What is the Fertility Awareness Method?
- Alexa Nikolai
- 7 hours ago
- 6 min read
Overview
Although often categorized as a form of contraception, the Fertility Awareness Method is more accurately an all-encompassing practice that can be used to prevent pregnancy, achieve pregnancy, or simply better understand and monitor your body. By definition, the Fertility Awareness Method is a method of tracking your menstrual cycle through observable biological signs, or biomarkers. Commonly used biomarkers (which will be discussed below), include body temperature, cervical fluid, urine, and cervical position.
Using Fertility Awareness Methods helps women better understand the patterns of their bodies and their cycles. With this familiarity, users can predict when they are fertile or infertile. This knowledge can then be used as a “natural birth control” or to increase the likelihood of getting pregnant by either avoiding or having sex during fertile windows, respectively. Attuning yourself to your menstrual cycle can also help you predict other symptoms associated with hormonal fluctuations, such as mood or energy levels.
How does the Fertility Awareness Method work?
The Fertility Awareness Method, or FAM, works because of the naturally cyclical nature of the female body. For a refresher on the phases of the menstrual cycle, read our post here. Unlike men, women are not fertile at all times.
In order for conception to take place, both an egg and a sperm need to be simultaneously present in the fallopian tube (check here for a refresher on female anatomy). It’s important to note that the presence of both egg and sperm does not guarantee conception but is required to have even a chance of conception. An egg is typically released from an ovary during ovulation about 14 days before the first day of your period (this is halfway through the average 28-day menstrual cycle). Once an egg is released, it can only survive for about 24 hours. Sperm, however, can survive in the fallopian tube for 3-5 days after sex. So, a fertile window, or the time during which sex could lead to conception, lasts from about 5 days before ovulation to 1 day after ovulation.
FAM uses this knowledge to track your fertile window from month to month. If you want to get pregnant, you should try to have sex during the fertile window. If you don’t want to get pregnant, you should avoid having sex (or use another form of birth control) during the fertile window.
Key takeaway: Women in their reproductive years are still only fertile about 25% of the time. The other 75% of the time, no egg is present in the fallopian tubes and thus conception cannot physically occur.
What biomarkers are used in FAM?
Although tracking your period isn’t too difficult, tracking ovulation can be a bit trickier. However, even if they’re less obvious, there are still a number of physical signs of ovulation, which are monitored when using FAM.
Basal Body Temperature (BTT): Your temperature fluctuates slightly throughout the day, however, your BTT (often defined as your temperature upon awakening) remains fairly consistent. At ovulation (and until the end of your period), though, your BTT typically rises by 0.5-1 °F. By taking your temperature every day when you wake up, you may be able to see this change and thus determine when ovulation has occurred.
Cervical mucus: At certain times of the month, you may notice a white discharge coming from your vagina. This mucus is released around the time of ovulation and is a good marker of when ovulation is about to occur and when it has passed. In the days leading up to and following ovulation, you may notice small amounts of thick mucus. However, just before ovulation, the amount of mucus noticeably increases and becomes thin and slippery. Cervical mucus can be assessed by wiping before you go to the bathroom and either visually examining the mucus or using your fingers to test the texture.
Cervical position: The cervix is a muscular organ at the base of your uterus, which you can feel by inserting a finger into your vagina. Over the course of your cycle, the position and texture of your cervix changes. During ovulation, the cervix is softer and at its highest position (and may be more difficult to reach). The cervix drops after ovulation and becomes firmer. The opening of the cervix also widens during your period, in order to let blood and fluids pass through.
Urine: Urine can be monitored in FAM by using special test strips that measure the hormone levels in your urine. These hormone levels can then indicate which phase of the menstrual cycle you’re in. Like BTT, urine testing should be done first thing in the morning to determine a reliable baseline.
What are the benefits of FAM?
Many people choose FAM, because it is a fully natural way to monitor your body’s cycles. FAM requires no additional hormones or equipment (although there is some optional equipment). By understanding their own natural rhythms, users are able to predict and manage cycle-related symptoms. Furthermore, using FAM can, in some cases, help users identify and treat hormonal imbalances that might otherwise be masked by hormonal birth control. Finally, since FAM is a daily practice (not a set-it-and-forget-it method), practitioners may find that they are more mindful of their fertility goals and often have more open communication with their partners.
What are the drawbacks of FAM?
As mentioned, FAM is a more intentional daily practice than many other forms of birth control, so it does require more focus and energy. Everybody’s bodies are different, so there is definitely an adjustment / learning period when first starting FAM and trying to learn your individual patterns. FAM also requires daily monitoring, so each day, users assess their biomarkers and determine what that means about their fertility. Lastly, when avoiding pregnancy, it is most effective to avoid sex entirely during fertile windows, which is difficult for some couples.
How effective is FAM?
Unlike certain other birth control methods, it can be difficult to assess the exact effectiveness of FAM, because researchers cannot always tell how closely users are adhering to FAM guidelines. For example, researchers can feel confident that someone with an IUD is always using their IUD. However, someone who is using FAM may not be tracking accurately or may have sex during their fertile window (either accidentally or on purpose). Due to imperfect usage of the method, FAM is often reported to have a lower effectiveness than other birth control methods, such as the pill. However, in “perfect” usage, FAM is as effective as any other method (90-98%).
What are different FAM options?
Within the realm of FAM, there are a few more specific methods. We’ll briefly describe the most common ones here, but if you want more information, there is plenty to be found for each. For several of these methods, it is also possible to find local experts and trainers who can help develop your understanding of the process in a classroom setting or one-on-one.
FEMM
Primary biomarker(s): cervical fluid
Optional biomarker(s): urine, BTT
Strengths: simple and user-friendly
Notes: can be charted through the FEMM app
Sympto-Thermal
Primary biomarker(s): cervical mucus, BTT
Optional biomarker(s): cervical position
Strengths: highly effective, due to inclusion of several biomarkers
Notes: reliance on multiple biomarkers makes it flexible and personal
Creighton
Primary biomarker(s): cervical mucus
Optional biomarker(s): none
Strengths: well-established and relies on a standardized chart, so it can be used by NaPro Technology practitioners (see more below) to address menstrual irregularities or infertility
Notes: relies on detailed cervical mucus analysis, so finger testing is crucial
Billings
Primary biomarker(s): cervical mucus
Optional biomarker(s): none
Strengths: easy to learn; relies on personal feel more than specific standards
Notes: focus on attention to how your cervical mucus levels feel throughout the day rather than finger testing at certain times
Marquette
Primary biomarker(s): urine
Optional biomarker(s): BTT, cervical mucus
Strengths: uses an electronic fertility monitor for high effectiveness
Notes: urine analysis can detect surges in estrogen and luteinizing hormone to predict peak days of fertility
What is NaPro Technology?
Related to FAM is Natural Procreative Technology or NaPro Technology. This branch of health science focuses on monitoring and maintaining reproductive and gynecological health without fertility control mechanisms such as hormonal birth control. NaPro Technology is closely associated with the Creighton Model, and NaPro practitioners place particular focus on establishing regular cycles through natural methods, such as diet or exercise control, or medical intervention, such as surgery to treat endometriosis, when needed.
Summary
At base, the method of fertility control you use is a highly personal decision. You can read more about other methods of contraception here. However, for anyone hoping to become more in tune with their body or looking for a natural way to pursue their fertility goals, there are numerous FAM options available. FAM is even an option for women with irregular cycles, and use of the Creighton Model and NaPro Technology may lead to diagnosis of an underlying imbalance. FAM requires some more thought than other methods, but that effort is traded for increased knowledge and understanding of your body.