Natural family planning

Many women today practise family planning with common methods like birth control pills, intrauterine devices (IUD) or contraceptive implants.

Quite often, however, I have patients asking me about natural family planning methods that do not involve the use of hormone pills or devices.

Whether for religious, spiritual or personal reasons, they prefer to rely on the body's natural physiological changes to gauge their fertile phases, and hence, decide when is the best time for intercourse.

There are several types of natural family planning methods that can be practised, each based on a different aspect of the female fertility cycle, and with varying success rates.

If you wish to use these natural methods, it is very important that you understand how it works and whether it is appropriate for your individual situation. Natural family planning requires more commitment and discipline, compared to other contraceptive methods, because it is not as simple as taking a daily pill or inserting a device. You should note that natural family planning methods do not protect you from sexually transmitted diseases, as there is no barrier (such as a condom) used.

Natural family planning involves being aware of your body's natural physiological changes and symptoms to identify the fertile and non-fertile phases of your menstrual cycle.

If you want to avoid conception, you would abstain from sexual intercourse during your fertile period, but if you are trying to have a child, then you would try to have intercourse during those fertile phases.

Couples can use natural family planning to space out their births and limit the number of children they want to have - both for health and economic reasons.

Ovulation method

Ovulation method

The ovulation method is also called the Billings ovulation or the cervical mucous method.

To use this method, you have to track the changes of your cervical mucous patterns during the course of your menstrual cycle.

Before your ovaries release an egg every cycle (called ovulation), your cervical discharge will change in characteristic. This is so that the mucous can provide an environment in your womb that helps sperm travel through the cervix, uterus and fallopian tubes to the egg.

There is a general pattern to cervical mucous discharge throughout your cycle. When your period ends, you will find that you do not secrete cervical mucous for about three to four days.

After that, for the next three to five days, you will start to produce a small amount of cloudy and sticky discharge.

Following that will be the period just before ovulation begins. For three to four days, you should have abundant, clear and wet cervical discharge, continuing throughout your ovulation period. This is the period when you are most fertile and conception is most likely to occur.

If the egg is not fertilised, then your menstruation will begin. Your cervical mucous cycle will also repeat itself.

To use this method, you need to record your cervical secretions for several cycles on a daily chart (there are many websites where you can download this chart), starting the day after your menstruation stops, so that you become familiar with your discharge patterns.

During this initial recording phase and when you actually start practising the method, you have to check your cervical mucous twice a day. Before you urinate, wipe yourself from front to back with a tissue and record the colour (yellow, white, clear or cloudy), texture (thick, sticky or stretchy) and feel (dry, wet or slippery).

Your most fertile period is when your cervical mucous is clear, stretchy, wet and slippery (and when there is a lot of it) - almost like raw egg white. If you are trying to get pregnant, this is a good time to have intercourse, but if you are avoiding pregnancy, do not have unprotected sex from the day you feel this secretion until four days after it stops.

The safest time to have intercourse and avoid conception is when you do not produce any cervical mucous after your menstruation has ended, until you start to feel discharge again. It is safe to have intercourse every other night, so that you will not confuse semen with your cervical mucous.

This method is more than 97 per cent effective in helping women to avoid pregnancies, but only if it is used correctly and followed strictly.

However, it is not easy to use this method because it requires a lot of experience and awareness of your own cervical discharge, strict discipline and several days of abstinence every month.

Basal body temperature method

Basal body temperature method

The basal body temperature (BBT) or sympto-thermal method requires you to monitor the changes in your basal body temperature to predict when you will ovulate.

Ovulation causes a slight increase in BBT, by less than one degree, and you are at your most fertile two to three days before your temperature increases. So if you observe slightly higher BBT occurring for three days or more, then you are most likely ovulating.

You are most likely to conceive during the two to three days before your BBT rises, and for up to five days after that (because sperm can survive for that long in your reproductive tract).

If you want to avoid conception, do not have unprotected sex from the time your menstruation begins, up till three to four days after your BBT rises every month.

Just like with the ovulation method, the BBT method has to be done correctly in order for it to be effective. This means that you have to measure your BBT every morning before getting out of bed and record the daily readings on graph paper. You have to use a special BBT thermometer, which you can get from any pharmacy.

Once you have monitored your BBT for one or two cycles, you will get to know your BBT pattern and be able to predict when the temperature will rise or decrease.

This method is 99 per cent effective, if done properly and diligently. However, you should bear in mind that your BBT can be influenced by illness, stress, lack of sleep, alcohol consumption, time zone differences, gynaecological problems and certain medications.

You should get advice from your gynaecologist about the proper way to practise these natural family planning methods, to ensure that they will be effective for you.

In my next article for this column, I will share some of the other natural methods, which include the rhythm (calendar) method, withdrawal and the lactational amenorrhoea (breastfeeding) method.

Datuk Dr Nor Ashikin Mokhtar is a consultant obstetrician & gynaecologist (FRCOG, UK).

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