In your search for “natural birth control,” or a simpler method of fertility awareness or natural family planning, you may have come across the TwoDay Method, the Standard Days Method, or Cycle Beads. Today, we’ll be talking about another option–The CoupleBeads Method–and how it stacks up in terms of efficacy for family planning and ease-of-use.
What is the CoupleBeads Method?
The “couple” in CoupleBeads refers to coupling cycle-day fertility probabilities with cervical mucus observations, as well as celebrating the fact that using fertility awareness to avoid (or achieve) pregnancy gives a couple shared responsibility for their reproductive goals.
As the name implies, CoupleBeads uses a string of different colored beads to keep track of cycle-day fertility probabilities and–this is the important part!–mucus observations. One of the primary goals of CoupleBeads is to be easy to teach and use, and to be accessible to couples regardless of education and income level.
The cycle-day fertility probabilities used by CoupleBeads were created using this 2000 study of 213 pregnant women, that used ultrasound measurements to gauge on which day of her cycle each woman conceived [1]. The study used this information to estimate the probability of conceiving on each day of the cycle, and to create the following fertility categories for different days of the cycle, based on those probabilities:
- Days 1–5: low fertility
- Days 6–7: intermediate fertility
- Days 8–14: high fertility
- Days 15–21: intermediate fertility
- Days 22–end of cycle: low fertility
How do CoupleBeads work?
A woman using CoupleBeads will start with a string of different colored beads representing the cycle-day fertility probabilities: brown for low fertility, yellow for intermediate, and green for high fertility. There is also a safety pin between each bead upon which can be added additional beads for personal observations: red for bleeding, gold for intercourse, and beads for mucus observations: brown (dry), yellow (tacky), and green (egg white). Orange beads are used to count off three days of post-peak day mucus to mark where low fertility resumes.
If a woman’s particular cycle corresponds with the cycle-day probabilities (meaning high fertility and ovulation around day 14), the personal observation beads on the safety pins should mirror the beads on the string. If not, she will be able to see how much earlier or later her fertile window is compared to the “standard,” and use that information to better inform her reproductive goals (whether that is achieving or avoiding pregnancy).
Someone using CoupleBeads without regular cycles (for example, while breastfeeding) can use a string of white beads with safety pins to remember to look for and track mucus observations to watch for returning fertility.
What separates CoupleBeads from Standard Days or Cycle Beads?
The key distinction between CoupleBeads and other methods which use cycle-day probabilities is the inclusion of mucus observations with CoupleBeads. Unlike the Standard Days or Cycle Beads Methods, which do not track cervical mucus (or any biomarkers of fertility, meaning they are not fertility awareness methods, and are essentially an updated form of the Rhythm Method), CoupleBeads uses three categories for mucus observations: dry, tacky, and egg-white. Tracking these observations allows a woman to understand her own cycle pattern, while having the benchmark of a “standard” cycle to compare it to.
Benefits of the CoupleBeads Method
CoupleBeads set out to be highly accessible, and it’s fair to say they’ve achieved this goal. Far from needing a special health-tracking device, monthly subscription, or smartphone, CoupleBeads doesn’t even require literacy. For the small upfront cost of plastic beads and safety pins, the tools can be used over and over again with a few simple rules to memorize and follow, making it a good candidate for use in communities with few health resources.
Drawbacks of the CoupleBeads Method
The 2000 study cited to calculate cycle-day fertility probabilities (meaning the probability that a given day of the cycle is high, intermediate, or low fertility) collected data from a little over 200 women, whose cycles fit perhaps too neatly into the classic 28-day cycle model with ovulation on day 14. In contrast, we at Natural Womanhood recently reviewed the 2023 data collected and published by Natural Cycles, which analyzed over 600,000 menstrual cycles.
The Natural Cycles data paints a different picture of what an “average” cycle looks like. In their analysis, the average cycle length was found to be just over 29 days long, with ovulation (and therefore, “high fertility”) most likely on day 17. Concerningly, Day 17 is in the “intermediate fertility” category in the CoupleBeads system.
Why does the average cycle length matter so much?
This matters because, according to Natural Cycles’ data, Day 17 may be the most fertile day of the whole cycle. The cycle-day fertility probabilities represented by the string of beads in the CoupleBeads method could prove to be misleading or confusing, as they may actually represent a significantly shorter follicular phase than the average woman might expect to see. It’s true that women using the CoupleBeads method are also encouraged to observe their own cycles via their cervical mucus observations, but confusion and/or difficulties may arise if the beads suggest infertility but mucus suggests otherwise (or vice versa).
By way of demonstration: Before having children, my cycle was usually around 35 days long, with peak day on day 21. CoupleBeads considers day 21 to be the end of fertility, barring any egg-white mucus observations on that day. Let’s imagine I had been using CoupleBeads for pregnancy avoidance during this time. If I had been inconsistent in recording mucus observations and instead fell back on using the cycle-day probability beads to time intercourse, pregnancy would have been a likely outcome in my situation. The disparity between a model “standard” cycle and real-life cycles (which can fluctuate and be different lengths at different times and life-stages) contributes to the high failure rates calendar-based methods use.
Takeaways
CoupleBeads was developed to help women in low-resource communities better understand their bodies, foster communication with their spouses, and space births. Cognizant of lack of access to healthcare resources, these women and couples stand to benefit from family planning methods that won’t simultaneously compromise their health. This is a worthwhile goal and a wonderful mission, and I’m glad that this tool is being provided at low-cost to women who otherwise would not be able to learn about fertility awareness and could be coerced or pressured to take hormonal contraceptives that threaten their health.
I can see the appeal of providing the cycle-day probabilities as a fallback option for women who are still learning the method and may lack confidence in their mucus observations, or for women who only chart intermittently and might miss when peak day occurred. My concern is that it may prove to be more confusing than helpful, especially for women with longer cycles. Ultimately though, CoupleBeads does teach and encourage daily cervical mucus observations so women can learn to understand their own cycles, giving it a huge advantage over simply using the Rhythm Method.
References:
[1] Wilcox AJ, Dunson D, Baird DD. The timing of the “fertile window” in the menstrual cycle: day specific estimates from a prospective study. BMJ. 2000 Nov 18;321(7271):1259-62. doi: 10.1136/bmj.321.7271.1259. PMID: 11082086; PMCID: PMC27529.Additional Reading:
