With virtually each patient encounter I, not surprisingly, find myself talking about contraception in quite a bit of detail. There is one conversation that comes up on a fairly regular basis. It is one which I have had several times this week alone. And that is whether a particular type of birth control is “natural” or not. Which then of course raises the question, “Is something bad if it is not natural?”
The only truly “natural” methods of birth control are barrier methods (condoms, diaphragms, cervical caps), withdrawal and fertility awareness method. Barrier methods need to be used with spermicides, which aren’t natural. Which leaves condoms (many of which come with spermicide in/on them), withdrawal and fertility awareness method (FAM). Withdrawal and FAM are completely natural. Withdrawal, however, is quite unreliable and completely dependent on the male partner’s control. FAM involves monitoring one’s body temperature each day, keeping track of when one’s period begins each month, monitoring the consistency of one’s cervical fluid, among other things. It is labor intensive and requires one to be very dedicated to the process, and then to not have sexual intercourse, or to use a condom on the days that one is likely to be most fertile each month. (Taking Charge of Your Fertility, by Toni Weschler, is a wonderful book that can guide you through FAM in great detail.)
The less labor intensive and more reliable options all involve hormones or chemicals that allow women to not have to spend as much time and energy each day thinking about their contraception. They are more effective at preventing pregnancy. None of them, however, is “natural.” Birth control pills, the patch, the vaginal ring, the shot, the implant and one of the IUDs all contain hormones that are released into the woman’s blood stream and impact her menstrual cycle in several different ways. (The hormones in these birth control methods are synthetic versions of the hormones made by all women.) The other IUD includes copper which is also slowly released by the device.
With some of these methods, a woman continues to have regular, monthly periods. With some she does not. Some of these methods allow a woman to decide if she wants to get a period, and how often. Since these periods are brought on by manipulating hormones, these periods also are not “natural.”
I would contend, however, that there is nothing bad about any of these types of birth control. In fact, all of these medicated methods have some very real and positive effects on women’s health – some methods decrease the risk of certain kinds of cancer, some decrease menstrual cramps and bleeding, some decrease acne, to name only a few. In addition, they give women, and couples, the security of knowing that the chance of getting pregnancy is very small. Most of these methods have a failure rate of less than 2% with perfect use. Even with the occasional mistake in taking one’s pill late, forgetting to change the patch on time, the failure rate is still considerably less than 10%. Most barrier methods and withdrawal have typical use failure rates closer to 20 or 30%.
The longer-acting methods, the IUDs and the implant, have failure rates well less than 1% because once they are placed by your health care provider you can forget about them. You don’t have to remember to use them each day or week or month. They are there for years at a time.
So I don’t believe that birth control has to be natural. I believe it needs to be safe, effective and have few side effects. There is no birth control method that is perfect for everyone. Since each woman is different, the only way to know if a particular method will work for you is to try it. We are happy to help you find the right method for you.