NFP / Fertility

Awareness

Coming Off Hormonal Birth Control:

Additional Sympto-Thermal Rules for
Avoiding Pregnancy (Celsius)
A follow on from “Sympto-Thermal Rules for Avoiding Pregnancy”

Lucy Povey
NFPTA
27th November 2016
What’s Happening Hormonally?
The synthetic hormones have been inhibiting your natural cycle of oestrogen and progesterone. The
hormones contained in HBC (Hormonal Birth Control) imitate your natural ones to simulate the post-
ovulatory infertile phase. Given the right balance, where progesterone (or in this case a similar
hormone that takes its place) is dominant over the “oestrogen like” hormone, ovarian development is
suppressed, just like when your body thinks it has already ovulated and is waiting to see if
implantation takes place. This also affects your cervix in the same way, keeping it low firm and closed
containing a density of cervical fluid which prevents sperm from entering the womb and creates an
unsuitable environment where they are unlikely to survive longer than 6 hours. These hormonal
influences can affect your mental state while on HBC, giving you an experience much like being in a
constant pre-menstrual state - depression, short fuse, less sex drive, along with other conditions
related to pre-menstruation like feeling bloated etc.

It can take some time for your natural oestrogen and progesterone to stabilise and give you what is
considered a “normal” cycle. Most have returned to “normal” within a year. If you were very young
when starting HBC and hadn’t quite reached a regular cycle pattern, then it’s likely your body will be
returning to a similar state of hormonal immaturity and will need a little extra time to continue
developing into a stabilised pattern. If you had other hormonal issues before commencing HBC, such
as acne or particularly bad menstrual cramps, then these may also return… much like hitting the play
button after being paused for a while, or waking up from a strange dream.

However, it is not all bad. Through fertility awareness you will be gaining tools which can help
enormously in pinpointing exactly which hormones are out of balance or can help identify other
conditions which may have been causing problems but that were masked by HBC. Hormonal health is
becoming referred to as the 5th vital sign of women’s health, alongside heartbeat, breathing rate,
temperature and blood pressure. You may even find that the same hormonal balances that can be
identified through charting may also be the root cause of other, seemingly unrelated, conditions.
Some more serious conditions need to be sorted properly like this rather than suppressed with HBC,
as they can lead to infertility in some circumstances.

The 2002 University of Düsseldorf study (Frank-Herrmann, P; Freundl, G; Gnoth, Ch; Godehardt, E;
Schmoll, A) gave the results below. One cycle could be shorter or, more likely, longer – it will not
necessarily be 28 days - so these numbers do not have a direct correlation to number of months.

Cycles since stopping Hormonal Birth Control Percentage of women returned to “normal”
1 53%
1-3 77%
3-6 89%

The study compared two groups of women, group 1 (175 women - 3048 cycles) immediately after
stopping hormonal contraception with group 2 (284 women - 6251 cycles) who had never taken
hormonal contraception. Parameters observed were: cycle length, cervical fluid, temperature rise, FP
length & LP length.
Common differences in ‘abnormal’ cycles:
 Cycle length – significantly prolonged up to cycle 8
 Luteal Phase (LP) length – shorter up to cycle 6
 Follicular Phase (FP) length – longer up to cycle 7
 Other minor differences for 1 year+

Coming Off Hormonal Birth Control: Additional Sympto-Thermal Rules for Avoiding Pregnancy (Celsius)
 Basal Body Temperature
What to expect

 While waiting for ovarian development to restart, you may have erratic temperatures due to
hormonal fluctuations.
 If they are erratic and begin to smooth out, this could indicate the stabilisation of hormones
and the build up to ovulation.
 Many women experience a short luteal phase in the first few cycles, but they will lengthen.
 It’s common to experience some anovulatory cycles with no temperature shift to be seen.

Interpretation

 For cycle 1 only, whether observing fluid yet or not, the usual rules for drawing the cover line
are used yet you must wait for 4 temperatures above it rather than 3.

Coming Off Hormonal Birth Control: Additional Sympto-Thermal Rules for Avoiding Pregnancy (Celsius)
 Cervical Fluid
What to expect

 A common abnormality is a longer follicular phase, which could involve little fluid or multiple
build ups to “Peak” quality fluid.
 You may need to establish a BIP if you have long follicular phases or anovulatory cycles.
 Anovulatory or long cycles may come with some break through bleeding / spotting.
 “Peak” day may not line up with temperature shift.

Interpretation

Pre-Ovulatory Infertility

 Cycles 1-3 have no pre-ovulatory infertility.

 If “normal” cycles have returned, cycles 4-12 are the same as usual but cycles 13+ use S-21
calendar rule rather than S-20.
 If “normal” cycles have not returned then use the BIP rules below.

BIP (Basic Infertile Pattern)

 You can establish a BIP of “Dry” after 4 consecutive “Dry” days or a BIP of “Potentially Fertile”
/ “Fertile” but NOT “Highly Fertile” fluid after 14 consecutive days of unchanging fluid.
 Once a BIP has been established, alternate nights can be used for intercourse, assuming the
BIP continues to go unchanged. Intercourse must be the evening, so that you have had all day
to observe any fluid changes, and it must only be on alternate nights because residual seminal
fluid can mask the presence of highly fertile fluid.
 Once a BIP has been established, if the cervical fluid changes at all:
1. It is considered a change in fertility and intercourse is stopped.
2. If the fluid reverts back for 4 consecutive days, a new “Peak” is established (regardless of
whether it is “Dry” or not). At this point, the alternate night rule can be used again.
3. Alternatively, if the fluid changes to another type of sub fertile fluid (NOT “Highly Fertile”)
for 14 consecutive days, then a new BIP can be established using the same rules.
 Any bleeding/spotting is considered “Highly Fertile” as it could be masking cervical fluid.

Post-Ovulatory Infertility

 Rules are
the same,
except in
cycle 1 you
wait for
P1234
rather than
P123 to be
confirmed
with a
temp shift.

Coming Off Hormonal Birth Control: Additional Sympto-Thermal Rules for Avoiding Pregnancy (Celsius)
Example Chart: Notes

 (Cycle 1) No pre-ovulatory infertility.

 Ovulation is late in the cycle, prolonged 28 day follicular phase.
 Short 7 day luteal phase.
 P1234 has to be met as well as 4 temperatures above the cover line.
 Multiple “Peak” days, but only 1 temperature shift.
 Multiple fertile movements of cervix, only the last reaching full height.

Coming Off Hormonal Birth Control: Additional Sympto-Thermal Rules for Avoiding Pregnancy (Celsius)