When we think of natural contraception most people think of unplanned pregnancy. Why? Because there are several ‘natural’ methods out there that simply don’t work. These methods are based on false assumptions and are not thorough enough to be reliable.
But what if there was a method that was as reliable as the pill, completely natural and didn’t mess with your hormones?
Well this method does indeed exist. Let me introduce you to the ‘Fertility Awareness Method’ or ‘FAM’.
If you have followed my blog previously, you may remember that hormonal balance is important for bladder health. And although the pill has been shown to help reduce UTIs in some cases, it has been associated with an increased risk of interstitial cystitis and can lower the production of our own hormones.
Long-term, messing with our hormones is probably not ideal and most recently the pill has been linked to depression  on top of the long list of potential side-effects included in the drug leaflet (including the potential increased risk of breast cancer).
I personally have experienced depression and mood changes on the pill and have sworn off hormonal contraception a couple of years ago.
The Bad Rap of Natural Contraception
Most people will probably be instantly put off when they hear the word ‘natural contraception’ and rightly so, as there are several methods that are not very reliable.
- The Rhythm Method: The rhythm method assumes that every woman’s cycle is reliably consistent over time using a statistical prediction based on past cycles to predict future cycles. This method also gave rise to the myth that ovulation usually occurs on day 14 and that the average cycle is 28 days long. In reality, cycle length and ovulation can vary significantly from cycle to cycle and from woman to woman.
- Withdrawal: Sperm may be present before ejaculation and if the woman is in the fertile part of her cycle one sperm could be all it takes. Also, timing of the withdrawal could be difficult.
- Temperature: Although temperature can indicate the shift between follicular (first half of the cycle) and luteal (second half of the cycle) phase, it is not adequate by itself to guarantee infertile days. Body temperature could also change due to thyroid issues, fever, calorie restriction etc.
However, FAM (and also ‘Natural Family Planning’ aka ‘NFP’) is very different from these methods and should not be put in the same box.
What is FAM?
FAM stands for ‘Fertility Awareness Method’, which is what it says: the awareness of one’s fertile days to prevent or achieve pregnancy.
It is a deep understanding of how the female cycle works that helps us determine exactly when we are or aren’t fertile.
To achieve this, we rely on three fertility markers: body temperature, cervical fluid and cervical position.
Combined, these markers tell us very precisely when we can or can’t get pregnant.
About the Female Cycle
You may remember some details about how the female cycle works from school but most of us are probably not overly familiar with the details anymore.
Every cycle, the body prepares for a potential pregnancy. This process is tightly regulated by four hormones: Follicle Stimulating Hormone (FSH), Estrogen, Luteinizing Hormone (LH) and Progesterone.
Here is the short form of what happens in each cycle:
- Under the influence of FSH, 15 – 20 eggs start to mature in each ovary. These eggs are encased in their own follicle, which produce estrogen. The biggest and most dominant follicle eventually releases an egg, which is when ovulation occurs. The other eggs that have started to mature disintegrate. Estrogen is the key hormone for ovulation to occur.
- This process takes around 2 weeks on average to occur but can take anywhere from 8 to 30 days or longer (which is the reason why the Rhythm Method is flawed).
- The rising levels of estrogen trigger and abrupt surge of LH, which causes the egg to burst through the ovarian wall and to tumble into the pelvic cavity where it is swept up by the fimbria (fingerlike projections) in the fallopian tubes.
- The follicle that held the egg collapses and becomes the ‘corpus luteum’, which starts to release progesterone. It has a life span of 12-16 days, 12 days on average.
- Progesterone has the following tasks:
- It prevents the release of more eggs in this cycle
- It causes the endometrium (uterine lining) to thicken and sustain itself until the corpus luteum disintegrates
- It causes a rise in body temperature, decreases in cervical fluid and changes in cervical position.
Therefore, once progesterone is being released, a pregnancy is impossible.
It is the 24 hour period around ovulation that we are fertile – only 1 day per cycle!
Men, on the other hand, are always fertile!
However, to increase our chances of becoming pregnant, the body produces cervical fluid, which is the female equivalent to seminal fluid in sperm. Both are designed to provide nourishment and motility to sperm and without this medium they would die. So without this medium in the vagina, sperm cannot survive.
Since survival is only critical during ovulation, this is also the time when the female body produces this fluid. It often starts being produced just before ovulation, as sperm can survive for a few days in this fluid.
Therefore, the quality and quantity of cervical fluid is an important fertility sign.
The cervix itself prepares for pregnancy every month by becoming soft and open and rising further into the vagina in order to provide a perfect gate for the sperm to enter into the uterus. The changes in the cervix are another sign of fertility.
How to Practice FAM
So I hope you have gathered from my above description that women have a very small window of fertility and therefore a large window of not being able to get pregnant. The knowledge of when this occurs is useful for both pregnancy achievement and prevention.
To practice FAM, we can measure the major fertility signs: temperature, cervical fluid and, for added peace of mind, cervical position.
To chart your cycles you can either use a pen and paper chart or a charting app (for example OvaGraph).
Upon waking, take your temperature (starting on day 1 of menstruation, the first day of the cycle) under the tongue before you move or get up and after you’ve had at least 3 continuous hours of sleep.
Ideally use a digital thermometer with at least 2 digits after the dot. This should happen at a similar time each day as temperature can change over the course of the day. Write the temperature in the chart.
In the follicular phase (first half of the cycle), the temperature should be lower and can vary by around 0.5 degrees.
In the second half of the cycle (the luteal phase), the temperature rises by at least 0.5 degrees above the highest previous number due to progesterone.
On the first day of menstruation in the next cycle, the temperature sinks again (unless pregnancy has occurred).
Outside of Menstruation there are four distinct qualities of cervical fluid: Nothing/dry, sticky, creamy, creamy and slippery and/or eggwhite.
Test the cervical fluid each morning by inserting a finger into the vaginal opening and then (without looking) first feeling the fluid and then taking a good look.
- Nothing/dry: No cervical fluid is present at all, any fluid present dissipates quickly and is clear.
- Sticky: This is usually white or yellow and can feel crumbly, gummy, springy with a dry feel to it.
- Creamy: This feels a bit like lotion or cream, milky and smooth and is usually white or yellow.
- Slippery/Eggwhite: This feels slippery and will usually stretch. It is clear, streaked or opaque, similar to raw eggwhite.
Nothing or ‘Sticky’ is infertile fluid. Creamy is getting fertile and the eggwhite fluid is the most fertile fluid.
The vaginal sensation is also important together with the fluid: a dry feeling with dry fluid indicates infertile days and a wet feeling with eggwhite fluid indicates fertility.
Note that the vagina can feel dry after the eggwhite fluid has passed on the same day.
To feel the cervix, insert a finger into the vagina and touch the cervix. On fertile days it should be low in the vagina, feel soft, has an open hole in the middle and feels wet.
On infertile days it should be harder to reach, feel firm, closed and non-wet.
It is an optional measurement but gives added security.
Start charting on the first day of menstruation.
The Four Fam Rules are:
- First 5 days rule: You are safe the first 5 days of the cycle if there was an obvious temperature shift 12-16 days before.
- Before ovulation, you are safe on every dry day: You are safe after 6 pm each day if cervical fluid was completely dry. Note that sperm can mask cervical fluid.
- Temperature shift rule: You are safe the evening of the third consecutive day of a temperature at least 0.5 degrees above the highest measurement of the first half of the cycle.
- Peak day rule: You are safe on the evening of the 4th consecutive day after your last most fertile day (as indicated by fluid and cervix).
Safety of FAM
Obviously, FAM cannot protect against STDs.
When practiced right, FAM is as safe as the pill.
During fertile days, the most secure measure would be to abstain. The other option would be to use barrier methods (such as condoms) and on these days contraception would be as safe as the particular barrier method used.
My description of FAM is merely supposed to be an introduction. For everyone who wants to know more or wants to practice this method I recommend reading the wonderful book Taking Charge of your Fertility by Toni Weschler.
There are several things that can change fertility signs, such as illness and travel through time zones, that are described in detail in the book.
Once the method has been learned, it only takes a couple of minutes each day to implement.
Even if you don’t want to practice this form of contraception, the knowledge of your own cycle will give you very valuable information about your health.
Every woman should be taught this knowledge, it is very empowering!
Now I’d like to hear from you: are you interested in using FAM? Have you heard of it before? Let me know in the comments!
Pin it for later:
Weschler, Toni Taking Charge of your Fertility (London: Random House, 2003)
- Grigg-Spall, Holly The pill is linked to depression – and doctors can no longer ignore it The Guardian October 2016 https://www.theguardian.com/commentisfree/2016/oct/03/pill-linked-depression-doctors-hormonal-contraceptives