National Reproductive Health Conference Presentation, 2012

1. Mother Nature &
Reproduction:
Standard Days
Method ® Using
CycleBeads®
Kimberly Aumack Yee and Katherine Lavoie Cain
NATIONAL RH CONFERENCE – New Orleans
August 5, 2012

2. Learning Objectives
1. Demonstrate basic
knowledge of Standard
Days Method® and
CycleBeads®
2. Demonstrate how to
screen and counsel
clients on the method
3. Identify strategies and
tools for integrating the
method into programs

3. “I always wanted to do the
calendar thing, but I never knew
how.”
“I like this method because I can’t
use hormones.”
“I don’t like the idea of something in
me all the time and that I can’t take
out.”
“It’s natural, easy, simple.”
“You can involve men.”
“It’s a great educational tool, if
anything. I never knew, none of us
knew, the exact dates [when one
can get pregnant].”

4. Fertility awareness-based methods
Symptothermal

5. Standard Days Method®
using CycleBeads®
THE BASICS

6. Standard Days Method®
 Helps a couple avoid pregnancy by
identifying the woman’s fertile days
 Identifies days 8 to 19 of the menstrual cycle
as fertile days
 Is appropriate for women with cycles
between 26 and 32 days long (about a
month long)
 Does not protect against STIs/HIV

7. CycleBeads®
The Standard Days Method is
used with CycleBeads®, a
color-coded string of beads
to help a woman:
 Track her cycle days
 Know when she is fertile
 Monitor her cycle length

8. How to use CycleBeads®

9. Determining the Fertile Window
Ovulation
5 days 12 to 24 hours
(sperm viable) (ovum life)
Day 8 Day 19

10. Research
 Efficacy: failure rate of 4.8 with correct use;
12.0 with typical use (similar rates seen in
follow up studies)
 Couples use the method correctly in 97% of
cycles
 67% still using the method 2 years later (range
from 60-77% in other studies)
 Attracts users not currently using another
method
Arevalo M et al., Contraception, 2002;65:333-338.
Gribble J et al., Contraception, 2008;77:147-154.

11. Effectiveness
Spermicides
Female condom
Standard Days Method
Male condom
Oral contraceptives
DMPA
IUD (TCu-380A) Rate during perfect use
Female sterilization
Rate during typical use
Implants
0 5 10 15 20 25 30
Percentage of women pregnant in first year of use
Source: Contraceptive Technology Communications, 19th Revised
Edition. 2008; updated 2009.

13. CycleBeads Counseling

14. CYCLEBEADS COUNSELING
1
Screening the client

15. Screening
a Is the woman’s cycle the right length to use
CycleBeads?
b Will the method work for the couple?

17. a Is her cycle the right length to use
CycleBeads?
 Is her cycle between 26 and 32 days long?
 Ask simple questions to assess cycle length
and regularity:
About how often do your periods come?
Do your periods usually come about a month
apart?

18. When to start using CycleBeads
Client knows
date of her START IMMEDIATELY
last period
Client does not
START ON FIRST DAY
know date of
OF NEXT PERIOD
her last period

19. Case 1: Ruth
Date of last menstrual period: April 8
Date of visit to clinic: April 14
Her periods come when she expects, about a month
apart. She is not breastfeeding and has never used a
hormonal BCM.
Q: Can she use CycleBeads? A: Yes
Q: If suitable, when can she start using it? A: Immediately
Q: Possible recommendations?
A: Give standard advice—
monitor cycle length over time, discuss with partner,
place the ring on the correct bead.

20. Case 2: Mercedes
Date last menstrual period: Beginning of month(does
not remember exact date)
Date of visit to clinic: May 20
Her periods always come when she expects them,
about a month apart, and she has not been using a
BCM.
Q: Can she use CycleBeads? A: Yes
Q: If suitable, when can she start using it? A: Wait until her next
period starts
Q: Possible recommendations?
A: Use another method until the 1st day of her next period,
when she puts the ring on red bead. Monitor cycle length
over time. Discuss with her partner. (If she already had
sex during this cycle she may be pregnant.)

21. Special circumstances can affect
cycle length
Postpartum/
breastfeeding WAIT UNTIL PERIODS
ARE ABOUT A MONTH
3-month Injection, pill, APART (SEE INSTRUCTIONS)
patch, implant, IUD
EC, miscarriage or WAIT UNTIL NEXT
abortion (previous
cycles within range) PERIOD STARTS

22. Case 3: Vicki
Date last menstrual period: October 25
Date of visit to clinic: October 30
Vicki stopped using the pill about one month ago. She has
had two periods since she discontinued the pill. The periods
were about a month apart. Prior to using the pill her cycles
were regular.
Q: Can she use CycleBeads? A: Not yet
Q: If suitable, when can she start using it?
A: When her last three periods have been about a
month apart (26-32 days).
Q: Possible recommendations?
A: Use CycleBeads to track cycle length while using a
barrier method. Help her put the ring on the correct bead.
When she gets her next period (if it comes between the
dark brown bead and the red bead) she can start using
CycleBeads.

23. Screening
a Is the woman’s cycle the right length to use
CycleBeads?
b Will the method work for the couple?

24. b Will CycleBeads work for the
couple?
Can you and your partner use a condom or
another barrier method, or abstain from sexual
intercourse, for 12 days in a row each month?
Using
CycleBeads
does not protect
against
STIs/HIV!!!

25. 2
Teaching the client
CYCLEBEADS COUNSELING

26. Using CycleBeads
Teach the client:
• How to track her
cycle to know if
she is on a fertile
day
• How to use
CycleBeads to
monitor her
cycle length
each month

27. How to use CycleBeads

28. Monitoring Cycle Length
• Periods must always
come between the
darker brown bead
and red bead.
• If period comes
early (before darker
brown bead) or late
(does not start the
day after the last
bead) more than
once in a year,
switch to another
method.

29. Practice Teaching CycleBeads

30. Alternatives to CycleBeads
iCycleBeads™
Smartphone app
iCycleBeads™ Online

31. CYCLEBEADS COUNSELING
3
Supporting the client

32. Support: Method use
 Put the ring on the correct
bead (if possible)
 Refer to the insert &
calendar in the packet
 Discuss what to do if she
has unprotected sex on a
fertile day
 Discuss what to do if she
has out-of-range cycles

33. Involving Men
SDM is a couple method. If men understand the
method, couples are more likely to use it correctly.
How would you involve men?

34. Supporting Couple’s use of
CycleBeads
 Encourage her to discuss
CycleBeads with her partner
 Offer to talk with her partner
 Discuss options for handling
the fertile days
 Ask how she will let partner
know when she is on a day
that she can get pregnant
 Discuss ways her partner could
help with method use
(marking calendar, etc.)

35. “It’s easier to talk about fertility,
and now we share responsibility
for sex.”
“When it’s not a white bead
day when there is a need to use
condoms, it feels more
intimate.”
“There is less stress in the
relationship because my
partner and I know when we
can have unprotected sex and
when I can get pregnant.”
“We can talk about birth
control more easily and have
better communication now.”

36. When to Return to the Provider
 Unprotected sex on
a white-bead day
 Difficulty handling
the fertile days
 Cycles that are too
short or too long
 If your period has
not returned and
you think you might
be pregnant
 If you would like to
use another method

37. Demonstration counseling videos
viewable at
www.CycleBeadsToolkit.com

38. Review: CycleBeads Counseling
Demonstrate
TEACHING
SCREENING
SUPPORTING
with
TEACHING
CycleBeads SUPPORTING
Cycle length Male
involvement
Refer to insert &
Will the method calendar
work for the If/when to
couple? return
Monitor cycle
length each
month

39. Integration of
CycleBeads into Family
Planning Services

40. www.CycleBeadsToolkit.com

41. Systems Integration
Clinic flow
Outreach Billing
Client CycleBeads
materials supply
Counseling

42. Effective counseling & support
 Offering CycleBeads
as an option
 Providing client-
centered counseling
 Screening
 Teaching what the
dark brown bead
means
 Supporting the couple

43. What users are saying
“I never had a way of checking
my cycle before. It’s amazing…I
can’t believe that something so
small can make a difference in
your life.”
“[I like that] I don’t have to take
a pill or injection.”
“I’ve used the calendar method
before and find that this method
is much easier…It’s easier to see
when you’re fertile.”
“[I like] having more control
about when to have sex or not.”

44. For more information, visit:
www.CycleBeads.com
www.CycleBeadsToolkit.com
www.irh.org
THANK KIMBERLY KATHERINE
YOU! AUMACK YEE LAVOIE CAIN
kaumackyee@acninc.net klcain@nola.gov