Betty Dodson with Carlin Ross

Better Orgasms. Better World.

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Dear Dr. Betty,

I love your blog and website! While perusing around I found a post from Feb 1 2008 about the rhythm method discrediting "natural method birth control." I agree the rhythm method stinks but there needs to be accurate information about there about natural birth control methods, such as the Fertility Awareness Method. I know the post is old news but the criticisms of the original poster spread a message about natural birth control that is negative because she is criticizing a method that has been widely recognized to be outdated.

You probably have heard about the Fertility Awareness Method (also called FAM, see Taking Charge of Your Fertility by Tony Weschler, www.tcoyf.com). This is NOT the same as the rhythm method, calendar method, billings method, etc. In the old days, it was thought that a cycle was always regular and ovulation happened at the same time every month. This is what the original poster was referring to, also called the the Rhythm Method. It was an ineffective method of predicting the current cycle's fertile phase based on *past* cycles. And yes, a lot of women got pregnant using it.

Improved scientific understanding of the monthly cycle has shown that this is not the case: ovulation can be delayed by stress, illness, medication, etc. These "irregularities," however can be detected by observation of three fertility signs (see below). FAM relies on charting cervical fluid(and position) and basal body temperature. Fertility is determined on a day-to-day basis using FAM and contraceptive decisions can be made accordingly.

The FAM is based on the following scientific principles:
1) A woman's menstrual cycle is influenced by estrogen and progesterone. Estrogen dominates the first (follicular) phase of the cycle and progesterone the second (secretory or luteal) phase. Luteinizing hormone catalyzes ovulation.

2) A woman produces three primary fertility signs that signal impending and completed ovulation: basal body temperature (rises after ovulation), cervical fluid (produced before and through ovulation), and cervical changes (the cervix moves up, softens, and opens during peak fertility).

3) The woman's egg can only live a short time - from 12 to 24 hrs. If a second egg is released within the same cycle (fraternal twins, for example), it happens within 24 hours of the first.

4) Sperm can live in fertile-quality cervical fluid for up to 5 days. The amount of time that a woman has fertile quality cervical fluid varies from woman to woman.

5) The corpus luteum, the remnants of the egg's follicle, releases progesterone and acts to inhibit the release of additional eggs until the following cycle.

FAM does NOT require abstinence. Natural Family Planning is what is endorsed by the Catholic church and involves abstinence. In FAM, many couples use a barrier method during the fertile phase: the risk of pregnancy is then effectively reduced to the risk associated with the barrier method of choice. In most cases, the fertile period is 8-10 days. That means there are 20 days a month to enjoy sex without the use of contraceptives of any kind. If practiced according to the rules, the risk of a pregnancy using FAM is roughly 2%.

Obviously there are some caveats. First, FAM doesn't protect against STDs. The usual business about best for monogamous couples applies. Second, because of the nature of the method, it means that "cheating" on the FAM rules (ie having bare back sex during the fertile period) does mean that the risk of pregnancy is higher simply because sperm are being introduced to optimal vaginal conditions. Third, It is important to be to following the rules and not rely on a "I just know" mentality because every cycle is different. Fourth, it involves learning the rules well and following them. It may be easier/more convenient for some women to rely on other birth control methods.

I personally have used FAM with my husband for five years to avoid pregnancy. This includes a cycle that was 60 days long because my ovulation was delayed by several stressful events and other cycles that I ovulated early day 8 of my cycle). During my fertile period, we use barrier methods such as condoms and a cervical cap. I've only had one scare in the past five years when my cervical cap got dislodged after sex (because I took a big poop, of all things, haha - you can print that or not).

The Fertility Awareness Method has taught me a lot about my body and given me a positive way of relating to my body throughout the month. I have been blissfully free of contraceptive interventions beyond the cervical cap and condoms, both of which I can live with since they are hormone free. This method was not created just to help people get pregnant, though it certainly can be used for that. Even for women who are not sexually active, it is an empowering way to take control of one's gynecological health.

Thanks for all the incredible contributions you have made to our understanding and appreciation of female (and male) sexuality!

Best regards,
A

Dear A,

Thanks so much for your valuable information and sharing. We will definitely post this.

Dr. Betty