Reproductive Choice and the Sympto-Thermal Method

Reproductive choice is a hot topic in the news lately, and I am completely for a woman's right to choose her method of birth control, but I am also for reproductive education. I think birth control pills are viewed as these magic pills that are completely safe without side effects, and so many of us just don't even think twice about taking them. But how much do we really know about birth control pills? How much does any of us research before taking them? They're so common that it's easy to forget that hormonal contraceptives are actually prescription medication that we take every day, often times for years and years. Serious side effects of birth control pills include stroke, heart disease, cancer, and infertility, along with many other serious and some less-serious side effects. Hormonal contraceptives directly led to some of my fertility problems, and it took me almost a year for my menstrual cycle to regulate afterwards. I'm still not sure exactly what impact they had on my body. I think many of us, myself included, don't do our due diligence before making the decision to take hormonal contraceptives, but I also think medical professionals do a pretty crappy job of making us think about the risks. It's also big business (think billions in profits), which unfortunately takes precedence over our health in so many ways. Birth control pills are also contaminating our water supply, as so many women are taking them and passing hormones through urine into the water supply. This is an issue with many drugs.

I want to talk a little about the fertility awareness method (FAM) of birth control, also called sympto-thermal method or natural family planning, because it's something you don't hear about very much but is extremely effective, inexpensive, and has no side effects. It is sometimes confused with the rhythm method (or calendar method), but these two methods are completely different. The Rhythm/calendar method is extremely ineffective, basically guesswork, whereas FAM is as effective as the pill. If you have an iphone, the "Sympto" app is a great resource and makes it extremely easy to follow this method. Taking Charge of Your Fertility, by Toni Wechsler is also a great, very comprehensive resource on this topic. It explains how you can use this method to prevent pregnancy or optimize your chances for conception. I will give an overview of this method here, but if you're interested in following it, I recommend seeking a more comprehensive source of information. It is a good idea to use a barrier method until you feel comfortable with identifying your signs.

There are three distinct signs that can be observed in your body related to your fertility. Two of them indicate that ovulation is about to happen or happening (cervical position and cervical fluid), and one indicates that ovulation has happened (temperature rise).

Cervical Position: During infertile days of your cycle, the cervix is firm, closed, and low. As ovulation approaches, the cervix becomes softer, opens slightly, and raises. You can feel your cervix by inserting two fingers into your vaginal opening. The cervix is the "neck" of the uterus, or the doorway between the uterus and the vagina. During childbirth, when you hear about how "dilated" someone is, the dilation is referring to the cervix and how far it has opened. It's normally completely closed, but during ovulation, it opens slightly (like, less than 1cm), and when you are ready to push a baby out, it opens to a diameter of 10cm. It makes sense biologically that the cervix opens slightly during ovulation, as it is allowing and welcoming sperm in to fertilize the egg.

Cervical Fluid: As ovulation approaches, cervical fluid goes through distinct changes in consistency and volume. It becomes more copious, clear, stretchy, and takes on the consistency of raw egg whites. This egg-white cervical fluid has channels through which sperm can swim and survive for up to a few days. If this special cervical fluid is not present, then sperm will not be able to travel to the fallopian tubes or survive for very long.

Temperature: After ovulation has occurred, your basal body temperature (BBT) rises slightly. BBT is measured first thing in the morning at the same time every day by a thermometer with high sensitivity. Once you are awake for some time or move around, your BBT is not accurate. It can be affected by illness, alcohol, sleep, etc. When used in combination with the other signs, it confirms that ovulation has taken place. If you become pregnant, the temperature stays high throughout your pregnancy.

It is also important to know that the menstrual cycle has two phases. The follicular phase begins on the first day of your period and represents the time during which the egg is being prepared. A follicle forms on the ovary, through which the egg is released. The follicular phase is generally about 2 weeks long, but it can be impacted by many things such as stress, illness, fatigue, diet, hormone imbalance, etc. It is incredibly common to have an extended follicular phase due to any number of reasons. It is precisely this reason that makes the rhythm method (or calendar method) highly unreliable. More on this below. The luteal phase begins after ovulation and represents the time during the cycle in which the egg travels down the fallopian tube and either implants into the uterine wall (if fertilized) or passes through the uterus (if unfertilized). The luteal phase is somewhere between 11 and 16 days and does not change from cycle to cycle. It is not generally impacted by stress or other life events.

To put it all together, by checking your cervical position and cervical fluid, you can tell when ovulation approaches. As soon as you detect any increase in cervical fluid or softening of the cervix, you know that your fertility window is opening. Abstinence or a barrier method of BC can be used during this time in order to prevent pregnancy. Once you've ovulated and detected a temperature rise, you know that your fertility window has closed for that cycle. If you're trying to get pregnant, you don't even need to take a pregnancy test if you're charting, as you can tell when your temperature has stayed high longer than your normal luteal phase. Eighteen high temperature days in a row is generally considered to indicate pregnancy, as the luteal phase is pretty much never longer than 16 except with pregnancy.

Here's more on why the rhythm/calendar method is not effective. The rhythm method is basically estimating ovulation based on previous cycle lengths. So, if your cycle is usually 28 days, you can work backwards and assume that ovulation occurred around day 14, as the luteal phase is usually about 14 days. The problem with this is that a) luteal phases can vary from 11-16 days even in normal cycles (They can be even shorter if there is a fertility problem.) and b) that the follicular phase can be extended due to any number of factors at any time without notice. So if you estimate that days 11-18 represent your fertile window, you might be off because you don't know what your normal luteal phase is, or you might be off because your ovulation was delayed that month. It only takes being off by a little bit to get pregnant.

I love that the fertility awareness method is free, green, has no side effects, and increases our connectedness with and awareness of our bodies. This information should be part of basic health education in schools and should be common knowledge amongst women. I also love something that Toni Wechsler says, that women are fertile for a few days/month and men are fertile every single day, and yet there are only 3 methods of birth control for men and at least a dozen for women. There's something not right about that. So yes, I believe that women should have choices involving their reproductive health, but I think we have a ways to go before we all really understand what we're choosing.

And, just in case anyone is using my blog as their only source of health information (gosh, I hope not!), FAM does not protect against STDs and is not a substitute for a barrier method in casual sex. I'm simply comparing it to the pill in this post. If you really want to avoid pregnancy, it is always a good idea to use two methods of birth control, one of which could be FAM. In that case, you could abstain from sex during your fertile days and use a barrier method the rest of the time.