Catholic Medical Quarterly Volume 65(2) May 2015

Practical Medical Ethics

The Symptothermal Method of Natural Family Planning

Mrs Carolyn Kerr RGN SCM

Photo of AuthorWhat exactly is Natural Family Planning? What does ‘natural’ mean? What is intended by the term ‘Planning’? Perhaps it brings different thoughts and understandings to different people. In past years NFP was thought of as an unreliable method, with large families that just ‘happened’. Very natural, but perhaps the planning side was not always strong, or considered relevant when population control and family size were not influencing factors. Knowledge of natural fertility has increased since those days.

The Sympto-Thermal method is now a well respected method of planning a family, based on a sound understanding of the relevant anatomy and physiology. It is taught to couples or individual women, taking into account her own natural signs of fertility.

Unless there is a medical problem, a male is fertile from puberty to end of life. The female fertility cycle fluctuates, and is under hormonal influence of the Pituitary gland. Prior to ovulation, there is a rise in the luteinising hormone which triggers ovulation. After ovulation, progesterone levels increase which establishes a rise in the basal body temperature (BBT) and the woman enters the infertile phase of the cycle.
The BBT is the temperature taken after a minimum of 3 hours sleep, when the temperature is at the lowest point in the day. Life stresses can influence the delicate sequence of hormonal activity.

Diagram of female fertile cycleThe women takes her temperature each morning, on waking, and records the information on a chart. A sustained temperature rise indicates that ovulation has taken place in that cycle, and helps define the end of the fertile phase. The temperature rise alone will not help a couple to achieve a pregnancy as it is now ‘too late’ for that cycle. The ovum lives for up to 12 hours. However the sperm can live for up to six days in optimum conditions, which occur before ovulation.

There are subtle changes that take place in the cervical mucus –these changes were recognised by Drs Evelyn and John Billings in Australia in the 1950’s. They formulated their research into a user friendly method which became known as the Billings method . The mucus symptom is the most important sign of fertility, for those couples who wish to achieve a pregnancy.

Once a woman has charted both mucus and temperature for 6 months, we can introduce the calendar calculation, based on the history of her cycles, which helps define the beginning of the fertile phase of the cycle.

If acceptable, she can also learn to recognise changes in the cervix, the 4th indicator of her fertility status.

Hence, rather like putting a jig saw together, we can help a client to recognise the beginning and the end of the fertile phase within the cycle and the days of optimum fertility. The sympto-thermal method gives clear boundaries, and also helps a woman to understand premenstrual symptoms, and hormonal influences. Ideally it needs to be taught by a qualified teacher, especially for those avoiding a pregnancy.

Once a couple understand the method, together they can plan whether to try and achieve a pregnancy, or whether to avoid a pregnancy, according to the fertility status at the time. The term ‘courtship and honeymoon phase of the cycle’, offers a lovely description of increasing intimacy. Used sensitively and with confidence it can strengthen the marital relationship, which in turn strengthens the family unit, on which our society is based. The World Health Organisation defines NFP as using abstinence during the fertile phase, and as such has an efficiency rate of 99% when measured by the Pearl Index.

In the Western and developed world, we live in a stressful and pressurised society. To learn the method effectively takes time and commitment. Career pressure, international travel across time zones, life stresses are some of the emotional struggles that present themselves to us all, and also to users of NFP. Likewise the support, or lack of support, of a couple for each other influences the success in using natural methods. However with increased interest in natural rather than artificial remedies to life style issues, NFP offers many benefits. It is inexpensive, does not introduce artificial hormones to the body, and is scientifically based. It is not medically or pharmaceutically dependant, and gives a couple autonomy to control their fertility. It is also education for life.

NFP ChartAfter all, if we were created by a loving God, surely He would have taken into account our ability to procreate. The discovery and understanding of natural fertility, has been a long and at times painful and discouraging journey. We are now benefiting from previous research, and NFP has become more accepted in the last few decades.

In this country we have Dr John Marshall to thank for his painstaking development of the temperature method, also Dr Anna Flynn and Mr John Kelly to thank, for building on his work and developing the Sympto–Thermal method of NFP.

NFPTA are the initials for Natural Family Planning Teachers Association. The organisation was established in 1977 by Mr John Kelly, an obstetrician and gynaecologist who worked at the Queen Elizabeth Hospital in Birmingham. He worked closely with Dr Anna Flynn, also an obstetrician and gynaecologist, whose research helped develop the scientific basis for the Sympto­Thermal method of NFP , and improved reliability. They developed the work of previous pioneers in this area of fertility research. Anna Flynn is internationally recognised for her work.

More can be learned by researching the NFPTA website: