Looking for a hormone-free form of birth control?
What are the risks of taking the birth control pill?
- Increased risk of developing blood clots (especially with pills such as Yaz and Yasmin)
- High blood pressure
- Increased breast cancer risk
While the pill may be an effective and suitable option for some women, many are seeking natural and safer alternatives to contraception and family planning, such as fertility awareness based (FAB) methods. FAB methods rely of looking at several indicators of fertility that change throughout the menstrual cycle in response to changing levels of estrogen and progesterone. Three of the most commonly observed indicators of fertility are basal body temperature, cervical secretions, and cervical positioning.
1. Basal Body Temperature
Basal body temperature is the body temperature measured immediately after awakening and before any physical activity has been undertaken. During the phase before ovulation, waking temperatures range from 97.0 ̊ F to 97.7 ̊ F (36.1̊ C – 36.5̊ C); postovulatory waking temperatures tend to rise about 0.4 ̊ F or higher and they usually stay elevated until the next period. Temperatures rise within a day or so of ovulation and are associated with the surge in progesterone, a heat releasing hormone, which occurs at the time of ovulation. When interpreting temperatures, it is important to look at the big picture and not to focus too much on the day to day changes. The key is to look for a pattern of highs and lows: temperatures before ovulation will go up and down in a low range while the temperatures after ovulation will go up and down in a high range.
There are certain factors that can increase your waking temperature, including: having a fever, drinking alcohol the night before, getting less than three consecutive hours sleep before taking it, taking it at a substantially different time than usual and using an electric blanket or heating pad that you don’t normally use.
2. Vaginal Secretions
The quality and quantity of vaginal secretions are influenced by estrogen and progesterone. The different types of secretions either impede or facilitate sperm motility and this determines the state of fertility. When estrogen levels are low, cervical secretions may be minimal, thick, white, and sticky. The acidic environment of the vagina rapidly destroys sperm. Rising levels of estrogen alter the cervical secretions from white and sticky gradually becoming more transparent, stretchy, and wetter (due to increased water content), similar to the consistency of egg whites. Immediately after ovulation, the rise of progesterone causes the secretions to thicken to form a sticky plug which is antagonistic to sperm penetration.
3. Cervical Positioning
Estrogen and progesterone also cause subtle changes in the muscle and connective tissue of the cervix. Women can learn to recognize these changes by gently palpating the cervix at about the same time each day. As ovulation approaches, the cervix tends to rise, soften, and open. It progresses from feeling like the tip of the nose to feeling soft like lips as ovulation approaches. The cervix will drop abruptly into the vagina when estrogen levels fall, and progesterone becomes dominant after ovulation. The fertile time starts at the first sign of the cervix becoming high, soft or open and ends after the cervix has been low, firm and closed for 3 days. These subtle changes can be detected by simply inserting a clean middle finger into the vagina and assessing the following conditions: softness, height, opening, and wetness.
How effective is it?
Studies have found that when using temperature as a single indicator of fertility, the overall failure rate was 5.4% compared with a method failure rate of 1% (this refers to perfect use). This illustrates that using this method alone is only effective if used by highly motivated couples who are able to tolerate lengthy time of abstinence or are willing to use a barrier method during the fertile time. Cervical secretions were found to have a failure rate of around 3% if couples were given good fertility awareness teaching and followed the instructions correctly. However, with imperfect use the failure rate rose to nearly 20%. There are no effectiveness studies using the cervical positioning indicator alone.
These studies find that the failure rate tends to be lower when combining indicators. The most common combination is cervical secretions and temperature which has been found to have a failure rate between 0.43% (perfect use) and 2.2% (overall pregnancy rate). Perfect use refers to using abstinence during the fertile time and therefore is a measure of true effectiveness. Interestingly, one study found that there was no difference in failure rates between the learning phase (first 3 months) and subsequent months of use. For a contraceptive method to be rated as effective as the hormonal pill, it requires a failure rate of less than 1%. The studies mentioned above found FAB to be as effective as the birth control pill when used perfectly.
What are the benefits?
Despite the limited scientific evidence, there are several advantages to FAB methods. It does not involve the use of chemical agents or physical devices and had no side effects. Educating patients on this method is empowering and fosters a sense of shared responsibility and increased communication for the couple. Also, it is not dependant on medical intervention after the initial visit, thus keeping costs low.
What are the limitations?
There are also some limitations to FAB methods. It can take time to learn and some women find charting difficult. Both partners must be committed to the practice and some couples find abstinence difficult. Times of stress or hormone changes can make charting more difficult and may affect efficacy.