The most common question I get from those thinking about discontinuing their birth control is “well how will I avoid pregnancy?”.
This common question stems from what we have been taught as women. We have always been given two options when it comes to our menstrual health and fertility:
Take hormonal birth control and avoid pregnancy
Don’t take hormonal birth control and get pregnant
This seems like a scary set of options to choose from, especially in a teenager who has pregnancy as the very LAST thing on her mind, and for someone whose parents don’t even know they are sexually active.
Fast forward ten years and being on birth control has become the “norm”, so much so that it’s not something that is even given a second thought until pregnancy is desired. At that point, my conversations with fertility patients become very different from “I NEED to avoid pregnancy”, to “wow, I didn’t realize that getting pregnant would require more than just having sex at a random time in my cycle”.
So are there effective birth control options for those not wanting to be on hormones but not ready to conceive yet? Absolutely! [and no, i’m not just talking about condoms].
Fertility Awareness methods
It sounds a little less than glamorous, but the fertility awareness method is a very safe and effective non-hormonal birth control method that can help you not only prevent pregnancy (and achieve it when you are ready), but also help you understand your cycle so that you also can identify critical changes to your health. The fertility awareness method is based on tracking symptoms and signs throughout your cycle, to understand your “fertile window”, to abstain from intercourse if trying to avoid pregnancy, or have intercourse if trying to conceive.
Fertility awareness-based methods “(FAB) of family planning” involve identification of the fertile days of the menstrual cycle by observing fertility signs such as cervical secretions and basal body temperature, or by monitoring cycle days. FAB methods can be used in combination with abstinence or barrier methods during a woman’s most fertile time.
Two Day Method
This is a type of fertility awareness method using cervical secretions to indicate fertility. A woman using this method checks cervical mucus at least twice a day and tracks this data throughout her cycle. With correct use, the two day method has been found to be 96% effective in preventing unwanted pregnancies. “2day method” is an app that can be found and downloaded in your cell phone’s app store.
Temperature method
This method relies on you taking your temperature daily throughout the month and watching for when your temperature exhibits a slight increase (this typically happens AFTER ovulation before you get your next menstrual period). This method is not an accurate way to prevent pregnancy during the current cycle, but can be a good method used retrospectively to identify whether or not ovulation was likely to occur.
Calendar Method
The calendar method can help you track your fertile window by tracking your cycle lengths and using the following formula:
- Find the shortest cycle in your past record (ie. this might be 26 days for example- remember day 1 is the first day of your period) and the longest cycle in your past record (ie this may be 29)
- Subtract 18 from the total number of days in the shortest cycle (ie. on a 26 day cycle this would be 8) and 11 days from the longest (ie. the 29 day cycle would be 18)
- Count both numbers from day 1 of your current cycle and mark those days with an X (this would be day 8 & day 18 of your current cycle)
- The days marked with an X would be your fertile window and intercourse should be avoided during this time OR additional measures should be used (condoms for example).
Standard Days Method
This method is a variation on the calendar method. Once you have established the length of your typical cycles (as long as they fall between 26 and 32 days), ensure you are using another form of contraception during days 8-19 which is the assumed fertile window in this method.
My Recommendation
I recommend that when you are just starting to use fertility awareness, more than one method is used to keep the fertile window as narrow as possible. I typically tell my patients the following
- Track your cervical mucous consistency and watch for when the mucous starts to look like a “raw egg white”. This clear stringy mucous will indicate the presence of your fertile window. Mark these days in whichever app you use to track your cycle
- Purchase LH strps (also known as ovulation strips) – Use these from day 8 until you get a positive. A positive indicates you will likely ovulate within 12-24 hours (mark this in your app as well)
- Make note of when these fertile days have been identified as & when they fall in the 8-19 day window
- Do this for a few months to get a tighter window of when you’re at your most fertile.
