Natural family planning methods - a safe solution for everyone?

Natural methods of contraception are used by many couples around the world. Some simply watch out for fertile days, others use the entire scheme. Some use them because their faith does not allow for other methods of contraception, others because they do not like condoms and do not want or cannot take hormones, and others use condoms but use them additionally. The entire scheme consists of the so-called calendar method, the thermal method, the sympto-thermal method and the Billings method.

The calendar is the most unreliable of natural methods of contraception. Based on her previous cycles, a woman is able to predict the day of her ovulation and simply not have sex on fertile days, but… Well, but each cycle can be a few days longer or shorter and there is no pathology in this, because as I have already mentioned in previous texts, a woman's cycle is influenced by a million factors from her well-being to the medications she takes. Sticking rigidly to the calendar alone, it is very easy to have an unwanted pregnancy.

That is why methods of monitoring our body's fertility come to our aid. The first one, the so-called thermal method, is based on daily measurement of our body temperature: preferably in the vagina or in the mouth. Remember to always measure the temperature in the same place ;) Additionally, the measurement must be taken before getting out of bed, right after waking up, so if you remember about it after your morning coffee, you can skip the measurement that day. According to this method, the infertile days of our cycle are divided into probable (preovulatory) and certain (postovulatory). What is this method based on? On the following rule: right after ovulation, our body temperature increases by about 0.5°C and remains at this level for about 3 days. After these three days, we have "certain" infertile days. We calculate probable days by subtracting 6 days from the first day of temperature increase. When do we have intercourse? It is best to do it exclusively from the 4th day after the temperature increase until the end of the cycle. When using this method, we must take into account that it does not apply to irregular lifestyles (when you work at night or like to party), to changes in the climate in which we live (it does not apply when traveling), during illness, after childbirth or while breastfeeding.

Another method is the Billings method, or observation of cervical mucus. It was developed by a married couple of doctors: John and Evelyn Billings in the 1950s. As in the previous method, we determine the phase of relative infertility (preovulatory) and absolute infertility (postovulatory). When starting an adventure with this method, we must first determine whether we have a wet or dry model of infertility. This comes down to observing whether after menstruation we feel dryness in the vagina, or whether we have scanty, thick discharge with a sticky consistency. We have already determined the "hydration" of our infertility, what next? It is good to devote one or more cycles before starting intercourse to observing our mucus. We assess the mucus from the vestibule of the vagina. On infertile days, it either does not occur or is thick, impermeable to sperm. It causes them to remain in the vagina and die after 8-12 hours. Fertile mucus is abundant, transparent and thin - its consistency is compared to that of a hen's egg. It is permeable to sperm, and even facilitates their transport from the vagina to the uterus. So the situation looks like this: menstruation, infertile days: thick or absent mucus, fertile days: when there is more mucus and when it is thin (the last day of such mucus is the peak of fertility and infertile days: from the fourth day after the peak of fertility until menstruation. What are the limitations of this method? We do not wear tight, artificial underwear, because it increases sweating and the amount of vaginal discharge, we watch out for vaginal infections (then the discharge completely changes its character and is unreliable), we remember that tampons and vaginal douches dry out the mucous membrane and measuring mucus also makes no sense then, and if we have intercourse often, there will also be more of this discharge and the assessment is difficult. The effectiveness of this method is most influenced by meticulously keeping a diary, in which we not only mark fertile and infertile days, but also keep detailed notes on the consistency of our mucus and the feeling of moisture in the intimate areas.

A modification of the Billings method is the Creighton model developed by Thomas W. Hilgers, but the Billingses themselves strongly distanced themselves from it. Like the Billings method, it takes into account the consistency of the cervical mucus, the amount of vaginal discharge, the occurrence of dry days and the intensity of menstrual bleeding. It differs from the Billings method in that it focuses much more precisely on the observation of mucus. It is the basis of NaPro technology, which we will discuss later - it was designed for couples who are trying to conceive but do not want to avoid pregnancy.

A combination of the thermal and Billings methods is the sympto-thermal method (Rötzer), where, in addition to observing cervical mucus and body temperature, we also pay attention to symptoms related to well-being, as well as examining the cervix, which is hard and directed backwards during infertile days, and slightly softer and more in the axis of the birth canal during fertile days (I know it sounds abstract, but I know women who can examine it themselves!).

There are also many devices available on the Polish market that are designed to computerize the cycle, but I don't want to advertise it too much. Basically, they are based mainly on temperature measurements and changes in well-being, but their prices are outrageous and I would rather keep a diary myself. But everyone likes something different, and the effectiveness of their use is really impressive - as with a meticulously kept diary.

Let's remember that when using natural contraception methods we have to be super precise, super meticulous and super stick to the guidelines. There is a huge range when it comes to the effectiveness of natural contraception methods, which results from how much someone puts into keeping a diary ;)

At the opposite end of the spectrum is NaPro Technology, whose name comes from "Natural Procreative Technology", a term coined in 1991 by the aforementioned Thomas W. Hilgers - he used it for the first time in his book. NaPro Technology is intended for people affected by infertility, for whom the cause of infertility is reversible (i.e. in the case of ovarian failure or blocked fallopian tubes, there is no chance of using it). It is based on self-observation according to a modified version of the Creighton model, which I wrote about earlier. The term of conscious intercourse and joint experience of fertility by spouses is also introduced. It is necessary to participate in an introductory meeting with an instructor, who later supports the couple on their path to having children. On the other hand, the last step in the case of failure to get pregnant, recommended by NaPro Technologists, is adoption.

You can find detailed information about instructors in the links below. I just found out that one of the two doctors specializing in this field in my city practices 50 meters from my house :)

The controversy surrounding NaPro Technology is that the procedure recommended in it is a conservative diagnostic and therapeutic procedure, and the methods used in it are not supported by EBM (Evidence-based medicine). When I type "naprotechnology" in PubMed, I get 11 scientific papers, most of which are published in humanities journals (philosophy, law, mentoring), and the search engine asks if I meant "nanotechnology" with a result of 102,877 publications. The Polish Society of Gynecologists and Obstetricians states that due to the lack of support in scientific research, it cannot be a recommended procedure for the treatment of infertility. Many of the objections directed at NaPro Technology are related to the fact that the patient is not allowed to actually treat her problems. So why do women choose this method? Mainly for ideological reasons: NaPro technology is in line with the teachings of the Catholic Church, so very often people with strong religious beliefs with infertility problems direct their steps in this direction. There is another group of women: those for whom modern medicine does not help. I will never forget a woman after several unsuccessful in vitro fertilizations said with tears in her eyes: "NaPro technology is my last resort."

Each of us has the right to be treated in a way that is consistent with our beliefs and convictions, and that is why NaPro technology has its place in society and there is nothing wrong with that. We just need to ask ourselves how we want to be treated: whether in accordance with medical knowledge gained through scientific research, or knowledge adapted to faith and ideology - the choice is always up to us. When it comes to natural contraception, the matter is much simpler, because we will not question its effectiveness if it is used in full accordance with the guidelines. However, it is worth remembering that if we are not able to regularly and carefully apply the guidelines of natural contraception methods, then in order to avoid pregnancy it is better to choose a method that interferes a little more with our physiology or the course of intercourse, but does not require such meticulousness ;)

The position of the Expert Team of the Polish Gynecological Society on the use of Natural Family Planning Methods for contraceptive purposes, Ginekologia Polska, (2011)
Creighton Model [LINK]
FertilityCare Centers of Poland - National Center for Fertility Care (NaPro Technology) [LINK]
Dolińska, B., 2011. Naprotechnology – distortion or misunderstanding? Science, (1). [LINK]