When the contraceptive pill became available in the 1960s, it was lauded as the liberation of women. Finally, women could take control of their own fertility and pursue ambitions outside of the domestic space. A little over half a century later, the cracks are beginning to show.
The everyday side effects that many women experience, including bloating, weight gain, mood swings, skin issues and migraines among a long list of others, are no longer acceptable to many women who are seeking autonomy over their bodies. Millennial women are turning away from traditional contraceptive methods in their droves, and it’s no surprise when a quick Google search of most traditional contraceptive methods reveals reams of personal horror stories.
Of course, some women tolerate hormonal intervention better than others — no two bodies will react in the same way — and there are still clear benefits of hormonal contraception. But for women who have struggled with the traditional methods, and have been left frustrated by the lack of adequate alternatives offered by their doctor, there are non-hormonal, side effect-free options worth exploring.
One such option is The Fertility Awareness Method (FAM). As the name suggests, FAM is about tuning into the fertile and infertile phases of your menstrual cycle by listening to your body’s physical signs and symptoms, so you can either avoid or achieve pregnancy. Understanding your body and fertility is some of the most empowering wisdom you can possess about your own health.
FAM is an evidenced-based method that relies on tracking tangible, physical symptoms including cervical mucus, basal body temperature and your menstrual cycle data (the length and patterns of your cycle). While this method is most commonly used to either avoid or achieve pregnancy, it’s useful for anyone who wants to become more body literate and better understand their gynaecological and overall health.
Benefits of FAM
- Can be used as an effective, natural, non-hormonal form of contraception.
- Can shorten the time it takes to conceive by giving insight into exactly when you are fertile and when to attempt conception each month.
- Does not contain synthetic hormones like many other forms of contraception, so does not interfere with your delicate hormonal system.
- Provides useful insight into your hormones and overall health.
- Empowers you by deepening the understanding of, and connection with, your body
- Is side effect-free, unlike many other forms of contraception.
- Is non-invasive, unlike some other forms of contraception such as IUDs.
- Is suitable for religious beliefs.
- Can be used throughout all phases of a woman’s reproductive life successfully, whether you have regular or irregular menstrual cycles, during adolescence, when coming off the pill or other forms of contraception, when breastfeeding or when in the peri menopause phase of life.
How it works
Shifting hormone levels throughout the menstrual cycle affect a woman’s resting body temperature and the volume and texture of mucus that is produced in the cervix. A healthy menstruating woman will have two distinct phases of her cycle — the follicular phase and the luteal phase — both of which have a corresponding temperature and mucus differences. Charting these changes daily provides you with a clear picture of the fertile and infertile phases of your cycle.
Many women are led to believe they can conceive every day, but in truth, there are only five to six days each cycle where conception is possible. While a released egg survives for just 12-24 hours, sperm can survive for up to six days, which means the fertile window lasts for up to six days. Outside of this window, a woman cannot fall pregnant.
In my line of work I often see women who are unsure about when this window is or indeed its existence; it’s no surprise then that many women are left frustrated and often heartbroken by their perceived lack of ability to conceive. One of my clients came to see me after three miscarriages, desperate for a healthy baby. After some pathology tests to rule out any concerns she had, I taught her FAM and prescribed some herbs, supplements and lifestyle and dietary advice. She fell pregnant soon after and has since given birth to a healthy baby.
Importantly, in situations such as these where a woman is worried she cannot conceive a healthy baby, FAM gives her a practical tool kit to track and, crucially, observe her healthy cycles. In this way, it’s a very comforting method; the evidence is right in front of your eyes.
“I now have a great understanding of my cycle and am more connected to reading the signs of my body,” one of my clients wrote to me recently. This is the most common feedback I get from those women to whom I teach FAM. Not only does the method successfully help you to avoid pregnancy or conceive, it’s a great tool for tuning into your body and learning to listen to its signs.
Basal Body Temperature (BBT)
When you are sleeping or completely relaxed, your core body temperature drops and this resting temperature is referred to as your basal body temperature. In the follicular phase of the menstrual cycle (the first half, before ovulation), a woman’s temperature will be lower than in the luteal phase (the second half, after ovulation). This is because progesterone, which is created after ovulation, increases a woman’s core body temperature by around 0.2 to 0.5 degrees Celsius.
How to chart BBT
Each morning around the same time, take your temperature orally and write it on your chart. When you are charting your temperature daily you will likely see a clear rise around mid-cycle, indicating ovulation has occurred. This temperature increase will remain high until your next period, or continue to rise if conception has occurred.
It is important to note that temperature readings are retrospective information, meaning they only show you post ovulation and do not indicate that you are about to ovulate, therefore BBT cannot be used to predict the beginning of your fertile window. Basal body temperature can confirm ovulation and help you feel confident in clearly identifying the fertile phase of that cycle. It also gives you clear insight into the length of your luteal phase, which is important information for your overall health. A short luteal phase, less than 12 days, is likely not an optimal fertile cycle, as not enough progesterone has been created.
It is preferable to have a temperature above 36.0 in the follicular phase. If your temperature is consistently lower than this, it may indicate hormonal or thyroid problems and it is important to have this looked into by your health practitioner. There are some things that can interfere with your temperature, so do note on your chart if any of the following apply to you: stress, late nights or disrupted sleep, overseas travel or travel to different time zones, illness or infection, overheating in bed, and moving around before taking your temperature.
Cervical mucus
Like your basal body temperature, cervical mucus is affected by the rise and fall of oestrogen and progesterone at different times of the menstrual cycle. Cervical mucus plays an incredibly important role in becoming pregnant, and research has shown that cervical mucus is the most reliable sign of fertility.
Mucus is primarily made up of water and as oestrogen rises in the follicular phase, the water content increases which thins and increases the volume of mucus produced by the cervix. As the mucus becomes thinner, the “mucus plug” that seals the cervix and prevents the entry of sperm slowly drips away, opening the cervix and allowing sperm to pass through. After ovulation, oestrogen levels decline and progesterone levels increase, thickening the cervical mucus once again, which causes the plug to reform at the base of the cervix and prevents sperm from entering.
Research has shown that observing your mucus changes throughout the day is the most accurate way of understanding your fertility.
How to observe mucus
Throughout the day, notice the amount and texture of your mucus when you go to the bathroom. If you do not have clear visual changes of mucus, tune in to how you feel at your vulva each day. An easy way to remember to do this is when you walk to the bathroom; tune in with the sensation you’re feeling at your vulva: do you feel dry, tacky, wet, slippery? You can cross check this sensation with what you see after you wipe your vulva from front to back with toilet paper.
Every woman is different when it comes to cervical mucus, so do not compare yourself to others; prioritise getting to know your own body. Chart down what you note each day without judgement and you will feel more confident as the weeks progress.
For example purposes only, this is a generalised pattern of mucus throughout a cycle:
- Menstruation: you will not be able to identify mucus clearly as blood and tissue disguise it.
- Early follicular phase: you may be dry and not notice any mucus, or you may notice an unchanging pattern of thicker mucus.
- Late follicular phase: you may notice your mucus thinning and becoming more translucent, indicating the beginning of your fertile window.
- Ovulation: you may notice a slippery type of mucus similar to raw egg white.
- Luteal phase: you may notice a sudden change in mucus, either back to dry or a thicker, tacky mucus that will stay this way until your next period.
You are in your fertile window as soon as you notice fertile-type mucus, and this is when you either abstain from intercourse or use a barrier method if you are using FAM for contraception. If you are using FAM for conception, you now know when to begin being intimate with your partner to increase your chances of conceiving.
The fertile window closes after counting three days of infertile-type mucus and three days of raised temperatures compared to the previous five. This may sound confusing, but as soon as you start charting, it becomes much clearer. Interestingly, trials by the World Health Organisation have shown that more than 90 per cent of women can identify the fertile phase and day of ovulation in the first month of observation and charting using FAM. There are some factors that can interfere with cervical mucus, including: surgery, infection, medication, smoking, hormonal imbalance, bacteria imbalance in vagina, under or overactive thyroid, stress, nutritional deficiencies, lubricants and douches.
As with any contraceptive method, there are limitations and considerations. FAM does not protect you against sexually transmitted infections, and if you choose to use this method for contraception, there will be a phase each month where abstinence or a barrier method of contraception such as condoms is required.
With perfect use, the fertility awareness method is up to 99.8 per cent effective as a contraceptive method, which research has shown to be comparable to the oral contraceptive pill. With typical use, however, the method is 76 per cent effective, so it’s necessary to undergo a “learning phase”, during which you use additional contraception.
Practising “perfect use”
- Learn the method from a skilled and qualified fertility awareness educator.
- Commit to a three-month minimum learning phase.
- Use an additional barrier method for contraception for a minimum of three months until you feel confident in understanding your fertile and non-fertile phases.
- Commit to continuous and complete charting each day.
- Have your charts reviewed by a skilful teacher who understands and uses the fertility awareness method herself.
- Ask for help when you are unsure.
- Have support from partners, friends and family.
While I have provided an overview of the basics of FAM here, I highly recommend learning this method from a trained fertility awareness educator who uses the method herself. By working with a trained practitioner, you will have step-by-step instructions and guidance on how to successfully and confidently use this method for contraceptive purposes, or for increasing your chances of conception. Remember we are all unique, and so are our fertility phases.
Ema Taylor is a naturopath, clinical nutritionist and certified fertility awareness educator. For more, visit emataylor.com or @emataylornaturopathy on Instagram.
