Thoughts On The Calendar Method

Over the last few months I’ve talked to several women who have told me that they “count their days” as a natural form of birth control. By this I assume they mean they are practicing some form of the calendar or rhythm method. These methods attempt to use past cycles to predict when a woman will ovulate and by abstaining from intercourse during this time each month. I would like to make something clear: although “counting days” can sound a lot like Natural Family Planning (NFP), it is actually very different and a lot less effective. Here is why:

1- The calendar method assumes a “normal" cycle with ovulation occuring the same day each month, typically day 14. In reality, even with a very regular cycle, a woman’s ovulation day can be days earlier or later than this, and can fluctuate depending on diet, stress and other factors – making the calendar/rhythm method even less accurate. And if a woman does not have a “normal” 28-day cycle, proper NFP methods become even more important.

2- The calendar/rhythm method leaves out several important factors. For instance, some women think that they can have intercourse up until the time they’ve ovulated. This seems reasonable because, how can pregnancy occur if there’s no egg yet for the sperm to fertilize? But sperm can live up to 5 days after intercourse, making the few days leading up to ovulation part of the most fertile phase – even though the egg is completely absent at the time of intercourse. Add to this the fact that the woman's egg can live for up to 24 hours after ovulation and you have a window that’s even harder to predict using the calendar or rhythm method. These factors are crucial in determining a woman's actual fertile time.

3- By miscalculating a woman’s fertile time, the calendar/rhythm method may actually lead couples to have intercourse during the days that pregnancy is most likely to occur.

4- It is possible that the calendar method may lead couples to abstain for longer than necessary since it is based on the woman's past cycles, not her current fertility signs.

Overall, the calendar method just isn't very effective. It’s an outdated guessing game that leaves couples at the mercy of a calendar. Although the calendar method is often equated with Natural Family Planning, NFP is actually very different. Instead of using past cycles to predict fertility, NFP uses a woman’s current biological indicators to determine when she is actually fertile. The difference between the two methods is evident when we examine their effectiveness rates-- NFP is 98% effective while the calendar method is only about 80%-90% effective.

For more on the effectiveness of NFP see my past blogs or read more here.

Natural Family Planning Made Easy

Over the last year Mark and I have had the opportunity to introduce several of our friends to Natural Family Planning, including three engaged couples. If I have learned one thing from this experience it's that NFP can get very confusing very quickly. In this post I hope to lay out the basics of NFP in an attempt to make it less confusing for those of you who are in the process of learning. This is by no means an extensive explanation of how or why NFP works, but it will give you an overview of the most important information you need to know to get started. I can not stress enough how important it is to do further study for yourself if you choose to make NFP part of your marriage. It is important to take a class, meet with an NFP doctor, or at least buy a book on the subject to learn more. I always tell couples that one of the reasons Mark and I are so confident in NFP is because of how much we have studied it-- we have taken a class together, I met with an MD for several months to review my charts, I bought a book, and I have an NFP-certified RN I still contact with questions occasionally. Basically, we've had several experienced medical professionals patiently and graciously teach us everything we need to know. So if you want to feel confident about NFP, I recommend doing more than reading this blog.

I must also add that although NFP can be used to achieve pregnancy, this post is geared towards those who want to use NFP to avoid pregnancy. It is also important to note that the rules and observations for postpartum women are slightly different than the ones listed here.

 Let's get started.

Supplies:

One of the things that is great about NFP is that it doesn't cost very much. There is only one item that you really need to buy--a basal body thermometer. The total cost should be $10-$20, depending on which thermometer you buy. Here are a couple that have worked great for me:

Nexxare Basal Thermometer

BD Basal Digitbal Thermometer

Walgreens Basal Digital Thermometer

 
In addition to a thermometer you may choose to buy a fertility monitor. This isn't absolutely necessary (NFP is still 98% effective without the monitor), but it does give you extra assurance, which is especially nice when you are first learning. My NFP instructor recommends the Clearblue Easy Monitor. It is a little costly upfront, but after the first couple of cycles you do not need to use it nearly as often, so you do not need to buy refills every month. I only have to buy refills about every 4-5 months. Again, this isn't a must-have.

Lastly, if you don't start off by taking a class right away, at least buy this book. It will help with unexpected questions.

Cycle Basics

The first step to learning NFP is understanding the cycle a woman's body goes through approximately every 28 days. Knowing this pattern is key to understanding when a woman is fertile, and therefore able to become pregnant. During her cycle a woman has her period, which is usually 5-7 days. After this, she is infertile for the several days leading up to ovulation which usually happens around day 14. During ovulation an egg is released from the woman's ovary which lives for 12-24 hours. This is the only time during her cycle that a woman is actually able to become pregnant. This event is followed by another infertile period.

The Fertile Window

NFP works by identifying when a woman is fertile each cycle (her "fertile window"). This allows couples to choose to abstain from intercourse during this time so that they don't conceive. The length of a woman's fertile window is usually about one week long, give or take a day or two.

Identifying the Start of the Fertile Window

At this point the natural question should be, "So how do I know when I am fertile so I can know when to abstain?" The answer is quite simple--cervical mucus (CM). My apologies to the gentlemen, but this is very important.

Through the course of her cycle a woman will observe several different kinds of CM. It will begin to appear several days before ovulation and start out sticky before turning creamy, and then to an egg white consistency. Egg white CM is the most fertile kind and it exists for the purpose of keeping sperm alive.

Without the presence of CM sperm can only live inside the woman for a matter of hours, but if the sperm is met by fertile CM then it can live for as long as 3-5 days. This means that if a woman has sex several days before ovulation her CM may keep her partner's sperm alive long enough for it to still fertilize the egg once she does ovulate. 

The rule is simple: Couples wishing to avoid pregnancy should start abstaining as soon as cervical mucus is present because this means ovulation is approaching. 

I don't want to gross anyone out with a picture, so if you need help identifying the different kinds of CM, click here.  

Identifying the End of the Fertile Window

The fertile window ends after the woman has ovulated and the egg has had adequate time to die. Because the egg can live for 12-24 hours, it is best to wait three days after ovulation has occurred before resuming intercourse. 

This is where the thermometer I mentioned earlier comes into play. A woman can know when she has ovulated by tracking her basal body temperature (BBT, or in regular people terms, her waking temperature).

During ovulation the woman's body releases a hormone (progesterone) which causes a rise in body temperature. Once a woman sees this rise in her temperature she has ovulated. After recording three consecutive temperatures that are higher than her previous six temperatures, couples can resume intercourse. The temperature pattern may look something like this:

Again, the rule is pretty simple: You may stop abstaining three days after your temperatures rises because this means that ovulation has occurred and the egg has had enough time to die. 

A Note on BBT

 Taking your temperature really isn't that difficult, but here are some important things to remember:

•  Use a Basal Body Thermometer, which can be found at any drug store or online.

• Starting the day after your period ends, take your temperature every morning when
 you wake up. For the most accurate results, try to take it at the same time each morning 
(Your temperature goes up the later you sleep.) 

• Take your temperature before talking, eating, drinking, or moving around too much 
for best results. 

• Record your results on your chart. (Most thermometers have a recall option, so you don’t 
have to write the results down right away.)

Charting 

Remembering your mucus pattern and temperature each day is going to be really difficult if you don't record it on some kind of chart. Thanks to modern technology, charting is actually very easy. There are several free charting websites such as fertilityfriend.com and apps like FertilityFriend and Kindara. With the push of a few buttons you can record your temperature, mucus observations, and when you have intercourse. These apps also allow you to record fertility monitor results, pregnancy tests, mood, amount of exercise, medications, and just about anything else you can think of. They are very easy to customize, and did I mention they are free? 

 

Summary

Overall, NFP is pretty easy once you get a hang out of it. The rules are simple: Begin abstaining whenever CM is present. 
Stop abstaining 3 days after ovulation (which can be determined via BBT). Chart it. Repeat.


Want to learn more by taking a class? Find one here.

Want to meet with an NFP-only MD? Find one here.
Want to know how I got started on this crazy adventure? Read about it here.

Natural Family Planning

Let me start by stating that I recognize that this is a touchy subject, especially for those of you who are on birth control. My intentions are not to condemn anyone for their use of chemical contraceptives, but rather to shed some light on an issue that seems to be tucked away in the darkness. My prayer is that this would be read with both an open heart and an open mind, and that selfish desires and ungodly insecurities would be recognized and put to death. May we seek to be imitators of Christ in all we do, no matter how uncomfortable the decision.  

The Journey

My husband and I first started looking into different methods of birth control after becoming engaged this past summer. We are both in school full time so we thought it would be best to wait a few years before having children. Most of the married couples we knew were on some form of chemical birth control and we assumed we would be eventually as well. The pill seemed like the best option since it has one of the lowest failure rates out of all contraceptive methods. As I began to research possible side effects of chemical contraceptives I already knew they could cause moodiness, weight gain and lowered libido, but I had also heard stories from my mother about women she knew who had died from pill related blood clots. I tried to brush the more severe side effects aside since they only affect a small percentage of women, but I still wasn't very comfortable with the idea of pumping my body full of synthetic hormones on a daily basis. 

I was still trying to talk myself into taking the pill for the sake of marital "happiness" when I came across something that was even more disturbing than the risky side effects—an "ethical considerations" link on the website of the American Pregnancy Association (an impartial non-profit organization not associated with any religious, political, or activist groups). The warning explained that the pill (along with all other forms of chemical birth control) does not merely prevent ovulation (and thereby prevent fertilization) but also works by thickening the woman’s cervical mucus and thinning the lining of the woman’s uterus, thus making it hard for a fertilized egg to implant. This means that, if there is a breakthrough ovulation (which doctors suggest happens 3-9% of the time) and a couple does conceive, the zygote (baby) will not be able to implant on the mother's endometrium where it continues to grow; instead it will be flushed out of the woman's body due to the hostile environment created by the hormonal contraceptive. 

I spent the next several days digging around on the FDA website and searching through the package inserts for various chemical contraceptive methods in hopes of finding something to counter what I had read on the APA website. To my dismay, the same description was plainly stated on the packaging: “It may thicken your cervical mucus, thin the lining of your uterus, inhibit sperm movement and reduce sperm survival. [It] may stop release of your egg from your ovary, but this is not the way it works in most cases" (This is from the Mirena IUD insert. The IUD's main function is to prevent implantation, not ovulation).  After expressing my concerns to my own OB/GYN (who is pro-choice) she responded by saying, "Yes, the birth control pill can prevent implantation, but it's okay because a fertilized egg is not a life, so you have nothing to worry about." She went on to pressure me to get on the pill so that I wouldn't ruin my life by getting pregnant or have to face the possibility of choosing an abortion. Whether she agreed with me or not, my doctor was clearly unconcerned with my religious and moral convictions about when life begins. I have found that both pro-life and pro-choice MDs tend to agree on what some chemical birth control pills do (e.g., cause the miscarriage of the zygote by altering the endometrium), the issue is, rather, whether or not the conceived zygote qualifies as a human person.

If you don’t believe that life starts at conception then miscarrying a zygote is probably a nonissue, but for those who believe that life starts at conception this isn’t something that can just be pushed aside.  This is a big deal — a really big deal. Taking chemical birth control would mean gambling with human life.  As I’m sure one can imagine, I was a little distraught. Mark and I were not ready to have children and seeing as condoms have nearly a 15-18% failure rate we didn’t see that as a very “safe” method. I am ashamed to say it now, but I found myself wishing there was a way to temporarily turn off my fertility for a few years (because being fertile is such a curse, you know). Thankfully, one of my husband's ethics books mentioned something called “Natural Family Planning” as a healthier and safer alternative to birth control. Mark and I were both skeptical assuming that NFP was nothing more than counting days like the "rhythm method," but we were also unwilling to compromise our moral convictions, especially if it meant knowingly taking a medication that may cause me to miscarry a child we had conceived.   

Since NFP seemed like the only option we had left, Mark and I decided to visit a free training class I found for us on this website with the Catholic Social Services.  The class consisted almost entirely of engaged and married couples. It was really interesting, and at times humorous, to see all the men actively engaging in the class and asking questions about their wife's reproductive system and what they could could do to help her track her fertility. It caught me a little off guard, but in a good way.  

To our surprise, our instructor began to explain that NFP has the same success rate as the pill— 97-99% (Here are some of the studies found in a leading European medical journal called Human Reproduction Today and others conducted by Marquette University). Petra Frank- Herrmann, who is the managing director of the natural fertility section of the Department of Gynecological Endocrinology at the University of Heidelberg, Germany, has stated, "The pregnancy rate for women who used the STM [sympto-thermal method] method correctly in our study was 0.4%, which can be interpreted as one pregnancy occurring per 250 women per year. Therefore, we maintain that the effectiveness of STM is comparable to the effectiveness of modern contraceptive methods such as oral contraceptives, and is an effective and acceptable method of family planning.” This is because, much to our surprise again, Natural Family Planning is very scientific and is much more advanced than the old-school "rhythm method."

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How It Works

In short, NFP works by monitoring just a few simple signs: cervical mucus, the Luteinizing hormone (LH), and waking body temperature (also called basal body temperature). While it's hard to predict ovulation, monitoring these signs will allow you to pinpoint the fertile time of each cycle. To avoid pregnancy couples should abstain (or use non-chemical barrier contraceptives like condoms or diaphragms if desired) during this fertile window of  5-7 days. 

Cervical Mucus

Cervical mucus starts to appear on the days leading up to ovulation. As soon as mucus is present the fertile window has begun. Though ovulation will not occur for a few more days, the cervical mucus is what keeps the sperm alive and healthy while it waits for the release of the egg during ovulation. The days right before ovulation are the most fertile days, so couples should start to abstain as soon as the cervical mucus appears.  
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LH

Another way to predict ovulation is by observing the LH hormone. This is a hormone that is released 24-48 hours before ovulation and can be tested using an ovulation kit or fertility monitor. When LH is present, a woman can be sure that she will ovulate within the next day or so. This isn't necessary for all women (most women do fine by just observing cervical mucus), but a fertility monitor can be used as an extra precautionary to determine the fertile days. 

Notice the extreme jump in temperature?

BBT

After ovulation the body produces the hormone progesterone, which causes a rise in body temperature. Women should take and record their waking body temperature every morning; the day after ovulation there will be a significant rise in temperature allowing women to pinpoint when ovulation has occurred (see image). Since the egg released during ovulation usually only survives for 24 hours (48 at most) couples should consider the three days following ovulation to be fertile days. Waiting for three days also takes into consideration the possibility of the woman’s ovary releasing a second egg. This is rare, but waiting the entire three days ensures that there is no chance of conceiving.

(For more on how to chart and observe fertility signs click here.) 

Sound like a lot of work? It's not, really; my daily NFP routine is actually quite easy. I take my temperature (orally!) every morning around the same time while lying in bed and then go straight back to sleep. Later I record my temperature on this (free) NFP app my doctor recommended. I also use the app to record all my other fertility signs that may be present throughout the day. There are only 3-4 days a month in which I test my LH levels with the help of my fertility monitor which takes all of 60 seconds. I input all the information on my iPod and let the app do all the charting for me. I can't imagine that doing any of this is any more inconvenient than remembering to take a pill. And even if it is, the benefits of using NFP rather than a hormonal contraceptive far outweigh what some might consider to be a slight inconvenience. 
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Mark and I have been practicing NFP for over a year now and love everything about it. I could go on and on about how great this decision has been for us as a couple, but for the sake of brevity I will just explain a couple of ways it has benefited us.
Aside from the most important benefit—avoiding abortifacients—NFP has really helped me maintain my overall health. Because I can physically see on my chart when I am under stress or dehydrated, I’ve been a lot more proactive about working out, eating right, and getting to bed at a decent hour because I can see how failing to do these things affects my cycle.

To my surprise, NFP has also helped me be a better steward of my time. During the week that I am fertile I spend more time studying, working and maintaining our home. I also try to let Mark work late these nights if he needs to. In fact, we both push ourselves a little harder during this time because being productive creates more free time to be with each other in the weeks to follow. We also spend more time with our friends during this week—I’ll get coffee with my girl friends and Mark gets to go out with the guys. NFP has definitely helped me manage our busy schedule.

A lot of people assume that couples that practice NFP have less sex than couples that use birth control. I can’t say for certain because I have never been on birth control, but there are several reasons why I think this is probably not the case. First, I know that charting makes me very aware of when and how often Mark and I are intimate. If we haven’t been together in a while, I know it because it’s on my chart and I see it every morning. Time flies for everyone, but it doesn’t seem to get away from us as much in this area. Charting has helped me to be more proactive about keeping things regular and often. Second, with NFP we are able to experience a “honeymoon” every month after our week of abstinence. Sometimes abstaining can be difficult, but we quickly learned that it is worth the wait.
There are also several great relational benefits to NFP, perhaps the biggest being better communication. Because pregnancy is a real possibility each month—not just some distant future idea—we discuss things like our finances, job insecurities, future goals, and fears quite often.
 
There are plenty of other benefits I could discuss. I could go on about how NFP has taught me that, opposed to what our culture has conditioned us to believe, it is possible for us to control our sexual desires. I could explain how NFP has taught me self-discipline, to love my husband better, and to be less selfish. It has helped me see how deeply Mark loves and respects me and has provided me with a way to do the same for him. It has changed the way I view marriage and children and has taught me to trust God more. For us, NFP has been about far more than avoiding dangerous chemicals; it’s been about loving each other better and growing in virtue. The relational, emotional, spiritual, and health benefits of NFP have been such a blessing to both of us that I can only hope others will soon catch on to what has been a life-changing decision.

Additional Resources:
Embryo: A Defense of Human Life by Robert P. George and Christopher Tollefsen
Does The Birth Control Pill Cause Abortions? by Randy Alcorn
Defending Life by Francis Beckwith
Ethics For a Brave New World by Feinberg and Feinberg
Biomedicine & Beatitude by Nicanor Pier Giorgio Austriaco, O.P.
http://onemoresoul.com/
http://www.ccli.org/
http://www.fertilityfriend.com/
http://nfp.marquette.edu/
Find an NFP training class- http://register.ccli.org/