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

[(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.