PILLS

The pill is a prescription method of birth control. It consists of a month-long series of pills
containing synthetic hormones progesterone with or without estrogen (without is the mini pill)
that are taken every day.
Why Take It?

To prevent ovulation (the release of an egg from the ovaries)

To Thicken the cervical mucus to make it harder for the sperm and egg to meet

To thin uterine lining to hinder egg implantation in the uterus if egg fertilization occurs

How Is It Used?

A pill must be taken every day. Generally, the pills taken during the first three weeks of the
month contain hormones, while the pills taken during the fourth week contain no hormones,
allowing you to have a menstrual period.

For most effective use, it is best to take each pill at the same time of day, such as each
morning when you wake up or before bed if you have a consistent bed time.

Does It Protect Against STIs?

STI stands for sexually transmitted infection. The risks of being infected with an STI vary depending
on how you choose to protect yourself and your partner during different sexual or intimate activities.
Unfortunately, the pill does not protect against STIs.
Does It Protect Against Pregnancy?
Yes, as long as the pill is taken every day consistently. Pregnancy can occur if the pill is not taken
correctly. For example:

If pills are begun too late in the course of the menstrual cycle

If two or more pills are missed in a row

If pills are not taken in the correct order

For the really low-dose pills, even if you are half-day late taking the pills

What are the chances of getting pregnant using the pill?

Typical use: 5 percent

Perfect use: 0.1 percent

MALE CONDOM
A male condom is a thin sheath that covers the penis during intercourse and is made of one of the
following materials:

Rubber (latex)

Plastic (polyurethane): the best alternative for people allergic to latex

Lambskin

Male condoms can vary greatly in color, size, and amount of lubrication and spermicide.
The male condom protects against sexually transmitted infection (STI) and pregnancy by covering
the penis and preventing direct contact between the penis and vagina, as well as collecting the semen
and preventing it from entering the vagina.
How is it used?
The male condom is rolled over the erect or hardened penis and prevents against direct contact
between the penis and vagina. The condom must be removed before the erection ends or the sperm
can leak out. Use the condom once only, then throw it in the garbage. Do not flush it down the toilet.
Does It Protect Against STIs?
Yes. The latex condoms can protect against STIs including HIV. Testing of the plastic, polyurethane
condoms suggests that they also protect against infections; however, this is not definite. Lambskin
condoms do not protect against HIV and other STIs.

Does it protect against pregnancy?

Yes, and using spermicide in addition to the condom improves pregnancy prevention. For best
protection, use the condom before any sperm or pre-ejaculate comes in contact with the vagina.
The chances of getting pregnant while using a condom (latex) are:

Typical use: 14 percent

Perfect use: 3 percent

FEMALE CONDOM
The only female condom available is marketed as the FC2 Female Condom. It is a synthetic nitrile
sheath with one flexible polyurethane ring at each end. Its open ring remains outside the vagina,
whereas its closed internal ring is fitted under the symphysis like a diaphragm. The female condom
can be used with both water-based and oil-based lubricants. Male condoms should not be used
concurrently because simultaneous use may cause friction that leads to condom slipping, tearing,
and displacement. Following use, the female condom outer ring should be twisted to seal the condom
so that no semen spills. As an added value, in vitro tests have shown the female condom to be
impermeable to HIV and other STDs.

The female condom is a lubricated polyurethane sheath/pouch that has two ends. One end is closed
and one is open, with flexible rings at each end. It protects against pregnancy by catching the sperm
in the pouch and preventing it from entering the vagina.
How Is It Used?

The closed end of the condom is placed inside the vagina (the ring holds the pouch in place), while
the open end stays outside the vaginal opening.
1. Lubricate the closed end (part with the small ring).
2. Squeeze the sides of the ring at the closed end together and insert the pouch into the vagina
like a tampon.
3. Insert the ring into the vagina until it can't go any farther (when it has reached the cervix).
4. Remove fingers from the vagina, allowing the large ring of the open end to hang outside of
the vagina.
5. To remove the condom, squeeze the ring located outside of the vagina, twist and pull,
ensuring that the semen remains inside of the pouch. Throw the condom away in the garbage
(do not flush)
Like

the

male

condom,

the

female

condom

is

intended

for

one-time

use

Does It Protect Against STIs?

Female condoms are made of polyurethane. Tests suggest that they protect against sexually
transmitted infections (STIs), but this is not definite.

Does It Protect Against Pregnancy?

Yes. The chances of getting pregnant while using a female condom are:

Typical use: 21 percent

Perfect use: 5 percent

CERVICAL CAP

only.

FemCap is currently the only available cervical cap in the

United States. Made of silicone rubber, it has a sailor-cap
shape with a dome that covers the cervix and a flared brim,
which allows the cap to be held in place by the muscular
walls of the upper vagina. Available in 22-, 26-, and 30-mm
sizes, it should be used with a spermicide applied once at
insertion to both sides of the dome cup. For contraception, it
should remain in place for 6 hours following coitus and may
remain for up to 48 hours. Even with proper fitting and
correct use, pregnancy rates with this method are higher
that with the diaphragm

A cervical cap is a soft rubber cap with a round rim that fits around your cervix. The only cervical
cap available in the United States is the FemCap, a non-hormonal latex-free contraceptive device
made of silicone rubber, a non-allergenic easy to clean material.
How Is It Used?
The cap is placed inside the vagina to cover the cervix. It is recommended that spermicide be added
in the rim of the FemCap to increase the effectiveness of this method.
The cervical cap acts by blocking the entrance to the uterus; the spermicide acts by killing and
immobilizing the sperm, preventing it from fertilizing the egg.
The cervical cap must be left in place for at least six hours after last intercourse before removing.
Does It Protect Against STIs?
NO! The cervical cap protects against certain STIs, including gonorrhea and chlamydia, but does not
protect against others such as HIV and herpes.
Does It Protect Against Pregnancy?
Yes. The chances of getting pregnant while using a cervical cap are:

Typical use: 10 percent

Perfect use: 4 percent

INTRAUTERINE DEVICE
(IUD)
An Intrauterine Device (IUD) is a T-shaped, plastic device
inserted into the uterus by a health care professional. There
are two types of IUDs available:
1. Copper, which can remain in place for 10 to 12 years.
2. Progesterone (natural female sex hormone); two
types:
o

Mirena, lasts five to seven years.

Other types, replace every year.

IUDs prevent pregnancy by inhibiting fertilization of the egg. Although not entirely known, it is
believed that the IUDs affect the way the sperm and egg move and/or affect the lining of the uterus to
prevent
implantation
of
the
egg.
IUDs are recommended for women in long-term mutually monogamous relationships, such that the
risk of getting a sexually transmitted infections (STIs) is low.
How Is It Used?
The IUD is inserted into the uterine cavity by a health care provider, usually during menstruation
when it is easier to insert. The string at the end of the IUD will hang down through the cervix a
short distance into the vagina and should be checked periodically (especially after menstruation).

How Is It Inserted?
The IUD is inserted during an office visit. It is placed into the uterus through the cervix. The patient
is placed on the table just like she is going to have a Pap smear. A speculum is inserted, like with a
Pap smear.
The area that the brush touches when you have a pap smear is your cervix. The IUD is inserted in

through the cervix up about 1 inch into your uterus. This is moderately painful, like bad cramping.
I usually ask people to take two Tylenol or ibuprofen before they come in for the procedure. After
that, the string is cut and the speculum is removed.
Does It Protect Against STIs?
No! Unfortunately, using an IUD does not protect you against any STIs.
Does It Protect Against Pregnancy?
Yes. The chances of getting pregnant while using an IUD is:

STANDARD DAYS METHOD

The Standard Days Method counsels
women to avoid unprotected intercourse
during cycle days 8 through 19. For
successful use, women must have regular
monthly cycles of 26 to 32 days. Those who
use this method can mark a calendar or
can use Cycle-Beads, which is a ring of
counting beads, to keep track of their days.
The standard days method (SDM) of
natural family planning has replaced the
old rhythm method as the method of choice
for a woman who wants to predict fertility
based on the length of her cycle. This method does not require the use of a calendar or charting;
rather, it uses CycleBeads.
The SDM, developed at Georgetown University, is the first new natural method of family planning to
be clinically tested and introduced on an international scale in over twenty years. To develop the
method, researchers used data from the World Health Organization to determine the probability of
pregnancy based on the menstrual cycle. Counting the first day of menstruation as day 1, they
determined that days 8 to 19 were the most likely fertile window. For SDM, couples avoid having sex
during the fertile window.

Who Can Use the Standard Days Method?

The standard days method is most effective for women who have cycles between 26 and 32 days long.
It is estimated that it takes about 20 minutes to properly learn to use the standard days method, and
it is recommended that you first meet with a trained counselor to be sure you understand this
technique before using it.
How to Use the Standard Days Method
To use the SDM you will need to count the days of your menstrual cycle, starting with the first day
your period begins.
1. Count the first day of your period as day 1.
2. On days 1 to 7 you are not fertile and can have unprotected intercourse (provided neither
partner has an STD, it is medically safe to have sex even while menstruating).
3. On days 8 to 19 you must avoid sex or use a barrier method if you do not want to get
pregnant.
4. From day 20 until your period starts you can have unprotected sex.
Most women who use this method use special color-coded beads called CycleBeads to help keep track
of where they are in their cycles. The figure below shows a set of CycleBeads used for the standard
days method.

CALENDAR RHYTHM METHOD

The Calendar Rhythm Method requires counting the number of days in the shortest and longest
menstrual cycle during a 6- to 12-month span. From the shortest cycle, 18 days are subtracted to
calculate the first fertile day. From the longest cycle, 11 days are subtracted to identify the last fertile
day. This is problematic because ovulation most often occurs 14 days before the onset of the next
menses. Because this is not necessarily 14 days after the onset of the last menses, the calendar
rhythm method is not reliable.

The calendar method, or rhythm method,

is the oldest and most widely practiced
method of fertility awareness. Early in
the twentieth century, the rhythm method
was promoted by the Catholic Church as
the only morally acceptable form of family
planning. At one time the CalendarRhythm Method was synonymous with
natural family planning. However, since
that time many other natural methods
have been developed and the modern
Catholic Church accepts all of these.
How the Calendar-Rhythm Method Works
In the 1920s, it was discovered that ovulation occurs about fourteen days before the next menstrual
period. Based on this discovery, it was possible to calculate the best times to have intercourse to
achieve or avoid pregnancy. The Calendar-Rhythm Method based on three assumptions:
1. That ovulation occurs fourteen days before the beginning of menstruation, plus or minus two
days
2. That sperm remain alive for three days, and
3. That the ovum (egg) survives for twenty-four hours.
For a woman with very regular cycles, she needs merely to count backwards from the first day of her
period to locate the day on which she ovulated, usually the fourteenth day from the first day of her
period. Using this information, she can predict when ovulation will occur the following month and
avoid having intercourse around that time.

TEMPERATURE RHYTHM METHOD

The Temperature Rhythm Method relies on slight changes
sustained 0.4F increasesin the basal body
temperature that usually occur just before ovulation. This
method is much more likely to be successful if during each
menstrual cycle, intercourse is avoided until well after the
ovulatory temperature rise. For this method to be most
effective, the woman must abstain from intercourse from
the first day of menses through the third day after the
temperature increase.
The purpose of charting your basal body temperature is to
determine when ovulation occurs. Charting is useful for
couples who are trying to get pregnant, trying to avoid
pregnancy, or for any woman who simply wants a better understanding of her body. The basal body
temperature is most easily measured with a special thermometer which has a range of only a few
degrees, known as a basal thermometer. This thermometer can be found at most large drug stores
and costs about $6. It can be used orally, vaginally, or rectally, but should be used in the same
location each time. Take the basal temperature upon waking, before doing any activity, and keep in
place for a full five minutes. Don't fall asleep with the thermometer in your mouth! You could break
it and swallow the mercury. If this happens, call your doctor at once! You might consider a, which is
safer, faster, and just as accurate.
Using a body basal temperature chart
Day one on the chart refers to the first day of bleeding in a woman's monthly cycle.
The blank boxes beneath are to write in the day of the month. During menstruation a woman will
write H, M, or S in the row labeled "Bleeding" for as long as menstruation persists. Any mid-cycle
spotting can be indicated in this row as well. On the fifth day, temperature taking should begin. The
temperature should be recorded on the corresponding line every morning until the next period starts.
Connect each dot with a line. A new chart must be used at the onset of a new period.
To successfully utilize the sympto-thermal method of birth control, you will need to chart your basal
temperature and in additional other body signs. By simply filling in the appropriate boxes, a woman
can record the presence of cramps, spotting, headaches, breast tenderness, and overall mood. Boxes
are also provided for tracking changes in the cervix, including cervical mucus characteristics, the size
of the cervical opening, how high the cervix is in the vagina, and the firmness of the cervix. (See
NATURAL FAMILY PLANNING page for more info.)

Interpreting The Chart

Ovulation will occur around the time of temperature shift. Before ovulation, the temperature is likely
to be between 97.2 and 97.4 degrees F. After ovulation, it will rise by at least 0.5 degrees and is
usually above 98 degrees F. When the temperature stays elevated for at least three days, a woman
may assume she has already ovulated. Intercourse for the rest of the cycle will not result in
pregnancy. A number of additional body signs should correlate with ovulation, including the presence
of a clear, stretchy cervical mucus, a soft, open cervix, and sometimes mild cramping or even
spotting.

CERVICAL MUCUS METHOD

The
Cervical
Mucus
Method, also called the
Two-Day
Method
or
Billings Method, relies on
awareness of vaginal
dryness and wetness.
These reflect changes in
the amount and quality
of cervical mucus at
different times in the menstrual cycle. With the Billings Method, abstinence is required from the
beginning of menses until 4 days after slippery mucus is identified. With the Two-Day method,
intercourse is considered safe if a woman did not note mucus on the day of planned intercourse or the
day prior.
A woman's body produces a special type of cervical mucus when she is fertile which acts as a conduit
for sperm to travel into the uterus. When she is not fertile no mucus is produced, or the mucus is
very thick and will not permit the passage of sperm. Without this "fertile" mucus sperm cannot
survive long enough or travel far enough to fertilize an egg.

During a typical monthly cycle, a woman first has a few days of menstrual bleeding, followed by a few
"dry days" when the vagina seems quite dry and no mucus is present. Closer to the time of ovulation
she starts to have more wetness or mucus. As ovulation approaches, the mucus becomes clear and
slippery and stretches without breaking, like a raw egg white. The last day of peak wetness is right
before ovulation, then come days of less mucus. If any is noticed it will be cloudy.
Using the Ovulation-Mucus Method for Birth Control
The ovulation method, or mucus method, requires that a woman be aware of what is taking place in
her body. Any time the slippery stretchy mucus is noticed, intercourse should be avoided until two

days after it is all gone about eight days out of each cycle. Mucus should not be checked right
before or after sex, as semen and natural sexual lubricating moisture can be confused with cervical
mucus.
Benefits and Limitations of the Ovulation-Mucus Method
The ovulation-mucus method is easy to use and costs nothing. It is a good adjunct to other natural
methods as it provides a cross-check for signs of fertility. Used alone it is not as effective as other
methods of fertility awareness, which is why is it often paired with the sympto-thermal method.
A newer, easier version of the ovulation-mucus method is the TwoDay Method, which uses a similar
technique. The ovulation-mucus is not a good choice for women who feel uncomfortable touching their
bodies or who have reproductive tract infections that can obscure the signs of fertility.

SYMPTOTHERMAL METHOD
The Symptothermal Method combines changes in cervical
mucusonset of fertile period; changes in basal body
temperatureend of fertile period; and calculations to
estimate the time of ovulation. This method is more
complex to learn and apply, but it does not appreciably
improve efficacy.
The sympto-thermal method of natural birth control
involves determining the few days out of a woman's
menstrual cycles when conception can occur, and then
avoiding sexual intercourse on those days. This method involves determining this fertile time in two
ways: based on a woman's basal body temperature (it rises after ovulation) and by recording other
fertility cues (such as mood and cervical secretions). The name "sympto-thermal" method, comes from
body cues (i.e. symptoms) and a woman's temperature (i.e. thermal or thermometer).
How It Works: The Thermo Part
The sympto-thermal method requires that a woman take her temperature every morning before she
gets out of bed and record the reading. Depending on where she is in her menstrual cycle, there will
be slight variations in her temperature. These variations are most easily measured with a special
thermometer that has a range of only a few degrees, known as a basal thermometer
Before ovulation, the temperature is likely to be between 97.2 and 97.4 degrees F. After ovulation, it
will rise by at least 0.5 degrees and is often above 98 degrees F. When the temperature stays elevated
for at least three days, a woman may assume she has already ovulated. Intercourse for the rest of the

cycle will not result in pregnancy. To determine the infertile time before ovulation, a woman needs to
look at her pattern of previous cycles. Her last "safe" day is one week before the earliest recorded day
of temperature rise, or 5 days after the first day of her period.
How It Works: The Sympto Part
By recording other cyclic symptoms, in addition to basal temperatures, the infertile time before
ovulation can be more accurately predicted Cervical mucus and firmness, mid-cycle cramping, breast
sensitivity, and mood swings are all symptoms which give insight into the progression of a woman's
cycle. With careful monitoring, it is not difficult to predict your fertile period, when intercourse is to
be avoided.
Intercourse during the time before ovulation is less safe than the time after ovulation because sperm
have been known to live up to six days. For this reason, some couples choose to have sex only after
the fertile period. This practice, known as the post-ovulatory temperature method, is the most
effective of all natural methods, with a failure rate of only 1% among perfect users. However, it is not
recommended because it requires a very long period of abstinence.