The term fertility awareness is having the self-knowledge and understanding of the hormonal and menstrual cycle, and the signs of fertility. Fertility awareness allows you to know when you are fertile and when you are not throughout the menstrual cycle.
The Fertility Awareness Method (or FAM for short) is a daily practice of observing and charting the body’s natural fertile signs to identify the fertile and non-fertile phases of the menstrual cycle and actioning specific guidelines or rules based on your intentions for using FAM.
FAM can be used for the purpose of achieving pregnancy, as natural birth control, or for general cycle health maintenance. FAM is natural in the sense that it requires no medications or synthetic hormones and is easily interchangeable based on your intentions for using the method throughout your reproductive life.
Now, you might be thinking: “Hang on, I think I’ve heard about this ‘Fertility Awareness Method’, isn’t it also called the ‘Rhythm Method’?”
Great question! But let me debunk that myth for you right now!
The Rhythm Method or Calendar Rhythm Method is a highly outdated method that uses calendar calculations from previous menstrual cycles to predict future ovulation days and the fertile window. It does not observe fertile signs. Unfortunately this method is what gives FAM a bad name as they are so often thought to be the same thing, particularly in the minds of many doctors. The Rhythm Method is NOT reliable for birth control or for achieving pregnancy for that matter! This method also doesn’t take into account variability in each menstrual cycle, nor does it consider irregular cycles, breastfeeding, or perimenopause.
“Okay, so what about ‘Natural Family Planning’?”
Another great question! Natural Family Planning (NFP) is the basis of which FAM stems from and follows similar principles. The difference being that NFP is a method developed by the Catholic Church for natural birth control (and conception) and therefore involves abstaining from sexual intercourse during the fertile time, as the use of barrier methods for contraception is forbidden. The terms NFP and FAM are sometimes used interchangeably.
FAM actually isn’t one method alone. There are various types of methods of fertility charting and natural birth control, which are collectively referred to as Fertility Awareness Based Methods. Some methods use all observable fertile signs, such as basal body temperature, cervical mucus, and cervix position changes, some only use one fertile sign alone, and there are also other methods that use fertile signs alongside tracking hormonal markers.
The Symptothermal Method, which is also called the Fertility Awareness Method, is just one type of Fertility Awareness Based Methods and is the method I have personally used for a number of years and teach others to use too. This evidence-based method involves observing your cervical mucus, basal body temperature, and optionally your cervix position to identify your fertile times within your menstrual cycle.
HOW DOES FAM WORK?
The Fertility Awareness Method works by observing certain fertile signs or hormonal biomarkers throughout each menstrual cycle to determine essentially the opening and closing of the fertile phase (fertile window) by confirming ovulation. These fertile signs are documented in a FAM-specific chart (either a paper chart or digital charting app) and together are used to interpret when you are and are not fertile in that given cycle. This may sound super complex, but really it isn’t!
Depending on the method of fertility awareness you use, specific guidelines are to be followed and actioned based on the observed fertile signs and how you intend to manage your fertile window according to your intentions of using that method. For example, to conceive or avoid pregnancy.
Below is an overview of each of the three fertile signs:
The Fertile Signs
Cervical Mucus: Cervical mucus (also called cervical fluid) is a hydrogel that is produced within cervical crypts inside the cervix. There are different types of cervical mucus that are produced as a result of fluctuations in the hormones, oestrogen and progesterone, throughout the menstrual cycle. Over the course of a menstrual cycle, cervical mucus changes consistency, amount, colour and texture.
In fertility awareness, the presence or absence of mucus helps you identify when you are fertile as well as plays a vital role in sperm survival. Some fertility awareness methods or older texts may suggest checking for cervical mucus by inserting a finger into the vagina and seeing what remains on the finger as you remove it. It actually isn’t necessary to do this. The most accurate way of checking cervical mucus is by noticing the external sensation at the vagina opening throughout the day, as well as noticing what is visible on toilet paper as you wipe your vulva before and after going to the toilet.
Basal Body Temperature: Basal body temperature (BBT) is the body’s core waking temperature and is a measure of your resting metabolic rate after at least 3 consecutive hours of sleep. Temperatures are taken orally with a basal body thermometer upon waking each morning before getting out of bed and before any activity. The BBT is used to track when ovulation is likely to have occurred, marking the end of the fertile phase. BBT cannot predict when you will ovulate, but it can tell you in retrospect that ovulation has occurred by a temperature rise that will remain elevated until your next period/menstrual bleed. The hormone progesterone is what causes the BBT to rise after ovulation and to remain elevated until the next cycle.
Cervix Position: Checking the position of the cervix is an optional fertile sign, meaning that it is not required for FAM to be effective. Having said that, checking cervix (or cervical) position can be very useful as an additional sign to cross-check with cervical mucus and BBT to confirm ovulation and during times when these fertile signs are unreliable – during illness for instance.
The cervix opening changes and moves at certain times during the menstrual cycle, again, due to hormone fluctuations. The position, opening, and texture of the cervix are different during the times when you are fertile and when ovulation is approaching vs. when you are not fertile. The cervix position is checked by inserting a finger into the vagina to physically feel the opening of the cervix and literally feeling for characteristic signs.
It is recommended to learn FAM from a qualified Fertility Awareness Educator or trained healthcare provider. This may look like taking a workshop, joining a group course or program (either in-person or online), or having one-on-one sessions (in-person or online). FAM can also be learnt via self-teaching in the form of reading FAM-based books or training manuals, taking online self-study courses, joining FAM forums, reading articles, listening to podcasts, etc. When self-teaching it is always recommended to choose one specific method and learn and practice that one method exclusively, rather than learning various methods at once.
HOW EFFECTIVE IS FAM?
Research has shown the Fertility Awareness Method, specifically the Symptothermal Method (tracking cervical mucus patterns and basal body temperature changes), is 99.6% effective with perfect use when abstaining from sexual intercourse during the fertile window. When using condoms as barrier methods during the fertile window, the method is 99.4% effective with perfect use.
It is important to note here that these effectiveness rates can be achieved provided the method is taught by a trained instructor and the appropriate guidelines are consistently adhered to.
The typical use of Symptothermal Methods for birth control is between 86.8% and 98.2% effective.
Perfect use effectiveness is how well the method works if used correctly and consistently all of the time. Whereas typical use effectiveness is based on what generally happens in real life and accounts for human error.
Conditions needed for effective and confident use of FAM:
- You learn from a trained and certified Fertility Awareness Method instructor, who also uses the method themselves.
- The instructor uses concise, relevant and everyday language.
- You have regular reviews, supervision and support.
- You have a three-cycle ‘learning phase’ where you are charting your cervical mucus, temperature (and cervical position if you choose) accurately and consistently.
- Use of abstinence and/or barrier methods during the learning phase.
- You follow the rules for avoiding pregnancy (if this is your intention).
- Accurate knowledge and continuous and complete charting.
- You have your partner’s full cooperation, where they accept a shared responsibility, with the use of the method and how you wish to manage your fertile window.
WHAT ARE THE BENEFITS OF USING FAM?
- It’s cost effective.
- It’s an effective alternative to hormonal contraceptives.
- No nasty side effects or health risks.
- No impacts on long-term fertility.
- No prescriptions necessary.
- Teaches you to learn about your body, your fertility, and your own cyclical rhythms – which is incredibly empowering!
- Can help you to conceive (if you choose to).
- Can help you identify hormone imbalances or health issues.
- Can improve communication and connection with your partner.
- It’s easily interchangeable from using it as natural birth control to trying to conceive and vice versa.
For full transparency and for those who love a pros and cons list, I’ll also list potential cons or ’disadvantages’ of FAM below:
- FAM alone does not protect against sexually transmitted infections (STIs), unless used in conjunction with barrier methods such as condoms.
- If using FAM for birth control, both partners must be completely willing and dedicated to use the method correctly and if they are not, they put themselves at a higher risk of unintended outcomes.
- FAM does require daily commitment of observing and charting your fertile signs and actioning the rules correctly to ensure effectiveness (especially in regards to using FAM for birth control). I personally don’t see this as a disadvantage as it really doesn’t take much time out of your day and the knowledge you have day-to-day about where you are in your cycle is so empowering. However, this is something to be aware of when considering using FAM.
- For some, self-teaching may be too difficult and overwhelming and is best taught by a qualified and trained educator. Proper education and training may not be available in your area or is financially inaccessible depending on the provider.
- Usually involves periods of abstinence in the learning phases (typically within the first 1-3 cycles of learning the method).
- Does require modification of sexual behaviour during certain periods of the menstrual cycle, especially when using FAM for birth control.
WHO IS FAM FOR?
- Teenagers, women, and people who menstruate who have natural menstrual cycles and are wanting to understand their cycles and learn how to interpret their signs of ovulation, as well as monitor their cycle health.
- Women and people who menstruate who are in opposite-sex relationships and are sexually active, who are wanting to avoid pregnancy and use a form of birth control that is natural and hormone-free.
- Couples (opposite-sex) who are planning on having a baby soon or who are already trying to conceive and are wanting to identify their fertile window to time sexual intercourse correctly for optimal chances of conception and achieving pregnancy.
- Couples (with one member of the relationship who menstruates) who are going through Assisted Reproductive Technology, such as IVF or IUI, and wanting to track and chart their fertile signs to identify their fertile window to correctly time fertility treatment and procedures.
Interested in learning the Fertility Awareness Method?
I’m currently putting together my FAM 1:1 education online program. If you would like more information and to go on the waitlist to be the first to know when this offer is available, feel free to email me.
References
Frank-Herrmann, P., Heil, J., Gnoth, C., Toledo, E., Baur, S., Pyper, C., Jenetzky, E., Strowitzki, T., & Freundl, G. (2007). The effectiveness of a fertility awareness-based method to avoid pregnancy in relation to a couple’s sexual behaviour during the fertile time: A prospective longitudinal study. Human Reproduction, 22(5), 1310–1319. https://doi.org/10.1093/humrep/dem003
Hampton, K. D., Mazza, D., & Newton, J. M. (2013). Fertility-awareness knowledge, attitudes, and practices of women seeking fertility assistance. Journal of Advanced Nursing, 69(5), 1076–1084. https:// doi.org/10.1111/j.1365-2648.2012.06095.x
Peragallo Urrutia, R., Polis, C. B., Jensen, E. T., Greene, M. E., Kennedy, E., & Stanford, J. B. (2018). Effectiveness of fertility awareness–based methods for pregnancy prevention: A systematic review. Obstetrics & Gynecology, 132(3), 591-604. https://doi.org/10.1097/AOG.0000000000002784
Trussell, J. (2011). Contraceptive failure in the United States. Contraception, 83(5), 397–404. https://doi. org/10.1016/j.contraception.2011.01.021
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