II. Indications
- Conception Planning (Fertility Tracking)
- Pregnancy Prevention ("Contraception")
- These methods are not recommended for reliable Contraception
III. Contraindications
- Irregular Menstrual Cycle
- Partner does not support fertility window abstinence or protection
IV. Types: Methods of Natural Family Planning
- Modern Methods with better efficacy
- Ovulation Method Criteria (Billings Method)
- Cervical Mucus characteristics
- Symptothermal Method Criteria
- Cervical Mucus characteristics
- Basal Body Temperature
- Ovulation Method Criteria (Billings Method)
- Rhythm Method (Calendar Method)
- Standard Rhythm Method failure rates approached 20% and should be avoided
- However, smartphone applications (e.g. Natural Cycles, Clue Birth Control) have 6.5% failure rate
V. Technique
- Review calendar history of 3-6 prior Menstrual Cycles
- Determine Ovulation time
- See Ovulation for specific findings
- Urine LH Kit (100% correlation)
- Detects Luteinizing Hormone surge
- Accurate and cost effective (e.g. $20 for 50 tests)
- Identifies 2 days in cycle most likely to conceive (start testing a few days before expected Ovulation)
- Predicts Ovulation before it occurs
- Cervical Mucus (48% correlation)
- Basal Body Temperature
- Identifies Ovulation after it has occurred (contrast with LH Kit)
- Electronic fertility trackers (e.g. Ava smart bracelet, Kegg Vaginal Sensor)
- Expensive (>$250 in some cases) and not clear they work any better than Urine LH
- Avoid ineffective methods
- Avoid unprotected intercourse for mid-cycle 7-14 days
- Approximately Cycle Days 9 to 19 would be higher risk
- At higher risk mid-cycle days
- Abstain from intercourse
- Use barrier Contraception
VI. Efficacy
- Pregnancy prevention rate (Abstinence planning)
- Calendar (Rhythm Method): 83% effective (avoid)
- Basal Body Temperature alone: 96.1% effective
- Cervical Mucus alone: 92.6% effective
- Symptothermal Method: 99.6% effective
- Intended pregnancy rate (Conception planning)
- Normal fertility: 66% pregnancy rate within 1 cycle
VII. Disadvantages
- Regular Menstrual Cycles required
- Offers no Sexually Transmitted Disease protection
- Requires significant Patient Education
VIII. Management
- Provide education on Emergency Contraception
- Review Menstrual Cycle and Ovulation
- Review Menstrual Cycle calendar over 3-6 months
- Review non-coital sexual activity
- Review barrier Contraception