Birth Control Myths, Part 3: Fertility Awareness, Timing, and Extended-Cycle Use

See Part 1 and Part 2!

*Disclaimer: This blog is intended for informational purposes only. The information on this blog should not be used as a substitute to medical advice or medical treatment. As always, your Primary Care Provider, a doctor, or another health professional is your best resource for specific questions and medical advice. If you believe you or a loved one are experiencing a medical emergency, please contact 911.*

Question: Natural methods of birth control (family planning, fertility awareness, etc.) work…

92.9% of 212 voters said “some of the time”. Correct! They can be an effective method of birth control, but not necessarily one that works for everyone.

Methods like fertility awareness (also known as family planning) can be effective (up to 99% according to some sources, but I’ll talk about this later), but this is not a one-size fits all method (like all birth control methods, frankly). Similar to lactational amenorrhea which I mentioned in Part 2 of this blog, there are a lot of criteria that have to be met for this method to be effective.

So first of all, you have to be willing and committed to tracking your cycle but before we even get to that, you should determine if your cycle is regular or not. If your cycle is irregular, other methods are going to be more reliable. This could mean you have a diagnosed medical condition or illness making your cycles irregular, you are on medication that may affect your cycles, in the last 3 months (roughly) you’ve stopped taking another form of hormonal birth control such as the oral contraceptive pill, you are postpartum and breastfeeding, you have a recent history of miscarriage or abortion; the list goes on and more exceptions can be found here. If any of these apply to you, talk to your doctor about the best method of birth control for you.

So if you do have a regular menstrual cycle (for the most part, I’ve talked about how stress & illness *can* impact your cycle in previous posts – so this is something you should always keep in mind), you could try this method after discussion with your HCP (I advise this because each person is different and it’s always a good idea to discuss risks/benefits with someone who knows you & your medical history).

There are a few different ways to “do” fertility awarenessyou can check your basal body temperature daily, track ovulation & cycle using a calendar, or use cervical mucus as an indicator. I couldn’t find a study comparing these methods (if you know one, please shoot it my way via Twitter), but this would be a great area of research for anyone interested in supporting women’s rights when it comes to choosing birth control. Non-hormonal methods that are effective are in high demand right now it seems, and according to one study, FAM teaching is not always included in OBGYN education. This may also then be an interesting point for medical educators to take into account.

I found a really great article here (it’s accessible, yay!) that talks about an approach to contraceptives that takes women’s desires and rights into account; it also talks about how wording in regards to FAM methods can be misleading, and that they are of course not as foolproof and effective for pregnancy prevention as IUDs and long-acting reversible contraceptives (LARCs) for example.

With the current situation in the USA however, I imagine many people may be relying on FAMs in the near future. I think, for providers, an important thing to remember which is highlighted by this article is not to use wording or language that essentially places different forms of contraceptives in the octagon and declares one a winner and the other a loser. Instead of putting them up against each other, be realistic and state the facts on efficacy for each type, but allow your patient to maintain their ability to choose what works best for them. Once they choose, respect this decision and help them by providing any additional information you can.

So in response to this question – I think it deserves a conversation with your doctor. It may be right for you, if it’s what you want and prefer. It may not, for various reasons too. In terms of “does it work”.. it may be right for you, but in regards to statistics, it is not as effective as other methods. I’ll leave you with one resource: this chart which is actually helpful when thinking about different types of contraceptives & what may work for you.

Question: The pull out method is…

59.2% of 213 voters said not effective, while 40.4% said moderately effective. It can be pretty effective, but it has to be done right (and that doesn’t always happen).

In a perfect and hypothetical world, the pull out method fails only 4 out of every 100 people per year. We don’t live in that world though, so it more realistically fails about 1 in 5 people. This is because ejaculation is a bodily function that although can generally be sensed, may also be missed due to…. being distracted by pleasure!

If you go back to the chart I linked above, it’s in the bottom tier (withdrawal), just before emergency contraceptives. So although it is not very effective when not done with 100% accuracy, it is always better to do something rather than nothing. Like FAMs, it’s a method that is available free of charge, so it is enticing to use it especially as I mentioned, in times where rights and access to birth control are being stolen away.

So – not a great option necessarily, but still an option. As always – discussion with your provider AND your partner. Figure out what works for you, find out your risk vs benefit ratio, anything you may need to be prepared for and so on.

Myth: If I’m taking the pill, I need to take it at exactly the same time every day.

86.4% of 213 voters said true. Actually – this only really applies to the mini-pill but you definitely need to be taking your birth control every day, but you don’t need to panic if you’re a bit early or late on the timing.

Combination pills (which I talked about in the first post) can be taken at any time of the day, as long as you take them every day. The reason we associate it with a time is really to help boost your memory – ie. if you set an alarm for 1 pm everyday to take your pill, you are probably more likely to remember (and if you’re not, then maybe have a discussion with your provider about switching types of birth control).

Pills with only progestin (often called the mini-pill or POP aka progestin-only pill) do need to be taken at the same time daily, or at least within a 3 hour window (pill dependent – desogestrel pills the window is 12 hours; if you want to know your window, check the insert on your prescription or ask your pharmacist/provider). Taking it outside of these windows decreases effectiveness, and increases your risk for pregnancy.

If you miss a pill – you need to check the insert or ask your pharmacist/provider in regards to what your next steps should be, for either/any type of pill. Generally speaking, if you miss a progestin-only pill:

  • Take one pill, the missed pill, as soon as you remember (if it’s outside of the recommended time frame)
  • Then resume your normal pill schedule, at the regular time – it’s okay if you take two pills in the same day as a result of this
  • For ~48 hrs, you should use additional protection if you have intercourse

If you miss a combination pill, you’d also take the missed pill as soon as you remember, then resume taking your pill normally.

Where it gets complicated is when you miss more than 1. Check your insert or call your pharmacist for more guidance if needed.

Myth: I’ve been on birth control for awhile, my body needs a break to stay healthy.

75.4% of 207 voters said false. No need to take a break, unless it is for any reason medically advised by your doctor.

Unless your PCP advises it (and they will explain their reasoning for this), there is no need for your body to have a “break” from hormonal contraception. If you’re concerned about the risks of cancer, which were discussed in the previous posts, this is again – something you should discuss with your provider.

Another important thing to discuss with your provider is if you feel your current form of birth control (whether it be hormonal or not, but specifically with hormonal ones) isn’t working for you – if you feel unusual, off, like something isn’t right. Your moods or emotions are every which way. There are so many options out there, you can work with your provider to find something that works just right for you – don’t feel like you’re “trapped” with your current form of birth control.

I am not an OBGYN or someone who studies the effects of birth control on the body so I don’t feel comfortable going into much detail here, but I can recommend a good read (and an easy read at that) for information on the female body, hormones, contraceptives, female anatomy, and pretty much anything you can think of related to those topics – the Vagina Bible. I read this last year and felt like I learned so much, and topics such as this are discussed there in more detail by an expert. Highly recommend!

Myth: Skipping your period with birth control is bad.

76.6% of 244 voters said false. It is has not been shown to be bad for you – the risks are the same as taking birth control and having a period (however – each person is different and always, discussion with your provider is what I recommend). There are actually types of birth control pills, extended-use pills, that allow you to do this more easily.

You can delay or “skip” your period (withdrawal bleeding) with birth control – you don’t need to be on an extended use birth control to do this, but they do make it easier to do long-term since they are made for this. On a regular combination pill, you would just skip your placebo/sugar pill week.

An extended cycle birth control would mean you would have withdrawal bleeding (“a period”) about every 3-4 months, depending on the pill. There is also the option to do continuous cycle – meaning you just keep taking only the hormonal birth control pills, no breaks.

There are benefits to skipping a period, for people who have painful or heavy periods since it obviously decreases the number of periods they have a year. It may also help with hormonal imbalances, other period-related symptoms, or be a totally preference-based decision. An IUD or birth control implant or shot, can help with many of the same issues since periods are often lighter, irregular, or do not occur.

The most common side effect of extended-use or continuous cycle use of birth control is spotting.

There were a couple additional questions that people asked on the poll thread – those will be covered in part 4, the final part of this series! As always, thanks for reading & participating.

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