Natural Birth Control - What It Is & How It Works
What is natural birth control?
As a Naturopathic Doctor in NYC, I get a lot of questions about natural forms of birth control. What natural birth control means is birth control without hormones.
Hormonal birth control on the other hand uses synthetic forms of estrogen and progesterone (progestins) to either suppress ovulation or make the uterus unfavorable for conception. The main forms of hormonal birth control are “the pill,” implants, shots, patches and hormonal IUDs.
Instead of synthetic hormones, natural birth control relies on either physical barriers, behavior modifications, or the copper IUD.
Why use natural birth control?
Some women use natural non-hormonal birth control because they prefer to avoid having synthetic hormones in their body and the side effects that these synthetic hormones can cause.
The main side effects of hormonal forms of birth control include acne, weight gain, mood changes, digestive problems, and sexual side effects including low libido and vaginal dryness.
In some cases, women will experience a delayed return to fertility following discontinuation of hormonal birth control, due to lack of ovulation. Return to ovulation make take months even years in some cases.
There are also more serious risks of blood clots and HPV infections (the virus that causes cervical cancer).
Types of Natural Birth Control
Copper IUD
The copper intrauterine device (IUD) is a small T-shaped device that is inserted into the uterus. It prevents pregnancy by changing the sperms’ course inside the uterus so that they can’t find and fertilize the egg. IUDs are made of copper because this metal actually repels sperm. Strings from the IUD are left intact and poke outside of the cervix for easy removal and as a way of checking to ensure that the IUD is in place.
Barrier Method
Barrier methods include condoms, female condoms, diaphragm, and cervical cap. As the name indicates, this method prevents pregnancy by using a barrier to block the entrance of sperm into the uterus. Condoms are widely available and even free at places like Planned Parenthood. Diaphragms and cervical caps need to be fitted so they require a visit to your gynecologist or health care provider. They also require use of spermacide and do not prevent against sexual transmitted diseases.
Fertility Awareness Method
The Fertility Awareness Method involves monthly charting of the signs of ovulation and can be used both to prevent pregnancy but also as a tool to get pregnant. The main signal used to determine ovulation is the monthly changes in cervical mucus. When cervical mucus becomes egg white and stringy, it is an indication that ovulation is on it’s way so it is a good idea to either abstain from unprotected sex or to have have sex if you are wanting to get pregnant. The other sign that is charted is basal body temperature (BBT) which is taken first thing in the morning every morning. A thermal shift indicates ovulation has occurred and continued rise with a missed period indicates pregnancy. The most important aspect of the fertility awareness method is that it must be done every month because even women who have regular consistent monthly periods can change from month to month for various reasons.
How effective is natural birth control?
Hormonal forms of birth control with perfect use have a very high rate of 99% effectiveness in preventing pregnancy. Natural birth control methods when used perfectly can overall be just as effective in preventing pregnancy without effecting your hormones. Of the barrier methods, condoms actually reign supreme as they are 98% effective. Diaphragms have a 94% effectiveness rate and 88% with typical use. Cervical caps are 84% effective in preventing pregnancy but their effectiveness is reduced to 68% if you have already had a baby. The copper IUD is extremely effective and also cost effective as the average use is 15 years. The effectiveness rate for a copper IUD is 99.5-99.8%. The fertility awareness method has been shown to be 98.2% effective.
What is the most effective non-hormonal birth control?
Copper IUD has the same if not a higher effectiveness rate that hormonal birth control in preventing pregnancy. Inserting a Copper IUD means that you don’t have to remember when to take it or replace it like the pill or the patch, thus it is very user friendly. It is also the perfect option for women who change time-zones often for work. In addition, an IUD is much more cost effective than the pill as it only needs to be replaced once every 10 years.
What are the pros and cons of using natural birth control?
Copper IUD
Pros
Very effective (99.5-99.8%)
Cost effective - only needs be replaced every 10 years
Easy to use
Spontaneity - can have sex anytime
Cons
Needs to be done in office
Painful insertion
Can make periods heavier and more painful
Possibility of PID and expulsion (though low risk)
Doesn’t prevent against STIs
Condoms
Pros
Readily available, and often free
Prevents against STIs
Cons
Reduced spontaneity - can only have sex when you have a condom
Failure rate due poor fit, improper use expired
Allergies
Diaphragm
Pro
When it’s inserted, you can’t feel it
Spontaneity - can be inserted 3 hours before sex
Cons
Needs to be custom fit, and needs to be refitted with 10lb weight changes or after pregnancy
Increases frequency of urinary tract infections (UTIs) and vaginal infections such as bacterial vaginitis (BV) and yeast infection due to frequent spermacide use
Can be damaged
Cervical cap
Pro
When it’s inserted, you can’t feel it
Cons
Less effective after pregnancy
Least effective than other methods
Fertility awareness method
Pros
Useful both in pregnancy prevention and achieving pregnancy
Low cost
Cons
Learning curve - it can take 3-6 months to master this method
Requires a period of abstinence or use of barrier method during fertile window
Not the best option for women with very irregular cycles
What is fertility tracking or a birth control calendar?
Fertility tracking is using the main signs of ovulation (cervical mucus and basal body temperature) to determine when and if you are ovulating. Every month, changes in both cervical mucus and basal body temperature are recorded either in an app or the old fashioned way graphing paper.
To be clear that you did ovulate, you will be able to see the thermal shift either on your app or on the chart you created on the graphing paper. Some women may also choose to use more elaborate ovulation kits which measure LH (luteinizing hormone). LH surges just before ovulation.
Now if you are using a period tracking app, you can not assume that the days indicated as your fertility window are actually your fertile window. The fertile window is the 5 days before and including ovulation. Why 5 days? Because thats about how long the average sperm lives. So it is possible to have unprotected sex 5 days before ovulation and a rogue sperm could fertilize an egg.
If your app is not also tracking BBT and cervical mucus, it can’t be assumed that your ovulation day is always half way through your cycle or that your cycle will always be the classic 28 days. Every cycle really needs to be treated as a stand alone cycle.
What is natural family planning?
Natural family planning is another name for the fertility awareness method. Women track their cycles every month using the two main signs of ovulation (cervical mucus and basal body temperature) to either get pregnant or prevent pregnancy.
Some women will also use a third indicator, cervical size, to determine ovulation. For basal body temperature, you take and record your temperature relatively at the same time every morning. If it stays higher than baseline for more than 18 days without a period, then congratulations, you are most likely pregnant.
The temperature will drop down again right before your period if you are not pregnant.
To assess cervical fluid you can simply observe discharge in your underwear or better yet, feeling inside with your finger. The fluid will either be dry, sticky, creamy, and egg white slippery. The days leading to ovulation will have the egg white consistency and maybe even be stringy between your fingers.
After ovulation, the fluid becomes sticky and then dry. For women trying to get pregnant, this is a great time for sex. For women not wanting to get pregnant, the 3-5 days prior to ovulation you will want to either abstain from sex or use barrier methods.
If you don’t experience consecutive days of increased temperature rise and egg white texture cervical fluid you most likely aren’t ovulating. This is another reason I like this method, as it can help determine if you may be having a hormonal imbalance as well as teach you what vaginal secretions are normal and which are a sign of infection.
If this is going to be your choice of pregnancy prevention, I would give it 3-6 months to gain mastery over charting and interpreting your records before using it as a stand alone form of birth control.
What is a fertility cycle tracking app?
Fertility cycle tracking apps help you determine most accurately when you ovulate. Knowing when you ovulate is useful in determining when you should be having or abstaining from unprotected sex.
Many period tracking apps also track fertility, if you are recording both basal body temperature and cervical mucus. Remember even if you regularly have a 28 day cycle, it doesn’t necessarily mean you ovulate on the magical day 14. So apps that assume ovulation happens in the middle of your cycle could literally be missing the window.
The luteal phase (second half) of the menstrual cycle tends to have a set number of days ranging from 12-16 after ovulation. So if you have a 28 day cycle, ovulation could occur anywhere from day 12-16 of your cycle.
It can even be more complicated for women who have much longer or shorter cycles. In fact, calendar-only apps have been shown to not be very accurate in predicting ovulation in women who have cycles that deviate too much from the 28 day cycle.
Bottom line - if you want to use a fertility cycle tracking app as birth control, it should at a minimum track basal body temperature and even better if it also tracks cervical mucus. It is also important that your data be entered consistently and accurately, so choosing an app that makes this as user friendly as possible is key.
My favorite app for tracking ovulation is Fertility Friend as it tracks both basal body temperature and cervical mucus.
Have questions?
If you have questions about natural birth control, please contact us to schedule an appointment.