Why Women Are Turning to Natural Birth Control
And why we should be offered Fertility Awareness methods as a routine option.
This morning, I put a thermometer in my mouth and recorded my temperature before getting up. A few minutes later, I checked the toilet paper for cervical fluid.
I’m not the only one with this slightly unusual morning routine. More and more women are using Fertility Awareness Based Methods, or FABMs.
Natural birth control was one of the main topics discussed on World Contraception Day, at least in The Netherlands. Most of the coverage was dismissive, cautioning women against ditching hormonal birth control.
A year or so ago, I would’ve wholeheartedly agreed.
And yet, here I am: using what most people still think of as the Rythm Method.
How did I get here? Why would women choose to put in all this effort for a supposedly unreliable birth control method?
If you, like me a few years ago, are puzzled by this shift toward natural birth control, you’re in the right place. Let me walk you through the process.
Getting on the Pill
On the 4th of March, 2021, I went to get my first pack of pills. I had looked up everything I could about birth control; the pros, the cons, and the ways it prevents pregnancy. I felt well prepared.
The doctor looked through the survey I filled out, advised me to start with the lowest dose, and gave me some flyers about the brand. I walked out with a month’s worth of pills and was told to come back for my 3 month supply if things worked out.
Once my period started, I popped the first pill. While it made my flow heavier, I didn’t notice any other issues. At first anyway.
About 3 days in, I woke up at 5 AM and threw up.
A few weeks later, I went to bed feeling nauseous and dizzy. The dizziness lingered throughout the next day. I couldn’t sit up without gagging. I had a partly remote job, so thankfully I didn’t need to leave my bed. When I did go back to the office, my colleagues said I looked like a ghost.
I’d read about side effects like nausea, but seeing it mentioned in bullet lists didn’t prepare me for the reality of constantly feeling unwell. Sleeping on my back and making escape plans in case I’d need to run to the toilet.
But I powered through, telling myself it was only temporary and worth the protection against pregnancy.
The nausea got better but didn’t go away completely. I always made sure to take the pill with a snack and go to sleep right after, so I wouldn’t feel the effects. Nausea wasn’t the only side effect, though.
I got night sweats.
Sores appeared on my tongue right after I swallowed the pill in the evening, only to vanish by the next morning.
I often started cramping and spotting about 30 minutes after taking it. I’d never had issues with spotting before.
I also had some health concerns. I was on the lowest possible dose, which some doctors are wary of. They advise at least 30 micrograms of estrogen for women under 30 to support bone health. But higher estrogen might mean more side effects. I didn’t want to start throwing up again.
Around the same time, I came across a study linking the pill to Crohn’s Disease, which runs in my family.
All this for a relatively low effectiveness rate. The pill has to travel through the digestive tract, so its effectiveness can be lowered by diarrhea, certain medications, and vomiting. How ironic.
I’d hoped to stop my periods using the pill, but it only made me bleed more. When I bled for 13 days straight in December, 10 months in, I’d had enough. I started looking for a more effective, less disruptive method.
The Mirena IUD
I settled on the Mirena IUD. The Mercedes-Benz of birth control, as it is sometimes called. The idea of having one inserted terrified me, but they’re known to either stop periods or make them significantly lighter. It is also as effective as sterilization.
So, I went back to my clinic and got up into the stirrups.
The insertion was underwhelming. I took 400 mg of ibuprofen. No extra medication to soften my cervix, not even a pregnancy test. All I felt was a weird pressure. I was sent home with some antibiotics.
I was spotting on the day of the insertion, but had no bleeding for the next 2 weeks. I did feel like my uterus was being stretched for a while, but that resolved.
Great! I thought I had found my method. I was gonna keep replacing these IUDs until menopause and never bleed again!
Well, that obviously didn’t happen.
I started bleeding 3 weeks later, and that bleed lasted for about a month. I ended up spotting most of the time, and my ‘periods’ often lasted more than a week.
I was also hit with a stabbing pain in my abdomen about 2 weeks after the insertion.
This stabbing pain was my main issue with the IUD. It was like ovulation pain on steroids. Sometimes, it was bad enough to stop me in my tracks.
On a few occasions, the pain built up to the point of being paralyzing. I felt like a knife was stuck in my abdomen and any movement would tear up my organs. My boyfriend said I was so bloated I looked pregnant. He urged me to see the doctor.
The doctor took a look and said the IUD was in place and everything looked fine. I had a growing follicle, but nothing out of the ordinary. When I suggested it might be ovulation pain, he said I could take the pill on top of being on the IUD to stop ovulation.
However, at this point, I had started learning about the benefits of ovulation. I declined and said I would wait a year or so to see if things improved.
This is another example of how reading about side effects is completely different from experiencing them. As someone lucky enough to be generally healthy, I had no idea how exhausting it is to be in constant pain.
I stuck with it for 14 months, but the pelvic pain kept coming back.
Transitioning to FABMs
During those months of going back and forth on my IUD removal, I started listening to the Fertility Friday podcast, which is all about the Fertility Awareness Method.
I rolled my eyes, irritated that this irresponsible woman was promoting a method that would send women straight to the abortion clinic. At a time when reproductive rights were under attack, I felt this was the last thing women needed.
But I was learning things I’d never been taught about my body. I learned about the benefits of estrogen and progesterone, and how the cycle works.
The entire process actually revolves around ovulation, which is suppressed by most methods of hormonal birth control. Rising estrogen levels trigger the release of an egg, which then leads to a surge in progesterone production.
I learned there is actual evidence behind modern FABMs. The effectiveness can be as high as 99.6% for the Sensiplan method. These are perfect use rates, but even typical use effectiveness sits at 98%. This is higher than the pill, which has a typical effectiveness rate of 91 to 93%.
Yes, there is a lot more research behind the pill. Perhaps the rate of FABM effectiveness will drop a bit once more women start using it, especially without help from a trained instructor. The effectiveness rates also vary depending on the method.
However, learning that I had an alternative made me less willing to endure the side effects and potential risks that come with hormonal birth control.
Serious risks of being on hormones, such as stroke or blindness, are rare. Pregnancy poses a much greater health risk than hormonal birth control. But this is a medication most women take for years without actually being sick.
Having a menstrual cycle is not an illness or defect.
Pregnancy is not like cancer; something that will spontaneously start growing in our bodies as soon as we get off birth control.
Pregnancy only happens when an egg gets fertilized, and there are reliable ways to prevent this that don’t involve these side effects.
The Right to Optimal Health
So. I’ve considered myself a feminist ever since I was 12. To me, the pill stood for women’s liberation. Access to hormonal birth control is one of the major feminist talking points. Talking about the side effects in depth is often considered fear-mongering. Irrational, even.
We’re scared that by talking seriously about the side effects, we’re playing into the hands of conservatives wanting to take away women’s choices.
However, by not talking about these issues, we’re pushing people away. If the only ones willing to listen to your experiences and offer alternatives are conservatives, do you really have a choice?
Not to mention ignoring women’s experiences isn’t very feminist to begin with.
Truth is, feminists were protesting the pill when they first found out about its risks. It’s thanks to these protests that we now have package inserts listing a medication’s potential side effects.
While the dosage has been lowered significantly since those protests, the pill still contains 4 times the estrogen levels of an average natural cycle, as Dr. Jerilynn Prior explains on her website.
As it turns out, our hormones impact more than just our reproductive system. The right balance is needed for many aspects of our health, including the cardiovascular system, our bones, and our mental health.
Even though the pill has been on the market for over 60 years, there’s still too much we don’t know about its effects on the body. We’re only now starting to study its effects on the brain, for example.
And that’s just the pill. While it seems like we have lots of options nowadays, most rely on hormonal suppression. As we’re still discovering unknown side effects from the pill, I worry about unexpected issues with newer methods.
On top of that, the same company that sells the Mirena has faced huge protests over the notorious Essure device.
While this doesn’t mean the side effects of IUDs are on par with Essure, it is clear that proper safety regulations don’t come about without pressure from consumers.
I used to dismiss women quitting hormonal birth control as blindly giving in to fear-mongering. But perhaps feminism is headed in a new direction.
Women have the right to optimal health.
We should have the information we need to make informed choices. We shouldn’t have to suffer silently to prevent pregnancy. And we especially shouldn’t be risking our lives.
Re-Evaluating Our Options
It may seem like I am now anti-pill and want to ban hormonal birth control, but I would say it’s the opposite. I want women to have more options, not fewer.
There is no perfect method of pregnancy prevention.
Hormonal methods essentially make you immune to sperm, which is like a superpower. Especially when sexual assault and limited access to abortion are an unfortunate reality. But it comes with both known and, as of yet, unknown side effects.
FABMs don’t alter your body, but you can’t be as spontaneous as someone taking hormones. It’s not for everyone, but it’s a sacrifice I’m willing to make.
With tracking our cycles comes a new awareness of our health and energy fluctuations. This can help us demand better care and work conditions. Hopefully, we can create space for female bodies to function optimally.
Educate girls about why their hormones are important for their health, not just for making babies. This should be common knowledge.
Develop care that allows those suffering from endometriosis or adenomyosis to ease symptoms without shutting down their cycle.
Provide a full range of options for family planning, including accurate information about hormonal birth control and FABMs.
And, here’s an idea, have men use condoms every now and then.
Originally posted Oct 27, 2023. Edited May 2024.
