Natural contraception – is it for you?

Many women are looking for natural contraception methods as they suffer side effects from hormonal options, particularly the contraceptive pill. I got pretty disappointed when I recently watched a documentary about the pill on BBC^​*​. At first it seemed objective, but in the end it basically concluded with “if it’s not working for you, just try another brand until you find one that works”. Really?

The pill as default contraception

I find it worrying that so many teenage girls and women are on the pill without seemingly a second thought as to how it may affect their health. Side effects are not uncommonly dismissed as a “nocebo effect” (this effectively means that because we expect negative side effects they can become a self fulfilling prophecy), and instead the advantages are highlighted. What the actual truth is probably requires more research but I know for certain that what I experienced from the pill was very real and I will never put myself through that again.

This being said there are also benefits with the contraceptive pill and I am absolutely not saying it’s all bad. For many it works great. I’m just saying that there are alternatives and that you don’t have to accept the pill “by default”. All women should consider the options available to them, and weigh up the pros and cons as well as the level of risk they are willing to accept.

Consideration for athletes

If you are an athlete, you might be interested in knowing that research shows that the contraceptive pill down-regulates high intensity performance and increases oxidative stress in the body compared to women on a natural cycle.^​†​ Therefore, athletic performance could be one reason to look at natural contraception alternatives. Also, the pill could mask issues with relative energy deficiency, RED-S. One sign that your body may not be healthy is if you lose your period, or in the case of young women, not actually get your period. When you are on the pill it could mask the symptoms because the bleeding you experience is not a real menstruation, it’s just a “withdrawal bleed”. It is tempting to think it is convenient to be able to manipulate your period with the pill, to for example not have your period on competition day. However, in doing so you could lose out on performance.

Tracking your cycle as a hormone free alternative

I tried the Natural Cycles app about 2.5 years ago and I have used it since. This has worked really well for me and I wanted to talk about it a bit more since a few people have asked me. Apart from a few months I haven’t actually been on hormonal contraception for at least 15 years (can’t remember, probably more) but I just didn’t track my period before. There are however great advantages in doing so.

How does it work and is it effective?

Natural Cycles is an app in which you record your basal temperature in the morning (the more frequently you do it, the more you get out of the app). Throughout your cycle your temperature changes and the app uses this to detect ovulation and the pattern of your cycle. You also add your period, and you can test for ovulation and add this data too if you wish but it is not necessary. Since you can only get pregnant certain days of your cycle, the algorithm will calculate your fertile and non-fertile windows and indicate these in the app with red or green days respectively. The more frequent your data input, the more green days you will have.

According to Natural Cycles the effectiveness based on “perfect use” is 98% and with “typical use” 93%. The typical use is what matters. Most methods are subject to human error, therefore few contraceptives are as effective as they could be in theory and “perfect use” is unlikely for most of us.

Is natural contraception being unfairly criticised?

Apps like these are often being unfairly criticised in my opinion. If you want to use it and do it right it works well. Of course, just installing it on your phone and hoping for the best won’t protect you from unwanted pregnancy, but to assume it is too complicated for women to measure their temperature in the morning, or that we simply can’t control ourselves and will inevitably fall victims to having sex on the wrong day^​‡​ I think is an offence of our intelligence.

The cynical point of view is that a natural contraception method is a threat to the pharmaceutical industry so there is perhaps no surprise that there are many critics. Also, much of the data that cites the effectiveness of this method doesn’t reference a specific app or algorithm that does the number crunching. Often it is just referred to as “Fertility Awareness” or “the Temperature method”, but this could be using pen and paper to record temperature, or just looking at how your cervical mucus changes, so it is hardly a great representation of the more advanced apps that now exist in this area. That being said it is definitely not a method for everyone so let’s look at the pros and cons and who might benefit from using it.

Drawbacks

What are some of the drawbacks with Natural Cycles and similar natural contraception apps?

• You have to measure your basal temperature, preferably every morning or close to, for maximum benefit.
• It is not quite as effective in preventing pregnancy as some other methods with “typical use”.
• You still need protection on the red days, eg your fertile window.
• It doesn’t protect against STIs, but then only a condom does.

Benefits

What are some of the benefits?

• If you have experienced problems with other contraceptives this is a non-invasive method with no foreign object or hormones entering your body.
• Getting to know your cycle is actually incredibly useful as you get a greater understanding for what is happening when, and why you might be feeling a certain way.
• It allows you to anticipate PMS, and lessen the symptoms by for example altering your diet and using supplements at the right time.
• You can tailor your training and diet to your cycle to get maximum return.
• It can vary your sex life and make you more innovative. The green days are “go” for penetration and on the red days you can, if you don’t want to use condoms, experiment with other things such as joint masturbation, anal sex, oral sex and so on.

Who is it for?

If some or all of the below resonates with you maybe this method is something you should try:

• You are looking for a natural contraception method which is free of hormones.
• Condoms or copper spiral are not suitable for you.
• You can accept a slightly higher risk of pregnancy than with hormonal methods or copper spiral.
• Being disciplined with measuring your temperature with regular frequency doesn’t put you off.
• Your menstrual cycle is reasonably regular.
• Getting to know your body better by tracking your cycle appeals to you.
• For religious or cultural reasons, you don’t want to use a contraceptive but you still want to be in control of the days you could get pregnant.
• You are trying to get pregnant and plan to use it for this purpose rather than as contraceptive.

Who might it not be for?

So when might a natural contraceptive like this not be the best choice?

• Preventing pregnancy is the single most important thing for you and you need a bomb proof method.
• You tend to forget things and it’s unlikely you would be disciplined enough to measure your temperature with reasonable frequency.
• Your sleep pattern is irregular due to for example shift work, frequent travel across time zones, or other lifestyle factors.
• You are a party animal with frequent late nights out and/or you drink a lot of alcohol.
• STI protection is high priority for you, in which case condoms is your only option.
• Your period is very irregular.

What about other options?

There is hormonal contraceptive with lower dose than the pill. Examples are implant, hormone spiral and vaginal ring. The copper spiral provides a hormone free alternative but doesn’t work for everyone. The most effective contraceptive, and one which doesn’t involve any user error, is the implant. Of course, if you are certain you do not want to have children in the future, sterilisation or vasectomy is an option. Here is an overview of methods and there are many more sources out there.

Hope that gave you some ideas. Let me know your thoughts ?. This is an independent article, not supported by Natural Cycles, just so you know!

If you are interested in talking to me about contraception or other topics, see my consultation options here.