Fertility Awareness Method (FAM)
Midwife Jessi here!
I use fertility awareness method (FAM) for birth control/family planning. Period. And I’ve been using this method successfully for 6 years (with no unintended pregnancies!).
There’s an old joke that care providers sometimes (in very bad taste) tell and it goes something like this:
What do you call a person who uses natural family planning?
Pregnant!
Ha! Except no.
This joke reveals some of our cultural lack of awareness about the fertility cycle, female anatomy and what it takes to make a baby. In our culture, we don’t get a whole lot of anatomy and physiology education as young people. We also don’t get a whole lot of sex ed.
This usually results in young people being told something along the lines of “Be careful when you have sex, you can get pregnant.” True. But it also leaves the distinct impression that this means you can get pregnant at any time of the month, which is just absolutely not true.
On the other end of the spectrum are those who misunderstand and think that you can only get pregnant 1 day out of the whole month. This, is also not true.
So let’s back up and clear up some misinformation:
You can get pregnant only for about 6 days out of every month. This is called your “fertile window.”
This is true for 3 reasons:
Ovulation (the actual release of an egg(s) from the ovaries) happens only 1x a month, this has been demonstrated by numerous studies, and does not vary by individual. The process of ovulation happens as a result of days of hormone build up, and cannot happen spontaneously (such as in response to really good sex, another myth). After 24-48 hours the egg dies and is no longer around to cause potential pregnancy. (At this point, if you are trying to get pregnant you’ll have to wait until next month when the cycle is in the fertile window again).
Cervical mucous is essential for the survival of sperm. And females are only making fertile-quality cervical mucous in the days leading up to ovulation (usually only about 5-6 days per cycle). This mucus is produced to try and “help” sperm make it through the acidic vaginal environment - which is primed to kill them - and keep them alive in the cervix and uterus until an egg is released.
Sperm can only live for 5 days. Even if your cervical mucous is awesome.
Put all of this together, and you can see that the opportunity to get pregnant each cycle is actually fairly brief: about 6 days. It’s also totally possible to track your cycle and to know this kind of information:
Whether or not you are currently in your fertile window.
Whether or not you have already ovulated this cycle.
When you can have penis-vagina sex without having to worry about getting pregnant.
The way to do this is through fertility awareness method (FAM).
Now, I should be clear that this is NOT the Rhythm Method. The rhythm method assumes that everyone has a 28 day cycle and that everyone ovulates on day 14. This method basically means counting the days since your last period and guessing you are ovulating around day 14. But this doesn’t work for most people, and can end in a lot of unplanned pregnancies. This is because every cycle is different. Some are 28 days, but some are 26, and some are 30. And ovulation can happen on day 14 or on day 16 (if just depends!).
Fertility awareness is different.
With this method EVERY DAY you track:
Your cervical fluid. Whether or not you have any each day. It’s consistency and amount. This information helps you identify your fertile window.
Your temperature. This helps you confirm ovulation, so that you know when your fertile window has ended for this cycle. This is because after you ovulate your temperature goes slightly up and stays up until your cycle starts over again with your period.
Your cervix position. The cervix can move up and down in the cycle, or open slightly and close. Knowing where it is at can help clarify whether you are in your fertile window or not if you are unsure based on the other two signs.
The combination of these three signs is tracked every day so that you know when you might become pregnant each and every single month. It also helps you identity health problems, diagnose pregnancy earlier than many tests, and predict your period (all of which are beyond the scope of this blog post but I am happy to chat about!).
I use fertility awareness to identify my fertile window so that I can effectively prevent pregnancy. And it works.
Many others use it to become pregnant when they choose to add to their families.
This method is flexible and allows you to learn the rhythms of your body and how to work with them to build the life and family structure that you want.
As for effectiveness, studies have shown that when used perfectly (which involves avoiding all penis-vagina sex during the fertile window) it reaches efficacy of 98-99%. That’s on par with IUDs. Which is pretty freaking awesome for a method that requires no supplies, restocking, prescriptions, or artificial hormones.
More people use FAM than you know.
People choose FAM for many reasons including:
“I did not want synthetic hormones in my body.”
“I tried several prescription birth controls and had progressively worse reactions, I was looking for natural alternatives".”
“Not using hormonal birth control was important. Learning about my body was a also huge plus".
When I asked folks using this method what they wished people understood about FAM these were their responses:
“I wish people knew this is a real method of family planning, but it takes openness and willingness to learn and understand.”
“I wish people knew that there is truly so much freedom when you use this method! But it is also more detailed than people assume. It’s not the Rhythm method.”
“I wish people knew that it’s so empowering for my partner and I to understand our fertility together as a couple.”
Some important notes about fertility awareness:
You can’t skimp on the tracking. You have to actually use the method for it to work. Saying “I know my body and can just tell when I’m ovulating” (while awesome) is usually not enough to prevent pregnancy long-term. This is because we often are surprised by our own bodies, and every cycle has the potential to be different! My ovulation has been delayed several times due to travel and stress, and without tracking I wouldn’t have realized my fertile window was longer than anticipated (and might have gotten pregnant, due to assuming I had ovulated “on time”).
This method will not protect against STIs (obviously). Just because you can no longer get pregnant that cycle doesnt mean you shouldn’t still wear a condom sometimes. Have safe sex when sexually transmitted infections are a possibility (especially with new or casual partners).
You can use this method to get pregnant when you are ready! Identifying your fertile window helps take the guess work out of making a baby. This is helpful if you have schedule restrictions, are using a sperm donor, or are wanting to become pregnant right away.
This method arguably works best with partner awareness and understanding. Explaining to your partner the whys of avoiding sexual activity (or the use of additional birth control methods) during your fertile window can help foster a relationship of mutual respect and consent. Talk about it.
Want to learn more about this method? Here are the some books I would recommend:
The Fifth Vital Sign by Lisa Hendrickson-Jack. This book is simple and easy to understand. The author is the host of the podcast Fertility Friday , which is also a great resource for more information about birth control methods, fertility and female health and wellness.
Fertility Awareness Mastery Charting Workbook. This is a great companion to the fifth vital sign book, and introduces newbies to the concept of tracking their cycles in a reliable and accessible way.
Taking Charge of Your Fertility by Toni Weschler. A classic, this book is the encyclopedia for anyone wanting to learn how to track their own cycles.
Cycle Savvy: The Smart Teens Guide to the Mysteries of Her Body. A book aimed at teenage girls, and packed with the info most of us didn’t get early on about our bodies, our cycles and our fertility.