"Safe Days": Should You Trust Calendar Contraception?
It is believed that the calculation of "dangerous" and "safe" days - one of the most unreliable methods of protection. However, it cannot be denied that this method will definitely not cause side effects, unlike hormonal or barrier agents - besides, it is extremely cheap or generally free. We tried to figure out whether to believe the calendar at all, whether it is possible to increase the reliability of this method and how the "contraceptive" application for the smartphone works.
How it works?
Although the menstrual cycle usually lasts about a month, pregnancy can only occur within a couple of days after ovulation. If you add a few days, during which the sperm remain active, you get six to seven fertile (that is, favorable for conception) days. The difficulty is that it is only possible to see ovulation during an ultrasound examination, and it is impossible to predict its date with absolute accuracy. True, you can focus on the length of the monthly cycle and use formulas to roughly determine the fertile period.
The classic calendar method is the calculation of "dangerous" and "safe" days based on the cycle length. With a serious approach, you need to start with to maintain the menstrual calendar for at least eight months, and preferably a year. After that, the first fertile day is calculated from the duration of the shortest cycle, and the last from the duration of the longest one. During fertile days, the probability of pregnancy is high, which means you need to either avoid sex or use condoms.
It is clear that the accuracy of calculations and the effectiveness of such contraception leave much to be desired, especially during an unstable menstrual cycle. To determine the period of fertility more reliably, you can measure the basal temperature, that is, body temperature early in the morning, immediately after waking up. The fact that it is slightly reduced the day before ovulation, and then increases by 0.3-0.6 degrees.
Special thermometers to determine the basal temperature differ from the usual in that they measure up to two decimal places. After waking up, you need to measure the temperature under the tongue, and then enter the result in a special schedule.
Even during the monthly cycle, the consistency of mucus covering the cervix changes; these changes are also sometimes taken into account in combination with counting days and measuring temperature in order to better distinguish fertile days from "safe" days. True, not everyone is ready to scrutinize the consistency of mucus, and the changes are not always obvious to a non-specialist. Nevertheless, the method is often recommended, but not for contraception, but on the contrary - to those who are trying to get pregnant.
Advantages and disadvantages
The main advantage of calendar, or temperature contraception - no side effects. Although hormonal contraceptives are improved every year, sometimes their selection takes a painfully long time, and the ideal can never be found (especially when you consider that in Russia there are about ten times less such drugs than in the US). Recently it was confirmed that hormonal contraception, including pills and intrauterine devices, increases the likelihood of increased depressive states by 40%. On the other hand, hormonal drugs are shown to many women for the correction of excess androgens (male sex hormones), treatment of acne or painful and difficult menstruation.
The calendar method of contraception is also called "natural family planning" and "method of periodic abstinence," and these terms describe its features well, which do not fit every couple. If you do not want to get pregnant, during fertile days you will have to use condoms or refuse to have sex. If the pregnancy is not planned specifically, but it does not frighten ("if I become pregnant, I will give birth"), then it would be good to normalize the lifestyle, cure chronic diseases, if any, and increase physical activity. In any case, the calendar method requires concentration and a good sleep pattern; it is unlikely to suit those who fly on business trips every week (try to get enough sleep regularly and do not forget to carry a thermometer with you).
To measure the temperature, count the days and keep the calendar, a more strict discipline is needed than, for example, than taking daily pills. Spontaneous sex does not work well with the calendar method even in a long-established couple, let alone new partners (however, in such cases you always need to use condoms to protect yourself not only from pregnancy, but also from infections). And yet the main problem of the calendar method is low reliability: its Pearl index ranges from 9 to 40, that is, 40 out of 100 women can become pregnant (almost half!) Within a year. But it seems that this situation is beginning to change thanks to applications for smartphones.
Is it possible to increase reliability?
Now there are many applications, menstrual cycle trackers and ovulation calculators, but usually they are designed to determine the most successful days for conceiving, and not vice versa. Applications aimed at preventing pregnancy, came down mainly to reminders about taking pills and trackers, telling when it's time to change the hormonal vaginal ring. But in February 2017, Natural Cycles became the world's first smartphone app, registered as a contraceptive medical device; the basis was the results of two full-fledged clinical studies.
In the "contraceptive" smartphone application, the calendar-temperature method is used (it is also called the symptothermal method). Users do not have to draw graphs - all they need to do is to take the temperature under the language every morning with a sensitive thermometer and bring it into the application, and it will do the rest itself using mathematical algorithms.
According to the creators of the application, the proportion of fertile days erroneously called safe does not exceed 0.5%, that is, when used ideally, the method is very reliable. It turns out that thanks to a complex algorithm, the effectiveness of the calendar method of contraception is close to that for hormonal drugs. On the other hand, in the study of the actual use of this application among more than 4,000 women, the Pearl index, which determines the effectiveness of contraceptive methods, was 7%.
This means that pregnancy occurred in 7 women out of 100 per year, but most often the fault was not an application error, but a human factor, such as unprotected fertile sex or inaccurate temperature measurement. Factors such as catarrhal diseases, hangovers or lack of sleep affect its accuracy. Sleeping too long (two hours longer than usual) also reduces the accuracy of the thermometer, so it is not clear what to do with the habit of how to sleep on weekends. Of course, like any other method of contraception, this is not for everyone; on the one hand, it is devoid of side effects and is now remarkably accurate, and on the other, it requires a stable lifestyle, discipline, and certain restrictions.
Considering that the tendency to use "natural" and "organic" which does not reduce turnover a year, and the registration of Natural Cycles in Europe as a medical device became a sensation (the application is used by more than one hundred and fifty thousand people), other similar ones may appear. The relative cheapness (65 euros per year, including a thermometer) for many can be a plus, leveling any inconvenience. In the end, the more opportunities, the greater the chance that every woman will choose the most suitable option for her.
