Birth Control Behavioral Methods (cont.)
Francisco Talavera, PharmD, PhD
Natural Family Planning
Natural Family Planning (NFP), endorsed by the Couple to Couple League, is one of the most widely used methods of fertility regulation, particularly for those whose religious or cultural beliefs do not permit devices or drugs for birth control. This method involves periodic abstinence (no sexual intercourse), with couples attempting to avoid intercourse during a woman's fertile period—around the time of ovulation. (Ovulation is the process in which during a woman's menstrual cycle, one of the woman's ovaries releases an egg.)
The current method of NFP taught by the Couple to Couple League and many other teaching organizations is the symptothermal method. Women who use this method keep track of their cervical mucus signs, their waking temperature (basal body temperature), and their own cycle history. They may also monitor physical changes in the cervix. This method breaks a woman's cycle into 3 phases. Phase I is preovulation infertility, beginning with the first day of menstruation. Phase II is the fertile period, in which conception could occur. Phase III is infertility after ovulation. It is best used by women who have consistent and regular menstrual cycles.
- The symptothermal method determines the first day of no sexual activity based on number of days since the first day of the menstrual period (usually 7) or the first day mucus is detected, whichever is noted first. The end of the fertile period (Phase II) is determined based on basal body temperature (body temperature at rest first thing in the morning, before getting out of bed). The basal body temperature of a woman is relatively low during the follicular phase (first half of her menstrual cycle) and rises in the luteal phase of the menstrual cycle in response so the thermogenic effect of progesterone (the second half leading up to her menstrual period beginning). The rise in temperature can vary from 0.2-0.5° C. The higher temperatures begin 1-2 days after ovulation and correspond to the rising level of progesterone. Intercourse can resume 3 days after the temperature rise. A basal body temperature chart
can be obtained from 4women.gov.
- To monitor cervical mucus, the woman examines her cervical mucus with her fingers. Under the influence of estrogen, the mucus increases in quantity and becomes progressively more stretchy and abundant until a peak day is reached. This is followed by scant and dry mucus because of the influence of progesterone, which remains until the onset of her period. Intercourse is allowed 4 days after the maximal cervical mucus, coinciding with the rise in temperature, until menstruation.
NFP has advantages and disadvantages:
- How effective: The American Journal of Obstetrics and
Gynecology reported that "the Sympto-Thermal Method of Natural Family
Planning can be used at the 99% level of effectiveness in avoiding pregnancy." If a couple takes chances and has intercourse during Phase II, the fertile period, their odds of pregnancy increase dramatically. In August, 2002, the U.S. Food and Drug Administration (FDA) reported a failure rate of 20 pregnancies per 100 women per year for periodic abstinence. This figure did not differentiate for particular methods of periodic abstinence. The American College of Obstetricians and Gynecologists (ACOG) lists a higher failure rate for periodic abstinence of 25%. Again, this figure does not differentiate for type of periodic abstinence.
- Advantages: No harmful effects from hormone use occur. This may be the only method acceptable to couples for cultural or religious reasons. NFP methods can also be used to achieve pregnancy.
- Disadvantages: This is most suitable for women with regular and predictable menstrual cycles. Complete abstinence is necessary during the fertile period. This method requires discipline and systematic charting. The method is not effective with improper use. To use this method effectively, a woman or couple should be trained by a medical professional or a qualified counselor. A relatively high failure rate has been reported. This method does not protect against STDs.
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