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Check new advances in natural family planning
Review the contraceptive options you currently discuss with your female patients. Where does natural family planning enter into the conversation?
You may want to include a discussion of the Standard Days Method (SDM). Defined as a fertility-awareness-based method, the SDM is appropriate for women with regular menstrual cycles between 26 and 32 days long. It identifies days 8-19 of the menstrual cycle as the "fertile window" — the days when pregnancy is very likely. To prevent pregnancy, a couple avoids unprotected intercourse during the 12-day fertile window by using a barrier method or abstaining from sex. About 500 women in Bolivia, Peru, and the Philippines participated in an efficacy trial of the SDM; researchers determined a first-year pregnancy rate of 4.8% when the method was used correctly.1
Researchers at Georgetown University’s Institute for Reproductive Health in Washington, DC, have been involved in educating providers in the United States and abroad about SDM. Presentations were made at the 2004 conferences of Contraceptive Technology and the Washington, DC-based American College of Nurse-Midwives, and training sessions have been held by state health departments, Planned Parenthood affiliates, and the Oakland, CA-based Center for Health Training, says Victoria Jennings, PhD, director of the Institute for Reproductive Health.
To broaden access to provider training, the institute is implementing an on-line training module through its web site, www.irh.org. The program is available free for a limited time, says Jennings.
Color-coded beads provide quick visual cue
To help couples learn and use the SDM effectively, the institute has developed a simple device known as CycleBeads. The device was introduced for retail sale in 2002; since that time, some 100,000 women around the globe use it, including 20,000 in the United States. Most women here buy the device on-line at its web site, www.cyclebeads.com, and it also is available from a growing number of health care providers and retail outlets. The web site also includes an easy screening tool to help women determine if the SDM is right for them.
The CycleBeads device consists of color-coded beads and a black ring on a circular chain, with each bead representing a day of the woman’s cycle. The color of the beads provides a quick visual cue as to a woman’s fertile and non-fertile days.
Researchers at the Institute of Reproductive Health are now looking at the TwoDay Method, which relies on a simple algorithm to help women identify when they are fertile, based upon the presence or absence of cervical secretions.
The TwoDay method was developed to address the need for a simple method based on secretions, says Marcos Arevalo, MD, MPH, assistant professor at Georgetown University and the institute’s director of biomedical research. Researchers used computer modelings to distill information on women’s secretions. The modeling confirmed that the mere presence of noticeable cervical secretions of any type, regardless of such characteristics as color, consistency, lubricity, and elasticity, was a very good indicator of fertility, explains Arevalo.2
Two questions help determine fertility
To use the method, Arevalo says a woman should check daily for secretions and ask herself two questions: "Did I notice any secretions today?" and "Did I notice any secretions yesterday?" If she notices secretions of any type "today" or "yesterday," the woman should consider herself fertile and should avoid unprotected intercourse that day if she does not want to become pregnant, explain Arevalo. If she notices no secretions on either day, then she is not fertile, he states.
The clinical trial of the TwoDay Method has been completed, with 450 women from five sites in Guatemala, Peru, and the Philippines using the method for up to one year. Researchers are encouraged by the results of the efficacy study, says Jennings. Results are scheduled to be published in fall of 2004.
How should clinicians evaluate these forms of natural family planning?
"They both have their strengths," observes Jennings. "The Standard Days Method is just so easy because it applies to everyone who uses this method [in that they] do exactly the same thing, and they know in advance every cycle what they are going to need to do. With the TwoDay Method, it gives people a little bit more information about their fertility."
Both methods are easy to teach, learn, and use, says Jennings. Their costs are low, and their flexibility allows couples to use them in a number of ways. Some people decide they will abstain during the women’s fertile days, while some will choose to use a condom. Couples can use the methods to avoid pregnancy as well as to get pregnant, she explains.
Women who are choosing these methods have used another method in the past and have stopped using it due to dissatisfaction, or they have never used an effective method of family planning, says Jennings.
"In other words, it is not taking the satisfied pill user and substituting another method," she explains. "It really expands contraceptive choice and thereby expands the number of women who can find a method that can work for them."
1. Arevalo M, Jennings V, Sinai I. Efficacy of a new method of family planning: the Standard Days Method. Contraception 2002; 65:333-338.
2. Sinai I, Jennings V, Arevalo M. The TwoDay Algorithm: a new algorithm to identify the fertile time of the menstrual cycle. Contraception 1999; 60:65-70.