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Family Health International |
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Fertility Awareness Improves Contraceptive Use -- October 5, 1996RESEARCH TRIANGLE PARK, NC -- Understanding a woman's fertility cycle plays a crucial role in teaching couples to use "natural family planning," such as the calendar or rhythm method of birth control. Family planning experts now say this same knowledge can help improve the use of nearly any modern contraceptive, including the pill, injectables and implants. For example, fertility awareness can help women understand that pregnancy can still be prevented even days after unprotected intercourse, by using what is called "emergency contraception." Because a man's sperm may live for days inside a woman's body, fertilization is still possible days after intercourse. Certain types of oral contraceptives taken within two or three days after intercourse can still interfere with ovulation or fertilization, thus preventing pregnancy. Many couples who want to avoid or delay pregnancy are at risk of pregnancy simply because they do not know when a woman is most likely to be fertile. Other couples are at greater risk of pregnancy because they do not use a contraceptive method correctly, due to a limited understanding of fertility. A better understanding of fertility can help couples improve their use of contraception, experts say in the fall issue of Network, Family Health International's quarterly health bulletin. Fertility awareness includes information on a broad range of topics related to reproductive health, including the woman's menstrual cycle, when during the cycle she is most fertile, the effects of family planning on women's and men's bodies, and signs and symptoms of sexually transmitted diseases. "To regulate your fertility, you first have to be aware of it," says Dr. Roberto Rivera, FHI corporate director for international medical affairs. "Fertility awareness has an important relationship to family planning." Lack of fertility awareness contributes to using a contraceptive method incorrectly or inconsistently, or to discontinue a method completely even though a couple wants to avoid a pregnancy. This can often lead to contraceptive failure and abortion. A recent survey of about 10,000 American women who had abortions shows that nearly six out of 10 reported they were using contraception at the time they became pregnant. If a woman can identify her potentially fertile days, a couple can use this information to time intercourse either to avoid or achieve a pregnancy. Couples who have a basic understanding of fertility may be able to choose the most appropriate method for their circumstances. Pregnancy is most likely to occur at or around the time the egg is released from the ovary (ovulation), about midway in the woman's menstrual cycle. Women are fertile for several days about once a month, from the beginning of menstruation during the teen years until menopause, usually around age 50. Men are typically fertile from puberty through old age. Knowledge of the fertile period is particularly important for couples using barrier methods of contraception condoms, spermicides, diaphragms, or cervical caps as well as periodic abstinence, withdrawal, or some combination of these methods. If a woman understands her fertility cycle, she and her partner will know more clearly the importance of using these methods consistently and correctly during the fertile period. Understanding the menstrual cycle is important for women using hormonal methods, which include the pill, injectables and the Norplant implant. Combined oral contraceptives, which contain estrogen and progestin, suppress ovulation and can cause breakthrough bleeding, amenorrhea (missed periods) and decreased menstrual cramps and bleeding. When a woman taking the pill does not menstruate regularly, she may think incorrectly that she is pregnant and stop taking the pill, thus leading to an unwanted pregnancy. Progestin-only contraceptives include progestin-only pills, the Norplant subdermal implant, and certain injectables, including depot-medroxyprogesterone acetate (DMPA). These methods suppress ovulation in about half the menstrual cycles and affect menstrual cycles in various ways. For example, amenorrhea is common among women using DMPA. Counseling about these changes before use can help women to continue to use hormonal methods properly. Women taught to be aware of deviations in cervical secretions, such as noticeable or painful discharge, are alerted to needing medical attention for sexually transmitted diseases or other reproductive health problems. For men, pain or abnormal discharge from the urethra may be a sign of STD infection. The current issue of Network includes articles on the latest scientific research on contraceptive methods that are particularly related to fertility awareness, including:
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