NFP/FA
NFP, Natural Family Planning or FA, Fertility Awareness, the method of determining when you are fertile and using that information to avoid pregnancy at unwanted times or to achieve pregnancy when desired. This method is up to 99% effective when practiced consistently. With NFP/FA you learn information about techniques used for natural family planning. You learn how to understand your menstrual cycle and how to prevent pregnancy without hormones or devices.

Natural family planning:

Basal body temperature

The basal body temperature (BBT) is your body temperature at the time you wake up each day. By measuring this temperature each day and noting the day that it changes, a woman can determine when she's least and most likely to ovulate and conceive.

Effectiveness rate.
The typical effectiveness rate among users of the BBT method is 80 percent, so 20 out of 100 women practicing this method for one year will get pregnant. The reliability of this method can be disrupted by:

  • Illness
  • Emotional distress
  • Interrupted sleep cycles
  • Smoking tobacco or drinking alcohol
  • Using an electric blanket

Side effects and health risks.
The major downside associated with using BBT as a means of natural family planning is the requirement for prolonged abstinence or use of barrier methods. Also, this method of birth control doesn't protect against STDs.

How to use the basal body temperature method.
Before relying on this method, you have to familiarize yourself with your cycle by charting your BBT for three months. During that time — and for as long as you continue to use the BBT method — you take your temperature with a special BBT thermometer every morning before getting out of bed. For the method to work, you need to predict when you'll ovulate, not just to realize when you have ovulated. To do that, keep a log of each day's BBT, and watch for it to rise slightly (less than one degree) at some point between menstrual periods. This BBT increase means you have ovulated in the past 24 hours.

It's necessary to abstain from intercourse or use a barrier contraceptive every time you have sex during the three months of BBT charting. Then, when you begin to rely on the BBT method, you should either abstain from intercourse or use a barrier method on the days when conception may occur. Because sperm can live for three days in your reproductive tract, the "unsafe" interval has to include at least three days before and three days after ovulation. In other words, unprotected intercourse is off limits from your menstrual period until the night of the third day after your temperature rises, every month.

Cost and availability.
Basal body temperature thermometers cost around $10. Classes that teach this technique may charge fees, which vary from region to region.

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Calendar

The calendar method attempts to predict ovulation using a woman's menstrual history. By keeping a written record of each cycle, you can determine when you're least likely to conceive.

Effectiveness rate.
The typical effectiveness rate among users of the calendar method is 87 percent. This means that 13 out of 100 women practicing this method for one year will get pregnant. The calendar method isn't dependable if your cycles vary in length.

Side effects and health risks.
The downside of using the calendar method is the requirement for prolonged abstinence or use of barrier methods and the need to monitor your cycle for several months before using the method. This method doesn't protect against STDs.

How to use the calendar method.
If you decide to use the calendar method, you'll calculate which days you're likely to become pregnant. During that time, abstain from sex or use barrier methods. Here are some tips for using this method:

  • Keep a record of the number of days in each cycle, counting from the first day of one period to the first day of the next period. When bleeding starts, circle that day.
  • Check your record of previous months, find the shortest cycle and subtract 18 from the total number of days. For example, if your shortest cycle is 26 days, 26 - 18 = 8.
  • Starting with the day that you circled, count ahead eight days and draw an X through that day. That's the first day you're likely to be fertile. That's also the first day to practice abstinence or use barrier methods.
  • To find the last day you're likely to conceive, subtract 11 days from your longest cycle. If your longest cycle is 30 days, 30 - 11 = 19. Starting from the first circle, count ahead 19 days and draw an X through that date. That's the last day you need to practice abstinence or use barrier methods.

Keep a cycle record for at least eight of your cycles before relying on this method. You must not be using hormonal contraception while you keep these records.

Cost and availability.
Using the calendar method costs nothing, but classes that teach this technique may charge fees, which vary from region to region.

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Cervical mucus

The cervical mucus or ovulation method refers to the observation of mucus patterns during the course of your menstrual cycle. By recognizing the changing characteristics of your cervical mucus, you can determine when you're least and most likely to conceive.

Effectiveness rate.
The typical effectiveness rate among users of the cervical mucus method is 78 percent. That means that 22 out of 100 women practicing this method for one year will get pregnant.

Side effects and health risks.
The major downside of using the cervical mucus method is the requirement for prolonged abstinence or barrier methods. This method doesn't protect against STDs.

How to use the cervical mucus method.
If you decide to use the cervical mucus method, you'll observe your cervical secretions every day, beginning the day after your menstrual bleeding has stopped. Here are some tips for using this method:

  • Note and record the appearance, consistency and how the secretions feel. Fertile secretions are clear, stretchy, wet and slippery.
  • Check your cervix position with your finger. During ovulation your cervix is slightly higher, softer and more open; before and after ovulation it's firmer, lower and closed.
  • It's considered safe to have unprotected sex during menstruation and a few days after it, before noting fertile cervical mucus, as well as after ovulation, when mucus decreases in volume and becomes cloudy and tacky.
This method is less reliable for women who produce little mucus or if the natural mucus pattern is altered by external factors, such as reproductive tract infections, douches, feminine hygiene products and use of some medications such as decongestants.

Cost and availability.
Using the cervical mucus method costs nothing, but classes that teach this technique may charge fees, which vary from region to region.

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TwoDay method

The TwoDay method is similar to the cervical mucus method, but it was devised to simplify the process of determining fertile days by only monitoring the presence — not the quality — of cervical mucus.

Effectiveness rate.
The typical effectiveness rate among those using the TwoDay method is 86 percent. In other words, out of 100 women using the TwoDay method over one year, 14 will get pregnant.

Side effects and health risks.
As with the cervical mucus method, the most significant disadvantage of the TwoDay method is prolonged periods of abstinence or the use of barrier methods. This method doesn't protect against STDs.

How to use the TwoDay method.
If you decide to use the TwoDay method, check for cervical mucus at the vulva or on toilet paper two times each day: once in the afternoon, and once before bed. Ask yourself two questions. Do I have any secretions today? Did I have any secretions yesterday? If the answer to either of these questions is yes, then you should avoid unprotected intercourse, because you might be fertile. If the answer to both questions is no, then you're not in a fertile part of your cycle and can have unprotected intercourse.

Many women use a chart to mark fertile and infertile days, as well as the start of each cycle. It's important for women using this method to know how to recognize cervical mucus.

Cost and availability.
Using the TwoDay method costs nothing, but classes that teach this technique may charge fees, which vary from region to region.

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Lactational amenorrhea

Lactational amenorrhea refers to the normal cessation of menstrual periods for the first few months a woman is exclusively breast-feeding. During this time, ovulation doesn't occur and so birth control is essentially automatic. The method is only effective in preventing pregnancy under the following conditions:

  • The mother is exclusively breast-feeding.
  • The baby is less than 6 months old.
  • The mother's period hasn't yet returned.

Effectiveness rate.
When lactational amenorrhea is used as a means of birth control, the effectiveness rate is 98 percent. In other words, two out of 100 women will get pregnant while using this method during the six months after childbirth. After the first six months, ovulation and fertility may return before the onset of a period.

Side effects and health risks.
Many women notice that they need to use extra lubrication during sex to be comfortable. This method doesn't protect against STDs.

How to use the lactational amenorrhea method.
If you decide to use the lactational amenorrhea method, you must breast-feed your baby at least eight to 10 times a day, including at least once a night, on both breasts. Don't allow more than six hours to pass between any two feedings.

Cost and availability.
Using the lactational amenorrhea method costs nothing, but classes that teach this technique may charge fees, which vary from region to region.

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Standard days
The standard days method requires abstaining from unprotected sex on certain days of your menstrual cycle — the days you're most likely to conceive. You keep track of your cycle by using a special string of beads, known as CycleBeads. The standard days method works for a woman who:

  • Has regular menstrual cycles
  • Has menstrual cycles not shorter than 26 days or longer than 32 days
  • Has a cooperative partner
  • Avoids unprotected sex on days eight through 19 of her menstrual cycle

Effectiveness rate.
The typical effectiveness rate among users of the standard days method is 88 percent. That means that 12 out of 100 women practicing this method for one year will get pregnant.

Side effects and health risks.
The major downside of using the standard days method is the requirement for prolonged abstinence. This method doesn't protect against STDs.

How to use the standard days method.
If you decide to use the standard days method, CycleBeads can help you keep track of which days you're most fertile. This string of beads contains 32 colored beads that each represent one day of your cycle. Here are some tips on using these beads effectively:

  • On the first day of your period, move the rubber ring attached to the string of CycleBeads to the red bead.
  • Advance the rubber ring one bead for each day that passes.
  • If the rubber ring is on a brown-colored bead, you're unlikely to get pregnant if you have unprotected sex on that day.
  • If the rubber ring is on a white-colored bead, pregnancy is likely on that day, so you should abstain from unprotected sex.

In your late 30s or early 40s, your menstrual cycles tend to shorten. In that case, the fertile phase may begin on day five rather than day eight.

Cost and availability.
The standard days method uses CycleBeads — at a cost of about $14 — to help you keep track of your fertile days.

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Symptothermal

The symptothermal method involves combining several of the natural family planning methods — including, at least, the basal body temperature and mucus methods — to prevent pregnancy. These methods can be checked against each other to determine the beginning and the end of the fertile period. Using a combination of methods increases the effectiveness rate, compared with other natural methods.

Effectiveness rate.
The effectiveness rate among users of the symptothermal method is typically 98 percent, meaning that two women out of 100 will get pregnant while using this method for one year. Women who have unpredictable periods, irregular body temperature patterns or recurrent reproductive tract infections shouldn't rely on this method.

How to use the symptothermal method.
If you decide to use the symptothermal method, use the basal body temperature and cervical mucus methods at the same time. The calendar method, the position and feel of your cervix, and any pain during ovulation, any breast tenderness, or both, can be other indicators of fertility.

Side effects and health risks.
The downside to the symptothermal method is the requirement for a prolonged period of abstinence or barrier methods and the time used to perform the monitoring methods. The method doesn't protect against STDs.

Cost and availability.
Using the symptothermal method costs nothing, but classes that teach this technique may charge fees, which vary from region.

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Withdrawal

Withdrawal, formally known as coitus interruptus, is the pseudo-contraceptive practice in which a man removes his penis from a woman's vagina and away from her external genitalia before ejaculating. This method attempts to prevent sperm from entering a woman's vagina.

Effectiveness rate.
Sperm are often released before ejaculation, rendering the technique ineffective. The typical effectiveness rate is 73 percent, so about 27 out of 100 women relying on this method will get pregnant.

Cost and availability.
The withdrawal method costs nothing, requires no devices and is available in any situation. But it's not an effective birth control option when used without a backup means of contraception.

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FA, Fertility Awareness, is a concept often linked (unfairly, I believe) to certain religious institutions and sometimes ridiculed as to its contraceptive value. Yet for some people with health risks or objections to current contraceptive technologies, it offers real hope for the disciplined couple. The basics of FA are well worth knowing regardless of the method of birth control selected. 
Pros and cons

Natural family planning helps you gain self-awareness and knowledge of your fertility. But it requires considerable diligence and training. To help you decide if it's right for you, keep the following points in mind:

Pros
  • It provides a "natural" method for couples who prefer not to use contraceptive devices.
  • There are no medical side effects.
  • It's immediately reversible.
  • It's inexpensive and doesn't require a prescription or follow-up medical visits.

Cons
  • It may inhibit sexual spontaneity and requires extensive periods of abstinence when used as the sole means of birth control.
  • It's less effective for women with irregular menstrual cycles.
  • It offers no protection against STDs, including HIV.