Wednesday, 6 January 2016

Fertility Awareness

Venetia Kotamraju

When I was at school, at a mixed boarding school in England, many if not most of us were on the pill by the time we left aged 18. Once you turn 16 in England you are entitled to a free supply of the contraceptive pill, subject only to a routine and regular check up by your GP. Some were on the pill to regulate periods or to clear up acne, but for many of us it was just something we started to take as soon as we entered the realm of sex. The terrible spectre of teenage pregnancy was forever before us. It would mean the end of our education, the end of our career prospects, and that pretty much meant the end of life as we knew it. So if there was even the slightest chance we might get into some kind of sexual situation at some point, even if it was just a drunken fumble on the walk back from the pub, it was better to be safe than sorry. Condoms too but you couldn't rely on them nor on the testosterone-fuelled teenager you were with, so to the pill we turned.

We knew about all the different types of pills, patches, implants, rings and barriers, but we had no idea about the magical events that were taking place every month, or would have been if we had let our bodies' natural rhythms continue undisturbed. Periods were something to be endured, something ugly and rarely discussed even among close girl friends. The rest was biology. The idea that our menstrual health was a huge part of our overall physical, emotional and mental health, and that our cycles were something to be respected and celebrated was an idea completely foreign to us.

Nor were we ever made aware of the far reaching impact of taking such contraceptives on a regular basis for years and decades together. The doctor would check our blood pressure, ask about deep vein thrombosis and that was about it. If one pill made you break out in spots, you simply switched to another type. Perhaps doctors were not aware then - perhaps they still aren't today - but several articles I've read recently link the long term use of such contraceptives to depression and other mental health issues. And of course, when we finally got to the stage where we actually wanted to get pregnant, after years of seeing it as the Most Terrible Thing Ever, many of us found it wasn't so easy. Those same friends who were on the pill for years to prevent an unplanned pregnancy are now taking artificial hormones to try and achieve a pregnancy, and many are struggling.

But could there have been an alternative? Other than abstinence of course.

Well as it turns out yes. Had we been introduced to and taught what is called the fertility awareness method we might not only have been able to steer clear of these type of contraceptives altogether, but we might also have found ourselves much more comfortable in our developing bodies.

Fertility awareness or natural family planning is most definitely not the rhythm method, because it is based on reading your body not a calendar, but it stems from the same idea. Figure out which days of the month you are fertile and then avoid those days, or focus on those days if you're trying to get pregnant. It aims to make you body literate by teaching you to read the signs your body gives at dfferent stages of your cycle each month: temperature, cervical fluid and cervix position, as well as other secondary signs such as breast tenderness.

By tracking these signs and noting them down - charting as it is called, and there are now apps to make it even easier - you soon know how your own cycle works, whether you're ovulating or not and when, how long your cycle is normally and thus whether your period is late, whether that's cervical fluid or an infection (as Toni Weschler points out in her book Taking Charge of Your Fertility, many people who have thought they continually had some kind of vaginal infection realise that it was in fact completely normal variations in cervical fluid). It also helps account for more subtle changes that earlier would have seemed random and thus more difficult to manage, that broody feeling you get just before your period as your body sub-consciously mourns the child that has not been conceived, or the sudden surge in libido as your body prepares to ovulate and the corresponding dip after ovulation, and of course the much caricatured PMS.

Ultimately, practising fertility awareness allows you to avoid pregnancy without having to resort to contraceptives and all the issues they bring - those in long term relationships who don't have to worry about STDs can finally ditch condoms too - and also improve your chances of achieving pregnancy when you want to. Indeed, just by understanding when you ovulate, which is all too often not on day 14 as almost all doctors tell you (that is just the average figure; many women have shorter or longer cycles, and ovulation can vary from cycle to cycle too), you can massively increase your chances of conception without having to start what can be very intrusive fertility treatment. And as a bonus, when you do get pregnant you will be able to help your doctor get the delivery date right; so often doctors predict a delivery date which is too early - because they take it from the date of your last period and use an average cycle length of 28 days to calcluate - and that can lead to women being unnecessarily induced because they are 'overdue'.

The pill was heralded as a wonderfully liberating tool for women, but by artificially regulating our cycles it robbed us of control over and appreciation of our menstrual and overall health. Fertility awareness puts us back in charge, bringing us fully in tune with the wonderful way in which our reproductive system works, allowing us to have sex for pleasure or procreation - or both - as we wish.

If only the NHS would dish out books on fertility awareness to the 16 year olds queuing up in its clinics, instead of oral contraceptives.


Resources
Taking Charge ofYour Fertility - Toni Weschler (probably the best known book on the subject, with a huge amount of details and discussion about common menstrual disorders such as PCOS and endometriosis). NB: this book is now available in the BBN book library
Ovagraph app for charting (the official charting app for Taking Charge of Your Fertility)


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