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Fertility Series #4: Fertility Awareness Methods

Over the last four weeks, the focus has been on gaining a better understanding of female fertility. In the first week, we discussed the importance of understanding how your body works. I stressed the need for women to get in-tune with their bodies before trying to or becoming pregnant. In the second week, we took a closer look at the menstrual cycle and introduced the phases and hormones necessary for a functioning cycle. Last week, we discussed the reproductive hormones and the observable signs that they are working (or not) in your body each month. That article provided the foundation for today’s topic: using Fertility Awareness Methods (FAMs). This method of birth control has also been called the Family Planning or Rhythm Method in the past. If you haven’t read the articles from previous weeks or have a limited understanding of the hormones of the female reproductive system, I encourage you to go back and check them out before continuing on in this article.

FAMs can be used both to conceive and prevent pregnancy because they require an understanding of when you can and cannot get pregnant. This is a great alternative to other forms of birth control, especially if you are in a committed relationship and not concerned about preventing sexually transmitted diseases (STDs). I need to emphasize this point; FAM is not a good option (on its own) if you are trying to prevent STDs. I have been using this method, in lieu of hormonal birth control, for the last two years to prevent pregnancy and, so far, it has worked very well. Today, we will be discussing the strategies and tools I use to prevent pregnancy! I will also discuss how it can be used when trying to conceive!

What is Fertility Awareness?

If using as birth control, it involves tracking ovulation so that you can avoid unprotected sex during that time. Since most people don’t “feel” anything during ovulation, there are a few different methods for tracking it. Based on my research, FAMs are between 75-80% effective in preventing pregnancy on their own. When using more than one of these methods in addition to a barrier method (e.g. condoms, cervical cap), the effectiveness increases.

Temperature Tracking

Everyone has a basal body temperature (BBT), or temperature of your body at rest. This method involves tracking BBT everyday of the cycle. Typically, a healthy person’s BBT will be around 98 degrees (Fahrenheit). A woman’s BBT will change throughout the month depending on which hormone levels are high at different times of the month. Progesterone causes a slight rise in BBT at two points in the menstrual cycle: right before your period and during ovulation. That is because levels increase in the week before your period and then decrease right before the onset of your period and remain low until right before ovulation. The presence of Luteinizing Hormone (LH) triggers a quick spike in progesterone during ovulation. This causes a brief spike in BBT that would be noticeable to a woman who was tracking it every day; thereby alerting her that ovulation is near.

BBT also comes in handy when trying to conceive. Progesterone levels continue to rise if the egg is fertilized and levels decline if no pregnancy occurs. If BBTs continue to remain elevated on or after the day of your expected period, there may be a chance that progesterone levels are remaining high to prepare the body to maintain a pregnancy!

This method could work for you if you are consistent and responsible enough to remember to take your temperature every single day. Personally, this never worked for me because I inevitably forgot to take my temperature on multiple days out of the month. In my experience, the changes to BBT are so subtle that if you miss one day, you may not be able to accurately detect the spike. Another issue I personally have with this method is that at any point, especially if you’re a mom to littles, you could spike a fever (or low grade fever) due to illness and that could disrupt the validity of your tracking system for that month.

Cervical Mucus (CM)

The hormones that control your menstrual cycle, like progesterone and estrogen, also affect your cervical mucus (the stuff on your cervix that comes out of your vagina as discharge). Your cervical mucus changes in color, texture, and amount throughout your menstrual cycle (especially around ovulation). To use the CM method to prevent pregnancy, you check out your CM every day and write the results on a chart (more on charting later). The changes in your CM help you figure out when you’re going to ovulate and can get pregnant.

During the first part of the menstrual cycle, you are on your period and the discharge is usually blood and fragments of uterine tissue. As an egg matures in the ovary, hormones trigger changes in the cervix that make the environment more receptive to incoming sperm. In the days leading up to ovulation, the CM will increase and become cloudy/yellow and sticky. When you are most fertile (closest to ovulation), your CM will be clear and slippery, like the texture of egg whites. I can speak from personal experience and say that this is a consistent and noticeable sign for me each month that I am in my fertile window. Once ovulation has passed, the CM will decrease in amount and become white and sticky. These are considered "dry" days.

It is expected that the CM would remain that way until the start of the next period, unless a pregnancy occurs. If a pregnancy occurs, the amount of CM may increase and become thick and creamy. This is because the cervix will begin to close and form a mucous plug, which stays in place to protect the growing baby until labor begins.

I’ve found this method to be incredibly helpful in tracking fertility. Everyone’s body is different, but I personally can see a clear change in CM at different times of the month. If for some reason, I haven’t been diligently monitoring my fertility calendar, a change in mucous is always my cue to check in and see how close to ovulation I am. It's fairly easy to do; I typically will check when I'm using the restroom. In my opinion, this is a great way to track fertility in addition to the next method I will discuss: calendar tracking.

Calendar Method

This is the most commonly used method for tracking the menstrual cycle. Most women have some way of tracking periods so that they are not caught by surprise when the bleeding begins. I found this to be the easiest way to transition into using FAM. It works to prevent pregnancy by giving you an estimate of the days you are most likely to be fertile. There are many apps available that help you to track your periods. I love using Ovia, because it also shows when you are most fertile (your fertile window) and has a bunch of features that allow you to track physical changes (such as cervical position and mucous texture) as well as changes in mood. It also allows you to document the days you had sex and the type of birth control you used during those events (e.g. pulling out, condom, unprotected). The more consistently you document in the app, the more reliable the prediction for the fertile window and expected period are. I’ve been using the app for several years now and I find that it is incredibly accurate in predicting when I am most fertile and when to expect my period. I find that using this method along with tracking my CM to be very effective in preventing pregnancy.

Ovulation Sticks or OPKs

Ovulation test kits are more frequently used when trying to get pregnant. They work like pregnancy tests because they detect a specific hormone in urine; and this tells you if you are close to ovulation or not. Ovulation tests detect the levels of LH in the body. When LH is high, the ovulation test will show two equally darkened lines (one for the control and one for the test line). When LH is low, only the control line will appear dark and the test line will be present but faint. While most women will use an ovulation test when they are trying to become pregnant, I find that it is the most helpful tool for me while trying to prevent pregnancy. I will typically buy them in bulk; they are usually about $20 for a kit of 50 test trips. I use the calendar and cervical mucous methods to get a general idea of when I might ovulate. When I start to notice signs of heightened fertility, I start to take ovulation tests. I consistently test every day until I get a clear positive result. During those days, I use a barrier method of birth control (e.g. condoms) or abstain from sex completely. Once the ovulation test results show declining LH levels (or a negative result), we resume sexual activity without the barrier.

Of all the methods, I like this one the most because it gives a somewhat objective picture of what’s happening in my body. Cervical mucous and the calendar method both give me a rough idea of when to expect things, but ovulation strips often “seal the deal” for me. When I see a clear positive test, I know for sure that ovulation will happen within a few days. That gives me a clear sign to use a backup method of birth control until the fertile window closes again.

FAM is for you if:

· You think you can consistently track and document your period and signs of increasing/decreasing fertility.

· You have a relatively “normal” menstrual cycle. By this I mean, your period comes at roughly the same time each month.

· You are in a sexual relationship where this is no risk of STDs

· You are able to handle the responsibility of a pregnancy if it occurs.

· You have a relatively “good” understanding of your cycle.

· You have a collaborative and supportive sexual partner (for maintaining accountability)

FAM is not for you if:

· You have irregular or absent periods

· You struggle with consistency (specifically for tracking symptoms)

· You have multiple partners or there is a risk of STDs

· You are not able to handle the responsibility of a potential pregnancy

· You are taking medication or have a condition that impacts fertility


I’ve enjoyed putting this series together! I hope that it has been helpful in increasing your awareness about your own fertility. I recognize Fertility Awareness may not work for everyone, but I’ve found this to be a great alternative to hormonal birth control. Let me know if you have questions and as always, leave a comment below!

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