Mucus Method

[joreth]

I have always been successful at avoiding pregnancy, even during my younger days of not-so-safe-sex - I've never even had a late period as a scare. My success was mostly coincidental. I had tried the pill several times but hormonal methods really don't work well with me. I don't like to use condoms because I consistently lose my arousal when I have to stop and put one on, and even if we take some time to get me back up to readiness, for some reason the use of a condom corrolates to no-orgasm for me during sex. However, sex without a condom has a SIGNIFICANTLY higher percentage of orgasm during sex. Plus, now that I prefer to exchange test results with my partners (and a couple other safety rules), and I'm aware that some STDs are not prevented by condom use anyway, I don't tend to view condoms as my most effective STD prevention option. I'm susceptible to Toxic Shock Syndrom, so the insertable methods aren't an option, and the newer birth control methods have come after many years of being comfortable with my current method, so it makes it difficult to want to change ... especially when my method is free and the others aren't (no medical insurance here!).

Historically I used the rhythm method (sometimes in addition to the pill or condoms), even though my cycle is irregular. My cycle is irregular in that the number of days between the start of each period is completely random, so the rhythm method really isn't a safe method for me to use. However, the Mucus Method is much more reliable. My cycle is irregular, but my *mucus* is not, and that has been my saving grace all this time.

But what *is* the mucus method?

I'm glad you asked.

The Cervical Mucus Method (also called the Billings Method) is based on the idea that a lack of cervical mucus indicates that an egg has not yet been released by the ovaries. Additionally, without the mucus, sperm will not be able to survive inside a woman until the time that an egg is released. Cervical Mucus has regular, cyclic pattern changes.

Like the rest of your reproductive system, your cervix is affected by the monthly changes in your body. Just after you finish your period, your cervix produces very little, if any, mucus causing you to have a few days where your vagina appears to be quite dry. As you progress through your cycle, you body will begin to produce more cervical mucus.

As you get closer to ovulation, your cervical mucus will become thinner and stickier. When ovulation is about to occur, your cervical mucus will be clear, slippery and very stretchy, similar to a raw egg white. This type of mucus is ideal for sperm to swim in and helps the sperm swim up to your uterus. While this is great for women who are trying to conceive, women who are trying to avoid pregnancy will want to abstain from sex or use another form of birth control, like condoms or the sponge, during this time.

After ovulation, the production of mucus is slowed down again. If you do notice any mucus, it will likely be thicker and cloudier.



Checking the Mucus
There are three ways in which you can check your cervical mucus:

• Use your finger or toilet paper to wipe across the opening of vagina and then take a look at the mucus.
  
• Wear a panty liner and examine any cervical mucus that may be left on it (this can be hard to detect, though)
  
• The best way: reach in and get a sample of your cervical mucus. Examine the consistency and try to stretch the mucus between your fingers. If you can stretch it at least three inches without it breaking, then ovulation is about to occur. The majority of women will have better results if they circle around the cervix or as deep as possible, and hook their finger while bringing the mucus out. This will allow you to gather as much of the CM as possible. If you just insert your finger, you may only gather the wetness of the actual CM.

If you notice the mucus just globbing to one finger, you are not ovulating. If the mucus is very stretchable and clear, you are probably near or at your ovulation phase. If you do not want to get pregnant, then sex should be avoided from the time you begin to notice the slippery, stretchy mucus until at least two days after it is gone.

Effectiveness
In trials, method-related pregnancy rates have ranged between 0% to 2.9%. In a recent trial in China 992 couples using the Billings Method were compared to 662 couples using the IUD. The method-related pregnancy rate amongst Billings users was zero and the total pregnancy rate was 0.5%. The Ovulation method effectiveness has been shown in several clinical studies to be over 98% effective. Since the fertile time can change every cycle, this method is effective regardless of an irregular cycle because you observe your fertility as it happens although some websites claim the overall pregnancy rate of this method is as high as 20%.

Prajanan Jagriti, a modified mucus method designed to fit the cultural needs of illiterate and semiliterate women with low status within the family, has enabled poor Indian women who cannot be reached with other methods of fertility control to plan their families. Although based on the observation of cervical mucus, this simplified method does not require its user to chart her menstrual cycle and demands fewer days of abstinence than traditional natural family planning (NFP) methods. In a 10-month period, 3003 women from North India, Uttar Pradesh, and Madhya Pradesh received structured teaching of the application of Prajanan Jagriti and supportive counseling from female village leaders. To ensure a thorough grasp of NFP concepts, only 10 women were instructed per month by each of the 37 village woman leaders, who were in turn supervised by 12 cluster coordinators from the Training and Action Pilot Project for non-Catholics. All 3003 women completed the first 3 months of training, and there were no unplanned pregnancies in the first month. In the 10 month study period, there were 42 unplanned pregnancies, for a Pearl index of 2.04. The main risk factor associated with these pregnancies was having no living child. Also contributing to method failure were cultural pressures to produce children, poor intraspouse communication, difficulties abstaining from sexual relations on the part of husbands, and the longer fertile period among younger women. Overall, however, project staff reported a high level of motivation on the part of these acceptors and a responsiveness to the shorter period of abstinence required by this modified method.

Trials of the Billings Ovulation Method carried out in both developed and developing countries reveal high reliability, effectiveness and satisfaction with the method.

The most recent large scale trial was conducted in China.

It is extremely difficult to evaluate and compare fertility control methods in clinical trials because of the terms used and the variety of methods available. To understand the terminology a list of terms is included below.

TERMINOLOGY USED IN TRIALS

METHOD-RELATED PREGNANCY RATE

This indicates the number of pregnancies, expressed as a percentage, occurring when couples carry out correct instructions for a particular method. The correctly assessed pregnancy rate under these circumstances is an indication that the method has not covered a percentage of biological circumstances.
All fertility control methods have such failures, including the Pill, the IUD, and even sterilisation.

TEACHING-RELATED PREGNANCY RATE

This figure applies to pregnancies resulting from incorrect teaching of a method, or to misunderstanding by the user of the method.

CONTINUATION RATE

This is a guide to the acceptability of a method and is judged by the readiness of users to continue with a method over an extended period and to return to a particular method after a pregnancy.

TOTAL PREGNANCY RATE

This total figure includes pregnancies resulting from a failure of a particular method to cover all biological circumstances, misunderstanding of the method, risk-taking by couples, ambivalence towards pregnancy, and the decision by a couple to exercise the second option of achieving a pregnancy. Within the total pregnancy rate there may also be a number of pregnancies resulting from an act of intercourse when agreement fails between partners.
Consult the 1997 edition of The Billings Method, Controlling fertility without drugs or devices, by Dr Evelyn Billings & Ann Westmore for further reading on terminology and the trials reported in the following tables

Summary of Trials

Location/Investigator	Years	Couples	Cycles or years	Method related pregnancies		Teaching related pregnancies
China (Nanjing, Anhui, Kunmin and Shanghai )/ Qian et al.	1996-97	992	1 year	0	0.0%	5 (use-related)	0.5%
Africa, Burkina Faso/Minister of Health and Social Action of Burkina Faso	reported in 1990	166	2,272	1	0.6%		1.7%
India, 5 States/Indian Council of Medical Research	1986-88	2,059	21 months		0.85%
Indonesia/Family Health International USA	1986-88	>425		0	0%
5 Nations-India, The Philippines, El Salvador, New Zealand, Ireland/World Health Organisation	1976-78	869	10,215		2.8%		3.9%
Australia (Victoria)/Ball	1976	122	1,626	4	2.9%	8	5.9%
USA/Klaus	1975-77	1,090	12,282		1%
Australia (Melbourne)/Billings	1972	98	3-4 years	0	0%	0	0%
Tonga/Weissman	1970-72	282	2,503	1	0.5%	2	1%

Remarks

China (Nanjing, Anhui, Kunmin and Shanghai )/ Qian et al.	1,654 healthy women of proven fertility (having at least one live birth), aged 24-35 years, with regular menstrual cycles (3-7/24-35 days), to be cohabiting and enjoying their husbands' support for participation in the trial, were enrolled. The participants were mostly peasants and also workers and white collars with different educational levels. They were randomly divided according to the ratio 3: 2 into two groups (the BOM group, 992 subjects, and the IUD group, 662 subjects) The observation was continued for 12 months.
Indonesia/Family Health International USA	Multicentre study of three methods of NFP - 850 women entered the trial, more than half entered for the Billings Ovulation Method (BOM) - results for BOM only. At the end of this survey the study investigators recommended that the Billings Ovulation Method be included within the choices of family planning methods provided by the national programme in Indonesia.
Australia (Victoria)/Ball	Indications were that sperm survival in one case was 5-6 days, 6-7 in two cases and 7-8 on one other. A sperm survival time of up to five days is credible in the presence of adequate amounts of fertile mucus, but present scientific knowledge does not allow a clear statement about sperm viability for longer than this.
Tonga/Weissman	Some time later it was revealed by the couple who had reported a method-related pregnancy that they had in fact been aware of fertile signs at the time. Therefore in this trial the method-related pregnancy rate was zero.

Scientific Basis of the Billings Ovulation Method
The Billings Ovulation Method is defined by several empirical rules developed over a sustained period of clinical research by Drs John and Evelyn Billings. The research has been followed by numerous trials, the most recent being a large scale trial conducted in China.
The scientific basis of the Billings Ovulation Method lies in the discoveries of two highly reputed scientists who have made major contributions in their fields.

Emeritus Professor James Brown has been responsible for fundamental work in the understanding of the phenomenon of oestrus, major developments in human reproduction, and in particular for the development of methods for measuring the oestrogen and progesterone metabolites in urine. He developed the Home Ovarian Monitor.

Brown collaborated with the Drs Billings during their years of clinical research on the ovulation method. His findings and contributions to the Billings Ovulation Method are described in the following publication which can be accessed at this web site.

Brown James B, Studies on Human Reproduction: Ovarian Activity and Fertility and the Billings Ovulation Method, Ovulation Method Research and Reference Centre of Australia, ISBN 0 908482 12 4.

Erik Odeblad: The second major scientific work of relevance to the Billings Ovulation Method is that of Emeritus Professor Erik Odeblad, Dept. of Medical Biophysics, University of Umeå, Sweden, in his study of the secretions produced by the cervix of the uterus during the menstrual cycle. It is the symptoms and sensations produced at the vulva by these secretions which provide the observations for the Billings Ovulation Method. The following review paper by Erik Odeblad can be accessed at this web site.

Odeblad, Erik, "The Discovery of Different Types of Cervical Mucus and the Billings Ovulation Method", Bulletin of the Natural Family Planning Council of Victoria, Vol 21, No. 3, September 1994.

A recent paper by Odeblad is:
Odeblad, E., "Investigations on the Physiological Basis of Fertility Awareness", Bulletin of Ovulation Method Research and Reference Centre of Australia Vol 29 Number 1 March 2002, pp 2-11

Comments

[phyrra.livejournal.com]

I had no idea that you used this method. You're only the second person I think that I've ever heard mention it.

[joreth]

to be totally honest, I didn't know about this method until a year ago (2 years?). It was only coincidence that my rhythm method coincided with the more accurate Billings discovery of mucus. Once I heard of it, though, I immediate altered my own patterns to accomodate. It just happened to turn out that the extra window I built in to my rhythm method to accomodate its failure rate perfectly matched up with the more accurate pattern of discharge :-) ... that and I tried to use condoms even when I didn't like them.

[summer-jackel.livejournal.com]

Fascinating! I appreciate the education; thank you for sharing. Always useful to know more about our bodies.

Still...I am REALLY happy that my only male lover has been fixed (yaaaay vasectomy) and the other is female, along with any others I can imagine taking on at this point. If it was any other way, I would be the one getting fixed. Birth control...cringe!

[joreth]

I would prefer my partners to be fixed, but that's asking a lot, particularly of partners I don't yet have ;-) I would get fixed myself, and I plan to, but what has stopped me until now has been a combination of cost, fear of surgery, and lack of medical support for sterilization for women under 30.

[sylvar.livejournal.com]

Besides, the recovery is a lot easier for vasectomies. With kick-ass insurance, I spent about $75 total (including prescription drugs before and after). So worth it. And I wasn't even 30.

It sucks that doctors will assume that your grown-up opinions haven't developed yet. No, dipshit, I'm totally uninterested in ever raising a kid. Come to the library and try to check out a book that I personally didn't like, and see if I give you a ration of shit for your preferences. You know what happens if a librarian refuses to let you check out a book because they don't approve of it? They end up on the news wire and the dartboard in the staff room of other libraries. And that's just a matter of forcing you to go to Barnes and Noble, not refusing medical care.

(Okay, so I don't actually work in a library -- but I *am* a librarian. Maybe someday I'll have to work the circulation desk. And then, bucko, you just try me.)

I'd be interested in learning more about what STDs condoms don't effectively protect against, and what protocols you use to reduce the risks.

[joreth]

Condoms are only partially effective against HPV and HSV. The reason is because these are spread by skin contact and the skin cells that shed the virus can occur outside the range of the condom.

I practice what I call HPV boundaries, which effectively eliminates genital-to-genital contact (at least one of us always keeps our clothes below the waist on), and for stricter observances, I can remove oral-to-genital contact (although there is some debate about whether either of these viruses can go from genitals to oral), hand-to-genital contact and toy-to-genital contact.

Basically, kissing, necking, snuggling, and many activities within the BDSM range are about as safe as you can get without total abstinence and will prevent everything other than orally-transmitted illnesses like colds, flues, oral-herpes, etc. But many of those you can get from your family members (even oral herpes) all the way up to total strangers simply by leaving your house.

[sylvar.livejournal.com]

Hmm. That seems to mostly eliminate pregnancy worries, too.

I recently asked for a full range of STD tests because I'd like to be able to play responsibly outside my existing relationship, and it really cheesed me off that there's no standard HPV test for guys. Hello! Causes cervical cancer and we still don't have a better test than "go see if you can give someone cancer"?!

[joreth]

Yes, I find that infuriating. Plus, there are several strains of HPV that seem to be linked with causing other types of cancer, including testicular cancer. HPV is not strictly a "woman's disease", nor is it acceptable for the only method to find out if a man has it by giving it to his partner.

Yes, HPV boundaries pretty much take care of all STDs including pregnancy :-)

Because I do not consider condoms to be very effective protection against STDs, by the time I choose to have sex with someone, it means that I am already accepting the risks of their STD safety level. So really, I am ONLY concerned about pregnancy by the time I choose to have sex. By that point, I have already exchanged STD results, had the discussion about sexual safety and acceptable risks, learned their history, and chosen to accept the risks of STD transmission with that particular partner. At that point, condoms are pretty much irrelevent anyway, except for contraception. And since I don't like condoms, finding another method of contraception seems reasonable.

[serolynne.livejournal.com]

Great information here! Before I went on the pill in my early 20s, I used a combination of intuiting my body and avoiding intercourse (wasn't as conscious as this method, but I somehow knew when I was most fertile) and the withdraw method at all other times if we weren't using condoms.

Did the pill for many years.. until my mother was diagnosed with estrogen triggered breast cancer and I became concerned about my own increased risk factors with using estrogen products. And, when I was diagnosed with HPV, all the reading I did indicated that long term use of BCPs might actually increase risks of HPV turning into cervical dysplasia.

So, my partner went through with his planned snipping.. and when I had to have a LEEP for the HPV, I just had the doc do a tubal on me at the same time. (One co-pay for two surguries.. rockin. And incidently, I was 30 and the doc didn't blink an eye when I asked.) I don't know if I've shared this with you yet or not.. but here's the surgery pics of my tubal ligation. http://farm1.static.flickr.com/131/413638107_391ba41310_o.jpg (Caution.. surgery pics.. very graphic views of my internal genitals.)



But this is great info to confirm my own intuition and get more in tune with my body, and to help better predict when I might bleed.. as I have a *very* irregular cycle. Thank you.

[joreth]

Yep, that's kinda how I did it with my version of the "rhythm" method, which is why I say my good fortune was coincidental. I just *happened* to be timing it according to this method without actually knowing I was. Now that I know, I do it intentionally.

I do know several people who had tubals younger than 30, but *I* met with resistance ... and my lack of health insurance probably contributes to that. I'm limited to which doctors I can approach.

In addition to the rather nasty side effects of the pill with mood swings and cramping (I never had a period-related mood swing until I went on the pill), I also choose to avoid it for the increased risks of HPV-related dysplasia and cancer. I contracted HPV when I was 17 ... and on the pill. It took some years before I found the research related to estrogen and HPV, and I simply added that to my negatives against the pill. I was extremely wary of these kinds of things because I am adopted and had no knowledge of my family medical history. I didn't want to push my luck.

My cycle is also extremely irregular. I've been known to have 3 periods in one month, skip a couple of months, go 28 days, go 34 days, etc. But this method is great because it isn't guess work. Your body sends a physical sign that says "Hey, I'm fertile now!" and you can adjust your behaviour *each time* when it *actually* is fertile, rather than trying to guess a pattern on a calendar that may or may not be accurate.

[joreth]

I also have to thank Shelly for telling me about this however long ago it was that she did. I was already aware of changes in my mucus and had already made note of the pattern of time between the end of my period and when the mucus changed, and my rhythm method window encompassed that time period by coincidence. It came up in conversation recently with a prospective partner and he didn't quite believe that a woman could *know* when she was fertile (he's young and inexperienced), so I re-researched the topic to put together information for him to understand the process I was talking about and decided that LJ was a good place to post it as well.

[datan0de.livejournal.com]

Something I find amusing about this is that this is only the second time I've heard of the mucus method. The first time was in a porn story I read. :-)

Who says porn isn't educational?

[joreth]

Who says porn isn't educational?

Not me! I learned lots of things from porn!

[(Anonymous)]

Thanks for the great post. Not sure if you guys know about sympto-thermal Fertility Awareness. Like the Billings Method, it helps users determine on what days of their cycle they're actually fertile. But sympto-thermal FA also uses basal body temperature (taken first thing in the morning upon waking) and position of the cervix to determine fertility. It's typically taught in a secular context, whereas Billings may be taught in a religious context. Billings is more geared toward use in countries with low literacy or numeracy. FA teachers often teach Western audiences quite a bit about anatomy & physiology, and may also discuss sexuality, STDs, gynecological health, and other related concerns. I highly recommend the books Taking Charge of Your Fertility, by Toni Weschler (did someone already post that?) and The Garden of Fertility, by Katie Singer. You might also want to check out www.fertaware.com (my site), www.gardenoffertility.com (Katie's site), www.tcoyf.com (Toni's site) and www.justisse.ca (a Canadian colleague's site). There is a ton of good information out there, and I would just like to emphasize that while FA and Billings are fabulous just for providing increased self-awareness, it's *really* important that a woman obtain some kind of instruction if she's planning to use these methods for birth control. I'm glad you've been so successful, Joreth - some people are more in tune with their bodies (and/or less fertile) than others. But FA is considered unforgiving - perfect use rates are very high; typical use rates are quite low. It *can* be an incredibly effective method of contraception - but only if practiced diligently. Good luck to all of you! It was fun wandering into your site, Joreth.

[joreth]

Well thank you, and welcome.

Yes, I'm aware of the basal body temperature methods. Unfortunately my schedule is not regular and that method is not optimal for me because I can never take it at the same time every day. One of the many reasons why the pill isn't a good method for me iether.

Thank you for contributing the other sites.

[(Anonymous)]

I love my IUD :) Because the very low dose progesterone acts locally on the uterus, it doesn't appear to have any of the mood related side effects and actually "calms" the uterus resulting in lighter periods. I felt I was ready for some chemical intervention as my body's natural way of doing things was rather arduous and painful :)

Right now I still spot half the month (takes about 6 months to settle in I guess), and I get a different, more localized kind of cramping; however I don't get the oh-my-god-I'm-going-to-die kind of cramps I used to get the first 2 days.

Just wanted to rave about it.. as I had never really considered it an option until recently - though it costs about a third of essure so it's a non-trivial expense for only 5 years of protection.

- Shelly

[joreth]

I've heard relatively good things about the newer IUDs and I'm glad you found a method that works so well with you. I would love something that would take away the pain of my endometriosis (the oh-my-god-Im-going-to-die" kind of cramps). The cost and the fear of any hormonal methods (yes, I know it's becoming an irrational fear with better research and results out nowadays) has prevented me from using this method so far, but I do recommend it to others when in a discussion of birth control methods.