Natural contraceptive method: withdrawal, temperature, efficient?

“”I notice an increasingly strong craze for natural contraceptions, because more and more women want a hormone -free method. Some women even divert the primary use of ovulation tests To calculate their fertility period“, Immediately notes Brigitte Raccah-Tebeka, gynecologist-endocrinologist. Or,”These methods such as the Ogino method, the Billings method or those of temperatures are based on Fluctuating or imprecise parametersand cannot therefore not guarantee optimal contraception“, Does she add. So what are these methods? Are they so random? Who can we recommend them?

The OGINO method (calendar method)

Still called “calendar method”, the Ogino method is a statistical method that is based on Calculation of fertility days. In theory and before being able to embark on this method of natural contraception, the woman must note the dates of the start and end of her menstrual cycles (natural and not modified by hormonal contraception) for a year, for 12 cycles. Note that a cycle begins the first day of the rules and ends the first day of the following rules. Generally, this cycle lasts 28 days on average, but it can be shorter or longer. Then, the woman must identify her longest cycle and her shortest cycle of last year. Then you have to do a little mathematics! To calculate the first day of the fertility period, 18 should be removed from the shortest cycle. For example, if its shortest cycle is 26 days, the woman is considered fertile from on (26-18 = 8) 8th day From the first day of its rules. And to define the last day of the fertility period, it is necessary to subtract 11 from the longest cycle duration. For example, if the longest cycle is 35 days, the woman is considered fertile until (35-11 = 24) 24th day of his cycle. In conclusion, the couple may have sex without risking conceiving a child From the 1st to the 7th day of the cycle, then From the 25th day to the 7th day of the following cycle, in our example.

“”In practicethis method is very restrictive Because it requires being very rigorous and having extremely regular cycles. However, the duration of cycles can easily be disturbed by stress, a jet lag … and ovulation remains unpredictable“, Specifies the gynecologist. Besides, the PEARL index (tool to measure the effectiveness of contraception methods) of the OGINO method is 20 in common practice, that is to say that 20 in 100 women using the contraceptive method analyzed for a year have fallen pregnant in the year. In addition, it does not leave much time for couples to have sex. In our example, period of abstinence remains high : Less than ten days a month are without risk of ovulating.

The Billings method (cervical mucus)

This method is to analyze The appearance and consistency of the cervical mucus. During non-ovulation, the thickening cervical mucus, acts as a “barrier” with sperm and prevents their passage in the uterus. “In practice, the woman takes a little substance produced every morning at the level of the cervix and analyzes her consistency with her fingers: if the cervical mucus is transparent, fluid and shooting, this means that women are in the ovulation period or when approaching ovulation. On the other hand, if she is thick and opaque, the woman is not a priori in her ovulatory period. Factors can modify the appearance of the cervical mucus such as having a yeast infection or another vaginal infection, the fact of having washed, sexual desire or having had sex before … This method is therefore in no way reliable because it can easily have a bad perception of the mucus“, Acknowledges the expert.

The temperature curve method

In this method, the woman must identify her ovulation period as a function of the temperature of her body. Indeed, the body temperature becomes higher After ovulation: it can rise from 0.2 to 0.5 ° C. Concretely, the woman must take her temperature every morning at the same time, in her bed and before getting up. It is estimated that the woman is not fertile more than three days after raising her temperature until the next cycle. However, “Here again, this method – which implies a relatively restrictive daily gesture – remains unclear because many parameters can influence body temperature (a cold, stress, fatigue …)“, Specifies the specialist. And add”Possibly, this method can be considered if the torque uses condoms up to three days after the rise in temperature, but this method is still random“. In addition, knowing that sperm can have a lifespan of 5 days, there can be a risk of fertilization if the couple had sex on the days preceding ovulation.

Withdrawal: unreliable because of the pre-Séminal liquid

In this method, we start from the principle that man withdraws his penis from his partner’s vagina before ejaculating. To hope to reduce the risk of pregnancy, ejaculation should not take place just at the entrance to the vagina. “”It is certainly the least reliable method when you know that the pre-seminal liquid (secreted during erection and just before ejaculation, sometimes without man realizing it) and even seminal (secreted during ejaculation) contain sperm. However, it is enough that one sperm is in the right place and at the right time for there to be fertilization“, Recalls Dr. Raccah-Tebeka. In addition,”If some men manage to determine all the signs of the moment of ejaculation, others do not always succeed in controlling it“. Ejaculation remains a sometimes uncontrollable reflex. And the fact of holding back and ejaculating out of the sex of his partner can be frustrating for the man and for the woman.

What women can use natural contraceptions?

“”As a rule, I formally advise against these natural methods which are blurred and unreliableespecially women with normal fertility, young women or women aged 40-45 no longer wishing to have children and whose cycles can be short or long“, reveals the specialist. These methods can possibly be used if they are coupled with another contraception such as the condom or the use of spermicides. In addition,”The patient can use this kind of method if she tells me that she wishes to have a child in the coming months and that “accidental pregnancy”, therefore not programmed, would not be a problem “she continues. At any rate, Always ask for the advice of your gynecologist Before you get into any contraceptive method.

What is the effectiveness of natural contraception methods?

Reliable and adapted contraception, with or without hormones

Women who turn to natural contraceptions are those who no longer want to take hormones (present in the pill, the hormonal IUD, the contraceptive implant, the vaginal ring …), because, most often, of their side effects or fears that are not always justified. In addition, one of the main advantages of natural methods is that they are free and that they do not require medical prescription. However, there are alternatives to hormonal methods such as copper IUD which remains the most effective non -hormonal contraceptive. “”The patient and her gynecologist can discuss contraception adapted to the woman’s profile and her lifestyle. And if the woman does not want to have prescribed contraception, she can use the condom. Well lubricated and used with each penetration and at all times of the cycle, it remains effective to avoid the risk of unwanted pregnancy“Concludes the gynecologist.

Thanks to Dr. Brigitte Raccah-Tebeka, gynecologist-endocrinologist. Interview in August 2018.