Are you one of the many women who can’t tolerate the side effects of the pill? But you aren’t ready for something permanent, like tubal ligation?
Or maybe your religion or culture prevents you from using medical birth control. Don’t worry; you’re not alone.
There are plenty of women in the world like you, who aren’t looking to have a baby right now. Natural family planning may be an alternative. While it takes some research and know-how to go about it, it doesn’t have to be overwhelming.
If you’re looking to learn the ins and outs of natural family planning, we’ve got you covered. We’re here to share the lowdown on these methods, what’s involved, and what it takes to go about things the natural way. Step by step, you may realize there are more options than you originally thought.
What Is Natural Family Planning?
Natural family planning, also called fertility awareness, is a term related to a group of contraceptive methods that don’t involve taking any medications. It relies on the self-monitoring of your fertility signals to figure out the days you’re most likely to get pregnant, so you can avoid a surprise announcement (1).
The three primary signals you need to look out for in natural family planning are:
- Ovulation days, which you can determine by tracking your menstrual cycle.
- Basal body temperature fluctuations, which you’ll track on a daily basis.
- Cervical secretions, which you will also assess regularly.
Tracking and recording one or more of these will be the basis for most natural family planning methods. However, take note that some of the methods will be more effective if used in conjunction with another one. We will explain how to track these fertility signals in the following sections, and map the benefits and pitfalls as well.
Benefits and Disadvantages
Before choosing natural family planning as your birth control method, you must understand the pros and cons. Let’s take an in-depth look below.
Benefits of Natural Family Planning
- No Side Effects: Most forms of contraception come with a slew of physical side effects, but natural family planning has none. No chemicals, hormones, or devices are being used to change your natural processes. If you’ve previously had difficulty with specific birth control methods, natural family planning might be attractive to you.
- Reversible: When you’re no longer interested in preventing pregnancy, you can use the same system to get pregnant. Knowing your most fertile days of the month will help you when you’re ready to start your family or add to the family you already have. Plus, you won’t have to wait any length of time for your birth control effects to fade away.
- Acceptable for Religious Individuals: For those with religious restrictions when it comes to birth control, natural family planning may also be the way to go.
- It’s Empowering: Monitoring your fertility signals can bring about a new awareness of your own reproductive system. This knowledge can be rather empowering and, once you fully understand it, you can do all the monitoring on your own. You will no longer need a health professional to help you make sense of it all. The in-depth information that you gain from monitoring your bodily secretions will also help alert you to something being amiss. You will be able to spot possible infections or abnormalities much sooner.
- Budget Friendly: This method is inexpensive to start, and you don’t have to worry about budgeting to maintain it (2).
- Partner Inclusive: With natural family planning, your partner can also be engaged in the process, learning more about your cycle while strengthening your bond with each other. If the time comes to get pregnant, he will then be better prepared for action.
Disadvantages of Natural Family Planning
- No Protection From STIs: While using fertility awareness as your main form of birth control, you will not have any protection from STIs. If you’re not in a monogamous relationship, you could be leaving yourself open to contracting infections or diseases, like chlamydia or HIV.
- Requires Partner Cooperation: This method will also require cooperation from your sexual partner. There may be fairly long periods of abstinence or a backup method — like condoms — will have to be used. This means communication, patience, and trust are all important for success.
- Time Commitment: The learning curve on this one is a little steep. Following and tracking all of your fertility signs can be more challenging than popping a pill once a day. You will have to commit to learning about your body and keeping accurate records. When learning about the process, it may take you several months to confidently and accurately identify when you are fertile. If you aren’t using another form of birth control, you may also need to abstain during this time.
- It May Be Unreliable: Your fertility signs can be disrupted by many environmental factors. Stress, illness, travel, and hormone treatments can all change your body’s balance, throwing off your signals. Even using the emergency contraceptive pill will change the accuracy of your signals. You’ll need to wait for two menstrual cycles before you can rely on natural family planning again (source).
- Every Woman Is Different: For some women, the fertility signs may differ from the norm. Others may find the signals just aren’t overt enough to track. These differences can add to the possible complications of natural family planning.
Who Shouldn’t Use Natural Family Planning
Unfortunately, the natural family planning method doesn’t work with equal success for everyone.
The factors that may negate your natural family planning attempts can come from three main areas: your body, your medications, or your lifestyle. If one or more of the following conditions or situations apply, NFP may not be right for you.
The systemic reasons why you should not use this method include:
- Your periods are irregular more often than not.
- You are currently breastfeeding or are newly postpartum.
- You recently had a miscarriage or an abortion.
- You have short or long-term conditions that affect your fertility, like pelvic inflammatory disease or a vaginal infection.
- You have cardiac disease, or your blood pressure is poorly controlled.
Some of these health-related factors are temporary, like having a vaginal infection. It’s possible you could begin natural family planning after a waiting period. You could start tracking your fertility signals to monitor when the condition has cleared.
Some medications make it hard to track your fertility signals, or they may even change them. This could put you at risk of getting pregnant. Natural family planning may not be right if:
- You’re taking a medication that could pose a health risk to a fetus (4).
- The medication you’re taking disrupts your body’s production of cervical mucus. Your doctor should be able to tell you if this applies to you.
- You recently stopped taking a hormonal contraceptive.
If your medication is a possible concern, speak with your physician. He or she may be able to change your prescription to something more suitable.
Finally, you may want to choose an alternate method of birth control if you:
- Regularly travel through different time zones.
- Are unable to take your temperature with an oral thermometer.
- Currently have multiple sexual partners.
- Consume more than eight alcoholic beverages per week (5).
You probably can’t do anything about the travel aspect, especially if it is work-related. However, if your alcohol consumption is holding you back, that can be adjusted so NFP could be an option.
If your goal is to definitely use natural family planning for birth control, don’t hesitate to speak with your doctor. He or she might have suggestions to help you with your NFP struggles.
Natural Family Planning Methods
Before we can explore each of the natural family planning methods, we need to understand the menstrual cycle. While you probably got that little overview in health class when you were a kid, it might not be sufficient.
Understanding the Menstrual Cycle
The menstrual cycle is the natural process by which your body prepares for a potential pregnancy. The cycle begins on the first day of your period and continues until the first day of your next period.
Typically, one’s cycle lasts approximately 28 days, give or take a few days on either side. For this day-by-day breakdown, we will use that measurement.
This is the first day of your period. The uterus has begun shedding blood and tissue.
The power players- estrogen and progesterone- are at a low point are at a low point, and you may feel irritable or depressed. The doom and gloom can be the pits, but rest assured it’s normal.
While most women will still be menstruating on days two through five, action is taking place within the ovaries. Follicles (fluid-filled pockets) are forming and each of these follicles contains an egg (6).
Fatigue and cramping are common during this time. Hold tight ladies, it won’t last long and relief is on its way.
Most likely your bleeding will stop at some point within these three days. One of the follicles will continue to grow, except in the case of twins where two lucky eggs will thrive, but the ovaries will reabsorb the others. Your estrogen levels start to rise and relief from the bad moods will likely be felt.
The remaining follicle is growing larger, and your estrogen levels continue to ramp up. Once again, the lining of your uterus will begin to thicken and grow, preparing itself for the possibility of an impending embryo. With the influx of estrogen in your system, you may feel more energized and happy.
Your uterine lining continues to grow to create a safe space for the embryo to land. As you get closer and closer to day 14, your estrogen levels will peak. LH, or the luteinizing hormone, will rise sharply, an indication that an egg is on the way.
The excess LH in your system will cause the follicle to burst and your egg to be released into the fallopian tube. You are now ovulating and your egg is prime for pregnancy for the next 12 to 24 hours. As a result of these changes, you may be feeling at your best during this time. Some women notice that their sex drive peaks when they are close to ovulation– it’s like nature’s trick to get you pregnant.
These are the travel days for your egg. Fertilized or unfertilized, it will make its way down the highway of fallopian tubes and into your uterus.
The rupturing of the follicle will cause your body to produce more progesterone, speeding up the process. At this time, the lining of the uterus will continue to thicken, preparing for implantation.
If a sperm happens to meet your egg while in the fallopian tube, that fertilized egg will then have a cozy place to land once in the uterus. Once attached, pregnancy has begun.
If your egg was not fertilized, it will start to break apart once it reaches the uterus. Your estrogen and progesterone levels will go back down, and you may feel the effects of PMS, including irritability, anxiety, and bloating. Have no fear though, this most likely means you aren’t pregnant.
The unfertilized egg will then prepare to exit your body, along with the lining of your uterus, and you’re back to day one when bleeding occurs again.
Now that you’ve had a quick refresher course about what happens during your cycle, let’s look at NFP planning methods, beginning with the calendar method.
Also known as the rhythm method, this is a little complex and can take six to 12 months of prep work (7). You will need to track the start date and finish date of your period each month, in order to accurately predict your most fertile days.
Since eggs only live for 24 hours, there is only a single day of the month when you can get pregnant. But before you get too excited, sperm can live in the body for up to five days and lie in wait for the incoming egg (8). To avoid pregnancy, you would need to abstain from unprotected sex for a specific amount of time, determined by a calculation.
Once you have your baseline data, you apply the calculation. For explanation purposes, we will use 25 days as the shortest cycle and 31 days as the longest.
The rhythm-method calculation:
- Find your shortest cycle of the months you were tracking (25 days) and subtract 18. This gives you seven.
- Subtract 11 from the longest period day count (31 days), which gives you 20.
- In this instance, your first “fertile day” is 7 days after the start of your period, and your last “fertile day” is 20 days after the start of your period.
- You and your partner will then abstain from unprotected sex during those “fertile days.”
This method requires you to be exact with your record keeping. However, keep in mind that your period can vary slightly. You will need to update your calculations each month.
If you are thinking about using any of these methods, start tracking your period. It makes everything more manageable if you’re going into this armed with data! Everyone should be familiar with their menstrual cycle.
Some medical conditions can affect your cycle and the possibility for success with this method. If you have an eating disorder or thyroid disease, we recommend trying something else. For those who are breastfeeding or have recently stopped using hormonal birth control, speak with your physician first.
If for any reason, you tend to lose or gain weight rapidly, it may not be a good fit either. Other factors include regular strenuous exercise, like a professional athlete would take on, which may also prevent accurate readings.
If you’ve had difficulty remembering to take the pill, this method may take some discipline as well. The best way to make it work is to use it in conjunction with one of the other methods included here.
Your body’s natural month-to-month variations might make your calculations inaccurate. Getting the days wrong can happen. There is a 24 percent chance this method will fail and you’ll find yourself pregnant (9).
While 24 percent is an impressive number, typical use of male condoms has a 13 percent fail rate, respectively. (source) It’s all about what risks you are willing to take. If you go without contraception, there is an 85 percent chance that you WILL become pregnant!
Women, who have migraines with vision changes, cannot be on hormonal birth control due to their risk of stroke. However, pregnancy can be an equally dangerous condition for some. The risk is relative to your medical history and comfort level.
For some women, natural family planning is the right choice. In my case, I am a personal fan of fertilityfriend.com!
Editor's Note:Caitlin Goodwin, MSN, RN, CNM
To use the calendar method, you can use a regular calendar or journal, or you can download a tracking app, which we will discuss further on.
This method incorporates a daily temperature reading, to indicate when you may be ovulating. To make this method most effective, you will need a basal thermometer.
This type of thermometer is necessary because it has accurate results to the 1/100th of a degree. Due to the need for strict accuracy, ear or forehead thermometers won’t be precise enough (10).
Ovulation can cause your temperature to go up by nearly a whole degree. On the days following ovulation, your temperature may go down by 0.4 degrees Fahrenheit.
To create an accurate record, you will need to take your temperature with the basal thermometer every morning. It needs to be done immediately upon waking and before you get out of bed. You shouldn’t eat or drink anything before taking your temperature.
These daily measurements will be used to track your averages. It could take several months to see the subtle fluctuations.
The basal temperature method does have a few flaws. On days you are ill, especially with a fever, your temperatures won’t fit accurately into your record keeping.
Plus, it is a sensitive measurement. Other factors could disrupt your normal temperature cycle. We’ve listed a few here:
- Waking at different times for various reasons.
- Drinking alcohol the night before.
- Sleeping in a room that is hotter or cooler than usual.
All the lifestyle and systemic fluctuations make this difficult to use on its own. It could easily pair with another natural planning method as a double-checking measure, though.
Similar to the other methods listed so far, good record keeping is necessary here. You will need to check the mucus coming from your cervix on a daily basis to estimate where you are in your cycle.
How to check your cervical mucus:
- Start with washed hands. Your fingernails should be trimmed short.
- Find a comfortable position. Some prefer lying down or sitting on the toilet.
- Insert your finger into your vagina until you can feel your cervix. Your finger will likely be inserted up to the middle knuckle.
- Touch the side of your cervix and then remove your finger.
- Assess your cervical mucus for consistency and color.
The changes in your cervical mucus will typically be progressive:
- Immediately after your period: This is the lowest point of mucus production. You may not notice any mucus at all, or it might be cloudy and slightly sticky.
- As ovulation nears: The mucus production is picking up, and it will feel more moist. It might be creamy in appearance.
- During ovulation: Immediately before you ovulate, mucus production is at its best. It will be clear and similar to egg whites, stretchy. If you have cervical mucus on one finger, you can touch the other finger to it and pull apart. It should stretch between the two fingers.
- Post-ovulation: As you move further away from your fertile days, the mucus production declines and becomes thicker in consistency again.
Some women do not produce much cervical mucus. If you fall into that category, it may be difficult to assess it for your record-keeping efforts. There are a few things that can affect your mucus production:
Staying hydrated is crucial. Make sure you drink water throughout the day. There are also dietary supplements, like “FertileCM,” that can be taken to stimulate production (11). One thing to note, improving cervical mucus is also a tactic used to better your chances of conceiving, so watch out.
Using a spermicide or douching can change the consistency and appearance of your cervical mucus. It can also wash it away. Plus, they are prone to mess with your body’s natural pH, increasing your risk of infection.
Lactational Amenorrhea Method
If you choose to breastfeed after giving birth, you may be practicing the lactational amenorrhea method without even realizing it. Lactational amenorrhea is the suppression of naturally-occurring hormones and a normal menstrual cycle due to breastfeeding (12). It’s triggered by the sucking of the nipple.
It generally only lasts for the first six months of breastfeeding and, for some women, their periods stop completely. If you are exclusively breastfeeding your baby, this method may be for you.
To keep your hormones from restarting your cycle, you’ll need to breastfeed, not breast pump, often. You should average every four hours in the daytime and at least every six hours at night. If you keep up the rigorous schedule, your body probably won’t release any eggs (13).
However, it’s important to note this method will become completely unreliable once the baby is six months old. Plus, once you introduce food other than breastmilk, or you start your period, it is no longer viable.
Something to keep in mind
This probably isn’t news, but the withdrawal method is when the man withdraws the penis from the vagina before he ejaculates. The goal is to keep the sperm from ever getting a chance to enter inside.
People use this method because it is free. Also, it doesn’t have any side effects, and it doesn’t require a prescription. It doesn’t require any record keeping or monitoring of the body’s systems.
Unfortunately, it also isn’t highly effective. It requires a lot of awareness and self-control on the part of the male. Plus, it is also possible that the second round of intercourse without urination in between has sperm present in seminal fluid.
The statistics aren’t good on using this one alone. As many as 28 out of 100 women will become pregnant when this is their primary form of birth control (14).
That said, the withdrawal method combined with another natural family planning method could increase the effectiveness of both methods.
The sympto-thermal method of natural family planning is a combination of three of the methods described above. It includes the calendar, basal temperature, and cervical mucus methods.
When using STM, you chart all the fertility signals required of the methods listed above. You then use the combination of the three different signals to show you the entire picture. Being able to see all the signs will give you more confidence in plotting your fertile days.
Using this method will take a lot of diligence and accurate record keeping. Do you have any of the factors that make your readings inaccurate? As stated above, issues like having irregular periods or traveling often mean this method may not be as accurate for you.
Statistically, however, when used accurately, this is the most effective form of natural family planning, with a 99 percent success rate in avoiding pregnancies.
Technology: Using Apps
Just like everything else in the world, when it comes to tracking ovulation, there’s an app for it! If you’d like to involve technology, there are a lot of apps for tracking your cycle.
The majority of the apps focus on helping you conceive, but you could easily flip the data to avoid conceiving. Here are a few of the most popular apps:
- Kindara: Focuses primarily on basal body temperature, and it can sync automatically with a smart thermometer.
- Clue: Collects data about your fertility signs and mood to make its calculations. You can use it with your Apple Watch.
- Natural Cycles: Uses your temperature readings to create an algorithm to predict your fertility. This app is marketed as a birth control app.
You could consider these apps as supportive in determining your most fertile days. As always, we recommend you use them in conjunction with other natural family planning methods, not instead of them.
How Effective Is Natural Family Planning?
The proof is in the pudding, right? To decide which method is for you, efficacy is the key deciding factor. So, let’s take a look at these natural planning methods and some traditional methods to see how they stack up.
All birth control methods are only as good as the consistency and accuracy of their use. Remember that the percentage of people who fail will include people who didn’t use them correctly, so it’s important to take it seriously.
Here are the statistics on medical or barrier birth control methods (15):
- Tubal Ligation: Less than 1 percent of women become pregnant each year after being sterilized.
- IUD: Less than 1 percent of women become pregnant with an IUD.
- Birth control pills: Seven out of 100 women will become pregnant while using pills.
- Male condoms: 13 out of 100 women will become pregnant while using a condom.
Let’s see how natural family planning methods compare:
- Calendar method: 13–24 out of 100 women become pregnant using this method alone (16).
- Basal temperature method: 24 out of 100 women will become pregnant using only the basal temperature tracking as their form of birth control (17).
- Cervical mucus method: 23 out of 100 women will likely become pregnant when only monitoring their cervical mucus (18).
- Lactational amenorrhea method: For the first six months after childbirth, only 2 out of 100 women will become pregnant (19).
- Withdrawal: Up to 25 out of 100 women become pregnant each year while using this method as their sole form of birth control (20).
- Sympto-thermal method: One out of 100 women will become pregnant while using the sympto-thermal method (21).
- Using Apps: As these are quite new, the statistics are limited. However, the FDA did study the Natural Cycles app before approving it. Women using the app ended up pregnant at a rate of two out of 100 (22).