What is #naturalbirthcontrol and does it actually work?

#Naturalbirthcontrol is trending on TikTok. 

Millions of people are watching videos where influencers talk about the terrible side effects they suffered while on the Pill and say they’re so much better now that they’re off hormonal contraception. 

“I’m so happy, and I feel like myself,” Shakira Victoria says. “I feel like when I was on the Pill I was just in a really weird cloud that I don’t kind of remember.” 

@beingwellishot Reply to @mm.cx17 ♬ original sound - Shakira Victoria

These TikTok influencers are plugging books and apps and fancy thermometers. They’re claiming incredible success rates for natural birth control – some saying 99 per cent or more. There are some pretty big claims being made to some pretty big audiences.  

The videos are finding fans among people who have suffered side effects from hormonal contraception themselves, or just like the idea of “natural” birth control. 

In the States, where most of the videos originate, the trend is causing some alarm. It’s come at a time when access to abortion is being limited by the Supreme Court’s decision to overturn Roe v Wade. There are fears these women promoting natural birth control on TikTok are playing into the hands of Republicans who would like to restrict access to contraception. Some people have pointed out the links between some of these creators and the religious Right.

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In Australia, doctors have been noticing an increasing number of people worried about the side effects of the Pill in recent years. It’s something that Dr Tessa King, a specialist women’s health GP at Jean Hailes for Women’s Health, has seen. 

“There’s certainly quite a number of women out there who prefer not to use hormonal contraception,” Dr King tells Mamamia.

She’s seeing people who could really benefit from the Pill being scared off by things they’ve heard. 

“There are women who come in to see me with severely painful periods that are really afraid of using hormonal contraception because of social media or because of discussions with their friends,” she says. “Hormonal contraception can be life-changing for some women that are struggling.”

So what exactly is natural birth control and can it be trusted to prevent pregnancy? And should we really be taking our birth control advice from TikTok, anyway?

Natural birth control works on the principle of fertility awareness – that is, identifying the days in the month when you’re fertile and avoiding unprotected sex on those days. These are the main methods:

Natural Birth Control: The Calendar method.

You track your cycle for at least three months, counting the first day of your period as day one. Then you use a formula to work out which days of your cycle you’ll be fertile. 

Under the “standard days” method, it’s from day eight to day 19. Under the “rhythm” method, the formula is a little more complicated. 

Obviously this is no good for women with irregular cycles, and Family Planning NSW advises that calendar-based methods should be used in combination with other methods.

Natural Birth Control method: The Basal body temperature method.

Your body temperature rises by somewhere between 0.2 and 0.5 degrees after ovulation, so you measure your temperature first thing every morning – at the same time, before getting out of bed – then use this to determine your fertile days. However, you need to be aware that your temperature can be affected by other factors. 

Natural Birth Control method: The Cervical mucus method.

The appearance of cervical mucus changes throughout your cycle. After your period it’s dry and sticky, when you’re ovulating it’s clear and slippery like raw egg white, and after ovulation it returns to dry and sticky. 

You can technically monitor this for the changes and use that as your indicator of when you're ovulating.

Natural Birth Control method: The Cervical changes method.

Your cervix goes through changes when you’re ovulating, including moving to a higher position. Monitoring these changes can help you determine when you’re fertile.

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Dr Clare Boerma, a GP and medical director at Family Planning NSW, says fertility awareness methods have evolved, but they’re certainly not new. 

“They’ve been packaged in new ways, in apps, but these methods have been around for a long time – and you don’t necessarily need a special thermometer to do it either.”

She says these methods work best when they’re combined – so keeping track of your periods but also taking your temperature and checking your cervical mucus and maybe your cervix too. Natural family planning educators can teach people how to do this. 

“But these all take quite a lot of work and effort and knowledge about what’s happening with your body,” she points out. “Your body temperature can be affected if you get to bed late or if you’re drinking the night before or if you have a cold. 

“There’s a lot of commitment that’s needed for these methods, and a regular lifestyle. If you’ve got a chaotic life, it can be a lot harder to implement and have them work for you.”

It was only in December 2020 that Australia’s drug regulatory body, the Therapeutic Goods Administration, approved a natural birth control app for the first time. The app, Natural Cycles, gets people to take their temperature every morning, and then advises whether they’re fertile or not fertile. Natural Cycles claims to be 93 per cent effective with “typical” use – about the same as the Pill – which means it’s likely that seven out of every 100 people who use it for a year will get pregnant. 

Dr King says natural birth control methods are anywhere from 76 to 93 per cent effective with typical use.

“It’s not something I would recommend using unless you’re in a committed relationship and pregnancy wasn’t going to be a major, major issue,” she says. “Certainly, if people are dating casually, they’re going to be using condoms to protect from STIs, so it’s not something they would use anyway, generally. 

“I think it definitely has its place and if a woman is feeling good without hormonal contraception, she doesn’t have period pain, then I think it’s definitely something that can be used, for sure.” 

Dr Boerma says if getting pregnant would be “a really big deal” for someone, she would recommend a long-acting reversible contraceptive method, like a contraceptive implant or an intra-uterine device.  

“You set and forget,” she says. “They can last three to five to 10 years. You can take them out at any time if you don’t like it, but once they’re in, you don’t have to do anything.”

When it comes to hormonal contraceptives, Dr Boerma says some people do seem “really sensitive” in terms of side effects. 

“While we don’t have strong data that the Pill causes depression, there are some associations. But association doesn’t mean that it causes it. There are lots of factors that go into impacting someone’s mood.”

She says doctors need to take patients’ concerns seriously and not dismiss them. 

“It’s their bodies, after all, so it’s their decision what they want to put in their bodies and use,” she says. “But we’re supporting them to make informed decisions – not just based on what they’ve seen on TikTok but based on our understanding of the evidence around these things. Sometimes it is a bit of trial and error just to find out what works well for people.”

Feature Image: Tiktok