As a naturopathic doctor that focuses on menstrual health, I get asked by patients if there are natural ways to prevent pregnancies. Which is why I love to educate people about the Fertility Awareness Method aka FAM. Unlike hormonal birth control methods or invasive procedures, FAM relies on understanding and tracking the body's natural fertility signs.
In this blog post, we will explore what the phases of the menstrual cycle and what Fertility Awareness Method is, how it works, its benefits, and considerations for those interested in adopting this method.
Breaking Down the Menstrual Cycle
Before we talk about the Fertility Awareness Method, I wanted to break down the basics of the menstrual cycle so you have a better grasp of the changes your body is going through each month. The average length of a menstrual cycle is 28 days but this can vary from 23-35 days depending on the person (1). There are 4 phases of the menstrual cycle: menstruation, the follicular phase, ovulation, and the luteal phase (1).
Phases of the Menstrual Cycle:
Menstruation: This is commonly referred to as a “period”. When you menstruate, your inner uterine lining sheds and flows out of the vagina. The average length of a period is typically three to seven days. The day you start bleeding is considered day 1 of your menstrual cycle (1).
The Follicular Phase: The follicular phase actually starts on the first day of your period and lasts a total of 13-14 days, with ovulation at the end of this phase. During the follicular phase, the pituitary gland in the brain releases a hormone called follicle stimulating hormone (FSH) to stimulate the production of follicles on the ovary (2). Usually only one follicle will mature into an egg. During this phase, the uterine lining will also thicken in preparation for a possible pregnancy (1).
Ovulation: Ovulation is when a mature egg is released from the ovary, moves along the fallopian tube, and finally toward your uterus. This happens about once a month (usually two weeks before your next period). Ovulation is short and lasts from 16 to 32 hours (2). The “fertile window” is the time in which intercourse is most likely to result in a pregnancy; this “fertile window” comprises the five days before ovulation and the day of ovulation itself (3). Once the egg is released, it will survive up to 24 hours and if sperm reaches the egg during this time, you may get pregnant (1).
The Luteal Phase: After ovulation, cells in the ovary (corpus luteum) release progesterone and a small estrogen. This causes the lining of the uterus to thicken in preparation of pregnancy (2). If a fertilized egg implants in the uterus lining, the corpus luteum continues to produce progesterone. If pregnancy does not occur, the corpus luteum dies, progesterone drops, the uterus lining sheds, and the next period begins again (1).
Learning about these phases and knowing when your “fertile window” is occurring is crucial for reproductive health and Fertility Awareness Method.
Understanding the Fertility Awareness Method
The Fertility Awareness Method, often abbreviated as FAM, is a set of practices that enable individuals and couples to track and interpret their menstrual cycles to determine when they are fertile and when they are not. By understanding their fertility patterns, couples can make informed choices about when to engage in sexual activity, either to conceive or to avoid pregnancy.
How Fertility Awareness Method Works:
FAM relies on the observation and interpretation of four primary fertility signs:
Basal Body Temperature (BBT): If you menstruate, your basal body temperature typically drops slightly before ovulation and then rises and remains elevated until your next menstrual cycle (4). Charting BBT over time helps identify your fertile window. Tracking BBT can take a bit of discipline because you have to check your temperature every morning before getting out of bed with a digital oral thermometer and recording the values on a paper chart or an app designed for this purpose. This is why the Tempdrop sensor (https://www.tempdrop.com) is my favorite alternative - it’s a wearable BBT tracker that allows for continuous monitoring and sync’s your information for easy viewing of your trends on their app.
Cervical Mucus: Also known as “cervical discharge” is the fluid that naturally flows out of the cervix (the opening to the uterus). The consistency and appearance of cervical mucus is sensitive to hormonal fluctuations and changes throughout the menstrual cycle (4). Around ovulation, cervical mucus becomes clear, slippery, and stretchy — resembling uncooked egg whites. This signifies when you’re at your most fertile as the mucus will return to being thicker and stickier after about 3 days (5).
Calendar Tracking/Calendar Method: Keeping a menstrual cycle calendar helps individuals predict their fertile days based on past cycles (4). However, this method is less precise because the “fertile window” varies from person to person and from cycle-to-cycle. If you do use calendar tracking, combine it with BBT and cervical mucus observations to give you a more accurate time of the fertile window. And note that sperm can live for up to 5 days in the vaginal canal after ejaculation so even though you didn’t have sex while ovulating, you may be after and pregnancy can still occur.
Cervical Position: Learning how to check your cervical position is easier than you think but will take some practice and patience. The position of the cervix and feeling changes is slightly more difficult since everyone’s body is different. In general, the cervix rises to the top of the vagina & feels soft and moist like lips during ovulation (4). Following ovulation, the cervix starts to drop in position & feels harder, like the tip of your nose (4). Click this link for step-by-step instructions for checking your cervix: https://www.verywellfamily.com/how-to-check-your-cervix-and-cervical-position-1960299
Benefits of the Fertility Awareness Method
Now that we’ve covered the signs of fertility, let’s get into the benefits of Fertility Awareness Method:
Natural and Non-Invasive: FAM does not involve hormones, devices, or surgical procedures. It respects the body's natural processes and allows individuals to become more attuned to their reproductive health.
Effective When Used Correctly: When practiced diligently and with proper education, FAM can be highly effective for both preventing and achieving pregnancy. Studies have shown that the method's perfect use efficacy rate can be up to 99%, comparable to some hormonal methods (4, 5). But even with human error, FAM can still be around 75% effective (5).
Enhanced Body Awareness: FAM encourages individuals to become more aware of their bodies and reproductive health. This heightened awareness can empower people to address underlying health issues and improve overall well-being.
Customizable: FAM can be tailored to fit an individual's unique cycle and circumstances. Whether someone has irregular periods or is approaching menopause, FAM can be adapted to their specific needs.
Considerations for Using Fertility Awareness Method
While the Fertility Awareness Method offers numerous advantages, it can be tedious and requires commitment and responsibility. Here are some important considerations for those interested in using FAM:
Education is Key: To use FAM effectively, it's essential to receive proper education and guidance. Consider consulting a certified fertility awareness educator or healthcare provider who specializes in this method.
Consistency is Crucial: Accurate charting and interpretation of fertility signs demand consistency and precision. Skipping days or misinterpreting signs can lead to unintended pregnancies or missed opportunities for conception. It can also take several menstrual cycles before you become confident in identifying your fertile time.
External Factors: Factors like stress, illness, travel, or medication can influence menstrual cycles and fertility signs. FAM users need to be aware of these potential disruptions.
Communication is Vital: If using FAM for contraception in a partnered relationship, open and honest communication is key. Both partners should actively participate in the process and understand the method's limitations.
Backup Methods: Some individuals use FAM in combination with barrier methods like condoms during fertile periods to enhance effectiveness of reducing pregnancy risk.
Lactation: The fertility signs used in FAM are not reliable in individuals who are breastfeeding. However, since menstruators don’t have periods while they’re breastfeeding, this can be used as a form of contraception to prevent unwanted pregnancy — known as Lactational Amenorrhea Method (LAM) (6). This method works for about 6 months after a baby is born as long as the baby is fully breastfed and the individual does not have a period (6). LAM isn’t the most reliable since it is possible to get pregnant before your periods resume again since ovulation occurs about 2 weeks before your period (6).
The Bottom Line
Phew, we covered a lot of information just now but let’s recap: Fertility Awareness Method offers a natural, non-invasive, and empowering approach to knowing your body better. By understanding the menstrual cycle and tracking their fertility signs, individuals and couples can make informed decisions about when to conceive or avoid pregnancy. While FAM requires commitment and education, it can provide an effective and customizable alternative to traditional birth control methods.
If you’ve made it this far, thank you and I hope you found this article helpful! Be sure to share it with a friend or loved one.
Love always,
Dr. Avni Dalal
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Disclaimer: As always, none of the information in this blog is personal medical advice. This is purely for educational purposes and is not a substitution for proper medical assessment, diagnosis, and treatment.