The aim of natural family planning is to determine as accurately as possible the beginning and end of the fertile phase, says Helen O’Callaghan.
ANN* wishes she’d known about natural family planning (NFP) in her 20s.
On the pill from the age of 22, the Cork-based project manager feels she’d have avoided 10 years of feeling awful.
“I always felt like throwing up in the morning. I’d be brushing my teeth and gagging.”
Now 45, she discovered NFP in her late 30s, when trying to conceive. She’d already had one child through IVF but a second IVF attempt failed.
“I came crashing down to reality. There was no specific reason why it failed. Then I got pregnant naturally. I miscarried, but it showed I could get pregnant naturally without IVF.
"It prompted me to investigate the cause of my infertility rather than looking for a quick fix.”
On the internet, she came across NFP, got herself a trainer and learned to track changes in her cervical mucus.
She cross-checked them by taking her temperature every morning (basal body temperature rises in the second half of a woman’s cycle, after ovulation), charted all her daily findings and was able to pinpoint when she was ovulating.
“The first cycle’s hard. You’re not sure what you’re looking for because you really haven’t paid attention before. But it became second nature. I couldn’t believe it — it made me aware of my own body.
"I built up a full picture of my cycle so I really knew, month by month, when I was at peak fertility. I made sure I had sex on those days.”
Through charting her cycle, Ann learned a hormone imbalance was inhibiting pregnancy.
She didn’t get pregnant but has taught NFP to three friends — who, like her, used it to try to achieve rather than avoid pregnancy. Two became pregnant.
Dr Deirdre Gleeson, a GP specialising in occupational health, as well as a course director with the Natural Family Planning Teachers Association of Ireland (NFPTAI), teaches the sympto-thermal method of family planning, the one used by Ann.
The aim is to determine as accurately as possible the beginning and end of the fertile phase.
The NFPTAI combines three classic family planning methods — calendar, body temperature and Billings (based on changes in cervical mucus).
The woman/couple need three or four sessions of training, each lasting an hour. Dr Gleeson loves that the method is woman-led rather than doctor-led.
“Other methods of family planning are doctor-led. NFP is an educational method, out of the realm of medicine. Any woman can train another once she’s fully equipped with the knowledge.”
Una O’Donnell is coordinator of pre-marriage courses at the Cork office of Naomi-Billings Ireland, an organisation that teaches women how to manage their own fertility through monitoring body changes.
On her initial visit, the woman learns the ‘indicators of fertility’ — there are three major ones: changing, developing pattern of mucus; slippery sensation; and swollen vulva.
O’Donnell says women often don’t know fundamental fertility facts.
“Few women realise the egg has a very short life — maximum 24 hours — whereas sperm, with fertile [female] mucus, can live four to five days.”
Dr Gleeson says NFP is very popular in Germany for ecological reasons, whereas in Ireland there’s a lot of prejudice against it — it’s seen as the ‘Catholic method’ that doesn’t work.
“But that’s because the older rhythm method relied on a regular 28-day cycle, which didn’t work for a lot of women.”
Yet Irish interest in NFP is growing, says Gleeson, who identifies two groups opting for it — those committed to it for religious reasons (this number is rising, according to Gleeson) and those who want it for green reasons.
“A lot are into alternative health. They’ve tried the pill and didn’t like the side-effects.”
O’Donnell recalls one woman saying: “I’m on medication for contraception but I’m not sick, so why am I on it?”
Penny Wilson, counsellor and NFP therapist with Accord, says the organisation saw seven clients interested in the method in 2016, nine the previous year and eight the year before that.
“One was a woman in her 40s approaching the menopause and not wanting to get pregnant. In their 40s, women are often told not to be on the pill but they don’t like to use barrier methods. This woman wanted something to tide her over ’til the menopause.”
As at Naomi-Billings Ireland, Accord finds most women interested in NFP are looking to conceive rather than prevent pregnancy.
At the Irish Family Planning Association (IFPA), director Dr Caitriona Henchion says clients rarely ask about NFP.
“We might get one or two a year. They often think it’s about working out the days in your cycle and that’s it.
"When we explain they’d have to be doing cervical mucus checks and taking their temperature, they’re overwhelmed and say ‘that’s not for me — maybe sometime in the future but right now it’s important to me not to get pregnant’.”
While a 2010 Irish-based study found about 3% of people using NFP, O’Donnell says it’s hard to measure interest.
“There are so many apps on smartphones and so much information on the Internet that women can access.”
And, increasingly, high-tech is getting into the natural end of the fertility business, with Swiss technology company Ava making a wrist fertility monitor that can identify when a woman’s at her most fertile.
She wears the bracelet-style device while sleeping — next day it delivers a verdict on her fertility on a smartphone app. The manufacturers say it’s almost 90% effective.
There’s also Lady-Comp, a German-manufactured fertility monitoring system that determines a woman’s fertile and non-fertile days by recording, analysing and storing the menstrual cycle data.
It came onto the Irish market in 2014 and — according to general sales manager Luke Manczak — its popularity is growing here, with most women buying it to avoid pregnancy.
Studies show NFP is up to 98% effective against pregnancy, when used by motivated couples and taught by experienced teachers. But Dr Gleeson agrees NFP isn’t for everybody.
“The woman has to be very motivated and disciplined to take her temperature every morning and to check the mucus.”
O’Donnell says having a supportive partner is vital. “You wouldn’t do it without the agreement of your partner. It’s a method that requires more of each partner.”
While some might see NFP as restrictive — couples abstain from sex during the fertile phase, though some use a barrier method at that time — Dr Gleeson says it really is a case of absence makes the heart grow fonder, with NFP actually enhancing relationships.
NFP is more in tune with the natural rhythms of the body than artificial contraception, she says.
“A woman can tell her partner ‘I’m fertile now’. He has to respect her feminine cycle — he knows at this time of month he has to abstain or risk fathering a child.”
Dr Gleeson says because the fertile phase is just six days a month, it’s not a big deal to abstain.
“Studies show couples make up for lost time — they have more sexual intercourse than couples on other methods.”
She points to a British study that found 75% of couples saying NFP improved their relationship.
“They have to communicate. The woman has to let the man know whether she’s fertile or not. He has to compromise and show respect for her fertile cycle. It requires a bit of restraint on his part and shows how committed he is.”
She cautions a couple learning the sympto-thermal method must abstain for about 10 days until they can reliably pinpoint ovulation.
At the IFPA, Henchion says it’s going to take time to get good at NFP.
“I’d say the same to someone using the diaphragm — during that lead-in you need to use something else as well, like condoms.”
And she warns there’s less leeway for mistakes with NFP.
“If you’re using the pill and forget to take one, the likelihood you’ll get pregnant is low. But if you have sex on a fertile day, risk of pregnancy is high.”
Meanwhile, Dr Gleeson says while men who come along to the NFP training sessions are often “a bit reluctant and shy at first”, women “really get into charting [their fertility symptoms] and taking their temperature”.
Ann feels if she’d known sooner about NFP, she’d have had a better shot at getting pregnant naturally.
“I didn’t even know I had an issue. Awareness is the first step. I might have started trying [to get pregnant] much younger.”
Names have been changed
When we wanted to conceive, we conceived
Amy Sheridan-Garrity is married to Samuel and mum to Evelyn, 5, Rose, 4, and Reuben, 1.
The 33-year-old Yorkshire woman is training in Ireland to be a natural family planning (NFP) teacher.
“Before getting married, I was on the contraceptive pill. I have polycystic ovary syndrome (PCOS) and the doctor said the pill would alleviate it.
"I wasn’t functioning well on it but I was reluctant to stop in case the PCOS symptoms got worse.
“After my honeymoon, I came across a leaflet about a GP training to be a NFP teacher — she was looking for people to practise on.
"I didn’t want to get pregnant. I’d only just finished university, I was living with my in-laws, we needed a house and I needed a job.
“I was so happy to talk to somebody who knew about fertility. The method I used was to check cervical mucus. I didn’t even know cervical mucus existed.
"I thought ‘I’ve been a woman all my life, how could I have gone through school and biology and not known about this?’
“I appreciated my body so much more. Up to then I thought it was failing me because of the PCOS. Then I saw it doing this amazing stuff and thought: ‘Wow! It’s functioning’.
"It was such a gift to me, it made me feel so much better as a woman.
“I saw the teacher every two weeks for about three months. I was up and running after the first session. Then it was fine tuning — making sure I was really well drilled. I used it for three years to avoid pregnancy.
“When we wanted to conceive, we conceived straight away each time. I’d say ‘I have peak time mucus today’ and I’d get pregnant that day.
“Abstaining [from sex], isn’t a problem. In the early stages, we wanted to have sex all the time but we’d have those few days off and then we’d just get back to it.
"Now with three children, I’m more tired, my libido is less than it was back then. It’s possibly harder for my husband than it is for me.
“It has brought us closer. Sex is so precious to us, more than if it was freely available all the time.”
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