Original research articleThe importance of screening and monitoring: the Standard Days Method☆ and cycle regularity
Introduction
When potential users contact a family-planning service provider, they often have a specific method in mind. Receiving that method is a good predictor of continued use [1]. Ideally, the method the woman selects would be appropriate for her. However, not all family-planning methods are suitable for all potential users. Some family-planning methods are more appropriate than others for individual women. It is important that the woman gets a method that she can use correctly, and that would not harm her health. Other requirements for correct method use also need to be considered, particularly for user-dependent methods.
Initial screening is essential to help providers and women choose suitable methods. Screening guidelines should strike a balance between being sufficiently selective and as inclusive as possible, to allow the greatest number of clients to access the method. For most methods, a degree of ongoing monitoring is desirable to assess whether the method continues to be appropriate for the woman [2], [3]. Specific guidelines have been developed for each method to assist clients and providers in making appropriate decisions on which method to offer [4], [5]. This article examines initial screening and monitoring for the Standard Days Method™—a fertility awareness-based method of family planning focusing on cycle regularity.
The Standard Days Method was developed by the Institute for Reproductive Health, Georgetown University (IRH), to help fill the need for simple, effective, fertility awareness-based methods of family planning. A significant number of women worldwide use periodic abstinence as their method of family planning [6]. Research indicates that many of these women do not know how to correctly determine when they are fertile, which accounts for many unplanned pregnancies. For women who desire to use fertility awareness-based methods of family planning, one of the barriers to achieving their family-planning goals is the relative complexity of established effective methods, such as the Ovulation Method and the Symptothermal Method, which require a substantial investment of time in teaching and follow-up. In many developing countries, therefore, there is a high demand for an effective fertility awareness-based method, such as the Standard Days Method, that is easy for providers to teach and for users to learn and use. One of the main attributes of the Standard Days Method is its inherent simplicity.
The Standard Days Method requires simply that women whose cycles usually range from 26 to 32 days long should avoid unprotected intercourse on days 8–19 (inclusive) of their cycle if they do not want to become pregnant. The method can be offered with CycleBeads™, a string of color-coded beads, to help users keep track of which cycle day they are on and monitor their cycle lengths. An analysis of the theoretical effectiveness of the Standard Days Method showed that the method would be extremely effective for women with cycles of 26–32 days, and would substantially reduce the probability of pregnancy for women who occasionally have a cycle that is shorter or longer [7]. Therefore, the current protocol for Standard Days Method use recommends that users who have a second out-of-range cycle in a year switch to another method.
An efficacy trial of the Standard Days Method, following 478 women for up to 13 cycles of method use in five sites in Bolivia, Peru and the Philippines, resulted in a 4.8 1-year pregnancy rate with self-reported correct use of the method. A 1-year pregnancy rate of 12 was calculated when taking into account all cycles and all pregnancies, including pregnancies that occurred in cycles in which users had unprotected intercourse on days identified as fertile [8].
Since the method works best for women whose cycles usually range from 26 to 32 days, study participants were screened for habitual cycle length prior to admission, and were monitored for cycle length throughout the study. But is this screening and monitoring necessary? If so, is it sufficient? This article addresses these questions, which have important programmatic implications.
Section snippets
Data and methodology
We compare patterns of cycle length of participants in two studies—the efficacy study of the Standard Days Method, in which women were screened for cycle regularity and monitored for cycle length, and a study of Ovulation Method users conducted by the World Health Organization (WHO), where screening was less stringent and there was no monitoring for continued cycle regularity. We use the WHO data also to examine the impact of not screening and monitoring on the theoretical effectiveness of the
Are screening and monitoring necessary?
The ideal methodology for studying the benefit of screening for cycle regularity of potential Standard Days Method users is to examine the number of pregnancies among women who were screened or not screened, and compare the number of pregnancies for women who had a cycle out of range to those who did not. However, our data do not allow us to do so because there were too few pregnancies during the efficacy trial of the Standard Days Method. Only 43 of the 478 women became pregnant during their
Discussion
Our results clearly indicate the importance and effectiveness of screening and monitoring, and suggest that the screening and monitoring mechanisms used during the efficacy study significantly reduce the probability of Standard Days Method users having cycles out of the 26–32-day range. But is this sufficient?
Acknowledgements
Support for the analysis and preparation of this article was provided by the Institute for Reproductive Health, Department of Obstetrics and Gynecology at Georgetown University, Washington, DC, which is funded under a cooperative agreement HRN-A-00-97-00011-00 with the United States Agency for International Development. The views expressed by the authors do not necessarily reflect the views or policies of USAID or Georgetown University.
References (13)
Contraceptive technology and family planning services
Int J Gynaecol Obstet
(1998)- et al.
Efficacy of a new method of family planningthe Standard Days Method
Contraception
(2002) - et al.
Choice and use-continuation of methods of contraceptiona multicentre study
(1993) - et al.
Can condom users likely to experience condom failure be identified?
Fam Plann Perspect
(1993) - et al.
Contraceptive technology
(1998) Improving access to quality care in family planning. Medical eligibility criteria for contraceptive use
(2000)
Cited by (14)
Knowledge and Experiences of Low-Income Patients With Natural Family Planning
2013, Journal for Nurse PractitionersCitation Excerpt :Overall, the typical failure rate for the natural methods is 12% to 20%, but the range is from 3% to 22%. This failure rate is similar to the typical failure rate for male condoms (15%) but is quite inferior to the copper intrauterine device’s (IUD) typical failure rate of 0.1%-2%.10,19-23 A cross-sectional survey was administered to patients at a national sample of health centers providing contraceptive and women’s health services to low-income patients.
Fertility awareness-based methods of family planning: A review of effectiveness for avoiding pregnancy using SORT
2013, Osteopathic Family PhysicianCitation Excerpt :This fertile window is about 6 days long—the 5 days before ovulation and the day of ovulation.6 While only 12% of menstrual cycles are the stereotypical 28 days long,7 most healthy women have cycles that usually range from 26 to 32 days.8 A woman's cycle is managed in the hypothalamus, where pulses of gonadotropin-releasing hormone regulate pituitary output of follicle-stimulating hormone and luteinizing hormone (LH), prompting the ovaries to produce estrogen and progesterone.
New Approaches to Fertility Awareness-Based Methods: Incorporating the Standard Days and TwoDay Methods into Practice
2006, Journal of Midwifery and Women's HealthCitation Excerpt :CycleBeads help women monitor their cycle lengths. The Standard Days Method is not as effective for women with cycles outside the 26 to 32 day range.18 Therefore, women who have more than one cycle longer than 32 days or shorter than 26 days in a 12-month period should return to their provider to consider another method.
Variability in the phases of the menstrual cycle
2006, JOGNN - Journal of Obstetric, Gynecologic, and Neonatal NursingCitation Excerpt :The experience of menses that is greater than 8 days is not normative. Clinicians should be alert for women who have greater than normal variability in their menstrual cycle parameters, this can be a sign of future risk of type 2 diabetes mellitus, heart disease, infertility, poly cystic ovarian disease, and other health problems (Solomon et al., 2001, 2002). In conclusion, variability of the menstrual cycle is normal.
Fertility tracking tool for visually impaired and non-visually impaired women: A qualitative study
2022, Belitung Nursing JournalImplementation and scale-up of the standard days method of family planning: A landscape analysis
2020, Global Health Science and Practice
- ☆
The Standard Days Method™ and CycleBeads™ are trademarks owned by the Institute for Reproductive Health, Georgetown University.