By @loruponyo

Fertility Awareness Method & Why Every Woman Should Track Their Cycle

The fertility awareness method (FAM), also commonly referred to as natural family planning or the rhythm method, is a type of cycle tracking used to determine which days in the menstrual cycle a woman is most fertile. Many women don’t know this, but you’re only fertile for 6 days of every menstrual cycle. I know, your high school sex-ed teacher really did you a disservice when they taught you that you could get pregnant anytime you had sex. Well ladies, let me re-educate you!

But first, if you need to brush up on your menstrual cycle 101, check out this post before you read on; in order to understand FAM you need to understand the basics of the female menstrual cycle.

What is FAM?

The fertility awareness method is based on specific body signs that change throughout the cycle to predict ovulation. Ovulation is when you release an egg from the ovaries. The days surrounding ovulation are when you are most fertile. The fertile window is based on the life span of the sperm and egg. Sperm can live in the uterus for up to 5 days and an egg is viable for up to 24 hours after it is released into the fallopian tubes. This means that the fertile window begins 5 days before ovulation and continues until 1 day post-ovulation.

Understanding this information allows you to use FAM as a tool to increase the chances of getting pregnant OR as a form of birth control. This is because depending on your goals, your actions will change during the fertile window. If you want to make a baby, the fertile window is your prime time to have intercourse. Whereas if you are using FAM to prevent a pregnancy, you will either abstain from intercourse or use an alternative birth control method during these days.

How to use FAM?

FAM requires tracking evidence-based indicators of fertility throughout your cycle. The most important determinants are cervical mucus, basal body temperature, and the position of the cervix. FAM is much more effective when you track a combination of signs, rather than just one alone, and I always tell my patients to track all 3. Luckily, there’s an app for that. Some of the best apps for tracking these fertility signs are Fertility Friend, Glow, Ovia, Kindara, Clue, Period Tracker, and many, many more. So, here is what you need to track:

  1. Cervical mucus: This is the fluid or discharge produced by the cervix. The appearance, texture and amount of cervical mucus changes throughout the cycle based on estrogen levels. After your period ends, you typically produce very little discharge for a few days, and as days pass, your discharge turns thicker, white or yellow and become sticky. In the middle of the cycle, near ovulation, the cervix begins to make more mucus and it becomes clear and slippery, with the appearance of uncooked egg whites. This is an indicator of fertility, and the chances of pregnancy when this type of cervical mucus is present are much higher.

You can check your cervical mucus a few ways:

  1. Wipe before you use the washroom with white tissue or toilet paper. Check the colour and texture of the mucus.
  2. Look at the discharge on your underwear.
  3. Put clean fingers into the vaginal opening and examine the discharge on your fingers. Although this may seem like the most intimidating way to get the data, it is my favourite way to have patients check. Try in the shower.

Then you want to record the type of cervical mucus each day, especially as you enter the middle of your cycle.

  1. Basal Body Temperature (BBT): This is your resting temperature or the temperature of your body first thing in the morning. Ovulation, and thus a rise in progesterone, is responsible for a small rise in our core body temperature. You will see a slight drop in temperature (about 0.5-1 degree Fahrenheit) and then the next measurement will show a rise to above pre-ovulatory temperatures. It is critical to understand, especially for those using FAM as birth control, that temperature is an indicator that ovulation has already happened – past tense! So we use this information to plan for future cycles or to know that ovulation occurred in general.

To obtain the most accurate BBT measurements, you must:

  • Take your temperature at the same time each day – I have my patients set a daily alarm
  • Get the measurement before you get up and start moving in the morning
  • Always use the same thermometer – an oral thermometer that records temperature to the 100th degree is most accurate as temperature changes can be very slight
  • Have been sleeping for at least 3 hours; if you are up tossing and turning in the morning before you measure, it may be inaccurate

Issues with BBT tracking:

  • Many things can alter your BBT including, fever or infection, alcohol, some medications, stress, jet lag, poor sleep, use of a heating blanket, breastfeeding, and changes in the temperature of your bedroom
  • It takes a few cycles before you can identify a pattern
  • Inconsistency in your routine can cause fluctuations, so consistency is key for BBT

BBT tracking can be tricky and inconvenient for some. Thankfully, there are great tools available that make BBT tracking much easier. My favourite is the iFertracker. This is a wearable thermometer that sticks to the skin under the arm during sleep. It measures core temperature throughout the night and integrates it into an app– no waking or self-measuring required! I have first-hand experience using the iFertracker and love it so much I was able to get a discount code – just use “bronwyn” at check-out for $10USD off.

If you are using a basic thermometer, enter your temperature each morning into whichever app you are using.

  1. Cervical Position: This is the one that many women are most uncomfortable with. The cervix, or the opening to the uterus, changes through the cycle in response to estrogen levels. A high cervix is farther away from the vaginal opening, and a low cervix is closer to the vaginal opening. Surrounding ovulation, the cervix changes position to better allow space for a male and for sperm to easily enter the uterus. When you examine your cervix with your fingertips, you will find the cervix is high, soft and open during the most fertile days. When you are infertile, the cervix is low, firm and closed.

How to examine the cervical position:

  • You need to check in the same position every day to accurately report the changes in position and firmness – this can be done while seated or standing
  • Insert a clean finger into the vaginal canal and find the cervix – it may take some practice to understand how to report the characteristics
  • Assess firmness: firm feels like the tip of your nose, whereas soft feels more like your lips
  • Assess the opening: in the middle of the cervix you will feel a small opening, this is called the cervical os. The os will be open during ovulation and during the period, at all other times it will be closed.
  • Assess position: use your finger as a ruler and as your cervix moves higher it should feel more difficult to reach.

Track these changes. Some apps may not have cervical position as a pre-programmed option, but this is a great indicator to add to the notes section of each day.

How effective is FAM as birth control?

FAM is about 76-88% effective as a form of birth control. Of course, the more disciplined and consistent you are with charting these changes, the more effective this form of birth control will be. Also, by using a combination of these indicators, the better. The effectiveness is also based on using this method alone as a form of birth control. FAM becomes more effective by avoiding vaginal sex completely on fertile days or by using an additional form of birth control, such as male condoms.

It is important to note that you must use FAM for at least 3 cycles before you rely on it as a form of birth control. FAM is about patterns, and so it is essential to see the changes over a few cycles to understand when you ovulate, to plan accordingly. This also gives you time to build the habits that are critical for using FAM.

Who is FAM for?

Simply put: every cycling woman.

FAM teaches you so much about your cycle, that every woman can benefit. FAM is safe, it has no side-effects, there is little cost associated with the method, there are no hormones, and most importantly, it promotes body literacy. It can be used to achieve pregnancy, to prevent pregnancy, and to track symptoms of reproductive health concerns like post-birth control syndrome, PCOS, irregular cycles, or other fertility-related issues. It can also be used in conjunction with many other forms of birth control, and for most women, likely should be!

However, FAM should not be used as your primary form of birth control if you have irregular cycles, PCOS, have recently come off the pill, have multiple partners, or if you have a very inconsistent schedule or routine. Furthermore, if you are using hormonal contraception, FAM will not be very helpful for you. However, if you plan to transition off hormonal contraceptives, you can start getting into the habit of tracking, even if the data is inaccurate. This will allow you to be prepared for adequate tracking while you regain your natural cycle!

Body literacy is one of the most important lessons that FAM will teach you and this is why I recommend FAM to almost all women! Even if FAM doesn’t sound like your choice when it comes to birth control, tracking merely one of these key indicators can help you better understand your cycle, and may still be helpful when the goal is pregnancy prevention. If you know when you are ovulating, you will know when to be extra careful, even when using other forms of contraception. If you don’t experience any changes in BBT, cervical mucus or cervical position changes throughout a few cycles, it’s a good idea to speak to your healthcare provider.

 

To natural birth control methods & body literacy,

Dr. Bronwyn

Image by: @loruponyo
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Dr. Bronwyn is a naturopathic doctor in Toronto, Ontario with a clinical focus in Women's Health. She works with women transitioning off the oral contraceptive pill and those with specific fertility concerns, to reach a state of hormonal balance or in preparation for a healthy pregnancy. Dr. Bronwyn is passionate about empowering women to reclaim their hormonal health, to enable a full and vibrant life.

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