Behavioral Methods

Also known as the withdrawal method

Method: The penis is withdrawn from the vagina before ejaculation.

Description: avoiding sexual intercourse during the ovulation period

Calendar method: The fertility period is estimated by documenting the timing of ovulation

• Based on 3 points: (i) an egg can be fertilized for ∼ 24 hours after ovulation; (ii) the lifespan of sperm is 48 hours following ejaculation; and (iii) ovulation occurs 12–16 days before onset of the next menses.

• Fertilization can occur anytime from 3 days before to 1 day after ovulation.

• The fertility period is calculated after recording 6 menstrual cycles

Cervical mucus method: The fertility period is estimated by evaluating the abundance and consistency of cervical mucus throughout the cycle.

• During the days leading to ovulation, cervical mucus becomes stringy/elastic, thick, and abundant due to an increase in progesterone.

• Conception is more probable up to 4 days after cervical mucus reaches its maximum abundance and elasticity; intercourse should be avoided during this time.

• Contraindicated in breastfeeding women < 6 weeks postpartum, non-breastfeeding women < 4 weeks postpartum, and in women with irregular menstrual cycles

Basal body temperature method: The body temperature is measured throughout the cycle. The increase in progesterone concentration after ovulation triggers an increase in basal body temperature, thus indicating the fertility period.

Symptothermal method: including a combination of the basal body temperature method and the cervical mucus method

Unreliable method of contraception, although still practiced by over 20% of women in the US. Not a recommended form of contraception, but many women in the US still have this misconception

Risk of promoting unintentional pregnancy by pushing semen into the cervical canal

Method: The vagina is flushed with water or other products immediately after male ejaculation during intercourse in an attempt to theoretically flush semen out

Amenorrhea is induced by exclusively breastfeeding for up to 6 months immediately postpartum

Method

• Suckling at the breast → ↑ prolactin and ↓ gonadotropin-releasing hormone → suppression of ovulation

  • FSH levels are normal/high → follicle growth; however, ↓ LH leads to inhibited follicular maturation and the absent LH surge prevents ovulation [3]