Factsheet

Natural Family Planning (including Lactational Amenorrhea Method and Withdrawal)

Date   21 January 2008

WHAT IS NATURAL FAMILY PLANNING?

Natural Family Planning is a method of birth control that is based on the understanding of days when pregnancy may occur during the menstrual cycle. It allows users to predict times that they should avoid penetrative sex or use a barrier method of contraception.

The following methods have been developed to predict or calculate fertile days:

• Calendar Method
• Temperature method
• 'Billings' ovulation method
• Symptothermal method (combination of the three above)
• Standard days method.

Efficacy

It is difficult to be specific about failure rates. The effectiveness is dependant on the user's level of education about the method and the couple's commitment to avoiding pregnancy. These methods are more effective the longer they are used. Generally there is a failure rate of between 1-25 pregnancies per 100 women each year.

Advantages as a method of contraception

• Women who have religious/cultural beliefs that forbid the use of artificial contraception can use these methods
• Cost effective
• Can be very effective if used correctly
• Useful for women who have a life philosophy that prefers 'natural' non-chemical solutions

Disadvantages as a method of contraception

• Requires daily awareness of physical changes, and continual observation of signs and symptoms of fertility in a cycle.
• May require long periods of abstinence
• Women with irregular periods could have difficulty in predicting fertile times
• It will take 6-12 cycles to accurately identify fertile days of a woman's cycle
• Indicators of fertility can be changed by events such as illness, having sex and stress
• There is no protection against sexually transmissible infections (STIs)

CALENDAR or RHYTHM METHOD

The calendar method calculates fertile days using the dates of previous months' cycles. This method is best used after charting at least six cycle lengths.

• The first day of a menstrual period is counted as day one of a cycle
• Cycle length is measured from the start of one period to the day before the start of the next.
• After reviewing six cycle lengths the woman must select the shortest and longest cycles
• From these, subtract 21 from the shortest cycle
• Then subtract 10 from the longest cycle

For example, for a woman whose cycle varies between 26-30 days:

• Shortest cycle: 26-21=5
• Longest cycle: 30-10=20

Therefore her fertile days are between days 5-20, and she should have no unprotected sex on those days. In a regular cycle the calculation is the same. For example in a regular 28 day cycle the fertile days are days 7 to 18. (i.e.28-21=7; 28-10=18)

TEMPERATURE METHOD

Following ovulation, rising levels of progesterone will RAISE the body temperature by between 0.2 - 0.5 degrees Celsius, which indicates ovulation is over.

• The temperature will remain elevated until the next period (approximately 12-16 days later).
• The fertile time ends and intercourse will be safe, when there are recorded temperatures for three days in a row that are higher than all of the six previous.
• This 'Basal Body Temperature' must be taken immediately after waking, before getting out of bed and before eating, drinking or smoking
• The temperature can be taken either orally or vaginally but must be from the same site throughout the cycle
• The temperature must be taken at the same time every day

Things to consider:

• Accuracy: a digital thermometer is best
• Body temperature can be raised by a number of additional factors such as illness, alcohol, sleeping in later than usual, too little sleep, and electric blankets.

MUCOUS METHOD (Billings Ovulation Method)

This is the observation of the variations in mucous discharge found at the vaginal opening each morning immediately on waking. This can be used to identify fertile days because the hormone changes through a woman's cycle affect the consistency of these secretions felt at the vaginal opening.

• Mucous is divided into three distinct patterns:
  1. Post menstrual infertile pattern: immediately after menstruation the vulva feels dry, or with a dense flaky mucous that has a sticky feel to it
  2. Ovulatory or fertile pattern: Rising oestrogen levels give a feeling of wetness at the vagina. Mucous is becoming clear, more watery and elastic (a texture like raw egg white)
  3. Post ovulatory infertile pattern: rising levels of progesterone cause the mucous to become cloudy, thicker and sticky and the vulva once again feels dry
• Sexual intercourse can resume safely after three consecutive 'dry' days

Things to consider:

• Consider any bleeding or spotting during the cycle as potential fertile days
• Sexual excitement, semen and menstrual blood can mimic or conceal the effects of fertile mucous, making mucous interpretation more difficult

SYMPTOTHERMAL METHOD

This method uses a combination of calendar, temperature and mucous to calculate fertile times during the cycle.

STANDARD DAYS METHOD

This is a simpler version of the calendar method and should not be used for a woman who has recorded two cycles outside the range of 26-32 days in any one year.

• First fertile day is day 8
• Last fertile day is day 19

Therefore there should be no unprotected sex between and including days 8-19

Lactational Amenorrhoea Method (LAM)

LAM is the informed use of breastfeeding as a contraceptive method when a child is still suckling. Breastfeeding has an affect on the production of hormones that reduces the probability of ovulation, which reduces the chance of pregnancy. When correctly used it is 98% effective. For this, three criteria must be met:

• Menstrual periods have not commenced since delivery
• The baby is not being fed supplements (still solely breastfeeding)
• It has been less then six months since the birth

WITHDRAWAL

Withdrawal is the method of contraception when a man removes (withdraws/pulls out) his penis from a women's vagina before he ejaculates (cums/comes).

Things to consider:

• Small amounts of sperm can be present in pre-ejaculation fluid, which can result in pregnancy
• Withdrawal can be an effective method of contraception particularly for experienced well-motivated users
• The few available research figures tell us that with perfect use the effectiveness rate is 96%, and with typical use 73%
• None of the temperature, calendar, LAM, mucous or withdrawal methods prevents STIs

These are just some methods of Natural Family Planning. Other methods could also include: ovulation predictors, anal sex, oral sex, outer-sex (heterosexual sex without any penis/vulva or penis/vagina contact), and mutual masturbation.

Further reading:

• Francesca Naish Natural fertility: achieving/avoiding contraception
• Dr Evelyn Billings The Billings Method
• Melissa Brooks and Anna M Flynn Manual on Natural Family Planning

For more information on any of these methods please contact

• Healthline on: 1300 658 886 or http://www.fpnsw.org.au
• Natural Fertility Services (Formerly Natural Family Planning) on 02 9390 5156 or rural: 1800 114 010 & ask for Natural Fertility Services or http://www.natfamplan.com.au

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For further information

Contact the Healthline on 1300 658 886.