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Natural Family Planning (NFP) is a term used to describe methods of planning or postponing pregnancy based on observation of naturally occurring signs and symptoms of the fertile phases of the menstrual cycle. Techniques include the Basal Body Temperature method, the Billing's Ovulation Method, the Symptothermal Method and the Rythm Method. It is important to note that NFP is not A METHOD OF CONTRACEPTION but rather A TECHNIQUE FOR DETERMINING THE FERTILE PERIOD.

There are four methods of NFP:

  1. Basal Body Temperature (BBT).
  2. Billings Ovulation Method (BOM).
  3. Symptothermal Method (STM).
  4. Calender or Rythm Method.

Basal Body Temperature (BBT)

BBT method is a method to detect ovulation by observing thermal shift of 0.04° F (Av 0.02° F-1° F) at luteal phase following ovulation. This thermal rise remains at a higher level till the end of the cycle and begins to fall to the pre-ovulatory level 2-3 days before the next menses begins. Thus, the temperature chart shows a biphasic pattern. This method has abstinence during first half of menstrual cycle till 3 days of elevated temperature. Maintaining and interpreting temperature requires lot of care. Moreover 7 to 10% ovulatory cycles can be monophasic.

Billings Ovulation Method (BOM)

This relies on changes in consistency and volume of cervical mucus in relationship to ovulation. On the basis of cervical mucus, dry days and wet days (fertile phase) are recognised by women. Wet days start with sticky white mucus for 2 to 3 days following 2 to 3 dry days after a menses. Sticky white mucus days are followed by clear, slippery, profuse mucus (capable of being stretched between 2 fingers) for 3 to 5 days, the last day is called peak day. To postpone pregnancy, the couple should abstain from sexual intercourse on all days of noticeable mucus and for three days thereafter.

The woman cannot recognize ovulation directly but every woman who ovulates produces mucus and she can recognise its presence from the wetness and sensation of lubrication in the vagina. On identifying the mucus, she can identify ovulation time, which is possibly the fertile time, the time of conception.

The three different phases of fertility in a menstrual cycle are:

The First Phase
This phase is relatively infertile and extends from the first day of the menses till the cervical mucus begins and is called the pre-ovulatory infertile phase. Following menstruation, there are 2 to 3 dry days called early dry days.

The Second Phase
This phase is fertile and extends from the beginning of the mucus sequence and ends, a few days after the mucus ceases. It is in this phase that ovulation occurs. The degree of fertility at this phase increases progressively, because at the start of the mucus sequence, the mucus is thick and sticky, opaque, non-stretchy which prevents sperm-entry into the uterus to a very great extent. Fertility is present, but it is very low. The fertility increases as the mucus becomes progressively more watery (thin), clear, slippery and stretchy like raw egg-white. Maximum fertility is present when these features are seen to an optimum degree which is usually a day before the actual day of ovulation and is called peak day.

The Third Phase
This phase is infertile and extends from the end of the fertile phase until the last day of the cycle, before the next menstrual period begins. It is called the post-ovulatory infertile phase which begins from the 4th day after peak. Thus, in a menstrual cycle, one sees a fertile phase occurring between two infertile phases.

Phase I

Rule: Abstain during the menstrual period
The word "abstain" used above means the avoidance not only of the marital act but also of any genital contact. During early dry days the marital act can be had, but on alternate nights.

Phase II

Rule: Abstain from all genital contact on all mucus days and also on the three days immediately following Peak.

Phase III

Is known as the "Completely Infertile Part" (CIP) of the cycle and the marital act will not result in conception.

Symptothermal Method (STM)

This combines the Thermal Shift, Mucus Symptom and a few other secondary symptoms such as pain, spotting of blood and mood changes. An enlarged pea sized lymph node can be felt in the groin on the same side as the ovary containing the maturing follicle in some women. These secondary symptoms are not constant.

Calender or Rythm Method

The fertile period is calculated based on the previous twelve menstrual cycle records. The first unsafe day is obtained by subtracting 20 days from the length of the shortest cycle and the last unsafe day by deducting 10 days from the longest cycle.

This method is not reliable as it is based on calculations from the previous cycles and cannot be used by people who have irregular cycles.




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