor kits, saliva or “ferning” microscopes, or fertility monitors. They can be used to measure the surge in hormones such as Luteinizing hormone and oestrogen in the body during ovulation.

– How is It Done?

• Ovulation predictor kits available in most drug stories test the amount of Luteinizing (LH) in the urine. These kits can tell the surges in the hormone that occur 12 to 36 hours before you ovulate and are more than 90% accurate.
• The Ferning microscopes are small and sometimes designed to look like lipstick cases. They examine a sample of your saliva. When oestrogen levels build up toward ovulation, salt levels in the saliva increase. When this saliva is examined under the microscope, the salt causes a pattern that resembles the leaves of a fern plant. They can predict ovulation up to a 24-72 hour window.
• Fertility monitors are expensive but have a significant benefit as they can predict 6 or 7 days of potential fertility, whereas most ovulation predictors can give a window of up to 2 days. They measure both LH and another hormone- e3G in the urine. The results are displayed on a screen and are also saved in the device. The devices have an accuracy of about 90%.

– Result

The hormone monitoring kits measure the levels of Luteinizing hormone (LH) and the results are displayed on a display unit or a test strip.

– What Affects the Method?

The results of hormone monitoring may not be correct if the instructions on the kit are not followed exactly.

Risks of Natural Family Planning

There are no side effects or health risks associated with natural family planning. The only risk with this method is an unplanned pregnancy. To prevent pregnancy while using these methods, it’s best to not have sexual intercourse the entire time that the egg can be fertilised. This includes 5 days before the ovulation, as sperm can live in the vagina 3 to 5 days after sex.

Is Fertility Awareness Reversible?

Yes. Since fertility awareness has no effect on the reproductive functioning of the male or female, pregnancy is possible without delay following the practice. Fertility awareness methods can also be used as an effective way to conceive easily, as the couple is well aware of the woman’s fertile days.

Physical Signs of Ovulation

It is possible to recognise your fertility window by paying attention to some of the functions of the body that can be felt or observed. Such physical signs of ovulation include:

• Cervical changes such as the cervix becoming soft, high and open
• Tenderness in the breasts
• A dull, one-sided pain in the region of the ovary

Keep in mind that if fertility awareness methods are the only birth control being used, these secondary symptoms should not be relied upon exclusively. It is always better to back them up by checking on the primary symptoms such as cervical mucus and basal body temperature.

Pros of Natural Family Planning

• Effective birth control when used correctly and consistently
• No side effects or health risks
• Can be reversed immediately
• Inexpensive or almost free
• Free from prescriptions, drugs, devices of clinic visits
• Does not contain hormones such as oestrogen which could elevate the risk of heart problems
• Acceptable birth control among couples who have religious restrictions related to contraception
• Works well both ways, whether the couple is trying for conception or avoiding pregnancy

Cons of Natural Family Planning

• Requires both partners to be diligent
• About a third of the month goes into periods that require abstinence or a backup contraception
• Demands accurate and consistent record-keeping of the menstrual cycle
• Challenging for women who have irregular cycles

With a thorough understanding of your menstrual cycle and the fertility awareness methods involved, it is possible to use natural family planning as an effective, natural contraception. Affordable, and easily understood, NFP is a frequently-used practice around the world.

Also Read: Ovulation – Causes, Signs and More