FSRH | Natural family planning for contraception

This is a new guideline from the FSRH on 'Fertility Awareness Methods' (FAM), otherwise known as 'Natural Family Planning'. I have had a couple of patients interested in this, so it is worth knowing about. Apparently 2% of women in the UK use FAM for contraception.

There is also a bit on using the lactational amenorrhoea method, which I have added at the end.

If used correctly (which is the difficult bit of the whole method), there is less than 1 pregnancy per 100 women per year, which is pretty good.

I won't go into too much detail, but basically several indicators are combined to give the woman an idea of her most fertile time, so that she can either avoid sex during that time, or use barrier methods. These indicators include the basal body temperature, calendar calculations, cervical secretion monitoring (no internal examination needed) and possibly cervical changes. Some women use a fertility monitoring device, like Persona, which measures hormone levels. These aren't licensed for contraceptive use, but may be helpful when combined with the other indicators. Fertility monitoring devices used alone are not accurate enough for FAM.

The most important aspect of FAM is that couples are trained to use the above indicators properly and this takes time. It also takes someone properly qualified to teach them.Most family planning clinic workers will not be trained - so don't send women there. www.fertilityuk.org has a list of local practitioners.

Lactational Amenorrhoea Method

3 criteria must be met - many mothers completely breastfeeding will not meet the first criteria - so beware! If used correctly, the failure rate is less than 2%

  • Fully or nearly fully breastfeeding - no longer than 4 hrs during the day and 6 hrs during the night between feeds. No other fluids should be give, other than infrequent water, juice or vitamins.
  • Amenorrheic
  • Less than 6 months post-partum

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