Natural Family Planning: Your Need-to-Know Guide

Some women are forgoing synthetic birth control methods in favor of a more hands-on approach -- and they're using their smartphones to do it.
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Kristina Gutilla, of Antioch, California, had tried eight different types of birth control by the age 30 -- but issues like low libido, headaches, nausea, and persistent yeast infections, which she attributed to the various methods, led her to keep searching. Finally, she somewhat reluctantly tried natural family planning (NFP), downloading the Kindara fertility awareness app on her smartphone. "At first, when I thought it was the rhythm method, I was definitely skeptical," she says. "But, the more I learned about it, the more excited I got."

Gutilla is not alone. Despite the influx of hormone-based birth control options -- pills and patches, implants and injections -- a small but growing number of millennials are embracing natural family planning. According to the Centers for Disease Control and Prevention (CDC), 1 percent to 3 percent of women currently rely on NFP as a form of contraception, though a study at University of Iowa found that 1 in 5 women would consider it as an option if they learned more about it.

This hormone-free method, also known as the fertility awareness method, involves decidedly low-tech tasks, like tracking your menstrual cycle, taking basal body temperature readings, and monitoring changes in cervical mucus to predict ovulation.

If NFP sounds old-fashioned, that's because it is. The practice of monitoring your temperatures, menstrual cycle, and cervical mucus has been around in some form since the 1950s, though women were tracking their flow long before then.

Unfortunately, NFP is no more effective now than it was decades ago, especially if you have an irregular period. According to the CDC and the American College of Obstetricians and Gynecologists (ACOG), it's still one of the least effective birth control methods out there (not to mention that it offers no protection against STDs). So why the resurgence?

Millennial devotees swear by the method's lack of devices, medications, and side effects, next-to-nothing cost, and ease of switching gears from avoiding a pregnancy to pursuing one. In fact, NFP can be used on both ends of the baby-making spectrum, since it helps you figure out your most fertile time of the month.

NFP 2.0

So how does NFP work? The most bare-bones approach is to track your period or basal body temperature on a paper calendar. That way, "a woman gets to know her own menstrual cycle and ovulation rhythms," says Joshua Hurwitz, M.D., a board-certified reproductive endocrinologist and infertility (REI) specialist at Reproductive Medicine Associates in Connecticut.

But technology-loving millennials are also relying on more than 200 apps to help them pinpoint their windows of fertility, including Daysy, Clue, Glow, iCycleBeads, Kindara, Maybe Baby, NaturalCycles, and Ovia. These high-tech helpers help make the job of recording fluids and temperature changes much easier and take some of the guesswork out of getting pregnant (or not).

In some ways, Dr. Hurwitz isn't surprised at the growing list of options. "What don't we do on a smartphone?" he asks. The apps are especially useful for noticing patterns and making accurate calculations, even in women with irregular cycles. "These apps are really smart and self-learning," he continues. "The more data you put into them, the more they can help you."

At the same time, Dr. Hurwitz sees the potential for added stress. Taking daily measurements and inputting seemingly endless numbers can easily become an obsession.

Still, he thinks that the benefits outweigh the risks and that the ability to store data and show it to a doctor to review together is hugely important, especially if a user sees a fertility specialist. "She already has information she can use," he says. "She doesn't have to start from scratch."

In fact, when it comes to managing your fertility, some NFP devotees say information really is power. "When you have fertility issues and don't want to use synthetic drugs, NFP gives you a sense of control," says 33-year-old Rachel Giordano, of Lynn, Massachusetts. Before trying to conceive, Giordano had been on birth-control pills to regulate her period, but they caused severe migraines and mood swings. So in April 2014, when she was ready to start trying for a baby, she read up on tracking her cycles and downloaded Ovia. The app helped her get pregnant with her son Alexios; this summer, Giordano and her husband plan to start trying again.

Not a Sure Thing

Of course, even with the high-tech help, NFP isn't 100 percent perfect. Just ask 34-year-old Kathleen Flippen, who first used a fertility tracking app in 2010, after her third child was born. Though she put a lot of faith in the app -- it noted everything from her daily basal body temperature to her emotions and mood changes -- she still unexpectedly became pregnant two and a half years later.

In fact, the success rate of NFP as a contraceptive is "all over the map," says Dana Stone, M.D., an ob-gyn in Oklahoma City and a spokesperson for the ACOG. She cites that 1 in 5 women out of 100 will become pregnant during the first year of perfect use, meaning that the method is used correctly and consistently throughout the menstrual cycle, and 12 to 24 women will become pregnant in the first year of typical use -- in other words, the way the average person uses the method, with some incorrectness or inconsistency. Compare that to other popular methods of fertility management, like condoms (typical use failure rate of 18 percent), diaphragms (12 percent), oral contraceptives (9 percent) and IUDs (0.2 percent).

"You not only have to really be in tune with your body's changes, you also have to avoid intercourse or use a barrier method during that time," Dr. Stone says.

In addition, NFP and related apps aren't a quick fix. Cycles must be tracked for at least six months before a user can feel confident in her readings.

With app-assisted NFP, the onus is on the woman to input her data -- and on the app to properly calculate it. What's more, temperature readings are functional only after three consecutive hours of sleep and only if you're not sick. Otherwise, the device may provide a false high.

In women for whom pregnancy would be dangerous -- such as a history of previous pregnancy complications, bleeding complications, high blood pressure, out-of-control diabetes, or a heart condition -- a more reliable method of birth control should be used, advises Dr. Stone.

In Flippen's case, the unplanned pregnancy didn't scare her off of NFP. But she advises other women to educate themselves before trying it. "Don't think you have it down after a month," she says, "especially if you're coming off of hormonal birth control."

Have you heard that breastfeeding is a great form of birth control? If so, you’ve heard half the story. Here’s what every nursing mom needs to know about birth control after Baby.

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