 | Any woman who uses fertility awareness as contraception needs a man who shares responsibility for avoiding pregnancy and uses condoms or other precautions for at least 11 days a month. For encouragement, I suggest Gabrielle Blair’s book Ejaculate Responsibly. The Conversation We Need to Have About Men and Contraception. Unfortunately, like many others, Blair dismisses fertility awareness methods, which can be up to |
Ejaculate Responsibly. The Conversation We need to have with Men about Contraception (Book review)30/8/2024
 So, did you watch Davina McCall’s Pill Revolution on Channel 4?
It told the stories of the many women and girls who have negative experiences with the pill, and how there needs to be more research and better information. This is very welcome. Too many women, and girls, are put on the pill with very little information about its potential impacts. We need to do better.  Like millions of women I used to take the pill, and was lucky enough not to have any unpleasant side effects.
In 1995, research was published that linked hormonal contraception to blood clots. I was working as a librarian for the NHS at the time, in public health. I paused but I felt young and fit enough to handle the risk. Then a friendly colleague suggested using fertility awareness as contraception.
 Camden New Journal recently published some articles imagining how local news might look in 2030 if all the climate goals were reached. I was very pleased to contribute this:
Camden wins NHS sustainability award for green contraception project NHS contraception used to mean medication or minor surgery. The NHS website listed fertility awareness (natural family planning) and said it was up to 99% effective but most GPs didn’t recommend it and women had to pay for support, or work things out for themselves.  Using fertility awareness as contraception can feel scary if you've ever heard it fails 1 in 4 women with typical use (25%).
That figure is unhelpful as it lumps together all the different fertility awareness methods and some of them are better than others. The failure rate mentioned in this BMJ update is more helpful because it gives a range of figures, depending on the method used. It ranges from 2% to 34% with typical use.  Feeling prepared for the zombie apocalypse used to be one of the things I liked about using fertility awareness as contraception.
And here we are – no zombies, but a pretty apocalyptic situation. Not a great time for popping to the GP or pharmacy for pill supplies, or getting a contraceptive injection or implant. So how is fertility awareness holding up? Well, if you're an established user you're probably fine.  If you want a baby (it’s not compulsory) you are probably all too aware of your fertility, and how it declines with age.
You might just want to sort a few things first. Like a suitable partner, a decent job, affordable housing, affordable childcare and while we're at it how about flexible working practices? Once you're ready, or reasonably ready, you have the small matter of getting pregnant to attend to.  Do you need periods, or are they “God’s design flaw” as a senior health professional said in a recent Guardian article?
If you mean a pill withdrawal bleed, I agree they are pretty pointless. They were originally introduced as a marketing gimmick, to help women feel better about taking the pill. FSRH guidance states there are "no health benefits" to pill withdrawal bleeds. It's a bit more complicated if you mean a true period, the bleed you get after ovulation.  You might think using fertility awareness as contraception means you only have a few red days a month when you need to use condoms or other precautions.
Unfortunately that's not how it works. Even with loads of data about your cycles, and regular periods, you need buffer days to allow for things changing from month to month. You need to allow for sperm that hangs around for 7 days, even though 5 days is more likely. And for releasing 2 eggs when you ovulate that  Period pain can seem inevitable, “a common and normal part of your menstrual cycle” as the NHS website says.
I used take a few ibuprofen a month and get on with my life. Then I came across Lara Briden's revolutionary idea that periods are not meant to be painful. This sounded too good to be true, but I was curious so I bought her book anyway I was sceptical because Lara is a naturopath
 I was nervous about this programme. A doctor, on the BBC, talking about pill safety - it’s bound to dismiss women’s concerns, isn’t it?
So I was pleasantly surprised when there was no lecture telling all women they should use a long acting method like the implant, injection or coil. Instead Dr Williams simply says most women prefer the pill to long acting  Using fertility awareness as contraception can seem like lots of work.
Record every day of your period, every waking temperature, every scrap of fluid. Wake up at the same time every single day. Never drink alcohol, or get sick, or travel, or get stressed. Who can handle that?
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