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Fertility Awareness
Fertility awareness (natural family planning) is a way of predicting ovulation, to work out when pregnancy is more likely
The method involves recording signs of fertility such as body temperature, thickness of fluid in the vagina, and calculating fertile times from menstrual cycle dates.
Teaching from a qualified fertility awareness teacher is recommended.
Fertility awareness can be very effective (with daily monitoring)
What You Will Get
Positives
Non-hormonal method
There are no side effects
The method involves learning how the body works
Skin to skin contact
Acceptable in most religions and cultures
Can be useful when trying to become pregnant
Negatives
It can be tricky to learn, and takes a few months to monitor patterns
May have a higher risk of pregnancy
Daily monitoring is needed (temperature, thickness of fluid in the vagina)
Illness, stress or travel can make it hard to interpret records
More difficult to use if cycles become less predictable as you get older
Unprotected sex must be avoided on the most fertile days
No protection from Sexually Transmitted Infections
To work best it should be taught by a qualified fertility awareness teacher
Are mobile phone apps reliable?
Fertility awareness apps indicate likely fertile times. There are hundreds of apps for monitoring periods, but most apps are unregulated.
To rely on fertility awareness, it is important to record two or more signs of fertility. For example, the Natural Cycles app records morning temperature as well as period dates. There has not yet been enough research to know how reliable this app is at preventing pregnancy.
Apps which only record period dates are not reliable enough to be used for contraception (21% accuracy). This is because the time of ovulation can vary from month to month, and from person to person, depending on biological and lifestyle factors. To estimate the time of ovulation with accuracy, an app must have as much evidence as possible about the app user’s period dates and other signs of fertility.
Apps are a really good way to learn more about your body and the menstrual cycle, but for pregnancy prevention, it is necessary to use one which records period dates and at least one more sign of fertility, such as temperature or vaginal fluid.
It is a good idea to discuss apps that you use for contraception with your doctor.
Which other methods are hormone-free?
If you’re keen to avoid hormones, contraception methods like the copper coil or diaphgram might suit you.
Good to know
Fertility awareness requires careful monitoring of the body’s patterns.
How much effort is Fertility Awareness?
Fertility awareness methods require close attention to patterns over time.
Monitoring involves recording body temperature first thing in the morning, feeling the thickness of fluid in the vagina, and recording the pattern of periods, to work out when it is likely that an egg will be released (ovulation). Fertility awareness is more effective when two or more of these signs of fertility are monitored.
You need to record patterns for at least three months before starting to rely on predicting the fertile days. If you have recently stopped using a hormonal method of contraception it takes longer to be able to predict fertile times accurately.
Fertility awareness does not work if hormones are taken at the same time, because the hormones will alter all of the signs of fertility.
There are fertility charts and mobile phone apps that can help track the changes and to predict fertile days.
To be effective, unprotected sex must be avoided around the most fertile days. This means typically avoiding unprotected sex for 8-9 days in a month, to allow for the time that sperm can survive, added to the time that an egg can survive.
How effective is Fertility Awareness?
Fertility awareness is generally not as effective as hormonal or long-acting methods of contraception.
When used perfectly, fertility awareness is between 91% and 99% effective, meaning that if 100 people used fertility awareness for a year, between 1 and 9 of them would become pregnant.
It takes commitment to use the method effectively, but it is a reliable method when used with attention to detail. However, allowing for the ups and downs of life, the method is around 76% effective, meaning that if 100 people used fertility awareness for a year, around 24 would become pregnant.
How does it work?
Fertility awareness works by calculating when it’s safer to have sex (when pregnancy is unlikely), and when to avoid penetrative sex or use another method (like condoms).
How effective is it?
Using copper coils (IUD), typically fewer than 1 in 100 will get pregnant in one year.
Using hormone coils (IUS), typically fewer than 1 in 100 will get pregnant in one year.
Using condoms, typically 15 in 100 will get pregnant in one year.
Using mini-pills, typically 9 in 100 will get pregnant in one year.
Using the implant, typically fewer than 1 in 100 will get pregnant in one year.
Using combined pills, typically 9 in 100 will get pregnant in one year.
Using patches, typically 9 in 100 will get pregnant in one year.
Using vaginal rings, typically 9 in 100 will get pregnant in one year.
Using diaphragms, typically 12 in 100 will get pregnant in one year.
Using fertility awareness, typically 24 in 100 will get pregnant in one year.
Using the withdrawal method, typically 22 in 100 will get pregnant in one year.
Frequently Asked Questions
How can I have lighter periods?
Most hormonal contraception is very good at making periods lighter.
The body’s hormones naturally go up and down. The hormonal methods of contraception work by levelling the ups and downs, and by stopping an egg being released (ovulation). The hormones in contraception are very similar to the body’s natural hormones, but the levels are steady instead of up and down. The steady level of hormones usually means that period bleeding is lighter, and also less painful.
The implant, pills, patches, and the ring are all ‘low dose’ methods. The lowest hormone level of all the methods is the IUS (hormonal coil) which is released into the womb slowly over 5 years.
Recommended methods:
Can I control when I have a period?
There’s no need to have a period every month – on the pill, patch or ring it’s easy to control when a period comes, by taking the method continuously without a break. A period will come when you stop the method (for a week).
You can decide when a bleed will happen, and can also take the pill, patch or ring continuously to temporarily stop your periods.
It’s safe to use two or three pill packets back to back to delay a period, going straight from one packet on to the next with no break (or changing the patch once a week with no break, or using the vaginal ring continuously).
The Combined Pill, The Patch and The Vaginal Ring are best for controlling when periods come, since these contain the hormone oestrogen.
Recommended methods:
How can I stop my periods?
Hormonal contraception makes it possible to have no periods at all.
Some methods are quite likely to stop periods so there is no bleeding at all, or only occasional light bleeding. The best method to stop periods is the Injection. Almost half of users (47%) will have no periods after a year of using the injection. The implant can also cause a pause in periods – periods will stop for about one in five users, and more than half have bleeding which is light and less frequent. Implant.
Periods can be delayed by using the The Combined Pill, The Patch or The Vaginal Ring continuously. So for example you can choose to have a period once every three months only.
It is safe, and there is no harm to future fertility in having a break from periods. When there is no period, the lining of the womb stays thin – blood doesn’t build up inside the body. There are some benefits to stopping periods – less bleeding helps to save iron (many people are anaemic because of their periods). Once the contraception is stopped, the body returns to it’s normal cycle. Periods.
Having no periods on contraception is a temporary effect which is completely reversible, and makes no difference to future fertility – having no bleeding does not affect the chance of getting pregnant in future. All of the methods are very quickly reversible (except the injection – it can take a few months to get periods back again).
Recommended methods:
Which methods can make breasts bigger?
The Combined Pill, The Patch or The Vaginal Ring can make breasts bigger, since these contain the hormone oestrogen.
Oestrogen can make breasts feel tender and swollen, particularly at first.
Recommended methods:
How can I treat Premenstrual Syndrome?
Premenstrual Syndrome is shortened to PMS. It’s also known as PMT (premenstrual tension).
The body’s hormones naturally go up and down. There’s a lot more progesterone in the week before a period, and that can cause pre-menstrual symptoms like bad moods and hunger. Hormonal contraception works by levelling out hormones, and so can be ideal for reducing PMS/PMT.
Some people get mood changes when they are not on hormonal contraception, and some get mood changes when they are on hormonal contraception. Often swapping to a different method solves the problem (e.g. choosing a different brand of pill)
These methods can help with PMS:
Recommended methods:
Which methods are the easiest to keep secret?
The Injection
The injection is the most invisible – there might be a tiny plaster put over the injection place (usually on the bum), but that’s all.
The Implant
The implant is on the inside of the arm, just under the skin – sometimes there is a small scar where it’s gone in, and you can sometimes see the outline of it if you have slim arms. In people with darker skin, a visible line can develop where the implant is resting. Since it’s on the inside of the arm, the implant is discreet.
Coils (IUD/IUS)
Coils are put into the womb, so cannot be seen. Occasionally a partner can feel the thin string of a coil during sex, and if this happens, it can be cut short so they don’t feel it.
Recommended methods:
Which methods are best at preventing pregnancy?
Nearly half of all pregnancies are unplanned (45%) – but that doesn’t necessarily mean that they are unwanted.
- If an unplanned pregnancy would be a big concern, the implant, the injection, the IUS and the IUD are the best at preventing pregnancies. Because they are long acting, you don't need to remember to use them every day
- As long as they're taken correctly, the combined pill, the patch, the contraceptive ring, and the mini pill are also great at preventing pregnancies
- If you want to delay getting pregnant, but want to get pregnant within a few months, the combined pill, the patch, the contracepive ring, and the progestogen only pill might be suitable as they come out of the body's system very soon after they are stopped, meaning that levels of fertility return to normal very quickly and might help with planning or delaying getting pregnant
- If pregnancy could be a happy accident, condoms, the diaphragm, fertility awareness and withdrawal are generally less effective methods of contraception, and so could be suitable
- Currently, contraceptive options for men are limited to condoms, withdrawal, or sterilisation (which is permanent). An unplanned pregnancy can cause stress for both both partners, and using contraception such as condoms is a way for men to have control over when they become a father. Men can talk to their partners about when they would like to have a baby, and ask them about preferred methods of contraception
Recommended methods:
Contraception and breastfeeding
Do I need contraception if I’m breastfeeding?
Breastfeeding can help to delay when you start ovulating and having periods again after giving birth.
Breastfeeding can help to prevent pregnancy on three conditions:
- If your baby is less than six months old
- If you’re fully breastfeeding (only giving your baby breast milk)
- If you haven’t had your first period since giving birth
Breast feeding can be 98% effective in preventing pregnancy if all three conditions apply. But the risk of pregnancy becomes higher:
- if you are breastfeeding less often
- if there are long intervals between feeds during the day or night
- if the baby is having other liquids as well as your breast milk
- if your periods return
Once your baby is more than 6 months old, you will need to use another contraceptive method even if you are fully breastfeeding and haven’t had a period.
Which methods are safe if I’m breastfeeding?
The contraceptive implant, injection, progestogen-only pill, IUD, IUS and condoms are safe if you are breastfeeding. If you’re using a hormonal method of contraception, a very small amount of hormone will enter the milk, but this has not been shown to be harmful to breastfed babies.
Emergency contraception (IUD and emergency pills) are safe when breastfeeding. If you use the IUD or emergency pill containing levonorgestrel you can continue to breastfeed normally. If you use the emergency pill containing ulipristal acetate (ellaOne®) you should not breastfeed for one week after taking it. During this week you should express and discard your breast milk, because the effects of ellaOne® on breastfed babies have not been studied.
Which methods are not suitable?
The combined pill, contraceptive patch and vaginal ring may make it harder for your milk to come in (because they contain the hormone oestrogen). So if you’re breastfeeding, it’s best to wait until your baby is six weeks old before starting one of these methods.
Fertility awareness methods are less reliable while breastfeeding because it is difficult to identify the signs of fertility. You should have 3 normal, regular periods before using fertility awareness methods, and this is unlikely to happen in the first 6 months after giving birth if you are breastfeeding.
Recommended methods:
Contraception after having a baby
Many unplanned pregnancies happen soon after having a baby.
How soon is it possible to get pregnant again?
You can get pregnant as soon as 21 days after having a baby. It is possible to get pregnant before you have your first period and if you’re breastfeeding.
Which methods can be started immediately after having a baby
The contraceptive implant, injection, progestogen-only pill and condoms can be started immediately after having a baby.
The IUD and IUS (coils) can be fitted at the time of a caesarean section or immediately after a vaginal birth. If they are not fitted within the first 48 hours, fitting should be at least four weeks after giving birth.
Emergency oral contraception (Emergency pills) are safe after having a baby but are not needed until 21 days after birth. All oral Emergency Contraception can be used after 21 days and the IUD can be inserted 28 days after birth. Emergency Contraception containing Levonorgestrel is not known to be harmful when breastfeeding.
Which methods are not suitable after having a baby?
The combined pill, contraceptive patch and vaginal ring should not be used in the first 3 weeks after having a baby. This is because the risk of blood clots is higher after giving birth. Those who have had uncomplicated births, with no risk factors for blood clots and who are not breastfeeding may be able to start as early as 21 days following birth. However, if you are at increased risk of blood clots, you may be advised to wait 6 weeks before starting one of these methods. Speak to your doctor or nurse who can advise you.
The diaphragm is not recommended in the first 6 weeks because the cervix (neck of the womb) and vagina change shape and size during pregnancy and birth. These changes make the diaphragm less good at preventing pregnancy.
Fertility awareness methods are less reliable after giving birth because it is difficult to identify signs of fertility. You should have 3 normal, regular periods before using fertility awareness methods.
How long should I wait before getting pregnant again after having a baby?
The advice is to ideally wait for 24 months, or at least 12 months, before becoming pregnant again. This is because if you get pregnant again quickly, the next baby might be too small, or be born too soon.
Leaflet: Contraception after having your baby
Recommended methods:
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