Fertility awareness and NFP: natural birth control

A couple sit in bed kissing. The woman is wearing a light coloured top, the man is naked on top .

“I don’t need the pill. I track my fertility and ovulation by measuring my body temperature and observing my cervical mucus. It’s my form of birth control” – honestly, when your friend tells you this, it’s hard to believe. But it’s a thing! It’s called Natural Family Planning (NFP), a natural from of contraception.

What is Natural Family Planning?

Natural Family Planning, or fertility awareness, is a method of contraception where a woman monitors and records different fertility signals during her menstrual cycle to determine when she ovulates and is most likely to get pregnant. Knowing when you ovulate is important because, although the egg released at ovulation is only fertile for 24 hours, sperm usually survives for up to 72 hours. This means that sperm entering the vagina 72 hours before ovulation can still fertilize the egg. The “fertile window” is further extended by the fact that that sperm can sometimes survive in your vagina for up to 5 days! If you know when you ovulate you also know the days in your cycle when there is a high risk of getting pregnant.

Natural Family Planning is an umbrella term for a variety of different methods of natural birth control used to identify a woman’s fertile phase. These methods can be used to plan or prevent a pregnancy. They can be used individually or combined, and are all based on identifying when you ovulate. One thing they also have in common is that you have to know your cycle and your body very well!

How reliable is contraception?

Different methods of contraception are not all equally reliable. The effectiveness of a birth control method is measured using the Pearl Index. It shows the number of women, out of 100, who get pregnant within the period of one year while using a specific form of contraception. For example, a Pearl Index of 2 means that two out of 100 women will become pregnant after one year despite using the contraceptive.

A high pearl index stands for a higher chance of getting pregnant unintentionally while a low pearl index represents a lower chance. It is very difficult to give an exact pearl index because the pearl index value depends on how long the method of birth control was used and how exactly and consistently it was used. In fact, there are usually 2 Pearl Indexes published as part of a birth control study - an Actual use Pearl Index, which includes all pregnancies and all months and a Perfect use Pearl Index which includes only pregnancies and months where the method was used correctly and consistently.

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Methods of Natural Family Planning?

The Temperature Method

There is a direct connection between body temperature and ovulation. When you ovulate your body temperature rises by about 0.2-0.5 C°. This tiny rise in basal body temperature after ovulation is as a direct result of ovulation and is a sure sign that ovulation has occurred. To use the temperature method correctly you have to take your body temperature every day, immediately after waking up, record the temperature measurements in a chart, and watch for the tiny rise in temperature which indicates ovulation. You need to use a very accurate thermometer for this because the temperature measurement must be exact and the rise in temperature is miniscule.

Pearl-Index: approx. 2

The Billings Ovulation Method

The Billings method is a natural method of family planning based on a woman’s observation of her cervical mucus or fluid. Cervical mucus is a secretion produced by glands in the cervix. It varies in texture and appearance during the different phases of your cycle. The closer you get to ovulation, the more your cervical mucus changes - sometimes quite significantly. This is due to the increasing levels of oestrogen in your blood. Monitoring these changes and tracking your cycle gives you useful information you can use to predict your ovulation.

Pearl-Index: 15

The Rhythm or Calendar Method

The calendar method predicts ovulation based solely on the length of a woman’s cycle. A woman keeps a diary of her cycles and based on the length of previous cycles and how regular her cycle is, she can predict approximately when her fertile window is. The rhythm method alone is not a very reliable form of contraception because it is based purely on predictions and not on other bodily signals.

Pearl-Index: circa 20

The Symptothermal Method

The symptothermal method is the safest variant of NFP. It combines the temperature method and the Billings ovulation method, i.e. temperature measurement and cervical mucus observation. “Sympto“ stands for the symptom of cervical fluid and “Thermal” stands for the temperature measurement. With this method you have double security because you always have two independent factors that show you when you are fertile.

Pearl Index: 0,3

A couple are lying in bed looking at each other lovingly. An intimate and loving image.

Could Natural Family Planning work for me?

It sounds so easy: all you have to do to prevent a pregnancy is take your temperature. Of course, it’s not that straightforward. You must be consequent and committed in your measuring and charting, it is time consuming and, as with all contraceptives, it’s not right for everyone. Here are 5 factors you should take into consideration before you start to use natural family planning.

1. Self-discipline is a must.

NFP is only effective if you keep a disciplined record of your cycle. Bodily signals should be observed and recorded daily so that subtle changes are noted and heeded. The femSense app is designed as a cycle tracker where not only period and cycle length can be recorded, but other signs and symptoms of ovulation too. The femSense app is not recommended as a form of contraception by itself but as a support tool for those practicing fertility awareness and NFP.

2. A regular daily routine is important

Do you work shifts or travel a lot? Then NFP might not be the right method for you. In order to be able to measure your body temperature reliably, you really need a fairly regular daily routine without too much stress and sleep disturbances. The measurement should always be taken at approximately the same time, first thing in the morning. It is important to use a thermometer that is as accurate as possible, because the temperature only rises very slightly during ovulation. Or; you can use femSense patches and let femSense do all the work for you! The femSense patch does all the temperature measurement, charting and analyzing – you only have to read the patch twice a day. The femSense patch alone is not a form of contraception, but a 21st century alternative to a conventional thermometer, which can be used as a tool to support your fertility awareness.

3. No inhibitions about intimate bodily observations

You should not be embarrassed or squeamish about cervical mucus when you want to practice natural family planning. Cervical mucus is the whitish, gooey, sometimes watery secretion you find traces of in your underwear or on toilet paper. During your cycle it changes in texture and appearance. Cervical mucus production reaches its peak before and during ovulation. At ovulation it is slippery and resembles raw egg whites in both its colour and in its stretchy consistency. To monitor these changes, you should check the consistency of your cervical mucus every day. The easiest way to do this is with your fingers.

4. Use a barrier method of contraception on fertile days

NFP is a way to calculate when you are fertile and likely to get pregnant. If you do not want to get pregnant you must either abstain from sex or use another form of contraception during your fertile window. The fertile window is usually approximately 7 days and during this time you could use condoms or a diaphragm.

5. Difficult with irregular cycles

It is completely normal for menstrual cycles to vary in length. 60% of women report that their cycle length varies by more than a week within a year. However, significant cycle fluctuations will make NFP less reliable.

If you used hormonal contraception before NFP, it may take your body a few months to restore your hormone balance and return to its natural cycle. If this is the case, you should wait a few months before using NFP for contraception.

Are you ready to track your cycle? Download the femSense app and start now!

clickable photo with a packet of femSense, a seal of approval for a medical device, the message: detects ovulation 93% of the time, simple and natural, hormone free

Sources:

https://www.frauenaerzte-im-netz.de/familienplanung-verhuetung/natuerliche-familienplanung

https://www.klinikum.uni-heidelberg.de/verfahren/natuerliche-familienplanung-200343

https://www.apotheken.de/krankheiten/hintergrundwissen/10370-pearl-index