GPs struggle in their practices with questions about natural contraception
More and more women are opting for hormone-free methods of contraception, such as coitus interruptus or the rhythm method, which takes the ovulation cycle into account. Apps respond to this need. But clear and reliable information from health care providers lags behind. “It doesn’t help that general practitioners do not yet recognize this form of contraception.”
Getting your period soon? “Stock up on chocolate” reads a push message on your phone. Did you ovulate? Then digital confetti will appear across your screen. With visually attractive animations, icons, and notifications, app developers know how to make your menstrual cycle understandable in a playful way. Such apps are used not only by women who want to get pregnant but also increasingly by those who do not want to. General practitioners should respond better to this, medical anthropologist Ellen Algera concludes in her research.
More and more women no longer want to use contraception with hormones and are opting for more natural methods, such as one that takes into account their ovulation cycle or uses early withdrawal. One reason for this is the fear of side effects, according to recently published research by the Rutgers Knowledge Center. “Besides side effects such as headaches, pain in the breasts, mood swings or nausea, more existential questions also play a role,” says Algera. “Some women describe their experiences with hormonal contraception as ‘I’m not comfortable in my skin,’ or ‘There’s a kind of veil hanging over my head.’”
“These women feel empowered by gaining insight into their menstrual cycle using apps,” Algera explains. By entering menstrual dates, changes in discharge, temperature fluctuations, or a combination thereof, they can determine when they are least at risk of pregnancy. “Except that there is often still a lack of proper guidance,” according to Algera.
Taking your temperature continuously or checking your discharge requires commitment, knowledge, and skill. “That makes these methods prone to human error, and these errors increase the chances of pregnancy,” says Algera. “That’s not to say that these kinds of practices should not be addressed in the consulting room.”
GPs could play a crucial role in this, Algera believes. “After all, they support people’s reproductive health by providing information about what is possible to prevent pregnancy. So it would make sense for them to advise on methods based on fertile days. I saw in my research that healthcare providers do not yet recognize this form of contraception, even though more and more people are using it to prevent pregnancy. The lack of information and research on the different methods and the reliability of apps doesn’t help, either.”
The Dutch General Practitioners Association’s Standard on Contraception, the guideline for general practitioners, states that nearly a quarter of women who use methods based on their ovulation cycle are at risk of becoming pregnant. “Because of that guideline, the GP’s position is often ‘It’s not reliable; don’t do it unless you’re open to pregnancy,’” Algera says. “Yet the current guideline falls short. The data used lump the various methods together, while these methods all have their own individual reliability and conditions of use. That information is not readily available to general practitioners. But that information is needed if you want to properly match individual patient needs.”
Still, GPs can no longer ignore hormone-free contraception, according to Algera. “Many people don’t feel they can go to their general practitioner, so they get information from the Internet or social media,” Algera observes. “That information is not always based on good scientific research. And that can lead to people not making well-informed choices and just downloading an app. But is that app being touted online well researched, and does it adequately protect against pregnancy? Or is there another app or method that works better and fits your needs better? We cannot keep hiding behind the fact that there needs to be more and better research on these methods and therefore not offer any support for them. Until then, let’s rely on available information.”
