Why?

A recent STAT article about apps like Clue and Natural Cycles suggests physicians aren’t prepared to discuss natural family planning with their patients. If your residency faculty has bias against it, or simply never learned it, you probably aren’t. Family Medicine is not immune to having contraception favoritism or unconscious preference for LARCs. So, let’s fix that knowledge gap in less than 10 minutes.

What is it?

Natural family planning is contraception without prescription – there is no medication or implant/IUD. It is essentially planned, temporary abstinence – based on avoiding intercourse during days one is likely to be fertile. In Ye Olden Times (the 70s?) it was called “the rhythm method” AKA: fertility awareness, hormone-free contraception, calendar method.

Benefits?

No hormones or procedures. Safe for those who have migraines with aura, hypertension, cancer, history of DVT, heart disease. In fact, technically safe for all. Success rate is based on “typical use” and varies from 66-98% depending on which type (or combination of types) used.

Risks?

  • No prevention of STIs
  • Effectiveness (and thus risk of failure) is user-dependent
  • Some type depend on having a “typical” cycle length of 26-32 days
  • Most require daily tracking of something (temp, cervical mucous consistency, menses)

How can you counsel patients about it?

As the STAT article pointed out, people are already worried their doctor will judge them for what birth control they want. So, don’t do that. YOU may love an IUD. I think the combined pill is still cool as heck (hello, I am an Old). But IT DOESN’T MATTER, because it’s what YOUR PATIENT wants and what fits in their life best that matters.

Orange square that reads "natural family planning 101"

So, listen to what they want. Ask if there’s a method they already have in mind. If not, do they have “regular” cycles and know how many days are between menses? Do they mind tracking or daily temperature checks? Are they comfortable with the idea of “checking” their cervix? Bottom line, you can’t effectively counsel without understanding the options well yourself, to know what questions to ASK.

What resources can I share with patients?

Bedsider.org is the BEST WEBSITE FOR CONTRACEPTION. The page on fertility awareness lists lots of options, as well as effectiveness based on both “perfect” and “typical” use. It also has a neat tool so patients can compare up to 3 types of contraception (even 3 types of NFP). Their comparison chart includes important, but frequently not considered aspects, like spontaneity, “ease of hiding” and effort. https://www.bedsider.org/methods/fertility_awareness

Also, I love the PDFs from RHAP (Reproductive Health Access Project) – they break the info down in a nice format with rates of success, how it’s done and pros/cons. https://www.reproductiveaccess.org/resource/natural-family-planning-methods/

Finally, the UK’s NHS site has a page that covers details about ovulation and sperm duration, but is not as complete as the two sites above. https://www.nhs.uk/conditions/contraception/natural-family-planning/

What resources can help me learn more?

First, use the two resources for patients above. Feel comfortable walking a patient through Bedsider’s contraception comparison tool, and RHAP’s lovely chart.

  • Want more? RHAP’s PDF is based on this BMJ article from 2019, Fertility awareness based methods for pregnancy prevention BMJ 2019;366:l4245 https://www.bmj.com/content/366/bmj.l4245
  • Bedsider has links to websites for each of the methods, including a secular organization that helps people learn about their bodies and NFP/FA.
  • AAFP’s article from 2012 is nearly pre-historic at this point, but included for completeness. https://www.aafp.org/afp/2012/1115/p924.html. I am NOT linking to the more recent patient focused article on familydoctor.org, because it’s not very good compared to Bedsider or RHAP.

I don’t have any other resources because many of them are from religious groups, and have inaccurate information on their sites.