"Natural Family Planning" or NFP, is, in a nutshell, a rejection of artificial contraception in favor of utilizing the natural times of fertility and infertility in a woman’s cycle to plan to achieve or avoid pregnancy. Many of the methods are supported and taught by Catholic organizations because the Catholic Church as an organization opposes artificial contraception. (However the science is the same regardless of your religion!) Different methods are more useful for trying to conceive or trying to avoid pregnancy. Not all methods are reliable enough for avoiding pregnancy. If you wish to use any of these methods to avoid pregnancy, make sure you fully understand how the method works and the effectiveness of your chosen method. None of these methods prevent the transmission of sexually transmitted diseases. Here are some of the most commonly used methods:
Breastfeeding: Breastfeeding is the oldest form of Natural Family Planning. Many cultures around the world have traditionally achieved three or more years of birth spacing from breastfeeding alone. However, not all breastfeeding spaces babies in this way. Frequent and unrestricted nursing will in most cases delay the return of fertility. There are many factors involved in how much infertile time a woman experiences after the birth of a child, and modern Western cultures tend not to experience quite as much infertile time as traditional cultures, but if certain practices are used, it can be an effective means of child spacing for a significant period of time even in Western culture.
- Lactation Amenorrhea Method (LAM): This method is the result of a significant body of research on the effectiveness of using breastfeeding alone to space births. It may only be used for 6 months and is approximately 98% effective.
- Ecological Breastfeeding: This method is an attempt to replicate the breastfeeding behaviors of traditional cultures. It is about 99% effective in the first 6 months and 94% effective whenever fertility returns, an average of about 14.5 months after giving birth. Alone, it normally spaces babies about 18-30 months, though individual results may vary.
Calendar-based methods: These were the first method of systematic Natural Family Planning to develop. It involves determining your fertile period based on the first day of your last period. Because of the potential for a lot of variation in a woman’s cycle, this method is considered to be fairly unreliable, but may be an acceptable option for women with extremely regular cycles. This option is not recommended for any couple with a serious reason to avoid pregnancy. With typical use, 25% of couples will be pregnant within the first year of use.
- Knaus-Ogino “Rhythm Method”: This is the traditional rhythm method used mainly by Catholics in the mid-twentieth century. It made some basic assumptions about fertility that were not true for every woman, causing a perfect-use failure rate of 9% per year. For women with irregular cycles, this method required a lot more abstinence than would be required by modern NFP methods. As a result, this method is not used or encouraged any more as it has been largely replaced by more modern and effective methods of NFP. However, modifications of the rules used in this method have brought greater effectiveness to other methods in conjunction with other fertility signs.
- The Standard Days Method (includes CycleBeads): Developed by the Institute for Reproductive Health at Georgetown University, this was a newer calendar-based method of NFP developed in 1999. It has about 95% effectiveness but may only be used by women with cycles between 26 and 32 days. There is now a set of postpartum guidelines (PPG) that goes along with this method.
Temperature-only: Temperature is a very effective method of determining the approximate time of ovulation so that it can be used as the most effective method to determine that ovulation actually happened and to define the period of post-ovulation infertility, but it is not effective in predicting that ovulation is coming in order to determine pre-ovulation fertility or infertility in order to acheive or avoid pregnancy. It also requires a woman to take her temperature at the same time every morning, and temperature readings may be affected by factors other than ovulation, sometimes making a temperature pattern difficult to interpret. Charting to avoid with temperature-only methods generally requires abstinence from the time a woman’s period starts until a few days into a temperature rise, leaving very few days available, especially for women with long cycles. So far, the Doering System is the only temperature-only method that effectively defines both ends of the fertile window. In more modern NFP, temperature-only rules have for the most part been absorbed into the sympto-thermal method.
Mucus-only methods: Cervical mucus is the most effective way to predict a coming ovulation and can also be used to determine the end of the fertile phase. It can be used with other signs such as temperature, but many people find that they do not need to use other signs and have an easier time only keeping track of only one symptom. This option would be best for individuals who have easily recognizable mucus signs. Paying attention to mucus, even if done in association with other fertility signs is the most effective method of acheiving pregnancy, and cervical mucus observations have been well-studied in order to determine the health of a woman’s reproductive system.
- The Billings Ovulation Method (BOM): This is the oldest of the mucus-only methods. Dr. John Billings did the original research to develop mucus-only methods. This method is about 94-98% effective for preventing pregnancy.
The Creighton Model (CrMS): This is a newer mucus-only method that uses a very similar set of rules as the Billings Method. It uses colored stickers on a chart to allow for easy understanding of the fertile and infertile times. There is also a large emphasis on determining the exact qualities of the mucus. It is taught only by a certified instructor in individualized lessons in order to maintain very high effectiveness of about 99%. This method is used in NaPro (Natural Procreative) Technology, a method of diagnosing and treating problems associated with a woman’s reproductive system in a way allows a woman’s fertility cycle to function properly on its own. It is highly effective for treating many infertility problems.
- The TwoDay Method (TDM): Developed at Georgetown University as a very easy and effective method of using fertility awareness to avoid pregnancy. With perfect use, it is 96.5% effective. With the use of a back-up method during the fertile period, it is 93.7% effective. With typical use, it is 86.3% effective.
Sympto-Thermal Method (STM): In its most basic form, this method involves checking and charting your basal body temperature each day and cross-checking it with observations of your cervical mucus. However, it may include many other observations such as checking cervix position and characteristics, noting ovulation pain, or any other observations that a woman notices about herself relating to ovulation. Studies indicate perfect use efficacy rates higher than 99%. This method is especially useful for individuals who have irregular cycles and/or weak mucus signs. There are several forms that this method takes:
- NFP International teaches the most encompassing version of the STM. It is the most complicated to learn, but it gives the user the most freedom to make NFP as effective as needed and gives several rules to allow couples to minimize abstinence without losing effectiveness.
- The Couple to Couple League was started by the same people as NFP International but has attempted to develop the method into more simple terms. They cut down the number of rules available for determining the end of the fertile period and added rules that include cervix position. They also added more specific instructions for practicing the STM during the postpartum period and menopause and have classes specifically structured to those times. They also publish Fertility Cycles and Nutrition by Marilyn Shannon, an excellent resource for understanding what may be behind many cycle abnormalities.
Taking Charge of Your Fertility (TCOYF) by Toni Weschler teaches the Fertility Awareness Method, a version of the STM related to Natural Family Planning from a secular perspective. (Note that this method differs from traditional NFP in that it does not discourage the use of barrier methods of contraception. This method attempts to make the STM as easy as possible to learn from a book and to use effectively. See the Fertility Awareness Method wiki for more information.
Garden of Fertility by Katie Singer uses the same methods as in TCOYF but gives fewer details on the intracacies of a woman's cycle. However, it does give more information on fertility during breastfeeding and advises on a diet for healthy fertility.
Fertility Monitoring Technology:
Ovulation Prediction Kits (OPK): These are urine tests that measure the amount of LH in your urine test. LH is present in various quantities throughout your cycle, but there is a surge or LH just before ovulation. A positive OPK (when the test line is darker than the control line or a digital test reads positive) indicates that you will likely ovulate within 12-36 hours from getting a positive test. Women’s bodies are different, though, reducing the accuracy of OPKs. A few women have LH surges that are not strong enough for OPKs to detect them as positive, or some women have LH surges that rise and fall quickly, so if a woman does not test regularly throughout the day, she may miss the surge on the OPK. Some women, especially those whith cycle irregularities may get positive OPKs at times that other symptoms such as CM seem to indicate that they could be getting ready to ovulate, but then ovulation does not actually happen. OPKs cannot confirm that ovulation did actually happen, but they can give women who are trying to conceive or avoid pregnancy a little more information about their cycles. Alone, they are not enough to avoid pregnancy.
Clearblue (Easy) Fertility Monitor (CBFM) / Marquette Method (MM): This is one of the most accurate fertility monitors currently on the market as far as predicting and pinpointing ovulation and is suitable for women whose cycle is normally 21-42 days. It relies on testing urine samples with nonreusable test strips regularly to determine when ovulation is coming. For trying to conceive, the CBFM gives you up to 6 days that you could conceive and 2 days of peak fertility, when conception is likely. For avoiding pregnancy, the CBFM itself does not normally give you enough warning that ovulation is coming in order to reliably avoid pregnancy, but the Marquette Method has been developed to help a couple reliably avoid pregnancy using the information from the CBFM. The MM has also developed protocols for using the CBFM in various special circumstances such as their breastfeeding protocol for using the CBFM to very accurately determine the return of fertility while breastfeeding even before the first postpartum period, though this requires a large number of test strips. The MM also works well when combined with other methods of charting.
Persona (Europe): Very similar to the CBFM, but marketed in Europe for avoiding pregnancy. It is suitable for women with cycles between 23 and 35 days and is 94% accurate in avoiding pregnancy with perfect use.
Lady-Comp/Baby-Comp: This fertility monitor is an alarm clock, a thermometer, and a computer all in one. It uses temperature-only rules to determine your fertile window. The Lady-Comp is designed to avoid pregnancy and can be upgraded with software to try to conceive. The Baby-Comp version is designed for trying to conceive.
Ovacue: This fertility monitor detects changes in electrolytes in your saliva to predict a woman’s impending ovulation. It may give a woman up to 7 days warning before she ovulates. The Ovacue is currently marketed only for trying to conceive, but since 7 days warning before ovulation is enough to prevent pregnancy as well, it could theoretically work to prevent pregnancy as well. Its makers are currently applying to the FDA to allow it to be marketed to avoid pregnancy. It comes with an optional vaginal sensor to help you confirm ovulation. It can be used by women with long or short cycles, and its makers claim that it can be used by women with irregular cycles. The difficulty with using the Ovacue with irregular cycles is that you have to input how long your cycle is going to be so that the monitor knows where in your cycle to look for changes. Since a woman with irregular cycles does not know how long her next cycle will be, this could make the Ovacue difficult or impossible to use for a woman with truly irregular cycles.
Ovulation Microscopes: There are several brands on the market. Most are small, about the size of a lipstik container, and can fit in a purse. They require that a woman apply some of her first morning saliva to the microscope and examine it for “ferning” patterns. While some women find this easy to use and helpful, especially for trying to conceive, others have a more difficult time interpreting the results. Saliva theoretically can give a woman enough warning that ovulation is coming to avoid pregnancy, but the accuracy of using these microscopes to avoid pregnancy have not been evaluated, and most people recommend against trying.
Related Wiki Resources:
Reasons to Choose Natural Family Planning - Why would you want to use charting to plan your family, anyway? Feel free to add your own reasons for charting!
NFP or FAM Methods While Breastfeeding - You have options in the postpartum period while your fertility is returning!
Resources For Learning About Fertility Cycles - Find books to read or websites to visit, find an instructor, post your chart online, and learn about how your diet affects your fertility.
Fertility Awareness Method - A quick-start guide to the Fertility Awareness, a version of the Sympto-Thermal Method taught by Toni Weschler in her book, Taking Charge of Your Fertility.
Common Abbreviations for Charting to Avoid/Fertility Awareness - BBT, EWCM, TCOYF, and more! Learn what all these crazy acronyms mean here.