Unpacking the Trend of Natural Birth Control

When Layna was a teenager, she went on her first birth control pill: Loestrin 24 Fe. For a few years, she was content with her hormonal contraception. Then Loestrin was discontinued. She tried taking Seasonale, another hormonal birth control pill, but she found that it made her bleed when she had sex. Other pills weren’t much better: She experienced mood swings, gained weight, and even says she felt suicidal. “I knew in my heart that I did not feel like that, that that was not me,” she says.

Eventually Layna, who requested that her last name not be included for privacy reasons, decided to move away from hormonal birth control altogether, which brought her to the fertility awareness method (FAM), a collection of behavioral birth control strategies that help people follow and predict their cycles through period tracking, daily temperature taking, cervical mucus monitoring, and a lot of math.

She first tried Natural Cycles, an algorithm-driven FAM app that recently became the first app to receive approval from the U.S. Food and Drug Administration (FDA) to market itself as a contraceptive. She says that app didn’t feel quite right for her, but she did stick with FAM. These days, Layna uses the OvaCue Fertility Monitor to track her fertile days, relying on condoms or abstaining from sex on days when she’s more likely to get pregnant. “I felt really strongly that it was one of the best things that I’ve ever done for myself,” she says.

Layna is one of a small but growing number of women who are turning to FAM-related methods. Although data suggests only about 3% of women who use contraceptives use a form of FAM, either with or without other methods, app-based and other FAM-based systems are becoming increasingly popular. Natural Cycles currently boasts 1 million registered users worldwide, and similar newfangled FAM solutions, like OvaCue, Daysy, and Kindara are gaining broad followings, as well.

It may be difficult to understand why someone would opt to use FAM, which requires substantial daily tracking, rather than, say, the copper IUD, which is 99.9% effective and, in some cases, can be used with little or no maintenance for up to 12 years.

In addition to rigorous period tracking and daily temperature taking, Natural Cycles, for example, requires users to either abstain from sex or use a condom on “red days” — the days when the app deems a person at risk of getting pregnant — a vastly more labor-intensive pregnancy prevention strategy than set it and forget it methods like the shot, implant, or IUD. Although the addition of temperature taking and cervical mucus monitoring can make FAM significantly more foolproof than the rhythm method, which relies on period tracking alone, the method still requires a lot of planning and mental energy — something that can be a deal breaker for many people. For people who want an effective birth control method without hormones, that work can often feel worth it: Natural Cycles boasts that, with typical use, its method is 93% effective, making it comparable to the pill. (Planned Parenthood is less optimistic about the effectiveness of FAM methods, rating them 76–88% effective on its website.)

FAM is not an ideal method for everyone. Dr. Gillian Dean, the senior director of Medical Services at Planned Parenthood Federation of America says fertility awareness methods “don’t work as well for people with irregular menstrual cycles, people who can’t track their fertility signs daily, and those with certain medical conditions such as thyroid disorders.”

“And it’s not a good method for people who don’t want to use condoms or another barrier method or abstain from vaginal sex on fertile days,” she says.

But for some contraceptive users, the appeal of FAM isn’t just about effectiveness rates or ease of use. It’s about finding a reliable contraceptive method that enables them to manage their fertility and reproductive health on their own, outside of a medical system that leaves many women, as well as transgender and nonbinary people, feeling ignored or misunderstood.

Whenever Layna spoke to her doctors about contraceptive options, she says she felt they were more interested in jotting off a prescription than actually listening to her concerns about the side effects. “I definitely do have a bit of distrust for the medical industry,” she says, adding that her experiences made app-based birth control that more appealing.

“There are doctors who believe that even the very well established side effects from oral contraceptives are just from the placebo effect and aren’t really that big a deal,” says Maya Dusenbery, author of Doing Harm: The Truth About How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed, and Sick. That cavalier attitude toward contraceptive users’ suffering, she says, is a serious disservice.

Recent research, however, is legitimizing the symptoms that many women have experienced and are expected to deal with while on hormonal birth control. A 2016 study of more than a million Danish women found a strong correlation between hormonal birth control and antidepressant use. “The risk of depression has been recognized since women were able to get their hands on oral contraceptives,” Cindy Pearson, executive director of the National Women’s Health Network, said at the time, adding that what’s changed is that there is now data to back up these experiences. “It makes sense biologically, and it’s been reported by women for 50 years.” Other recent research has questioned the link, finding no evidence of a cause of depression from progestin-only contraception specifically.

Preventing pregnancy without barrier methods is a challenging task that is always going to come with tradeoffs; the nausea, weight gain, depression, and reduced libido that can come with hormonal contraception may feel like an acceptable cost compared to the option of an unwanted pregnancy. But researchers and doctors may take that appeal as a given.

All contraceptive methods come with their own list of pluses and minuses; even Natural Cycles founder Elina Berglund acknowledges that her app is most appropriate for people who are in their thirties; in a stable, committed relationship; and potentially interested in becoming pregnant later on. FAM apps seem unlikely to displace hormonal methods as one of the most popular ways to prevent pregnancy. But it may benefit the medical community to take heed of what’s attracting women to FAM in the first place; whether it’s fewer side effects or a desire for more reproductive knowledge.

“Birth control methods are not one-size-fits-all,” says Dean. “The best birth control method is the one that meets your needs, and those needs can change throughout your life.”

Ultimately the growing use of FAM as birth control may signal an unmet need. And it could help open up an honest dialogue about the benefits — and costs — of all types of birth control, creating an opportunity to greatly improve the reproductive health landscape.

Unpacking the Trend of Natural Birth Control

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