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Contraception- Natural Family Planning (Calendar, Ovulation, Sympto-Thermal, Post-Ovulation)

How do ovulation predictor kits assist in preventing pregnancy?

Home ovulation predictor kits are available to confirm the presence of urinary luteinizing hormone (LH), which precedes ovulation by one to two days. These kits are expensive and usually used by women who wish to conceive, rather than as an adjunct to monthly contraception. By establishing when the LH surge occurs sex can be avoided for the next five days (for contraception) or scheduled around this time when pregnancy is desired. The couple is not protected from sexually transmitted diseases including HIV.

How do ovulation predictor kits assist in preventing pregnancy?

Home ovulation predictor kits are available to confirm the presence of urinary luteinizing hormone (LH), which precedes ovulation by one to two days. These kits are expensive and usually used by women who wish to conceive, rather than as an adjunct to monthly contraception. By establishing when the LH surge occurs sex can be avoided for the next five days (for contraception) or scheduled around this time when pregnancy is desired. The couple is not protected from sexually transmitted diseases including HIV.

How does the Basal Body Temperature Method of natural family planning work?

The temperature is obtained orally after at least six hours of sleep prior to rising (placing the special basal body temperature thermometer into a cup containing the first voided urine sample is a simple way to do this). Following the postovulatory elevation of progesterone, the temperature should rise by at least 0.5C. Although this temperature rise is a consequence of ovulation, not a predictor, it may reveal a pattern for future cycles. It also confirms that ovulation has already occurred and, therefore, the fertile period will end shortly (48 hours later). Since other factors can cause a temperature elevation, resumption of unprotected intercourse too soon after the presumed "ovulatory temperature rise" may lead to unintended pregnancy. Unprotected intercourse should be delayed until at least three consecutive days of raised temperatures have been documented. Up to 20 percent of women with documented ovulation may not show a biphasic basal body temperature (BBT) chart and therefore cannot use this method. The couple is not protected from sexually transmitted diseases including HIV.

How does the Calendar Method of natural family planning work?

This is the most common of the fertility awareness methods. Women will calculate the onset and duration of their fertile period based on several assumptions that:


  1. ovulation occurs 12 to 16 days before the onset of the next menses,

  2. sperm remain viable for two to three days and

  3. the egg survives for 24 hours.


Based on this method, a couple would avoid intercourse or use another contraceptive during an eight- to ten-day period in each cycle. The woman should chart a menstrual calendar over several months. Her fertile period is determined by subtracting 20 days from her shortest cycle (to establish when the fertile period begins) and subtracting 10 days from her longest cycle (to establish when the fertile period ends). Recent studies show that there may be a wider variation in the "fertile time" than traditionally calculated by this method-hence inadvertent pregnancies may result when this technique is used as a means to avoid pregnancy. The couple is not protected from sexually transmitted diseases including HIV.

How does the Lactational Amenorrhoeic Method of natural family planning work?

Lactation has been a major form of contraception for centuries, and has played a key role in family spacing in many parts of the developing world. Breastfeeding in the traditional fashion of nearly constant suckling suppresses ovulation. Modifications of the traditional breast-feeding patterns that were incorporated to accommodate western lifestyles however have dramatically reduced the effectiveness of this technique. Accordingly, the time from delivery to resumption of ovulation varies considerably and is affected by a number of factors, including the frequency and intensity of suckling and the use of supplementary feeding. The lactational amenorrhoeic method (LAM) is an effective temporary contraceptive method as long as the woman can recognize reliably when she is again at risk of ovulation or wouldn't care if it failed. The risk for return of ovulation increases as breast-feeding frequency declines, if milk supplements are used, or if menstrual bleeding resumes. In these circumstances, even if lactational amenorrhoea persists, a supplementary contraception should be used to avoid conception. The couple is also not protected from sexually transmitted diseases including HIV when using this method.

How does the Ovulation or Billings Method of natural family planning work?

This method relies on the observation of changes in the quality of vaginal mucus around the time of ovulation. One day before, during, and one day after ovulation, the vaginal mucus (arising from the cervix) may change in quality to become opaque, sticky and tacky. The recommendation is to check vaginal secretions before urinating and examine the elasticity, consistency and lubrication. Intercourse can be resumed on the fourth day after peak mucus production. It is less reliable for women who have an insufficient quantity of mucus, or vaginal conditions, for example, vaginal infections, masking cervical mucus changes. The couple is not protected from sexually transmitted diseases including HIV.

How does the Symptothermal Method of natural family planning work?

This method uses a combination of BBT (basal body temperature) change and change in cervical mucus, or other cyclic symptoms. A chart of symptoms and basal body temperature is helpful in identifying the fertile days. Some women are aware of ovulation discomfort (Mittelschmerz), which may also be incorporated into the charting. Pain may occur just prior to, during or just after ovulation. The couple is not protected from sexually transmitted diseases including HIV.

How effective are the natural family planning methods?

Among typical users, approximately 20 percent of women conceive during the first year. However, ideal use can result in a pregnancy rate of less than five percent per year. The Pearl index is 15/100 women years (failure rate for 100 women using the method for one year).

How effective is the Lactational Amenorrhoeic Method (LAM) of natural family planning?

The LAM is 98 percent effective in preventing pregnancy in the first six months after delivery provided that (1) the woman has not experienced her first postpartum menstrual bleed, (2) the woman is fully breastfeeding with feeds not more than four hours apart, and (3) the infant's diet is not supplemented. As the pregnancy rate increases in women whose infants are receiving supplementary food, despite continued lactational amenorrhoea, a supplementary contraceptive method should be used to avoid conception in this circumstance.

My boyfriend says we don't need contraception, because he will pull out at the last minute. Is this effective?

Withdrawal (also known as coitus interruptus) is better than nothing. However, the failure rates of this method are high, around 27% with typical use. The idea is to withdraw the penis from the vagina prior to ejaculation. This is very difficult to do consistently because it requires considerable self-control. This method also does not provide protection from sexually transmitted infections.

What are the advantages of Coitus Interruptus?

There are no costs involved and the method is universally available.

What are the advantages of the Abstinence (non penetrative sex) method of contraception?

The advantages of abstinence include


  • Minimal risk of misuse

  • Freedom from the threat of STD and HIV infection, if no exchange of body fluids occurs

  • No physical side effects

  • No need to visit a health care provider

  • No cost, unless condoms and dams are used for oral-genital sex

What are the advantages of the natural family planning method?

There is no drug or device related side effects. The method is ideal for the motivated couple when the woman has regular, predictable menstrual cycles.

What are the disadvantages of Coitus Interruptus?

This method requires self-control on the part of the man, who must recognize impending orgasm and resist the urge to pursue coital movement. He must withdraw the penis in time to prevent the ejaculate from coming into contact with the vagina or vulva. The couple is not protected from sexually transmitted diseases including HIV. Examinations of the pre-ejaculate of HIV-infected men have revealed the presence of HIV-infected cells in some cases. There is also a theoretical risk that the pre-ejaculate may contain spermatozoa, therefore making conception possible even if withdrawal is achieved prior to ejaculation.

What are the disadvantages of the Abstinence method of contraception?

There are no disadvantages of abstinence if a couple is able to maintain a fulfilling relationship without the need for penetrative sex. When couples choose this approach they are wise to become knowledgeable about contraceptive alternatives and to have barrier methods available in the event that they decide to have penetrative sexual intercourse at some later date.

What are the disadvantages of the natural family planning method?

The couple should be willing to accept the risk of failure. It requires the participation of both partners and is dependent on an understanding of the fertility cycle. There is no protection from sexually transmitted diseases and HIV transmission. If the woman has an unpredictable cycle these methods are unreliable. Furthermore not all ovulatory women have recognizable cyclic mucus changes.

What are the instructions that all women should receive before initiating a natural family planning method?

When starting to employ these methods, all couples should use abstinence or another non-hormonal method of contraception until the cycle pattern is established and recognized. The couple should also be carefully instructed about the reproductive cycle, the symptoms to monitor and methods for temperature charting (including the need for a special basal body temperature thermometer). The couple will likely benefit from a repeat visit following a few cycles of charting to review the method and individualize the concept of fertile days.

What are the instructions that all women should receive if they have chosen abstinence (non penetrative sex) as their preferred method of contraception?

Any couple practicing abstinence should be offered education about other methods of birth control and safer sex to help them in the future if their sexual agenda changes. It is also important to suggest that condoms be readily available in case they change their minds. They must also be aware of emergency contraceptive options.

What are the instructions that all women should receive if they have chosen Coitus Interruptus as their preferred method of family planning?

Any couple that chooses the withdrawal method should know about the significant risks of failure of the method and should be provided with information and a prescription (where needed) for emergency contraception should there be inadvertent contact between ejaculate and vagina or external genitalia. Spermicides may also be used although the effectiveness after ejaculation has not been determined.

What is Coitus Interruptus?

Coitus interruptus or the withdrawal method is a frequently used method of family planning. During coitus, the man attempts to withdraw the penis from the vagina prior to ejaculation. This form of contraception carries significant risks for pregnancy and is used mostly by couples with no other method of contraception available (less commonly by those who prefer to avoid hormonal or barrier methods of contraception).

When is abstinence (avoidance of vaginal penetration) an acceptable form of contraception?

Avoidance of vaginal intercourse is very effective for preventing unwanted pregnancy and still allows a couple to be involved in other forms of sexual expression. However, if a secondary goal is to avoid sexually transmitted infection, then oral-genital sex and other activities that expose the partner to pre-ejaculatory fluid, semen, cervical-vaginal secretions or blood must be avoided unless the partner is known to be free of any possible infectious agents.

Which method of natural family planning is the most effective? Least effective?

Of the available natural methods, the symptothermal method is the most effective and the calendar method the least effective.

Why do natural family planning methods fail?

Failure of these methods may be attributed to improper teaching and understanding of the method, risk-taking during the fertile days and/or natural variability in timing of ovulation resulting in conception during the so-called "safe period" of the cycle.

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