For most people who are sexually active, the question of the right contraceptive method arises sooner or later. In my practice, I see patients of different ages and at very different stages of life. However, almost all of them have one thing in common when it comes to the topic of contraception: For most people, the focus is primarily on the highest possible safety of the method used and a simple and practical application, as well as the best possible tolerability and the absence of side effects.
Many women take the contraceptive pill because they find other contraceptive methods unsafe or are put off by the variety of methods on offer. You can read about the sometimes serious consequences that taking the pill can have in my blog article „The Pill – a Ticking Time Bomb?“. Many women suffer from severe side effects from the pill, or they discontinue it in the course of their lives because they no longer want to supply their bodies with artificial hormones. For others, hormonal contraception is not an option anyway due to personal or medical circumstances. But some women also experience unpleasant side effects with the IUD or the copper chain. For all these reasons, the demand for methods of natural contraception without hormones or other interventions in the female body has been growing in recent years. And yes:
Even without the pill can be effective and safe contraception!
Natural family planning
Natural family planning primarily refers to contraceptive methods in which physical changes in the course of the cycle are observed, on the basis of which conclusions can be drawn about the fertile and infertile days in the current cycle. The fertile days in the cycle are limited to a few days, since the egg itself is only fertile for a maximum of one day. However, sperm can survive in the female body for about up to five days, which is why the fertile days increase by at least this number. With natural contraception, there is no external intervention in the female cycle, only the fertile and infertile days in the natural cycle are determined. With methods of natural family planning, depending on the objective, pregnancy can be effectively avoided as well as targeted. But:
There are many unsafe natural contraceptive methods!
Often the calendar method is considered as a method of natural family planning. However, in the calendar method, the fertile days are determined only from previous cycles by means of probability calculation. This method is very uncertain, because the length of a woman’s cycle can vary slightly from time to time, and sometimes very much. In addition, even in a cycle with the same length, ovulation does not necessarily have to take place on the same day and can occur earlier and later in the cycle. Therefore, it does not make sense to base fertility in the current cycle solely on past cycles. According to the current state of science, the calendar method is in no way suitable for reliably avoiding pregnancy.
Hormone measurements are prone to interference
Hormone measurement in urine is also frequently used. In most cases, luteinizing hormone (LH) and/or estrogen are determined. However, since the hormone levels in the urine are very susceptible to interference, hormone measurement alone is also not suitable for reliable contraception. For example, the hormone level may only rise above the critical value when ovulation has already occurred or shortly before. This means that not all fertile days can be reliably detected and pregnancy can still occur.
Observation of a single symptom is not sufficient!
When observing the cervix, the woman herself palpates it daily and assesses how high or deep it is, how firm it feels and whether its opening is closed or open. This method is not suitable as the sole method of contraception, because although there is a close temporal relationship between the changes and ovulation, it is not possible to assess whether ovulation has actually already occurred or whether it is yet to occur.
The Billings method is based on the observation of cervical mucus, but as a sole parameter it is also not very reliable. The appearance of cervical mucus can be strongly influenced by external circumstances and does not indicate whether ovulation has already occurred or whether it is yet to occur.
In the temperature method, body temperature is measured every morning after waking up. Since temperature changes occur during the cycle, this method provides information about which phase of the cycle a woman is currently in. However, there are some factors that can influence the temperature, such as the consumption of alcohol or acute infections. Therefore, the temperature method should also not be used as the sole method of contraception.
The Symptothermal Method
In the symptothermal method, body temperature is also measured at the same time each day after waking. In addition, however, observations of physical changes during the cycle are also made, such as changes in cervical mucus, the cervix or hormone tests. In this way, fertility is always assessed on the basis of at least two characteristics at the same time, which ensures a result with significantly greater certainty than if only one characteristic were used alone. This means that the fertile days can be narrowed down very reliably to just a few days per cycle. This makes the symptothermal method the only highly reliable natural contraceptive method. The data is noted daily in a cycle sheet. There are already some good apps that make it easier to enter the data in the (digital) cycle sheet and can help with the evaluation. So-called cycle computers are also on the market that automatically evaluate the observed characteristics and display the fertile and infertile days.
To prevent pregnancy, unprotected intercourse can take place accordingly on the infertile days. On the fertile days, this should be avoided or a barrier method should be used, for example a condom or diaphragm.
Bei der symptothermalen Methode gibt es verschiedene Regelwerke, in welcher Form die Auswertung der erhobenen Messwerte und Symptome genau zu erfolgen hat. Je nach Regelwerk unterscheiden sich die Bestimmungen zur Auswertung. Es ist daher wichtig, dass diese strikt eingehalten werden, um die Sicherheit der jeweiligen Methode zu gewährleisten. Ein bekanntes Regelwerk zur symptothermalen Methode ist die Natürliche Familienplanung mit Sensiplan. Bei dieser wird die Temperaturmethode kombiniert mit der Auswertung des Zervixschleims oder alternativ auch des Muttermunds. Wenn im nachfolgenden Text also von natürlicher Verhütung oder natürlicher Familienplanung die Rede ist, sind damit immer Regelwerke zur symptothermalen Methode mit wissenschaftlich bewiesener Sicherheit gemeint.
How safe is contraception using the symptothermal method?
Die einzige Verhütungsmethode, die zu 100% sicher ist, ist die komplette Enthaltsamkeit. Bei allen anderen Verhütungsmethoden wird die Sicherheit der einzelnen Methode in Methodensicherheit und Anwendersicherheit angegeben.
Die Werte sagen jeweils aus, wie viele von 100 Frauen innerhalb eines Jahres bei Anwendung der jeweiligen Verhütungsmethode durchschnittlich dennoch schwanger werden. Die Methodensicherheit ist die Sicherheit einer Verhütungsmethode bei 100%-ig korrekter Anwendung und keinerlei Auftreten von störenden Faktoren. Diese beträgt für die symptothermalen Methode NFP nach Sensiplan 0,4. Das bedeutet, es werden durchschnittlich vier von 1000 Frauen schwanger, wenn keinerlei Störfaktoren vorliegen und alle Regeln befolgt werden. Die Anwendersicherheit beschreibt die Sicherheit der Methode bei alltäglicher Anwendung. Diese beträgt bei der Sensiplan-Methode 1,8. Zum Vergleich: Bei der Anti-Baby-Pille beträgt die Methodensicherheit 0,3-0,5, die Anwendersicherheit liegt allerdings bei 9.
In the fertile period, be careful!
If sexual intercourse takes place during the fertile period, then of course only the safety of the respective barrier method used applies during this time. Whereby the probability of getting pregnant with abstinence is lower than with contraception with condoms or diaphragm. When using barrier methods, it should be mentioned that the correct application and an optimal fit should be absolutely observed! Very many men, for example, wear the wrong condom size, which greatly compromises safety.
What are the advantages of natural family planning?
First of all, natural contraception is free from health side effects, which are very common, for example, with hormonal contraceptives. In addition, contraception using symptothermal method is very safe, if the respective rules are followed. Moreover, the method can be used at any stage of life, both in adolescence and in the transition to family planning or in advanced age, and it can be used immediately after hormonal contraceptives are discontinued.
Contraception using the symptothermal method is easy to learn and can also help women to get to know and appreciate their own bodies better. It can promote body literacy and create a deeper understanding of one’s own bodily processes. For many women, learning a natural contraceptive method is the first time they truly engage with their cycle and the bodily changes that occur during it, as well as their significance. This can lead to a better feeling of one’s own femininity and to more inner harmony and a feeling of “being in one’s own center” for the women using the method. Many women also notice a balancing effect on the psyche, since, for example, cycle-related changes in mood or other symptoms become explainable and lose their terror or can be more easily managed. These effects can also have a positive impact in partnerships and at work, of course. In addition, natural contraception promotes awareness of the shared responsibility in a partnership on the subject of contraception and family planning and can form a valuable basis for discussion. Many couples also report an improved relationship as a result.
One of my patients started using the symptothermal method after stopping the pill. She is very tech-savvy and has therefore decided to record and evaluate her values with the help of a smartphone app and a Bluetooth thermometer. She regularly reports back to me how exciting it is for her to really track her cycle for the first time in her life and to observe and get to know her body better during the different phases of her cycle. She also reported that her mood has improved a lot since then and that she has also received positive feedback from her partner. Since then, her partner has perceived her as much more balanced and satisfied.
What should be considered in natural family planning?
The method of natural family planning must be learned, assuming about three cycles of learning and testing. It can take a few cycles until one’s own physical changes can be reliably recognized and evaluated. It is therefore important to study the subject in detail and not to use this method lightly. In addition, the respective physical changes must be observed regularly in order to enable a reliable evaluation. There are also some exceptions and circumstances that should be known (e.g. stress, illness, lack of sleep and others), as they can complicate or falsify the evaluation of the body signs. In addition, it is absolutely necessary to strictly follow the rules and know how to specifically deal with deviating readings. Furthermore, natural family planning takes both partners into responsibility. The cycle and the individual phases of fertility are crucial here.
Do you have questions about contraception or are you interested in natural family planning? Are you dissatisfied with your current contraceptive method and would like expert support? I will be very happy to advise you on these topics in a free online video appointment, or you can contact me by e-mail at firstname.lastname@example.org or by phone at 089 32 80 88 97.
I look forward to seeing you!
Ihr Sebastian Weber
- Arbeitsgruppe NFP (2021). Natürlich und sicher – Natürliche Familienplanung mit Sensiplan. Das Praxisbuch. Stuttgart: Trias Verlag.
- Neue BZgA-Studiendaten: Verhütungsverhalten Erwachsener (2019). Bundeszentrale für gesundheitliche Aufklärung. Verfügbar unter: https://www.bzga.de/aktuelles/2019-09-19-neue-bzga-studiendaten-verhuetungsverhalten-erwachsener/ [10.02.2022].
- Rötzer, et. al (2017). Use of Natural Family Planning (NFP) and Its Effect on Couple Relationships and Sexual Satisfaction: A Multi-Country Survey of NFP Users from US and Europe, Frontiers in Public Health.
- Strowitzki et. al (2013). Natürliche Familienplanung heute: Modernes Zykluswissen für Beratung und Anwendung. Berlin: Springer Verlag.
Important note: The treatment methods mentioned in my blogs originate from empirical medicine. The majority of these established, medical therapy methods have not yet been sufficiently scientifically validated according to the principles of evidence-based medicine (orthodox medicine). In particular, randomized, controlled studies or comprehensive meta-analyses do not yet exist. A success of the empirical medical therapy forms cannot be guaranteed in every treatment case.