"It's out!" Between my legs, the doctor is grinning, a copper IUD dangling from her fingertips. It's a lot bigger than I thought it would be, sitting in my uterus as it had done for the last two and a half years. Like a tiny man with iron fists, punching at the spongy walls and giving my ovaries a good squeeze for, oh, three days once the relief of my period was over. You bastard.
The copper IUD was my third attempt at finding a contraception which I felt I could live with. I popped my first pill at 15 and now, 11 years later, I'm walking away from the sexual health clinic with a dull ache down there but an overwhelming sense of relief. I'm done. No more. No more pain, no more rollercoaster emotions, no more desperation, no more confusion. I'm going contraception-free (well, kind of).
This is one experience and is by no means the only possible experience. We all have different bodies, different needs, different tolerances. This isn't about what you *should* do but about what you *could* do. It took me 11 years to realise that contraception is my choice.
So how did I reach that simple but not-so-straightforward epiphany? Let’s rewind 11 years, with a short history of contraception and me.
Age 15 with first boyfriend. Boyfriend is 18. Panic ensues and I’m in the family planning centre, despite the fact we are nowhere near sexual intimacy yet and wouldn’t actually do ‘it’ for another 12 months. A little overwhelmed, I go along with what the adults tell me and start my contraception journey, with the combined pill, Microgynon. Two, three years, all is fine, except I’m starting to feel quite sad, a lot, and always around my period. I bring this up with the nurse who assures me that, no, there is absolutely no link between low mood and the pill but if you insist, let’s change the brand. Rigevidon. I struggle through into my 20s, sadness arriving like clockwork, but grateful for light, regular periods. I broach the subject with a new doctor; is there another way? I am injected with Depo-Provera, sending three months' worth of regular pill hormones surging through my body at once. Not good, not fun, not the one. It was a long 12 weeks waiting for that to leave my system. Back to the pill I go, defeated.
Another 12 months down the line and the PMS symptoms have become unbearable. Crashing lows that leave me crumpled and sobbing, before I soar high as a kite once my period arrives. The rollercoaster is exhausting. At some point I forget to renew my prescription on time and spend one month with no pills, hormone-free. I feel incredible. I feel present in my own body for the first time in years; no longer yanked like a puppet by chemical forces. I stay this way for maybe six months.
They say starting or stopping the pill can cause you to fall out of love as your hormones are thrown off kilter, or return to their natural state. Whether that’s true or not, something along those lines happened to me and I am launched into single, London life; a young fertile woman on no contraception. Shit. Off I go to the sexual health centre, early on a Saturday morning, rehearsing my pleas and my defence. There has to be another way. (If you’re wondering why I haven’t tried the implant yet, it’s because my mum had a terrible time on it and I’m not about to tempt genetic fate.) I leave after several, pretty painful, unsuccessful attempts to insert a hormone-free copper coil, and return to another centre a few days later for a second, still painful but swift, successful attempt. By this point, the PMS has crept back and I am left wondering whether irreversible damage has been done by the pill. Yay.
Two and a half years later, I’m still learning to make peace with the PMS symptoms, which have worsened. What I cannot make peace with, however, is the absolute chaos the coil has created in my uterus. My periods went from four days, five at a push – which I could predict starting almost to the hour, with one ‘heavy’ day – to eight-, even nine-day irregular monsters. I won’t go into the gory details, but what I once called ‘heavy’, I now consider ‘light’. And the actual bleeding part is only half of the problem.
The PMS symptoms start a week before and always, inexplicably, take me by surprise. I feel like I have been hit by a bus. Then there’s the waiting game, my uterus walls teasing me with drops here and there as if they were letting me off lightly this month. The cramps take my breath away, and often leave me bent double. Once the messy part is done, the ovulation pains begin, squeezing out an egg with a vice-like grip just to remind me, as if I couldn’t forget, that my body is here to procreate. I’m left with maybe 10 days of peace in each cycle. I accepted this situation as the best possible one given my options, and doctors – only one of whom was sympathetic – told me “that’s just how it is”. Until I FOUND ANOTHER WAY.
As of August 2017, age 26, I am doing what generations of women before me have done. I am tracking my cycle, revealing the most fertile and infertile phases by making a note of fertility signs. Otherwise known as the rhythm method: planning your sex life around the days when you are ovulating.
Instead of fighting to control a biological ‘problem’ (fertility), I am just…going with it. After 11 years of not really knowing or trusting who I was, because I couldn’t fully understand the impact hormone and hormone-free contraception was having on my wellbeing, and with only faint memories of what my natural period is like, I am embracing this opportunity to understand the unique ins and outs and the patterns of me. Hello Natasha, it’s nice to meet you.
Unlike generations of women before me, I am embarking on this personal adventure with the help of tech. The Natural Cycles app now sits on my iPhone home screen next to Clue, Instagram and The Guardian. Founded by Dr. Elina Berglund Scherwitzl and her husband, Dr. Raoul Scherwtizl, the app’s algorithm detects and predicts ovulation, using temperature readings which you input daily. Your temperature fluctuates during your cycle, beginning low and rising after ovulation with the increase of progesterone. (The difference is tiny, about 0.3 degrees, but significant.)
The app has two uses: to prevent pregnancy, or to help you get pregnant, and you choose your path when you first sign up (a yearly subscription with thermometer costs £40). Want a baby? Have unprotected sex on your most fertile days, as calculated by the app. Definitely don’t want a baby? Do not have sex on those days. Or at least, use a condom. The failure rate of Natural Cycles is 7% per year – for every 100 women who use the app in a ‘typical’ way, taking temperatures regularly but occasionally slipping up, seven get pregnant. For the pill it’s 9%, for the injection it’s 6%, and for an IUD it’s less than 1%.
The app doesn’t protect against STIs, obviously, so you’ll need to use protection regardless if you’re getting it on with someone new. Other than helping you get pregnant, or not, it’s absolutely worth saying that Natural Cycles can be used simply to get to know your own body better. Ultimately, that’s why I’m here.
I’d been trialling the Natural Cycles app for several months before the coil was finally removed (the algorithm won’t calculate accurately if you use it while on hormonal contraception), figuring out how it could slot into my life with minimal disruption. I am a creature of habit, so the idea of doing something every morning at the same time appealed to me. But to be honest, I struggled to start with.
Getting up in the morning is really hard, and remembering to pop a thermometer in my mouth before I scrambled out with 20 minutes to spare wasn’t easy either. If you have a hangover, or sleep for more than two hours over (or under) your usual pattern, you have to record your temperature as ‘deviating’ – which I took as void, and didn’t bother. So weekends were a write-off.
The app encourages you to take LH (luteinizing hormone) tests on certain days in your cycle to add another layer of accuracy to the algorithm. But the tests cost £22 a pack through the app shop, and while I was still half-arsing this, that seemed like too much to spare. (I later learned you can buy 30 LH tests for about £5 on Amazon.)
Unsurprisingly, the app, up until this point, wasn’t telling me much. With limited data, it extremely cautiously told me I was ‘not fertile’ during my period (green for go!) and ‘fertile’ every other day (red for woah, there!). Which didn’t really inspire diligence. As the nightmare of my periods seemed to worsen, and the PMS continued to circle back to torment me every month, my boyfriend gently encouraged me to take the leap, and commit.
So here I am. The coil removal was three and a half weeks ago, and with that safety net (literally) whipped out from beneath me, my commitment to the app has, unsurprisingly, improved. Needing every bit of help I could get, I switched on the push notifications. They pop up at bizarre times occasionally (“Good morning! Time to take your temperature” – at midday), but remind me to check in on the app, my cycle graph, and what’s coming up. This awareness and involvement in my own biology is a positive leap in itself.
Every night, after I set my alarm and check Instagram for the final time, I put the thermometer on top of my phone. This works for me because the first thing I reach for when my alarm goes off in the morning, is my phone. (If you keep your phone away from your bed, you might want to put the thermometer elsewhere.) The thermometer stores the last temperature you took until you take another, so usually I’ll log it on the app a little later in the morning when I’m more human.
The more temperatures you input, alongside other data like sex/no sex, spotting/period, the smarter the algorithm gets. I challenge myself to input as many days in a row as I can – the app rewards you for this, too, with little congratulatory messages.
Once I'd settled into a temperature-taking routine, I sat back and waited for my period to arrive. PMS came – hiya, friend – and I braced myself for the onslaught. Well guys, if you’ve read this far and are even slightly invested in where this is headed, you’ll be pleased to hear that bleeding was…a dream. A. Dream. There may have been a cramp at some point, but that’s probably all the carbs I’ve been eating. I have super ultra sanitary pads stocked everywhere I frequent and now I’m wondering what to do with them all. The box of teeny light tampons I kept just to torment me with their pointlessness is almost empty.
This miraculous turnaround has got me further into the app. I bought those £5 LH tests on Amazon and I’m geekily excited for cycle day 11, when I can dip the stick and add another metric. I am in control here. I am making the connections between my body, my mind and what I want from life. I am making the decisions.
Unfortunately, PMS and mental health can’t be managed with an app. That shit just happens. But without a distressing bleed to contend with, and a deeper understanding of what the hell is going on, I can put more energy into acceptance, and letting it just be. Less time wailing and wondering when it’s all going to end. (If this PMS experience feels familiar, you have my full sympathy. It’s really fucking shit, but you are not alone. I’ve tried lots of things, and mindfulness really helped.)
There is one significant downer, though: condoms. Carefree sex is a hard habit to break, and we’re still getting used to remembering. Although the USP of the app is letting you know when you’re ok to go condom-free, I’m not about to play chicken with a human life.
If your experience of hormonal contraception isn’t great, or you’re interested in a method that doesn’t require sticking bits of plastic in you, or you’re just curious to know more about your cycle AND you’re cool with putting a bit of extra work in, then I recommend giving Natural Cycles your best shot. If you’re quite happy where you are, then that’s cool too. This is your choice.