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Aug. 6, 2010
By Lois McGuire, R.N., M.S.N., W.H.N.P.
Teens and the rhythm method: Bad news
A growing number of teenagers are trying to use the rhythm method for birth control, according to a survey by the National Center for Health Statistics (NCHS). The rhythm method, also called the calendar method, calendar rhythm method or periodic abstinence, is a type of natural family planning.
To use the rhythm method, you track your menstrual history to predict when you'll ovulate. Once you know when you'll ovulate, you can determine which days to avoid unprotected sex.
Couples who use the rhythm method for birth control generally take classes together for detailed understanding of the menstrual cycle and the factors that control it. Effective use of the rhythm method also requires diligent record keeping. You and your partner both need know what's going on with your reproductive cycle from one day to the next.
Successful use of the rhythm method takes more than just identifying the woman's most fertile days and avoiding intercourse on those days. You also need the discipline to abstain from intercourse for several days before ovulation, as well as during ovulation and for a few more days afterwards. If you and your partner aren't comfortable talking about sex, or if you generally avoid sexual activities other than intercourse, the rhythm method is not right for you. Out of about 100 typical couples who use the rhythm method for a year, 22 will get pregnant. In other words, the rhythm method is about 78 percent effective.
If the rhythm method has a 22 percent failure rate in adults, its performance in teens must be abysmal. No statistics are available on teen pregnancy due to rhythm method failure. But the survey cited at the top of this blog, based on interviews of thousands of teenagers about their sexual behavior, contraceptive use and childbearing, reported that 17 percent of sexually experienced girls said they had used the rhythm method for birth control. That's a striking increase since 2002, the last time this survey was conducted. In 2002, only 11 percent — still too many — reported using the rhythm method.
The rhythm method is a poor birth control choice for teens partly because they lack the emotional maturity to track their fertility and abstain from sex for several days a month. But there's another obstacle that may trip up even the most stable and responsible teen couple favoring the rhythm method: Teenage girls may take several months to establish a regular menstrual cycles, so they might find it particularly hard to calculate their fertile and safer days. This unpredictability may be one reason why teen pregnancy rates rose from 2005 to 2007, after a steady decline starting in 1992. In 2008, teen pregnancies declined again, but only by 2 percent.
Remember, too, that the rhythm method protects neither partner against sexually transmitted diseases. Unless you've both been tested and found to have no STDs — and you're both absolutely committed to your monogamous relationship — you should use a condom every time you have intercourse, preferably along with a hormonal contraceptive, such as birth control pills. Responsible, caring sex partners want reliable birth control as well as protection from STDs. For most young people, the rhythm method fails on both counts.
Personal comment: The rhythm method is not to be confused with the Fertility Awareness Method. The Rhythm method can be disrupted by any number of factors that make it unsuitable for adults much less teens. Fertility Awareness on the other hand where a woman’s fertile signs: basal body temperature, cervical fluid and cervical position are monitored to tell when she is fertile and a barrier method or abstinence must be used, can be extremely effective if all the rules are followed all the time and the woman doesn’t take risks with just-this-once behavior. Even so, I don’t think teens should try using FAM because most lack the emotional maturity to follow the rules
I encourage recreational sex as I think it is a wonderfully healthy way to relax and get to know a ballet partner. It also helps to tone the abs. So I teach my students and the dancers who come to me for advice that the rhythm method should be avoided and an effective method of birth control either barrier, hormonal on implant should be used for contraceptive protection and a condom should always be used if you aren’t certain of a partner’s sexual history.
I don't think I've heard the term Fertility Awareness Method as you mentioned above, though I do think it must take a lot of discipline and knowledge of the woman's anatomy. How difficult is it to perform FAM? I could probably see the reason you don't recommend that for teens. I would think FAM might be better for couples *wanting* to bear children, so they know when it's best to try to conceive.
ReplyDeleteTo use FAM fully (including taking basal body temp) takes discipline and a stable schedule, because the temp readings should be taken at the same time each morning, immediately after awakening after more than 4 hours of sleep. the temps are recorded so the woman can see her temp shift at ovulation. So for any woman with an erratic schedule the temp part is questionable. The temperature shift upward by a few tenths of a degree at ovulation is a sort of after-the-fact measurement that tells you when you’ve ovulated and about two weeks later when your progesterone level drops if you aren’t pregnant – causing a decrease in temp – that occurs a day before your period starts.
ReplyDeleteIt’s good to know that you have ovulated and therefore after another 24 hours (O+1) it should be safe to go without protection if you’re sure STIs aren’t a problem. However, if you haven’t been carefully watching up to that point for slippery stretchy cervical fluid and a ripening of the cervix when it softens, opens and rises higher in the vagina - that tells you you’re fertile and should be using a barrier - you may find you’ve been truly fucked in every sense of the word. That’s because when sperm reaches fertile cervical fluid it can live in a woman’s tubes as long as 5 to 7 days waiting for her to release an egg. In the teens and early 20s (19 to 26 years old) a woman has a 50% chance of becoming pregnant from a single act of unprotected IC on her most fertile day. So a woman really needs to be careful using FAM.