What Is a Benefit of Natural Family Planning Methods?
Natural Family Planning
Am Fam Md. 2012 November 15;86(x):924-928.
Related editorials: Is Natural Family unit Planning a Highly Constructive Method of Nascency Control? Yes: Natural Family unit Planning is Highly Effective and Fulfilling and No: Family Natural Family Planning Methods Are Overrrated.
Patient information: Run into related handout on natural family planning, written by the authors of this commodity.
Related letter: Physicians Need More Education About Natural Family Planning
Article Sections
- Abstract
- Methods and Mechanisms of Action
- Effectiveness of Modern NFP Methods
- Patient Counseling
- References
Natural family unit planning methods provide a unique choice for committed couples. Advantages include the lack of medical agin effects and the opportunity for participants to learn virtually reproduction. Modern methods of natural family planning involve observation of biologic markers to identify fertile days in a woman's reproductive cycle. The timing of intercourse can exist planned to reach or avert pregnancy based on the identified fertile flow. The electric current evidence for effectiveness of natural family planning methods is limited to lower-quality clinical trials without command groups. Nevertheless, perfect utilise of these methods is reported to be at to the lowest degree 95 pct effective in preventing pregnancy. The effectiveness of typical use is 76 percent, which demonstrates that motivation and delivery to the method are essential for success. Depending on the method, couples can learn almost natural family planning methods in a single office visit, through online instruction, or from certified instructors.
Family planning allows individuals and couples to anticipate and attain the desired number, spacing, and timing of children.ane Fertility awareness methods of family planning use one or more biologic markers to identify fertile days of a woman's reproductive cycle. Intercourse is avoided or a contraceptive method is used on these fertile days to avoid pregnancy. Conversely, couples desiring pregnancy are more likely to conceive if they have intercourse during this fertile period. Fertility awareness methods qualify equally natural family planning (NFP) if they are used with periodic abstinence rather than an artificial contraceptive method.2–4
Although less than 1 per centum of respondents to the 2006–2008 National Survey of Family unit Growth reported current use of NFP, 19 percent reported prior utilize of the rhythm method, and v pct reported prior utilize of some other NFP method.v If asked for family planning information, one-half of physicians report that they would provide information about NFP to prevent pregnancy, and three-fourths would provide information almost its use to reach pregnancy.6 This article discusses methods, mechanisms of activity, and demonstrated effectiveness of NFP to enable physicians to provide appropriate information and counseling to their patients.
SORT: KEY RECOMMENDATIONS FOR Practice
| Clinical recommendation | Prove rating | References |
|---|---|---|
| Lactational amenorrhea is 92 to 100 percent effective in preventing pregnancy during the beginning vi months postpartum in women who exclusively breastfeed their infants, provided that menstruation does not resume. | B | seven |
| With perfect employ, modern natural family planning methods can be as effective in preventing pregnancy as hormonal contraceptives. | B | 16, 20–23, 25, 28–30 |
| The Creighton Model for cervical fungus monitoring and the symptothermal method are the most effective natural family planning methods currently available. | B | 16, 22–24 |
Methods and Mechanisms of Activity
- Abstruse
- Methods and Mechanisms of Action
- Effectiveness of Mod NFP Methods
- Patient Counseling
- References
The 5 principal types of NFP are calendar calculation, basal torso temperature charting, cervical mucus monitoring, the symptothermal method, and lactational amenorrhea4 (Table 1). The first 4 methods allow couples to plan intercourse around the days of increased fertility during the woman's reproductive cycle. In lactational amenorrhea, ovulation does not occur, and at that place are no fertile days. Use of this method is limited to women who are exclusively breastfeeding during the first six months postpartum, and applies merely if menstruation has not resumed. When these weather are met, lactational amenorrhea has been shown to be 92 to 100 percent effective.iv,7
Table one.
Natural Family Planning Methods
| Method | Clarification |
|---|---|
| Basal torso temperature charting | Identifies the luteal phase of the menstrual cycle by postovulatory increase in basal body temperature; all other days are considered fertile |
| Agenda calculation | Predicts the fertile period by menstrual dating |
| Cervical fungus monitoring | Identifies starting time and end of the fertile period from cervical secretions |
| Lactational amenorrhea | Maximizes suppression of ovulation during breastfeeding; effectiveness limited to six months postpartum |
| Symptothermal method | Based on cervical mucus monitoring; calendar calculations or basal torso temperature charting monitoring provides redundancy |
Identification of the fertile period is the fundamental focus of well-nigh NFP methods. In the days leading up to ovulation, estradiol from the maturing follicles stimulates the section of thin, stretchy, watery fungus in the cervical canal that facilitates sperm entry into the upper reproductive tract. Sperm can remain viable in that location for upwards to five days. Sperm entry is inhibited after ovulation by the secretion of thick, sticky cervical mucus stimulated by increasing progesterone levels. The ovum is capable of being fertilized for upwards to 24 hours after ovulation. The usual viability periods of sperm and ovum generate an average 6-day fertile period that has been verified past empiric studies.two,three,viii
CALENDAR CALCULATIONS
Agenda methods of NFP are based on the relative consistency in the length of the luteal phase of the reproductive cycle. The rhythm method is the oldest NFP technique. The length of past cycles is used to predict the fertile menstruum in the current wheel. The beginning of the fertile catamenia is calculated by subtracting eighteen days from the shortest of the previous six to 12 cycles. The stop of the fertile period is calculated by subtracting 11 days from the longest bicycle. For a woman with a perfectly consequent 28-day bicycle, the rhythm method predicts an 8-day fertile period from days 10 through 17. Variations in bicycle length increment the length of the predicted fertile menstruation.3,4,ix The Standard Days Method is a simplified calendar method that assumes a cycle length of 26 to 32 days and sets a 12-day fertile period from days 8 through xix.ten
BASAL Body TEMPERATURE CHARTING
Basal body temperature charting takes advantage of the increase in a woman's temperature that occurs during the luteal phase of the reproductive cycle. An increase of at least 0.4°F (0.two°C) above the baseline temperature recorded early on in the morning time at the aforementioned time each day indicates that ovulation has occurred. This increment is monitored over iii consecutive days, at which point the fertile menstruation is considered over. Considering basal body temperature charting does not identify the commencement of the fertile period, it is of express employ. Couples who desire pregnancy must apply historical information to predict the next fertile period. Couples trying to avoid pregnancy must restrict intercourse to the luteal phase of the cycle.three,four,9 Basal body temperature charting is typically used in combination with other methods.
CERVICAL Fungus MONITORING
Cervical mucus monitoring has go the basis for most modernistic NFP methods. These methods let users to identify the beginning and end of the fertile catamenia by recognizing cyclical changes in the amount or consistency of cervical secretions. The Billings Ovulation Method, Creighton Model, and TwoDay Method are different systems for observing cervical secretions and using them every bit markers of fertility. The oldest of the three, the Billings Ovulation Method, is taught worldwide, and instructions are available online.11,12 The Creighton Model is a standardized modification of the Billings Ovulation Method taught and personalized for couples over multiple sessions.13 The TwoDay Method reduces the estimation of cervical secretions to two questions: "Did I note secretions today?" and "Did I annotation secretions yesterday?" If a adult female answers "yes" to either question, she is considered fertile.14
SYMPTOTHERMAL METHOD
The symptothermal method combines calendar calculations, basal body temperature charting, and cervical mucus monitoring. Cervical secretions are the foundation for this method, and the other techniques provide a "double-check." Women may utilize other signs (eastward.thou., consistency and position of the neck) or symptoms (e.g., breast tenderness, ovulatory hurting) to aid in the identification of the fertile catamenia.15,16 The Marquette Model combines the use of an electronic hormonal fertility monitor to find metabolites of estrogen and luteinizing hormone in the urine with observation of cervical secretions or basal body temperature charting to identify the fertile period.2,17
Effectiveness of Modernistic NFP Methods
- Abstract
- Methods and Mechanisms of Action
- Effectiveness of Modern NFP Methods
- Patient Counseling
- References
The effectiveness of family planning methods is measured for perfect and typical utilize. Perfect use failures represent failure of the method itself, whereas failures occurring during typical use include wrong use.18 The reported failure rates for modern NFP methods range from less than 1 to five per centum for perfect employ, and 2 to 25 percent for typical utilise.16,19–thirty The few randomized controlled trials of NFP methods have been limited past poor recruitment and high dropout rates.31 Therefore, the bear witness for NFP methods is based on observational trials that are prone to selection bias. Although many of these studies were conducted in emerging and developing countries, trials involving cervical mucus and symptothermal methods accept been done in Europe and the United States.16,twenty–24 However, the procedures used to measure and summate effectiveness rates may overestimate the observed effectiveness.xviii Some trials have provided a more direct accounting of method failures and used preferred statistical techniques to make up one's mind failure rates.xvi,19,25,28,30 A comparison of NFP methods is provided in Table ii.7,sixteen,19–30
Table ii.
Effectiveness of Natural Family unit Planning Compared with Other Family unit Planning Methods
| Contraceptive method | Percent of women with an unintended pregnancy inside the commencement year of employ | ||
|---|---|---|---|
| Typical apply | Perfect use | ||
| None19 | 85 | — | |
| Spermicides (foams, creams, gels, vaginal suppositories, vaginal films)19 | 28 | eighteen | |
| Withdrawal19 | 22 | 4 | |
| Condom (male, without spermicide)19 | 18 | 2 | |
| Diaphragm19 | 12 | six | |
| Contraceptive pill (combined), patch, or vaginal ring19 | 9 | < 1 | |
| Depo-medroxyprogesterone (Depo-Provera)xix | vi | < 1 | |
| Intrauterine device, etonogestrel implant, sterilization19 | < 1 | < 1 | |
| Natural family planning | |||
| Standard Days Method25–27 | 8 to 25 | 5 | |
| Billings Ovulation Method28,29 | iii to 22 | iii | |
| TwoDay Method30 | 14 | four | |
| Marquette Model20,21 | eleven to fourteen | one to 2 | |
| Symptothermal method16,22,24 | ii to 8 | < i | |
| Creighton Model23 | ii to v | ≤ 1 | |
| Lactational amenorrhea7 | — | 0 to 8 | |
Patient Counseling
- Abstruse
- Methods and Mechanisms of Activeness
- Effectiveness of Modern NFP Methods
- Patient Counseling
- References
NFP methods take unique benefits and important limitations. Ane do good for patients is an enhanced understanding of the reproductive procedure. This knowledge empowers couples to manage their reproductive lives without medical intervention. By routinely observing biologic markers, women may detect medical problems and bring them to the attention of their dr. earlier than might otherwise occur. All NFP methods encourage couples to engage in a shared discussion about sexual activity and reproduction. Finally, because these methods do not require pharmaceutical or procedural intervention, they accept no medical adverse effects.3,9
The limitations of NFP are related to the requirement of periodic abstinence. As evidenced by the relatively high failure rates with typical use, some couples may non be able to do this. All NFP methods tin can, to varying degrees, overestimate the fertile period and require longer periods of forbearance than might otherwise exist needed.2 Additionally, illness, disrupted sleep, and the utilize of medications can change or interfere with the observation and interpretation of some biologic markers.4 The monitoring of fertility hormones in urine may provide NFP users with a more objective, specific, and reliable marker of the fertile menses.two
Despite challenges, NFP methods are a feasible and effective family planning option for motivated patients, and may be the platonic selection for some. Interested couples crave educational activity in their chosen method. The Standard Days and TwoDay methods can be taught during an role visit.32 If this is not practical, or if couples are interested in other methods, several organizations provide detailed information and pedagogy (Table 3).
The American Academy of Family unit Physicians' policy statement on providing communication about contraception is bachelor at https://www.aafp.org/nigh/policies/all/contraceptive.html.
Data Sources: We used search results from Essential Evidence Plus, the Cochrane Database of Systematic Reviews, the National Guideline Clearinghouse, and PubMed citations. Cardinal terms included condoms, contraception, contraceptives, oral, intrauterine devices, family planning, and natural family unit planning. Last search date: September 17, 2011.
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REFERENCES
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1. World Health System. Health topics: family planning. http://world wide web.who.int/topics/family_planning/en/. Accessed September 12, 2011. ...
2. Fehring RJ. Efficacy and efficiency in natural family unit planning services. Linacre Q. 2009;76(1):9–24.
3. Jennings VH, Arevalo Yard. Fertility awareness-based methods. In: Hatcher RA, Trussell J, Nelson AL, Cates W Jr., Stewart FH, Kowal D, eds. Contraceptive Applied science. 19th ed. New York, NY: Ardent Media; 2008:343–360.
4. American College of Obstetricians and Gynecologists ACOG patient education: natural family planning . Washington DC: ACOG; 2003.
v. Mosher WD, Jones J. Apply of contraception in the U.s.a.: 1982–2008. Vital Wellness Stat 23. 2010;(29):one–44.
6. Choi J, Chan S, Wiebe East. Natural family unit planning: physicians' knowledge, attitudes, and do. J Obstet Gynaecol Can. 2010;32(7):673–678.
seven. Van der Wijden C, Kleijnen J, Van den Berk T. Lactational amenorrhea for family planning Cochrane Database Syst Rev. 2003(4):CD001329.
8. Wilcox AJ, Weinberg CR, Baird DD. Timing of sexual intercourse in relation to ovulation. Effects on the probability of conception, survival of the pregnancy, and sex of the infant. N Engl J Med. 1995;333(23):1517–1521.
nine. Pallone SR, Bergus GR. Fertility awareness-based methods: another option for family unit planning [published correction appears in J Am Board Fam Med. 2009;22(v):596]. J Am Lath Fam Med. 2009;22(2):147–157.
10. Georgetown University Establish for Reproductive Health. Nigh SDM. http://world wide web.irh.org/?q=content/standard-days-method-sdm. Accessed September 12, 2011.
11. BOMA-United states of america. http://www.boma-the states.org. Accessed September 12, 2011.
12. Ovulation Method Research and Reference Centre of Australia. Billings ovulation method. http://www.woomb.org/bom/index.html. Accessed September 12, 2011.
13. Pope Paul VI Found for the Study of Human being Reproduction. Creighton Model FertilityCare system. http://world wide web.creightonmodel.com. Accessed September 12, 2011.
14. Georgetown University Institute for Reproductive Health. About TwoDay Method. http://www.irh.org/?q=content/twoday-method. Accessed September 12, 2011.
15. The Couple to Couple League. Sympto-thermal method of NFP. http://ccli.org/nfp/stm-method/index.php. Accessed September 12, 2011.
16. Frank-Herrmann P, Heil J, Gnoth C, et al. The effectiveness of a fertility awareness based method to avoid pregnancy in relation to a couple'southward sexual behaviour during the fertile time: a prospective longitudinal study. Hum Reprod. 2007;22(5):1310–1319.
17. Marquette Academy. Natural family planning. http://nfp.marquette.edu. Accessed September 12, 2011.
18. Lamprecht V, Trussell J. Natural family planning effectiveness: evaluating published reports. Adv Contracept. 1997;13(ii–3):155–165.
19. Trussell J. Contraceptive failure in the U.s.a.. Contraception. 2011;83(5):397–404.
20. Fehring RJ, Schneider M, Barron ML. Efficacy of the Marquette Method of natural family planning. MCN Am J Matern Kid Nurs. 2008;33(half-dozen):348–354.
21. Fehring RJ, Schneider Thousand, Raviele K, Barron ML. Efficacy of cervical mucus observations plus electronic hormonal fertility monitoring as a method of natural family unit planning. J Obstet Gynecol Neonatal Nurs. 2007;36(2):152–160.
22. European multicenter report of natural family planning (1989–1995): efficacy and drop-out. The European Natural Family Planning Study Groups. Adv Contracept. 1999;15(1):69–83.
23. Hilgers TW, Stanford JB. Creighton Model NaProEducation Technology for fugitive pregnancy. Use effectiveness. J Reprod Med. 1998;43(6):495–502.
24. Rice FJ, Lanctôt CA, Garcia-Devesa C. Effectiveness of the sympto-thermal method of natural family unit planning: an international study. Int J Fertil. 1981;26(3):222–230.
25. Arévalo M, Jennings V, Sinai I. Efficacy of a new method of family planning: the Standard Days Method. Contraception. 2002;65(five):333–338.
26. Gribble JN, Lundgren RI, Velasquez C, Anastasi EE. Being strategic about contraceptive introduction: the feel of the Standard Days Method. Contraception. 2008;77(three):147–154.
27. U.S. Agency for International Development, George-town University Constitute for Reproductive Wellness. Long-term utilise of standard days method: experience of operations enquiry study participants. http://pdf.usaid.gov/pdf_docs/PNADL887.pdf. Accessed April 26, 2012.
28. Trussell J, Grummer-Strawn L. Further analysis of contraceptive failure of the ovulation method. Am J Obstet Gynecol. 1991;165(six pt 2):2054–2059.
29. Thapa S, Wonga MV, Lampe PG, Pietojo H, Soejoenoes A. Efficacy of 3 variations of periodic abstinence for family unit planning in Indonesia. Stud Fam Plann. 1990;21(6):327–334.
30. Arévalo Thousand, Jennings Five, Nikula Yard, Sinai I. Efficacy of the new TwoDay Method of family planning. Fertil Steril. 2004;82(4):885–892.
31. Grimes DA, Gallo MF, Grigorieva 5, Nanda K, Schulz KF. Fertility awareness-based methods for contraception. Cochrane Database Syst Rev. 2004(4):CD004860.
32. Germano East, Jennings V. New approaches to fertility awareness-based methods: incorporating the Standard Days and TwoDay Methods into practice. J Midwifery Womens Health. 2006;51(half-dozen):471–477.
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