Can “natural family planning” actually work as a method of birth control?

Or are people who use natural family planning basically guaranteed to be parents pretty soon?

I’ve been dedicating the Wednesdays in October to looking at birth control methods! We started with the pros and cons of different methods, and then looked specifically at The Pill. I also talked about how birth control should be a shared responsibility!

But as we’ve been having this conversation, I’ve been amazed at how many women said that the Pill just didn’t work for them (it didn’t work well for me, either!). And that’s why I want to spend today talking about how you can actually track your fertility naturally.

I’m actually going to turn this post over to Joanna, a young woman who does a lot of work behind the scenes on this blog. She’s done a ton of research into this, and has used it herself both to avoid pregnancy AND to get pregnant, and so I thought she’d be the perfect one to share it with you (plus she has a Master’s in Public Health and she’s super smart). So here’s Joanna!

The more we looked into hormonal birth control methods, the more we loved barrier methods and natural family planning.

As Sheila talked about last week: lots of people find the pill (or other methods of hormonal birth control) work really well for them but lots of others don’t. And you can’t know which category you’ll be in until it’s too late.

In contrast to hormonal birth control, which changes your body to make you unable to conceive that month, non-hormonal methods either physically keep the sperm and egg apart (barrier methods) or temporally keep them apart (Natural Family Planning) to prevent pregnancy.

Natural Family Planning (NFP) operates by taking advantage of this one simple principle: a woman can only become pregnant a few days a month. If sex is avoided during that period (or if barrier methods are used then), pregnancy won’t occur.

Pretty simple, right?

The trick is in identifying the fertile window each month (and providing enough buffer so that random differences between cycles don’t cause a surprise baby).

NFP isn’t the rhythm or calendar method your grandmother may have used, which is based solely on dates. We’ve developed much more scientific and accurate methods of tracking fertility.

If you’re at all thinking about using NFP or are thinking about trying to conceive sometime soon, please purchase Taking Charge of your Fertility. It’s a real winner of a book and gives a great overview of all these topics in much greater depth.

Natural family planning really isn’t terribly difficult. It requires three things:

  • understanding your body
  • understanding the method you’re going to be using
  • and having the self-discipline to carry it out

If used correctly, the unintended pregnancy rate with natural family planning is about 1% in a year–basically the same as other methods of birth control. The downside is that if it isn’t used correctly, the unintended pregnancy rate can be as high as 25% in a year.

But, honestly, it only takes a few minutes a day to deal with. You’ll need to take your temperature in the morning before getting out of bed, keep an eye on your toilet paper (to track cervical mucous), and use a journal or an app to keep track. If you’re using the Marquette method, you’ll also need to take a urine estrogen sample (more on that later). Personally, I’ve never done the temperature taking or the urine estrogen test, but I found the mucus testing really easy and manageable.

Maybe all that sounds like WAY too much work, and it might be. But seriously, it’s less intense than you’d think (and it’s the most overwhelming at the start). We’re going to cover some of the basics in this post, but to do NFP well, take a course! Give a look for one in your area or check one out online.

An additional note: while I have many ties to the Catholic church (my Dad was raised Catholic, my siblings attended Catholic school, etc.) I’m not Catholic. I agree with a lot of what the Catholic church has to say about fertility, but I am going to cover – and even recommend – using barrier methods or pulling out in this post, which I know contradicts the Catholic church’s teaching on this area. However, in my research into NFP (both for this post, during my engagement years ago, and during my infertility journey more recently) most of the information I found about NFP was from a Catholic perspective. I hope this post helps bring an Evangelical perspective to the topic, while being grateful for the wonderful NFP resources and methods developed by the Catholic church.

To do NFP well, you need to understand your cycle

The menstrual cycle is about 28 days on average, though many women have longer or shorter cycles, and has 4 distinct phases. First, the uterine lining is shed (“menstrual bleeding” aka “period” approximately 3-6 days), then a follicle develops (the follicular phase; approximately days 7-13), an egg is released (ovulation; approximately day 14), and then the uterus prepares either for the long haul of pregnancy or menstruation (the luteal phase, approximately days 15-28). Then the whole thing starts again.

Sperm Are Alive!

The vagina is a rather hostile environment (it’s about as acidic as apple cider vinegar!) but once sperm are inside the uterus, they can live, happily swimming away, for up to a week. So if you had sex on day 5 of your cycle and then you ovulated on day 11, you could get pregnant! And you are actually more likely to get pregnant if you have sex the day before you ovulate than if you have sex on the day you ovulate. The egg, by contrast, only has 12-24 hours of viability before it disintegrates after ovulation. That’s why sex BEFORE ovulation is so important if you’re trying to get pregnant: you want a host of sperm ready and waiting for the egg when it’s released, not swimming upstream in hopes of making it on time.

While the vagina is a rather hostile spot, if your husband pulls out but gets any ejaculate on your vulva, those little determined swimmers can still sometimes manage to literally become one with an egg. Additionally, preejaculate can also contain sperm, especially if he’s had a recent orgasm.

So how are you to manage dealing with all of the phases of your cycle AND sort out the sperm lifespan issue AND manage to keep your sanity intact…

How do I actually DO Natural Family Planning?

“Natural family planning” is not “the rhythm method.” Each method uses the same general guiding principle: accurately identify the fertile window and avoid unprotected sex during it. The variation comes in which markers of fertility each method uses.

Basal Body Temperature – your body’s temperature is 98.6 degrees Farenheit, right? Nope! That’s just the average. Different people have slightly different baselines (I run cold, for example) and your temperature actually changes throughout the month, with a pronounced spike after ovulation. Basal body temperature tracking involves taking your temperature each morning when you wake up, at the same time each morning, before you get out of bed. I’ve only dabbled in this method, but I’ve heard it’s a great way for husbands to be involved, as they can be the keeper of the thermometer. If you’re going to use BBT, buy a thermometer that will store its last readings, so that you don’t have to write down your temperature the second you take it. Not having the right thermometer was a big reason why I didn’t stick with the BBT method, if I’m being honest.

Cervical Mucus – Remember how we talked about how hostile an environment the vagina is? Well, around the fertile window it makes sperm’s lives better (and longer) by providing a nice medium for them to swim to. We call it mucus (I wish there was a better word…) You may have noticed globs on your toilet paper after you urinate. If you pay attention, the mucus becomes more stretchy and abundant as you move toward ovulation. It will achieve a consistency kind of like an egg white at ovulation, then suddenly dry up. I used this method to keep tabs on my fertility and I found it really intuitive. You’re wiping anyway, so all it takes to do is a smidge of brain power and a little record keeping.

Estrogen Tracking – We talk about being hormonal at certain points during our cycle, and that’s kind of a misnomer. We are hormonal ALWAYS and there are spikes and troughs throughout the menstrual cycle of the various sex hormones (the charts are enough to make my eyes cross). At home pregnancy tests take advantage of the fact that we secrete hormones into our urine and test it to see if it contains HCG, which is secreted in large amounts throughout pregnancy. Home tests can also be used to track estrogen as a marker of fertility. I haven’t used them as they were out of my price range when I was first married, but there something I’ll consider as part of my family planning arsenal down the road, now that my husband and I are done with school.

Choose a Natural Family Planning Method

The Creighton Method uses tracked cervical mucus to identify fertile days. I’m a little wary of suggesting it as a means of avoiding pregnancy because you’re going to be better off also tracking basal body temperature (as in the sympto-thermal method), but because Creighton doesn’t require waking up at the same time every day or taking a daily temperature before grabbing your caffeinated beverage of choice, or the expense of urine tests, it may be the right choice for you if you’re willing to live with a decrease in effectiveness.

The Sympto-Thermal Method uses both cervical mucus tracking and basal body temperature to identify the fertile window.  NFP methods that use two or more methods to identify the fertile window tend to work better.

The Marquette Method adds an additional indicator: urine samples of estrogen. This is more expensive than other methods, but the additional layer does help with accuracy. You also don’t have to use basal body temperature to use the Marquette method.

Each method has rules about which days barrier methods or abstinence need to be used to prevent pregnancy, and that’s beyond the scope of this post. If you’re interested in a method, find a book and a class and get learning!

Everything you want to know about how to do Natural Family Planning as a method of birth control. The advantages and disadvantages of using this birth control.

A Note About Abstaining During the Fertile Period

One thing that I genuinely dislike about NFP is that it isn’t fair to women. Our libido tends to ebb and flow with our fertility, and… well… this can lead to a lot of abstaining just when sex seems most interesting. That’s why I’d recommend having an additional barrier birth control method (like a condom or a diaphragm) to use during the fertile period if you’re going to use NFP.

Use a fertility tracking app for record keeping, but don’t let it tell you what to do

One thing we found in the comments to the posts on birth control this month was that there are lots of women who chose to use a fertility tracking app who ended up with an unexpected pregnancy. Here’s the problem: the app can only predict your fertile window accurately based on the data you give it. If you are letting the app do your guesswork, it will only be a guess. You need to feed it really accurate data.

If you understand your cycle and how NFP works, you won’t need the app to tell you if you’re fertile or not – that will be obvious to you. Use the app as a record keeper only. 

Side Benefit to NFP: EMPOWERMENT!

Tracking your cycle is also a really great way to catch hormonal or other gynecological problems early. In the spring of 2015, I noticed that my cycle had suddenly gone haywire. It was a rather unpleasant experience and, after a few months of remembering what day things started and ended and getting rather concerned each month when my period failed to show up when I expected it, I got myself a period tracking app. It was so convenient because I always had my phone handy and could quickly mark down if I saw mucus or bleeding. Armed with data, I went to the doctor, which eventually led to a diagnosis of PCOS. Because I had a condition that causes infertility, even though we were in our mid twenties, my husband and I only had to try to get pregnant for 6 months before we were eligible for infertility treatment. It still took us 18 months to conceive our daughter, but we are so grateful we had the 6 month head start!

Periods are great health indicators. If things aren’t normal one month, no sweat, but consistently weird cycles can be a sign of PCOS, anorexia, hormonal problems, or another health problem and are a great reason to go visit your primary care doctor. If you’re paying attention to your cycle, you will be able to identify problems quickly and you’ll have data to show your doctor.

Honestly, I’d really recommend taking the 15 seconds a day to track your period and cervical mucus, regardless of whether you are using NFP or not. Having had a health problem I identified by tracking my cycle while not trying to conceive, I am SO grateful for the empowerment I got from understanding what my body was doing and from having tracked what was happening when so that I could get help.

What do you think? Have you ever tried to track your fertility? Let me know in the comments!

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