The traditional or natural methods of contraception involve all measures to prevent pregnancy due to sexual act other than the use of any device, barrier, medication or surgery. It involves taking note of the woman’s fertile periods; using the menstrual calendar, some symptoms, signs and avoiding sex during the fertile period.
Naturally, a woman’s sexual receptiveness increases during her fertile period so, natural methods of contraception require a great deal of discipline. This increases the failure rate; the number of women per 100 that will conceive while on a particular method of contraception in one year.
LACTATIONAL AMENORRHOEA METHOD OF NATURAL CONTRACEPTION
Amenorrhoea is the cessation of menses for a period of at least 6months. Lactation is the secretion of milk from the breasts. Some women after delivery will not see their menses for about 6 to 12 months while actively breastfeeding their babies. During breastfeeding, there is an upsurge of the hormone prolactin which suppresses the hypothalamic hormone (gonadotrophin releasing hormone) and the pituitary hormones (follicle stimulating and luteinizing hormones). This results in suppression of ovulation and cessation of menses.
This physiologic process is used as a form of natural contraception. For this to be effective, breastfeeding has to be exclusive. This method should not be used for more than 6months. It is worthy to note that a woman can conceive within three to four weeks of delivery even if her menses has not returned. Its failure rate is 2 per 100 women use per year with typical use within the first 6months.
THE WITHDRAWAL METHOD OF NATURAL CONTRACEPTION
The withdrawal method also called coitus interruptus involves the removal of the penis from the vaginal before ejaculation. Both partners here will require self-control; the male may not be able to withdraw before ejaculating or the female may interfere preventing successful withdrawal. This result in high failure rate of this method. Also, before ejaculation occurs, the pre-ejaculatory fluid may contain some sperm cell. In couples using only this method with high success, one may wonder whether the withdrawal is very efficient or it is the sperm that is inefficient. Its failure rate is about 22 pregnancies per 100 women use per year with typical use.
DOUCHIING AFTER SEX
The use of a combination of water, vinegar and certain substances to wash the vaginal after sex has been practiced traditionally for contraception. The aim here is to wash out the sperms before they get the chance to swim up. This method is highly ineffective because it takes few minutes for the sperm cells to get into the cervix where the douching cannot reach.
THE PERIODIC ABSTINENCE METHOD
This method takes into consideration the fertile and non-fertile periods of a woman using symptoms, signs and knowledge of the menstrual cycle. During the fertile period, sex is avoided, this is how contraception is achieve using this method. Periodic abstinence in typical use is associated with a failure rate of 25 pregnancies per 100 women use per year.
The calendar method: is a method of periodic abstinence where a woman’s menstrual cycle is studied to know her fertile period. The time of ovulation to onset of the next menses is constant which is 14 days. This method is preferable for women with a regular 28days cycle. The sperm survives in the female genital tract for about 2 to 3days after ejaculation, while the egg survives for about 24 to 48hrs after release from the ovary. The use of this knowledge and the estimate of a probable day of ovulation, sex can be avoided as a means of contraception.
However, the above may not really apply to women with menstrual cycle shorter or longer than 28dys. For this group of women, their fertile periods can be calculated from their cycle length calendar. A calendar of at least 6month is preferred, where 20 is subtracted from the shortest cycle and 11 from the longest cycle to get a range of days for the fertile period.
For instance, a woman whose shortest cycle in a 6 or 12 calendar month is 26days and her longest cycle is 30days, her fertile period is days 6 to 19 of her cycle. During this period, sex should be avoided when using the calendar method of contraception.
The basal body temperature method: the hormone progesterone has thermogenic effect, that is, it can cause a rise in body temperature. This can be used to monitor ovulation for contraception purpose. The body temperature drops 24 to 36hrs after ovulation and suddenly raises again by about 0.3 to 0.40C (0.5 to 0.70F) and remains so for the rest of the cycle. The fertile period ends on the 3rd day of the rise in body temperature.
To use this method, a vaginal or rectal thermometer is used daily to measure the body temperature before the woman gets up from her bed to do any activity. She has to be sure that the rise in temperature is not due to any infection that may give a wrong interpretation.
The basal body temperature readings can be combined with the calendar method for a more accurate prediction of ovulation. This is associated with a failure rate of 5 pregnancies per 100 women use per year.
The cervical mucus method: this is also called the billings method. The cervical mucus has different consistency at different time of the menstrual cycle due to the influence of hormones. Shortly before and just after ovulation, the cervical mucus becomes thin, clear, slippery and stretchy (spinnbarkeit). This is the fertile period and sex should be avoided for contraception. The hormone progesterone released after ovulation makes cervical mucus thick and opaque, this hinders sperm penetration. Sex is allowed 4days after the maximum thickness of the mucus till menstruation.
The progesterone component of oral hormonal contraception works using this mechanism. The drawback of this method is the challenge in assessing the cervical mucus in the presence of infection.
The sympto-thermal method: combines symptoms and signs of ovulation with measurement of basal body temperature to predict ovulation. The cervical mucus assessment is used along with other symptoms such as nausea, bloating and vulvar swelling to predict ovulation.
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