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    Explaining ovulation awareness-based family planning methods

    These easily taught birth control methods may be just what some patients are looking for. Nonhormonal approaches like the Standard Days and the TwoDay Methods hinge on identifying a woman's fertile window: the days during her cycle when pregnancy is likely.

    Quality of care in family planning demands that obstetrician/gynecologists be knowledgeable about every birth control method in order to educate a patient about all her options. An important component in helping a patient choose an appropriate contraceptive method is to consider her preferences as well as medical eligibility criteria.

    TABLE 1Comparative failure rates of various methods: Percentage of women experiencing unplanned pregnancy during first year of use
    The many patients who prefer nonhormonal or nonsurgical methods may be interested in approaches that involve understanding their natural fertility. [Fertility Awareness-Based (FAB) methods of family planning are based on a patient's observations of the fertile and infertile phases of her menstrual cycle.] Women who use this method avoid unprotected intercourse on fertile days, by abstaining or using a barrier method, to prevent pregnancy. Succeeding at a given method depends on three things: the method's accuracy in identifying the fertile days, the woman's ability to follow the method instructions to determine when she is fertile, and the couple's ability to avoid unprotected intercourse on the woman's fertile days.

    As is true for many other contraceptive methods, FAB methods are very effective when used correctly (Table 1).1-4 Moreover, they pose no threat to either the woman or—should pregnancy occur—to the developing fetus.5,6 Some FAB methods (e.g., Ovulation Method, Symptothermal Method) require patients to attend several instruction sessions lasting a few hours or more.1-4 In contrast, you can teach patients about two more recent methods, the Standard Days Method (SDM) and the TwoDay Method, in one brief session.

    Safe, effective, and practical, these newer methods were studied and field tested by the Institute for Reproductive Health at Georgetown University with support from the U.S. Agency for International Development.

    Most likely, FAB methods were not stressed in your medical school or residency training in obstetrics and gynecology. Our goal is to bring you up-to-speed in educating patients about these options by summarizing the currently available FAB methods to make it easier for you to incorporate them into a typical ob/gyn practice. Although we'll focus on the SDM and the TwoDay Method because their simplicity makes them much easier to teach to patients, we'll also refer readers to other sources for more detailed information on the Ovulation and Symptothermal Methods.

    FAB methods

    Not surprisingly, effectiveness is highest when FAB methods are used correctly. But your patients can achieve correct use with appropriate instruction and support. Since incorrect use involves having unprotected intercourse during a woman's fertile time, pregnancy rates may be high depending on when—and how often—during the fertile time she has unprotected intercourse (with estimates of pregnancy rates with incorrect use higher than 22%, according to some studies). It's important to consider the efficacy of FAB methods in the context of other user-directed methods. Table 1 compares both the correct and typical use failure rates of FAB methods to other user-directed methods. Women who've chosen the FAB method who use barrier methods on fertile days have a somewhat higher risk of pregnancy than do those who abstain, because of the inherent failure rate of barrier methods.

    Helain J. Landy, MD
    DR. LANDY is Professor and Chair, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Georgetown University ...
    Victoria H. Jennings, PhD
    DR. JENNINGS is Director, Institute for Reproductive Health, Department of Obstetrics and Gynecology, Georgetown University, Washington, ...


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