Rhythm Method

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Rhythm Method
An illustration of the Standard Days Method. This method may be used by women whose menstrual cycles are always between 26 and 32 days in length
Background
B.C. type natural birth control
First use 1999 (Standard Days)
1930 (Knaus-Ogino)
Ancient (ad hoc methods)
Failure rates (per year)
Perfect use Standard Days: 5%
Knaus-Ogino: 9%
Typical use 25%
Usage
Reversibility Yes
User reminders Dependent upon strict user adherence to methodology
Clinic review None
Advantages
Benefits No side effects, can aid pregnancy achievement
Disadvantages
STD protection No
Weight gain No

The Rhythm Method, also known as the Calendar Method or the Knaus-Ogino Method (named after Hermann Knaus and Kyusaku Ogino), is a method of natural birth control that involves counting days of a woman's menstrual cycle in order to achieve or avoid pregnancy. A recently developed variant of the Rhythm Method is known as the Standard Days Method.

Contents

[edit] Incorrect use of the term

The phrase "the rhythm method" is frequently used, in error, to describe the behavior of any people who have unprotected sex yet wish to avoid pregnancy. While the failure rate of Rhythm is very high compared to most other methods of birth control, correct use of the Rhythm Method prevents a significant number of pregnancies and should not be compared to no method at all.

The phrase "the rhythm method" may also be incorrectly used to describe the practice of observational fertility awareness (FA) methods. This often comes as a source of chagrin to practitioners of FA, because FA methods are significantly more effective than Rhythm. Many FA teachers consider the Rhythm Method to have been obsolete for at least 20 years.[1]

For over 100 years, the Rhythm Method was promoted by members of the Catholic Church as the only morally acceptable form of family planning. Methods accepted by this church are referred to as natural family planning (NFP) - so at one time, Rhythm was synonymous with NFP. However, the modern Catholic Church also accepts certain uses of FA, and some sources now use the terms "fertility awareness" and "natural family planning" interchangeably. This overlap between uses of the terms Rhythm, NFP, and FA may contribute to confusion.

[edit] Description and effectiveness

Most menstrual cycles have several days at the beginning that are infertile (pre-ovulatory infertility), a period of fertility, and then several days just before the next menstruation that are infertile (post-ovulatory infertility). The first day of red bleeding is considered day one of the menstrual cycle. The formula for Calendar Rhythm requires the woman to know the length of her menstrual cycles.

[edit] Knaus-Ogino Method

To find the estimated length of the pre-ovulatory infertile phase, nineteen (19) is subtracted from the length of the woman's shortest cycle. To find the estimated start of the post-ovulatory infertile phase, ten (10) is subtracted from the length of the woman's longest cycle.[2]

A woman whose menstrual cycles ranged in length from 30 to 36 days would be estimated to be infertile for the first 11 days of her cycle (30-19=11), to be fertile on days 12-25, and to resume infertility on day 26 (36-10=26). When used to avoid pregnancy, the Rhythm Method has a perfect-use failure rate of up to 9% per year.[3]

[edit] Standard Days Method

Developed by Georgetown University's Institute for Reproductive Health, the Standard Days Method has a simpler rule set and is more effective than Rhythm. A product, called CycleBeads, was developed alongside the method to help the user keep track of estimated high and low fertility points during her menstrual cycle. The Standard Days Method may only be used by women whose cycles are always between 26 and 32 days in length. In this system, days 1-7 of a woman's menstrual cycle are considered infertile. Days 8-19 are considered fertile. Infertility is considered to resume beginning on day 20. When used to avoid pregnancy, the Standard Days Method has a perfect-use failure rate of 5% per year.[4]

[edit] Perimon

A software program developed in Germany from 1995 to 2001, Perimon is a stricter variant of the Knaus-Ogino method. It requires a greater period where unprotected sex is not allowed when used to avoid pregnancy, designating a maximum of 10.5 days each cycle as infertile. No clinical studies have been done to determine effectiveness, but the program's developers claim a perfect-use failure rate of 4% per year. The Perimon software is distributed for free.[5]

[edit] Imperfect use

Imperfect use of the Rhythm Method would consist of not correctly tracking the length of the woman's cycles, thus using the wrong numbers in the formula, or of having unprotected intercourse on an identified fertile day. The discipline required to keep accurate records of menstrual cycles, and to abstain from unprotected intercourse, makes imperfect use fairly common. The actual failure rate of the Rhythm Method is 25% per year.[3]

[edit] Reasons for high failure rate

Even when used perfectly, the Rhythm Method results in a high pregnancy rate among couples intending to avoid pregnancy. Of commonly known methods of birth control, only the cervical cap and contraceptive sponge have comparably high failure rates. This lower level of reliability of the Rhythm Method is because its formula makes several assumptions that are not always true.

The postovulatory (luteal) phase has a normal length of 12 to 16 days,[6] and the Rhythm Method formula assumes all women have luteal phase lengths within this range. However, many women have shorter luteal phases, and a few have longer luteal phases.[7] For these women, the Rhythm Method formula incorrectly identifies a few fertile days as being in the infertile period.

The Rhythm Method uses records of past menstrual cycles to predict the length of future cycles. However, the length of the pre-ovulatory phase can vary significantly, depending on the woman's typical cycle length, stress factors, medication, illness, menopause, breastfeeding, and whether she is just coming off hormonal contraception. If a woman with previously regular cycles has a delayed ovulation due to one of these factors, she will still be fertile when the Rhythm Method tells her she is in the post-ovulatory infertile phase. If she has an unusually early ovulation, the Rhythm Method will indicate she is still in the pre-ovulatory infertile phase when she has actually become fertile.

Finally, the Rhythm Method assumes that all bleeding is true menstruation. However, mid-cycle or anovulatory bleeding can be caused by a number of factors. Incorrectly identifying bleeding as menstruation will cause the Rhythm Method's calculations to be incorrect.

[edit] Current utilization of Standard Days Method

The Standard Days Method (SDM) is increasingly being introduced as part of family planning programs in developing countries. The method is satisfactory for many women and men who find other methods unacceptable; offering it through family planning centers results in a significant increase in contraceptive use among couples who do not want to become pregnant.[8][9] The low cost of the method may also enable it to have a significant positive impact in countries that lack funding to provide other methods of birth control.[10]

[edit] History

It is not known exactly when it was first discovered that women have predictable periods of fertility and infertility. St. Augustine wrote in the year 388, "Is it not you who used to counsel us to observe as much as possible the time when a woman, after her purification, is most likely to conceive, and to abstain from cohabitation at that time...?"[11] One book states that "[The Rhythm Method] had been recommended... by a few secular thinkers since the mid-nineteenth century".[12]

The Catholic Church first recorded approval of the method on Mach 2, 1853[13], by a ruling of the Sacred Penitentiary. This ruling was reaffirmed and expanded upon on June 16, 1880.[14]

However, it was not until 1905 that Theodoor Hendrik Van de Velde, a Dutch gynecologist, showed that women only ovulate once per menstrual cycle.[15] In the 1920s, Kyusaku Ogino, a Japanese gynecologist, and Hermann Knaus, from Austria, independently discovered that ovulation occurs about fourteen days before the next menstrual period.[16] Ogino used his discovery to develop a formula for use in aiding infertile women time intercourse to achieve pregnancy. In 1930, John Smulders, Roman Catholic physician from the Netherlands, used this discovery to create a method for avoiding pregnancy. Smulders published his work with the Dutch Roman Catholic medical association, and this was the official Rhythm Method promoted over the next several decades.[16]

The early Church father St. Augustine condemned the use of the Rhythm precursor he was aware of by the Manichaeans, who used it to totally avoid the conception of children, which they considered evil ("From this it follows that you consider marriage is not to procreate children, but to satiate lust.")[11] In more recent times, the December 1930 encyclical Casti Connubii by Pope Pius XI said that there was no moral stain associated with having marital intercourse at times when "new life cannot be brought forth." Although this referred primarily to conditions such as current pregnancy and menopause, the Pope through his Sacred Penitentiary in yet another ruling.[17], and Catholic Theologians also interpreted it to allow moral use of the newly created Rhythm Method.[18] In 1932 a Catholic physician published a book titled The Rhythm of Sterility and Fertility in Women describing the method, and the 1930s also saw the first U.S. Rhythm Clinic (founded by John Rock) to teach the method to Catholic couples.[19] Pope Pius XII gave emphatic formal Catholic acceptance of the Rhythm Method in 1951, from two speeches he delivered.[20][12]

Humanae Vitae, published in 1968 by Pope Paul VI, addressed a pastoral directive to scientists: "It is supremely desirable... that medical science should by the study of natural rhythms succeed in determining a sufficiently secure basis for the chaste limitation of offspring." This is interpreted as favoring the then-new, more reliable fertility awareness methods over the Rhythm Method.

It has been suggested that unprotected intercourse in the infertile periods of the menstrual cycle may still result in conceptions, but create embryos incapable of implanting.[21] It has also been suggested that pregnancies resulting from method failures of periodic abstinence methods are at increased risk of miscarriage and birth defects due to aged gametes at the time of conception.[22] The most recent research, however, suggests timing of conception has no effect on miscarriage rates,[23] low birth weight, or preterm delivery.[24]

[edit] References

  1. ^ Weschler, Toni (2002). Taking Charge of Your Fertility, Revised Edition, New York: HarperCollins, pp.3-4. ISBN 0-06-093764-5. 
  2. ^ Kippley, John and Sheila Kippley. The Art of Natural Family Planning. The Couple to Couple League, Cincinnati, OH: 1996. p.154. ISBN 0-926412-13-2
  3. ^ a b Hatcher, RA; Trussel J, Stewart F, et al (2000). Contraceptive Technology, 18th Edition, New York: Ardent Media. ISBN 0-9664902-6-6. 
  4. ^ Arévalo M, Jennings V, Sinai I (2002). "Efficacy of a new method of family planning: the Standard Days Method.". Contraception 65 (5): 333-8. PMID 12057784. 
  5. ^ Perimon (2007). Retrieved on February 11, 2007.
  6. ^ Weschler, p.48.
  7. ^ Kippley, p.111
  8. ^ Kalaca S, Cebeci D, Cali S, Sinai I, Karavus M, Jennings V (2005). "Expanding family planning options: offering the Standard Days Method to women in Istanbul.". J Fam Plann Reprod Health Care 31 (2): 123-7. PMID 15921552. 
  9. ^ Urmil Dosajh, Ishita Ghosh, and Rebecka Lundgren. "Feasibility of Incorporating the Standard Days Method into CASP Family Planning Services in Urban Slums of India" (PDF). The Institute for Reproductive Health, Georgetown University. Retrieved on 2006-12-2.
  10. ^ Gribble J, Jennings V, Nikula M (2004). "Mind the gap: responding to the global funding crisis in family planning.". J Fam Plann Reprod Health Care 30 (3): 155-7. PMID 15222918. 
  11. ^ a b Saint, Bishop of Hippo Augustine; Philip Schaff (Editor) (1887). A Select Library of the Nicene and Post-Nicene Fathers of the Christian Church, Volume IV. Grand Rapids, MI: WM. B. Eerdmans Publishing Co., On the Morals of the Manichæans, Chapter 18. 
  12. ^ a b Yalom, Marilyn (2001). A History of the Wife, First edition, New York: HarperCollins, p. 307. ISBN 0-06-019338-7. 
  13. ^ On the Question of Natural Family Planning. cmri.org. Retrieved on April 1, 2007. "Question: Certain married couples, relying on the opinion of learned physicians, are convinced that there are several days each month in which conception cannot occur. Are those who do not use the marriage right except on such days to be disturbed, especially if they have legitimate reasons for abstaining from the conjugal act? Response: Those spoken of in the request are not to be disturbed, providing that they do nothing to impede conception."
  14. ^ On the Question of Natural Family Planning. cmri.org. Retrieved on April 1, 2007. "Question: (1) Whether married couples may have intercourse during such sterile periods without committing mortal or venial sin? (2) Whether the confessor may suggest such a procedure either to the wife who detests the onanism of her husband but cannot correct him, or to either spouse who shrinks from having numerous children? Response: Married couples who use their marriage right in the aforesaid manner are not to be disturbed, and the confessor may suggest the opinion in question, cautiously, however, to those married people whom he has tried in vain by other means to dissuade from the detestable crime of onanism."
  15. ^ A Brief History of Fertility Charting. FertilityFriend.com. Retrieved on June 18, 2006.
  16. ^ a b Singer, Katie (2004). The Garden of Fertility. New York: Avery, a member of Penguin Group (USA), pp. 226-7. ISBN 1-58333-182-4. 
  17. ^ Is Natural Family Planning a 'Heresy'?. rtforum.org. Retrieved on April 1, 2007. "Question: Whether the practice is licit in itself by which spouses who, for just and grave causes, wish to avoid offspring in a morally upright way, abstain from the use of marriage – by mutual consent and with upright motives – except on those days which, according to certain recent [medical] theories, conception is impossible for natural reasons. Response: Provided for by the Response of the Sacred Penitentiary of June 16, 1880."
  18. ^ Kippley, p.231
  19. ^ Gladwell, Malcolm (2000-03-10). "John Rock's Error". The New Yorker. 
  20. ^ Moral Questions Affecting Married Life: Addresses given October 29, 1951 to the Italian Catholic Union of midwives and November 26, 1951 to the National Congress of the Family Front and the Association of Large Families, National Catholic Welfare Conference, Washington, DC.
  21. ^ Luc Bovens (2006). "The rhythm method and embryonic death". Journal of Medical Ethics 32: 355-356. 
  22. ^ Gray, RH (October 1984). "Aged gametes, adverse pregnancy outcomes and natural family planning. An epidemiologic review". Contraception 30 (4): 297-309. PMID 6509983. 
  23. ^ Gray RH, Simpson JL, Kambic RT (May 1995). "Timing of conception and the risk of spontaneous abortion among pregnancies occurring during the use of natural family planning". American Journal of Obstetrics and Gynecology 172 (5): 1567-1572. PMID 7755073. 
  24. ^ Barbato M, Bitto A, Gray RH, et al (June-September 1997). "Effects of timing of conception on birth weight and preterm delivery of natural family planning users". Advances in Contraception 13 (2-3): 215-228. PMID 9288339. 

[edit] External links

  • CycleBeads - A website promoting the Standard Days Method


Birth control edit
Sterilization: Tubal ligation, Vasectomy, Essure
Post-intercourse: Abortion: Surgical, Medical
Emergency contraception
Intra-uterine: IUD, IUS (progestogen)
Anti-estrogen: Ormeloxifene (a.k.a. Centchroman)
Hormonal: Combined: COCP ('the Pill'), Patch, Nuvaring
Progestogen only: POP mini-pill, Depo Provera, Norplant, Implanon
Barrier: Male condom, Female condom, Diaphragm, Shield, Cap, Sponge, Spermicide
Behavioral: Coitus interruptus, Rhythm Method, Lactational, Fertility awareness
Avoiding vaginal intercourse: Anal sex, Oral sex, Outercourse, Masturbation, Abstinence
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