Natural family planning (NFP) is a form of pregnancy planning. It does not involve medicine or devices. NFP helps people observe their body’s fertility signs to know when to have sexual intercourse. It can be used if you are trying to achieve or avoid pregnancy. It involves keeping track of a person’s bodily changes throughout the menstrual cycle. People may choose NFP for religious or personal reasons, or because they are concerned about the side effects of artificial means to achieve or avoid a pregnancy.

Path to improved health

Pregnancy can occur if sexual intercourse takes place right before or after ovulation. Ovulation is when the ovaries release an egg. It usually happens at around the same time each month. The egg moves toward the uterus through the fallopian tubes. This is where conception takes place. An unfertilized egg may live for up to 12 hours. The body will shed the egg during the menstrual period if it isn’t fertilized.

There are three methods of natural family planning. The first is the mucus or ovulation method. A woman checks and tracks her cervical mucus. During ovulation, your cervical mucus is stretchy, clear, and slick. It looks and feels like an uncooked egg white. You will write down your mucus’ consistency each day.

The second is the symptothermal method. A woman takes her daily basal body temperature (BBT) using a BBT-specific thermometer. You can take it in your mouth, vagina, or rectum. A regular BBT is between 97° and 98°F. At the time of ovulation, your BBT will rise between .5 and 1 degree. You should take your BBT in the morning before you get out of bed. Ideally, it should be the same time of day. You should use the thermometer the same way each day to get accurate results.

A third approach is the rhythm method. It is based on the calendar dates of a person’s previous menstrual cycles. This method can be more difficult and is not as reliable. It doesn’t allow for changes in the menstrual cycle, which are common. A normal menstrual cycle is between 28 to 32 days. The day a person starts their period is considered to be cycle day 1. Ovulation often occurs around day 14 of the menstrual cycle.

Sometimes, people combine the approaches. In all 3 methods, you must use a calendar or chart to track the data and changes. This predicts when you ovulate, so you can have or avoid sex. You may notice other symptoms you can track. These include bloating, backache, tender breasts, or pain in your ovaries. It generally takes 3 to 6 cycles of charting to get an accurate idea of your ovulation pattern.

Things to consider

You may choose to find someone who teaches NFP methods. You can ask your doctor or gynecologist for a recommendation. When you follow NFP methods to prevent pregnancy, the success rate is about 90%. When you follow NFP methods to conceive, on average, 2 out of 3 couples who don’t have fertility problems become pregnant. If you do not follow instructions completely, NFP will be less effective.

There are benefits and risks of NFP. It is free, or less expensive compared to the use of birth control or condoms, which can be expensive. NFP doesn’t have side effects. It meets certain religious guidelines. You can stop NFP at any time and it won’t affect your menstrual cycle. On the other hand, NFP requires you keep a constant schedule. If you veer from it or aren’t careful, you may not be successful. You may need to use back-up contraceptives. NFP can be hard if you have abnormal menstrual cycles or are breastfeeding.

Questions to ask your doctor

• Are there any health conditions that may prevent me from using natural family planning?
• What should my cervical mucus look and feel like when I’m not ovulating compared to when I am?
• How long should it take for me to rely on NFP?
• Do you recommend working with an NFP teacher?

Resources

American Academy of Family Physicians: Natural Family Planning

American Pregnancy Association: Fertility Awareness

National Institutes of Health, MedlinePlus: Pregnancy – identifying fertile days

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A progestin-only birth control pill is often called the mini pill. Regular birth control pills have 2 female hormones: estrogen and progestin (a synthetic version of the naturally occurring hormone progesterone). The mini pill has only progestin in it. Because this pill doesn’t contain estrogen, it may have fewer side effects than regular birth control pills.

Path to improved health

This pill works in three different ways. First, it thickens the mucus between your uterus (where a baby grows) and your vagina, the tube leading to the uterus. Sperm have a hard time getting through the thick mucus to reach the egg.

Second, like regular birth control pills, the progestin-only pill makes your body think you’re pregnant and stops your ovary from releasing an egg. This doesn’t happen as often as with combination birth control pills. Forty percent of women taking the progestin-only pill will continue to ovulate.

Third, the mini pill causes changes in your uterus that make it less likely to let a pregnancy get started, even if an egg is released.

Is the progestin-only pill better than regular birth control pills?

The progestin-only pill is safer for women who are older than 35 and smoke, have high blood pressure, or have a history of blood clots or migraine headaches.

Regular birth control pills make some women feel sick to their stomach. They also can cause severe headaches due to the estrogen in them. The progestin-only pill might not cause this problem.

This pill is better than regular birth control pills if you’re breastfeeding. That’s because the mini pill will not change your milk production. Estrogen in a regular birth control pill may reduce the amount of breast milk your body produces.

Things to consider

Remember both kinds of birth control pills are better at preventing pregnancy than condoms alone. However, no contraceptive method is perfect, even when used correctly. With typical use, as many as 9 out of 100 women who use the mini pill will get pregnant during the first year. With perfect use as directed, the pregnancy rate is less than 1 in 100 people per year. The risk of pregnancy is almost the same as the risk with regular birth control pills.

It’s very important that you take your progestin-only pills at the exact same time every day. If you don’t take them at the same time each day, your risk of pregnancy increases.

Make sure your doctor knows all medicines and dietary supplements you’re taking. Some of them, including St. John’s Wort and certain antibiotics, can interfere with birth control pills.

Does the progestin-only pill have disadvantages?

The mini pill must be taken on time. It works best if you take it every day at the same time of day. Timing is much more important for the progestin-only pill than for regular birth control pills.

If you are more than 3 hours late taking the progestin-only pill, you should take your missed dose right away and use a backup method of contraception (such as a condom) for the next 2 days.

You might have bleeding between your periods for several months after you start taking the progestin-only pill. This can be inconvenient, but it’s not a health risk. The bleeding may go away on its own after you use the mini pill for a few months. If the bleeding seems heavy or if it bothers you, discuss it with your doctor.

Like regular birth control pills, the progestin-only pill must be taken for a week before it can protect you from pregnancy. So for the first week, you need to use another kind of contraception, such as condoms, along with the mini-pill.

If you miss a day completely, you must use a second method of birth control for one week. You can’t take two mini pills the next day to make up for a missed pill.

Like all birth control pills, the progestin-only pill does not protect you from getting a sexually transmitted infection.

When to see a doctor

If you continue to have bleeding between your periods after the first few months, you should see your doctor. Also, if your periods seem more severe or unusual in any way, contact your doctor.

Contact your doctor right away if you experience any of the following:

• Leg pain, swelling, or your leg feels hot to the touch
• Chest pain
• Difficulty breathing
• Unexplained fever or chills

Questions to ask your doctor

• How can I know which birth control pill is best for me?
• If I take progestin-only birth control pills, am I less likely to gain weight as a side effect?
• Is one birth control pill more effective than another at preventing pregnancy?
• Does one birth control pill have fewer side effects than another?
• Can I use birth control pills to skip having a period altogether?

Resources

National Institutes of Health, MedlinePlus: Birth Control Pills – Progestin Only

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According to the Centers for Disease Control and Prevention (CDC), the teen birth rate in 2020 was 15.4 births for every 1,000 females ages 15-19. This birth rate is down from previous years. However, many teenage pregnancies are unplanned and can be prevented.

Path to improved health

The CDC and the American Academy of Family Physicians (AAFP) support an evidence-based approach to sexual health education. This includes education that is comprehensive. The AAFP doesn’t recommend abstinence-only sexual education. Family physicians are trained to discuss all matters on sexual health. Teens should be able to talk to doctors, parents, or other trusted adults for information on how to prevent pregnancy.

There are two main ways to prevent pregnancy.

• Abstinence: The only way to prevent pregnancy 100% is to not have sex.
• Birth control: There are many types of birth control. Females can use a pill, patch, or shot. Another option is an intrauterine device (IUD). Both males and females can use condoms and/or spermicide.

Teenagers can get a prescription for birth control from their family doctor. Some local clinics, such as Planned Parenthood, also can provide access to birth control.

If you decide to be sexually active, you should use condoms even if you use other birth control. This is the only way to prevent sexually transmitted infections (STIs).

Keep in mind, birth control only works when used consistently. If you forget to take a pill or use a condom, there is still a chance of becoming pregnant. In this case, you can talk to your doctor about emergency contraception as a potential option. Also different states have different laws regarding parental approval of birth control, depending on the child’s age. Your family doctor can provide more information about the laws in your state.

Things to consider

Pregnancy health risks are greater for teenage girls and their babies. These risks include:

• Premature birth
• Low birth weight
• High blood pressure

When to see a doctor

Contact your doctor if you are or are thinking of becoming sexually active. He or she can talk to you about your options to prevent pregnancy and STIs. If you can’t see a doctor, visit a local clinic, such as Planned Parenthood, for assistance for sexual health.

If you become pregnant, see your doctor right away. It’s important to begin prenatal care as early as possible. Teenagers who are pregnant also should:

• Avoid alcohol, tobacco, and other drugs.
• Take a prenatal vitamin to support healthy growth and help prevent birth defects.
• Use condoms, if still sexually active. Condoms protect against STIs that could harm the baby.

Questions to ask your doctor

• Can anyone get birth control?
• What is the best type of birth control for me to use?
• How effective is birth control?
• What are the side effects of birth control?
• Do my parents need to know if I want to use birth control?
• What are my options if I become pregnant?
• What should I do if I miss a dose of my oral contraceptives?

Resources

American Academy of Family Physicians: Sex: Making the Right Decision

National Institutes of Health, Medline Plus: Teenage Pregnancy

Planned Parenthood

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