How effective is the sympto-thermal method?

This is known as a “behavioural” method of fertility management. It’s effectiveness in avoiding pregnancy varies according to the couples motivation. No method of fertility regulation is 100% effective, natural or otherwise. The more motivated you are to not get pregnant the less likely you are to ‘break the rules’ and to take the occasional risk.

A study carried out by the World Health Organisation on 19,843 very poor women in Calcutta from 1971-1978 showed a pregnancy rate of 0.2%. The pregnancy rates were of 0.16% for those who used the method strictly and 0.35% including those who took risks or misunderstood the rules. These results are similar to those enjoyed by couples taking the pill.

A number of studies have found the pregnancy rate to be less than 1% among couples who did not want any more children. This is far more reliable than condoms and diaphragms and comparable to the effectiveness of the contraceptive pill.

Couples who aim to space their children tend to have a higher rate of unplanned pregnancy than those who were motivated to completely avoid a pregnancy. Although, in this group the success rate is still 98%. This means that if 100 women use the method for 1 year, 2 of them will become pregnant. This is about the same as the mini pill and is slightly better than condoms and much better than diaphragms.

Couples experiencing unplanned pregnancy in 1st year of perfect use
Natural Family Planning (STM) 2%
Oral Contraceptive Pill 0.4%
Condom 3%
Diaphragm with Spermicide 6%
From Hatcher RA et al (1994)”Contraceptive Technology” 16 ed. Ch5 & 27 , Irvington Pub.Inc.New York

The oops factor.

Unplanned pregnancies can be:

Method related

This occurs when a couple followed the rules and had not planned to get pregnant at the beginning of the cycle and some reason unknown to all, got pregnant anyway. This happens with all contraceptive methods.

Informed choice

This happens when a couple did not plan to get pregnant but decided to ‘risk it’ and have intercourse on a day of recognised fertility. I like to call this an unplanned planned pregnancy. The majority of unplanned pregnancies that occur while using natural fertility awareness are informed choice pregnancy.

Teaching related

This is when an unplanned pregnancy results from a misunderstanding of the rules. This is likely to happen in the learning phase so it is best not to rely on the method until you are comfortable with recognising your fertility signs and you know that you can stick to the rules. It is also best to have a teacher that can support you through this learning phase if you absolutely do not want to get pregnant.

Using natural fertility awareness in the pre-ovulatory phase.

This is a riskier time to rely on this method since the egg can be fertilised several days after intercourse and we can’t predict exactly when ovulation will take place.

Post-ovulatory intercourse is extremely unlikely to result in a pregnancy because once ovulation occurs, the egg is only viable for 12-24 hours. Provided you wait the 3 days of higher temperature readings to confirm ovulation has taken place and that the egg is no longer viable, you will have no chance of pregnancy.

Some couples may choose to use a condom or diaphragm or withdrawal in the pre-ovulatory phase and then abstain from genital contact in the fertile time in order to absolutely rule out the chance of a method failure unplanned pregnancy.

The next safest alternative to barrier or abstinence in the pre-ovulatory phase is use the dry days, dry nights rule. That is if you haven’t felt the presence of cervical mucus at the vaginal opening and you haven’t seen any fertile mucus then your safe. For this to be most effective it is best that you only have intercourse on alternate days so that you can tell the difference between cervical mucus and seminal fluid. That way you are less likely to miss the beginning of the fertile mucus.

And then there is the point of change rule. This says you can have intercourse until you notice any deviation from your unique basic infertile pattern. This is the more risky of the options especially while you are learning or if you have unreliable mucus signs.

Putting it all together

The mucus symptom

Avoid intercourse as soon as you see a change from your basic infertile pattern and don’t start again until the evening of the third day past the last sign of fertile mucus.

Temperature

Look for a sustained temperature rise that is 0.2-0.6 ° C (0.4-1.1 ° F) higher than the previous six readings ignoring any weird readings ie. dips and spikes. This will tell you that you have ovulated. Once you have seen four consecutive high temperatures, you can assume that you have ovulated and are in the infertile phase of your cycle.

Changes at the cervix

Confirm fertility or infertility with changes at the cervix. Make sure the cervix feels firm, closed and sits low in vagina before having intercourse if you wish to avoid a pregnancy.

What about contraception after I have a baby?

Lactational amenorrhoea method (LAM)

How reliable is it?

Recent research has shown this method to be between 98 and 99% effective in preventing pregnancy when all three criteria for LAM are met. The research is based on data collected over years of studying thousands of women in more than a dozen countries.

How does it work?

During breastfeeding, ovulation is inhibited by a series of hormonal and nerve responses to nipple stimulation by the breastfeeding baby. More intense or more frequent breastfeeding sends nerve impulses to the mother’s brain which in turn prevents the ovary from producing the hormones which cause ovulation. When breastfeeding starts to diminish, the chance of ovulation and consequently pregnancy rises.

Will LAM be right for me?

To be able to use LAM effectively, there are three criteria that need to be considered. These are:

You must not have had a period since the birth of your baby

Firstly and most importantly you must not have had a period since the birth of your baby. This does not include the initial bleeding after birth which can continue for up to 6 weeks after the birth of your baby.

If you have had a period even though you are meeting all the other criteria, LAM is not suitable for you and you can consider using other natural fertility awareness methods.

Be fully or nearly breastfeeding

This means no artificial milk feeds, no extra foods and to still be breastfeeding at night.

Occasional extra fluids and cultural ritualistic feeds have been shown to not affect the effectiveness of LAM, but remember that it is the nipple stimulation from the baby that stops you from ovulating, so there still has to lots of breastfeeding.

If you are not breastfeeding then it is possible to ovulate 3 weeks after the birth of your baby and you will need to start charting your temperature and mucus symptoms as soon as the post birth lochia bleed is finished or three weeks after the birth of your baby, which ever comes first. It would be advisable to get some help from a natural family planning teacher or to use me to help clarify things as it is likely take a few cycles before usual cycles returns.

Your baby should be less than 6 months old

This is the more flexible of the criteria. Several studies have found that the unplanned pregnancy rate remained low for women who were near fully breastfeeding beyond 6 months, provided they were breastfeeding very regularly and had not had a period. While the rates of pregnancy are higher after the baby is 6 months old, the sympto-thermal method is still more effective than condoms and diaphragms or caps up to 9 months and possibly 12 months if you are still breastfeeding lots and haven’t had a period. Unfortunately, there haven’t been any studies done to confirm the effectiveness of LAM with use in extended breastfeeding.


What if I don’t meet the criteria?

If you do not meet the three criteria for LAM, it is advisable to start charting your mucus signs and temperature.

Charting after pregnancy:

Begin charting as soon as the initial bleed after the birth finishes. Check your cervical mucus every time you go to the toilet and keep a record on a fertility chart. Take note of sensation at the vulva such as wet, dry, slippery as well as the appearance.

After keeping a record for a couple of weeks you will get to notice a pattern, mucus will most likely be the same in appearance, colour, texture and sensation. This is your basic infertile pattern . Once you are confidant you know your basic infertile pattern you can stop charting.

If you notice any deviation to your basic infertile pattern, start charting again and the safest option is to abstain or use a barrier method until you can either establish a new pattern or the mucus has changed back to the previous pattern of fertile mucus.

If you notice any fertile type mucus, it would be a good idea to abstain or use another method of contraception until 4 days past the last sign of the fertile mucus.

It is advisable to chart your temperature daily even though it could be 18 months before you start to ovulate again. This is because the temperature rise is the only way to confirm that ovulation has taken place and that you have returned to fertility.

Avoiding pregnancy while coming off the pill

It can be a bit tricky getting started when coming off the pill. You may not be used to the appearance of mucus; in fact many women who have been on the pill since their teens have never noticed fertile mucus. It can be difficult to observe when you don’t know what you are looking for. It can also take several cycles after stopping the pill for mucus to appear. In fact it can take several months for ovulation to occur. It can take a while for the artificial hormones to clear out and for your body to kick in with the natural hormones. This said, it could be months before you can use the sympto-thermal method as a reliable method of contraception. So for many couples, condoms become a good option while they are learning their unique signs of fertility.

Why not use the pill?

There are many reasons why the pill is not a healthy choice when it comes to contraception. Firstly, it has many potential side effects. Some are very common and some are quite rare.

Minor to Moderate Side Effects

These are quite common, especially with long term use:

  • Spotting or bleeding between normal periods, “break-through bleeding”
  • Weight and/or appetite changes
  • Nausea, prevented by taking the pill with food
  • Breast tenderness or fullness
  • Mood changes, irritability
  • Lowered libido
  • Hormonal changes resulting in vaginal itching and possible vaginitis

Serious Side Effects

  • High blood pressure. There may not be any symptoms. Blood pressure should be checked every 6 to 12 months by a health care practitioner. High blood pressure will usually reverse after stopping the pill.
  • Failure of menstrual periods to return after stopping the pill. There may be slight delay, as long as six months, in return of regular menses after stopping the pill. This is sometimes accompanied by galactorrhoea, a milky discharge from the nipples. Amenorrhoea is more likely to occur in those women who had irregular periods prior to pill use.
  • Development of gallstones. Symptoms are upper abdominal pain, indigestion.
  • Liver tumours have rarely been reported with long-term oral contraceptive use. Symptoms include abdominal pain occurs, possible rupture and extensive bleeding.

Severe Side Effects (rare)

Circulatory problems due to blood clots or thrombosis are the potential life-threatening side effects of the pill. These include stroke, heart attack, and cardiovascular disease. Women over the age of 35, are obese, have high cholesterol levels, and who smoke are most at risk.

The pill will cause the following changes in every user:

  • It depletes vitamin and mineral stores
  • It changes the balance of gut flora
  • It increases the blood levels of copper which can lead to a zinc deficiency
  • It increases blood levels of vitamin A
  • It reduces acidity in the vagina, thereby increases the risk of developing thrush

To an extent many of these things can be mitigated by nutritional supplementation. It is very wise to correct these imbalances before attempting to get pregnant.

How does the pill work?

There are three ways the combined contraceptive pill works.

  • It stops you from ovulating
  • It builds up a mucus plug at the cervix to stop sperm from getting into the fallopian tube
  • It thins the lining of the uterus to stop an embryo from implanting.

How to use natural fertility awareness after the pill

Start charting temperature, mucus and changes at the cervix.

Note anything that may be even a little bit relevant on your chart. Any tummy pains, headaches, nausea, mood swings, everything you can think of. Chart it. This will be valuable information for you to help you to get to know your unique signs of fertility.

The safest way to get started is avoid intercourse in the first cycle. This stops you making errors of judgement and allows you make accurate mucus observations.

You could use the post ovulatory days for intercourse if you have confirmed ovulation with a temperature shift and waited at least until the evening of the 3rd day after this shift has occurred (see Basal Body Temperature).

In the following cycles:

If you can’t get a good understanding of your fertile and infertile mucus signs, make close observations of the changes at the cervix and use the temperature shift as the only indicator that you are not fertile.

Using Natural Fertility awareness to avoid pregnancy after a pregnancy loss

If you have experienced a pregnancy loss, conception and contraception may well be the furthest from your mind. It may be helpful to find someone to talk to about your feelings and how you as a couple wish to proceed in regard to your plan for a further pregnancy. Many couples find that they wish to try again as soon as possible while others can not bare the thought of another pregnancy for some time. Some couples may find that one partner wants to try again straight away while the other can’t even think about the possibility of another pregnancy. Grief is an ongoing process, respect it and allow as much time as is needed to work through it. EFT can be a wonderful tool for helping couples to work through the feelings and anxieties associated with pregnancy loss. You may also find it helpful to speak with your health practitioner, a counsellor, spiritual leader or a trusted friend.


How long before fertility returns?

This can be a bit of an unknown, my usual answer, every women is different.

But generally:

  • If miscarriage occurs early in a pregnancy, that is between 4 and 8 weeks then ovulation may occur within 2-3 weeks and normal cycles will start again fairly quickly.
  • If miscarriage occurs after around 12 weeks then ovulation may be delayed somewhat longer.
  • The return of periods will depend on when ovulation occurs.

In order to avoid pregnancy after a pregnancy loss:

  • Count the day of the miscarriage as day 1 of the cycle and start charting.
  • Record mucus signs and symptoms
  • Record temperature signs and symptoms. Readings may be a bit higher than expected to begin with but tend to drop as the mucus phase approaches.
  • Take care as a short pre-ovulatory is possible; this means you could ovulate very soon after a miscarriage and therefore get a period as quickly as 2 weeks after a miscarriage.

Note: Since this is an unpredictable situation it is advisable to learn natural fertility awareness from a teacher who will be able to help you to interpret your chart.

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