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No matter your age or stage in life, there is a good chance you’d benefit from learning about the fertility awareness method -- provided you have a monthly visitor (and while I could list all of the creative names a woman’s period has received over time, I’ll just leave it at that awkward term).
Though it is true that in this day in age, women are fortunate to have multiple choices when it comes to birth control, many birth control options have unwanted side effects, costs, and visits to a doctor’s office. So, what is the fertility awareness method (also known as FAM), what are the benefits, and how do you do it? Let’s dig in.
What is The Fertility Awareness Method?
FAM is basically a combination of the rhythm method (tracking your cycle each month), measuring basal body temperature (BBT), and assessing cervical mucus (CM). Together, these 3 indicators provide a helpful picture to women who are trying to get pregnant, trying to avoid getting pregnant, or even just trying to learn more about themselves and their bodies. There are so many factors that can affect your cycle and your fertility – ranging from stress, to eating patterns, to hormonal influences – employing FAM can give you a great window into what your body might be experiencing.
Fertility Awareness Method Benefits
Before we get to the benefits of FAM, let’s first talk about the numerous negative side effects that accompany most birth control options. The infamous “birth control pill” is likely the most commonly used, with some women starting it as young teens just to regulate their cycles, but then potentially staying on it for decades. The pill is a hormonal contraceptive, like other similar devices known as the patch, intrauterine device, or a ring placed in the vagina. By design, these hormonal contraceptives bring in synthetic versions of estrogen and progestin to influence your cycle.
Reported side effects include headaches, nausea, elevated blood pressure, bloating, and breast tenderness. They are also reported to increase risks for blood clots, heart attacks, and liver disorders. Fun, right? More women are actually starting to wonder if other health issues might be related to their contraception. For example, a 2016 study in Denmark found that hormonal contraceptive use, especially in adolescents, was associated with depression.
Even more concerning, a literature review in 2017 found good evidence that hormonal contraceptives are associated with an increase in autoimmune disorders. With 80% of these disorders and conditions occurring in women for unclear reasons, this relationship really demands a closer look. So – if you’d like to remove all of those potential side effects from your list of worries, the good news is that FAM is completely non-invasive, non-hormonal, and dare I say cost-effective!? The only side effect is improved discipline from daily charting!
But does it work? As you can probably guess, the important caveat is “when used correctly.” But when followed as designed, FAM can have 90% effectiveness! To safely avoid pregnancy though, it is important to either abstain from sex during your fertile period, or use a backup method like condoms. And while there are countless apps that can help you keep track, don’t rely on them completely. One study evaluating nearly 100 apps found that the majority are not even evidence-based, and many had disclaimers discouraging use for avoiding pregnancy!
How Do You Start the P
So you’re intrigued by the idea and you’ve been wanting to get off the pill, now where do you begin?
First of all, it’s important to remember that every woman’s cycle is different. Your cycle may even change month to month depending on events happening in your life. While the average cycle is usually around 28 days, they can be as short as 21 or as long as 40. Using a calendar, note the first day of your period (the first sign of any blood) as day 1, sometimes referred to as “CD1”. Continue numbering each day, through the end of your period, and the rest of the month until you see the first sign of blood again, showing your next cycle beginning. After a few cycles, you should start to get a better sense of how many days your average cycle is.
Ovulation generally occurs around CD14, but because sperm can survive in the right conditions for up to 5 days, your fertile window is somewhere between CD10 and CD17. But this window is just one piece of the picture. When paired with your cervical mucus charting and BBT, you’ll be able to narrow that window much more accurately.
For the 2nd piece of insight, you’ll need to start taking your temperature (orally) every morning. Overall, it should be very consistent, but be sure to record it every day on your calendar. It may dip the day before ovulation, and will spike the morning after ovulation. After a few months of this, you should also begin to have an idea of the 24-hour window in which you are ovulating. Of course, it goes without saying since the spike occurs AFTER ovulation, it’s best to do this for a few months before relying on it to either attempt or avoid pregnancy.
And finally, the 3rd and critical piece of our overall picture, CM. Don’t worry, this stage weirds out everyone at first. If you are like many women, you’ve probably realized your CM shows up differently throughout the month, with different consistencies. But isn’t it just random? As it turns out, there is a method to the madness! Many women are completely unaware of this before starting this method, so – listen up. On average, after menstruation ends, you will have 3-4 dry days. From there, CM will get progressively wetter for about 9 days. On the last wet day, it should be slippery and stretchy with an “egg white” consistency. Collect the mucus from your vagina each day, and record the color, consistency, and feel. The days leading up to ovulation, as well as the day of, your CM will be most slippery and wet. If you’re looking to get pregnant – THIS is your golden (24) hour(s)! After ovulation, you’ll notice it goes back to dry almost immediately.
So – before you go seek out a specialist, or shell out hundreds of dollars on some digital tracking bracelets, FAM is worth a test. While this method is generally great for anyone, women who are breastfeeding, perimenopausal, recently postpartum, or have PCOS should not rely on FAM, as their cycles are too irregular for it to work correctly. But otherwise – grab yourself an old fashioned calendar planner, start charting, and see what you think! If you’re the kind of person who thrives on more details and science behind how it all works, read Taking Charge of Your Fertility by Toni Weschler. It’s an excellent resource for navigating your menstrual cycle and learning your body. Happy charting!
Mayo Clinic Staff. Combination birth control pills [document on the Internet]. Mayo Clinic online; [cited 2019 Mar 31]. Available from: https://www.mayoclinic.org/tests-procedures/combination-birth-control-pills/about/pac-20385282.
Skovlund, C. S., Mørch, L.S., Kessing, L.V. Association of Hormonal Contraception With Depression. JAMA Psychiatry. 2016;73(11):1154-1162. doi:10.1001/jamapsychiatry.2016.2387.
Williams, W.V. Hormonal contraception and the development of autoimmunity: A review of the literature. Linacre Q. 2017 Aug; 84(3): 275–295. DOI: 10.1080/00243639.2017.1360065
Fairweather, D.L., Frisancho-Kiss, S., Rose, N.R. Sex Differences in Autoimmune Disease from a Pathological Perspective. 2008;173(3):600-609. DOI: https://doi.org/10.2353/ajpath.2008.071008
Unknown. Fertility Awareness: Natural Family Planning (NFP) [document on the Internet]. American Pregnancy Association online; [cited 2019 Mar 31]. Available from: https://americanpregnancy.org/preventing-pregnancy/natural-family-planning/.
Duane, M., Contreras, A., Jensen, E.T., White, A.The Performance of Fertility Awareness-based Method Apps Marketed to Avoid Pregnancy. J Am Board Fam Med. 2016 Jul-Aug;29(4):508-11. doi: 10.3122/jabfm.2016.04.160022.
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