Fertility Awareness Methods

Also Known as Natural Family Planning

What are Fertility Awareness Methods (FAM)?

Fertility Awareness Methods are techniques to help a woman determine when she is most fertile each cycle. Women can use FAM to achieve or avoid pregnancy.

Calendar (or Rhythm), Mucus, Billings and Temperature are all types of FAM. While a combination of these methods may be used, the various centres that teach FAM may have differing opinions on the best ones.

Who can use FAM?

Most women can use FAM. You don’t have to have regular cycles to use these methods, but women with regular cycles may have more success in avoiding pregnancy with FAM. FAM cannot be learned or used while a woman is taking birth control pills because the Pill causes changes in the natural menstrual cycle. FAM isn’t hard to use, but you must understand how it works and be willing to put in the time and effort necessary to use it correctly.

How does FAM work?

FAM is based on the fact that a woman is fertile only around the time of ovulation (when an ovary releases an egg). The aim of FAM is to recognise when ovulation is approaching (fertile phase begins) and when it has passed (fertile phase ends).

The various methods of FAM use different signs to determine the beginning and end of the fertile phase. FAM relies on the following facts:

Ovulation occurs only once in each cycle
Menstruation occurs 11-16 days after ovulation
The egg lives 12-24 hours
Sperm may live for up to 5 days in a woman’s body

Calendar (Rhythm) method

This method of FAM estimates when ovulation will happen based on a record of past cycles. As cycle length can vary considerably, the calendar method is very unreliable and is not recommended to be used on its own.

A woman calculates the length of her shortest and longest cycles, preferably over a period of at least six months. The first day of the period counts as Day 1.

Shortest cycle minus 20 = first fertile day
Longest cycle minus 10 = last fertile day
E.g. For a woman with 26 to 31 day cycles
26 minus 20 = 6th day
31 minus 10 = 21st day
This woman must consider herself at risk of pregnancy from unprotected sex between days 6 and 21 of her menstrual cycle.

The main use of this method is to provide a double check with another FAM on when fertile days may start.

Cervical mucus method

A woman can learn to tell when ovulation is about to happen and when it has passed by checking her mucus discharge daily or becoming aware of sensations at her vulva.

A woman may be aware that, several days after menstruation, she has no noticeable discharge and her vulva feels relatively dry (dry days). As oestrogen levels rise approaching ovulation, there is a feeling of wetness at the vulva, with the mucus becoming clear, slippery, more watery and elastic (fertile mucus). Any of these changes mark the beginning of the fertile phase. A woman should avoid unprotected vaginal intercourse at this time if she wishes to avoid pregnancy. After ovulation the mucus once again becomes dry and sticky and the woman notices a dry sensation at the vulva. Sexual intercourse can be resumed after three consecutive dry days.

Note: Vaginal infections or surgery of the cervix which interfere with production of mucus may affect the use of this method. Seminal fluid (semen) can also interfere with mucus readings.

Billings ovulation method

This method instructs a couple in being able to identify the start and finish of a woman’s fertile phase by monitoring changes in her cervical mucus.

The couple avoids intercourse at this time to prevent pregnancy. Instruction in this method is available in WA.

Temperature method

The temperature of the body after at least three hours of rest is known as the Basal Body Temperature (BBT). This is usually around 37 C/98.6 F, but it may vary slightly from woman to woman. Knowing what is normal for you will help determine your personal pattern of temperature shifts.

Before ovulation the BBT will be relatively lower. After ovulation, the BBT usually rises several tenths of a degree, and remains up until the menstrual period begins. Keeping a BBT record helps indicate when an egg has been released. When a woman sees her temperature rise and remain higher for at least three days, she knows that ovulation has occurred and her fertile phase has passed. When using the BBT method alone to avoid pregnancy, a woman must abstain from unprotected vaginal intercourse from the end of menstruation until at least three days of higher temperatures have been recorded.

Temperature taking tips: temperatures can be disturbed by different things such as fever, taking drugs, lack of sleep, travel, stress and electric blankets. It’s important to note these things on your daily chart, otherwise it’s possible to mistake them for a sign that ovulation has occurred. The temperature must be taken every morning immediately after waking and before getting out of bed, smoking, eating or drinking.

A digital thermometer is recommended because it measures small temperature changes accurately and quickly.

Other body signs

Some women may notice physical signs of ovulation with temperature and mucus changes. Recognising these changes may help a woman determine the time of ovulation.

Some of the signs are:

changes in the position of the cervix
softening and opening of the cervix
slight pain in the lower abdomen in the area of the ovaries, often on one side or the other
slight and temporary bleeding (spotting)
breast tenderness, or
a feeling of heaviness in the abdomen

Lactational Amenorrhoea Method (LAM)

This method can be used by women:

who are fully breastfeeding (no artificial feeds, supplements or solids) AND
whose baby is less than 6 months old AND
who have not had any bleeding (other than during the first eight weeks following the birth)

If all these conditions are satisfied, then the risk of pregnancy is 2%.

Combination methods of FAM

Each method can be used alone, but if a woman combines different methods of FAM she may be able to more confidently determine her fertile phase.

What can be done on fertile days to avoid pregnancy?

Some couples don’t have sex at all on fertile days
Some couples choose to have sex without having intercourse, by using other ways to bring each other to orgasm (climax) during fertile days
Some couples supplement FAM during fertile days by using various barrier methods, such as the condom or diaphragm with or without spermicide

Note: Spermicidal cream, jelly, or foam can interfere with mucus patterns, so women using these products will need special instruction in order to continue using the cervical mucus method.

How effective is FAM?

Pregnancy rates vary depending on the particular group surveyed, whether one method or a combination of methods is used, and whether barrier methods are added during the fertile time. FAM is most effective when used correctly, with no intercourse during the fertile phase. About 25 out of 100 women who are average users and who rely only on FAM become pregnant during the first year of use. Careful and consistent use can give much better results, for example with perfect use, the mucus method may be up to 97% effective.

If couples decide to have intercourse during the fertile period, they can use barrier methods in order to reduce the chance of pregnancy.

To make a method or a combination of the methods work best for you, you should talk with a counsellor, take a class, or read a book on FAM (contact the FPWA Library on 9227 6177 for more information).

What are the advantages of FAM?

There are no health risks or side effects
It can be used to prevent OR plan a pregnancy
It can be quite effective if used correctly
It’s acceptable to couples with religious concerns about birth control
The method is free, except for possibly a thermometer and class fee and charts
It can lead to a greater awareness and understanding of how a woman’s reproductive system works
Couples may find that using FAM leads to better communication and cooperation

What are the disadvantages of FAM?

Learning FAM takes time and effort
Using FAM requires a commitment to keeping careful note of daily body changes
Even with correct use, the failure rate is often higher compared to other methods
Both the woman and her partner must be prepared not to have vaginal intercourse, unless a barrier method is used, during her fertile time
Vaginal infections interfere with mucus detection

How can I start?

This pamphlet provides general information only. To use FAM effectively, people need careful instruction and must be willing to put in time and effort to learn and use it correctly. Find a counsellor or class in FAM by contacting FPWA, Natural Fertility Services (9223 1396) or Billings WA Fertility Management and Education (1800 819 841).

What to do if the method is not correctly used

If you are worried that you have miscalculated your fertile time and had unprotected vaginal intercourse during an unsafe time, you can use emergency contraception (EC) to reduce the risk of unplanned pregnancy. EC is available over the counter at pharmacies, so you don’t need to see a doctor to get a prescription. It is most effective at preventing pregnancy when taken within 24 hours of having sex (the sooner it is taken the more effective it is). There is some effectiveness for up to 120 hours (5 days) after intercourse, however effectiveness decreases as time passes and is significantly reduced 72 hours (3 days) after sex.