"Perfect efficiency" may not exist when it comes to birth control.

We’ve all heard stories of babies conceived even while mom was on the Pill, right? Until recently, it’s mostly been assumed that those conceptions were due to user error, but recent research indicates that a woman’s genes could impact the efficacy of her birth control.

When taken “perfectly,” most formulations of the Pill are highly effective at preventing pregnancy (about 99 percent effective by most estimations), but because we are human and can forget to take our medications at the same time every single day (or just plain forget to take them at all), the “typical” use usually yields efficacy rates closer to 9192 percent. This is why implants (like the IUD or the arm-implant) have higher perfect and typical use rates—they mostly take human error out of the equation through their “set and forget” functioning.

But a recent study has found that some women possess a gene that causes their bodies to produce an enzyme that breaks down the synthetic hormones birth control needs to work. More research is needed to confirm that this effect actually leads to more unplanned pregnancies and whether the effects are the same for implants as oral contraception, but researchers are hopeful that this research could be a good jumping off point for a more “personalized” approach to contraception for women.

An uphill battle

I must admit, reading the line in the study’s conclusion about researchers hopes of making contraception more “personalized” for women made me chuckle. As the most mass-prescribed drug, hormonal contraceptives have been more one-size-fits-all than personalized from their conception.

The fact is, taking a daily pill of synthetic hormones (or having an implant that constantly delivers a steady dose of the same) to suppress a woman’s fertility is inherently imprecise because women are not fertile all of the time. Unlike men, who are fertile all of the time, women are only fertile for a very small window of time each cycle—during and surrounding ovulation. Outside of this fertile window, conception simply cannot occur because an egg is not present for fertilization. Unfortunately, conventional forms of hormonal birth control more or less ignore this scientific fact.

Other options

And as a fertility awareness instructor, I know that there is truly no more personalized approach to family planning than teaching individual women how to read and interpret the signs of their unique cycles. Fertility awareness options actually teach women to recognize when they are fertile, and how to act accordingly to either achieve or prevent a pregnancy from occurring. Learning to read the unique language of your own body can not only be a fascinating personal experience but an empowering one, as well.

Furthermore, unlike the Pill, IUD, or implants, which put the burden of contraception (and their associated side effects) on women alone, with fertility awareness methods the woman’s partner also has to participate in the process. Depending on their family planning goals, both parties make a mutual decision about their sexual activity during their fertile window. The result is a more equal distribution of responsibility when it comes to decisions about sex and the children they could conceive.

Despite researchers saying they want to offer more personalized options of contraceptives, doctors often first hear about options from pharmaceutical companies that have a lot to gain from continued sales. But considering the FDA recently approved the fertility charting app Natural Cycles as a form of natural contraceptive, many women are starting to realize they have more options.

Fertility awareness already affords women and their partners the most precise, personalized option for family planning possible. And with efficacy rates (both with “perfect” and “imperfect” use) similar to conventional methods of birth control (especially when women and their partners take the time to learn an established method from a certified instructor), many women are learning they need not sacrifice peace of mind in their quest for a more personalized family planning tool. 

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