Thursday, July 15, 2004

Worry Beads

The Washington Post recently had an article about a new contraceptive tool: CycleBeads. It's really just a way of counting fertile days, and in that way not truly new. The rhythm method has been with us a long time, beginning with the assumption that the least likely time for conception would be in the middle of a woman's menstrual cycle (you can imagine how successful that was in contraception) and later using the assumption that ovulation is most likely roughly seven to fourteen days after the start of the cycle. What's new about the CycleBeads is that this method is based on actual average ovulation rates and takes an extra safe position: it marks twelve days as high-risk for conceiving:

It looks like an uncommonly ugly necklace, made up of 32 oblong plastic beads. Slightly more than half are a translucent amber brown, a dozen are white, like piƱa colada jelly beans. One bead in the center is throat-lozenge red, and next to it is a small black plastic cylinder, which bears the necklace's brand name: CycleBeads.
CycleBeads are not jewelry, exactly. They're integral to a new pregnancy-prevention method called the Standard Days Method, developed at the Institute for Reproductive Health (IRH) at Georgetown University.
The necklace is a tool that helps a woman track her menstrual cycle: Slide the little black gasket onto the fat part of the red bead on the first day of a period. Then advance that gasket across the brown beads, at the rate of one a day. When the gasket reaches the 12 white beads, pregnancy is likely if a woman has unprotected sex. (This danger zone is easy to confirm in the darkness of the bedroom, since the white beads glow in the dark.) After the gasket slides past the white beads, it resumes its march across brown beads, and pregnancy is unlikely once more.
According to two studies in the peer-reviewed journal Contraception -- one published this year and one two years earlier -- the method, used correctly, is more effective than a diaphragm and nearly as effective as a condom. This summer, the Standard Days Method and CycleBeads will be inducted into the bible of contraception, "Contraceptive Technology." Being included in the latest update of this family planning reference book used by health care professionals could feed demand for CycleBeads, which retail for $12.95, and never require a refill. In the 13 months since they became available, 30,000 women have started to use this method, according to the IRH. CycleTechnologies, the New York-based company that's manufacturing CycleBeads, projects that figure will double by the end of 2005.

CycleBeads are fine for women who practise contraception but for whom a pregnancy would not be a disaster. For others certain warnings should be added, and the article mentions quite a few of them: there is a 2% risk of ovulation outside the white-bead days even for those with very regular cycles, women who have irregular cycles should not use this method alone, and remembering to move a bead each day is absolutely required.

Some other warnings should be added. For example, the article notes that only 15% of the couples in the study totally abstained from sex during the risky days. This suggests to me that abstinence may not work really well in this method, either, and that any user should do some soul-searching about how likely abstinence will be when the heart beats faster and the loved one looks especially delectable. Maybe adding a barrier method is needed, too?

Another warning I'd like to add concerns the way the study calculated the efficacy rates of contraception for this method:

Among women with regular cycles of 26 to 32 days, efficacy tests published in the journal Contraception show that over the course of a year, 12 percent will become pregnant with typical use -- a rate comparable to that for diaphragms and male condoms.

Given that this method does require some abstaining from sex, and even those who don't completely abstain might have less sex during the white-bead days than if they were using barrier methods of contraception like the condom or the diaphragm, these efficacy rates are not calculated on the same basis. The number of intercourses in the CycleBead method is likely to be smaller, and this means that the pregnancy rate per intercourse is actually likely to be higher than in the barrier methods. Just something to keep in mind.

If you like this method, buy your own nice beads and make a pretty bracelet or necklace. The white beads don't have to shine in the dark. If you're too shy to turn the light on to check them, choose white beads that feel different in the dark. Bulkier, for example.