What are natural methods of contraception?
These methods to prevent pregnancy are mainly based on not having intercourse during the fertile days of the woman. Use is made of the knowledge about the woman’s normal fertility. This knowledge is not necessary for the application of coitus interruptus (CI). How the fertile period is determined depends on the method chosen.
With a regular cycle of 28 days, there are 13 periods of around 4 days per year that a woman is fertile. That is on the day of ovulation and the days that precede it. The fertility then depends on the survival time of the sperm cells. That is on average 2 days, but some sperm can even survive up to 5/6 days. A cycle starts by definition on the first day of menstruation and ends on the last day before the next menstrual period. During the first part of the cycle, the follicular phase, one or more follicles mature until one or more eggs are released on the day of ovulation (ovulation).
The second phase is called the luteal phase, where the womb lining is prepared to allow a fertilized egg to be implanted 5 to 7 days after a possible fertilization. If there has been no fertilization, the womb lining is shed 7 days later (menstruation) and the cycle starts again. The second phase (luteal phase) lasts 12 to 16 days; the duration of the first phase (follicular phase) can vary. A normal cycle can have a length of 18 to 35 days. With a cycle of 18 days there is already ovulation during the last days of menstruation. With a cycle of 35 days ovulation occurs 3 weeks after the start of menstruation. From the second day after ovulation, fertilization is no longer possible.
How do natural methods of contraception work?
With the exception of the CI method, the natural methods are effective if there is no sexual intercourse during the fertile days. We also call this periodic abstinence (PO). The natural methods of birth control are intended to determine the fertile period in which no sexual intercourse may take place. The NFP (Natural Family Planning) method also referred to as symptom-thermal method is based on the woman’s perception of a number of changes that the cycle takes place in relation to the fertile period. Three changes are observed during the cycle:
· The body temperature
· The (cervix) mucus
· The consistency (softness) of the cervix
The temperature method uses the fact that the basal body temperature is 0.2 to 0.3 ºC higher in the period after ovulation up to the next menstrual period than in the first part of the cycle. The body temperature should always be recorded at a fixed time in the morning before getting up in order to be able to interpret it reliably. The cheapest is to measure the temperature with a simple thermometer and to record the data daily.
By combining the data obtained, the time of ovulation can be determined with fairly high accuracy. To reliably apply the method, courses are organized that are given by specially trained NFP consultants.
Pregnancy is no longer possible from the second day with the elevated temperature. With this method it is therefore only possible to determine the moment of ovulation afterwards. You first have to measure the temperature daily for three months and record this in order to be able to determine your own rhythm. Sexual intercourse must then be avoided from 7 days prior to the day of the calculated ovulation up to and including the second day after ovulation.
The principle of the temperature method is also used with a number of systems that take over the calculation for determining the fertile days. Examples of these microcomputers are the Babycomp®, the Cyclotest 2 plus®, the Ladycomp®, the Minisophia® and the Pearly®. These microcomputers are often promoted by the suppliers as a method of birth control per se with a reliability that would be comparable to the reliability of the pill. However, they remain (expensive) tools based on the temperature method. The time of ovulation can also be determined by making use of the determination of some hormones that are present in the body shortly before ovulation. This can be done with ovulation tests or with the Persona® system.
Coitus interruptus (CI) literally means interrupted sexual intercourse. Hereby the penis is withdrawn from the sheath when the man feels the ejaculation coming and then lets the ejaculation take place outside the body. This method is also called: “Before singing (or for blessing) leave the church!”
The Billings method uses the properties of the cervical mucus to determine the time of ovulation. In the period prior to ovulation, the natural estrogen estradiol increases the elasticity of the cervical mucus. The elasticity can be assessed by inserting a small tampon up to the cervix into the sheath and then removing it again. In the fertile period, a clear slime thread with the pad will be pulled out. The production of the cervical mucus stops abruptly after ovulation. To ensure safe application of this method, one must wait another day after the disappearance of the c experiential mucus to avoid becoming pregnant. A tool is also available for determining the quality of the cervical mucus: the Donna®. This is an ovulation tester in the form of a small pocket microscope. During a period of 3-4 days before ovulation to 1-2 days afterwards, the concentration of the estrogen hormone estradiol is increased and this is visible through a “fern” structure in the saliva or cervical mucus.
The LAM or lactation amenorrhea method can be applied for 4 to 6 months after the birth of the baby if the baby is fully breastfed. No ovulation will occur if the following conditions are met:
· The baby must not receive any food other than breastfeeding, including snacks in between
· Breastfeeding must not be pumped
· There must be no more blood loss from 15 days after the birth. If bleeding occurs afterwards, the method is no longer reliable
How do you use natural methods of contraception?
All natural methods of birth control should be used carefully according to the method described. That means great discipline and good administration. A barrier agent may be used during fertile days.
How reliable are natural methods of contraception?
A reasonable reliability can be achieved in theory. The more carefully the instructions are followed, the more reliable the results will be. Combination of the different methods to determine the fertile period, such as when applying the NFP method, still gives the best results. In practice, the number of women who become pregnant with long-term use of one of the natural methods appears to increase to around 20% per year. This is partly due to the fact that natural methods are actually unnatural: the need for sexual contact is greatest in the fertile period!
Of the methods discussed, the coitus interruptus is the least reliable. Often there is so-called ‘pre-moisture’ from the glands of Cowper in the sheath prior to the feeling that the ejaculation is coming. This can nevertheless lead to pregnancy, since this pre-cum can also contain active sperm.
With careful application of the LAM, the reliability during the first 4 months is comparable to the reliability of the pill. After that, reliability quickly diminishes.
What are the side effects of natural methods of contraception?
When applying a natural method of contraception there are no side effects.
When to the doctor?
The methods of natural birth control can be applied without the intervention of the doctor.
Are the natural methods of contraception suitable for you?
The LAM method is suitable for women who breastfeed completely during the first 4-6 months after the birth.
The natural methods can also be used if no hormones or intrauterine agents are desired or if there are medical reasons that do not allow the use of hormones or intrauterine agents. Natural methods of contraception can also be used by those who reject religious or ethical motives for the use of hormonal, intrauterine or barrier agents as a method of contraception.
The natural methods are not suitable if the discipline required to use the methods reliably is lacking.
General advice and precautions
Natural methods only protect against pregnancy with correct application, not against sexually transmitted diseases (venereal diseases). To be protected against sexually transmitted diseases, the use of a barrier agent such as a condom or female condom is necessary. More about this can be read in the brochure barrier means. Extra protection is not required only in a stable sexual relationship. It is recommended to use extra protection in a new relationship and to test both partners after 3 months for the most common sexually transmitted diseases such as chlamydia and HIV.