A Fertility Awareness Based Method (FABM) is any method based on the principles of fertility awareness, using real-time observations of fertility signs, sometimes in conjunction with calculations based on previous cycles. A sympto-thermal method is any FABM that involves keeping track of your cervical fluid, cervical position and feel—this is the sympto part, since these are symptoms of the different phases of your cycle—and your waking temperature—the thermal part. These types of methods are usually referred to colloquially as FAM (for Fertility Awareness Method). The method that I teach is a sympto-thermal FAM. Some FABMs are sympto-only (relying on cervical fluid observations alone), some are thermal-only (relying on waking temperature alone), and some incorporate calculation rules and various types of fertility monitoring tests and devices in addition to these observations. FABMs showcase a wide range of effectiveness at preventing pregnancy that depends on various factors; see more on effectiveness below.

The Knaus-Ogino Calendar Rhythm Method, more popularly known as "the rhythm method", is not a true FABM, since it does not rely on real-time observations*. This method uses calculations based on past cycles, as well as generalized assumptions about cycle length and timing of ovulation, to predict when the fertile wave will happen in each cycle, regardless of whether or not it actually occurs at that point. This method may be fairly effective for people who have a very specifically-timed and extremely regular cycle, but since most people don't have "textbook" cycles, overall this method, as any calendar-based method, has a significantly lower effectiveness rating than sympto-thermal FAM.

*Some people like to consider the rhythm method as an FABM anyway, since it is another tool for identifying fertile times, and since, in many ways, it is an important scientific ancestor of current FABMs. Personally, I don’t like to lump it in with methods that are actually promoting awareness and body literacy, and prefer to keep a firm line between what I see as pretty distinct practices.

Different FABMs have different effectiveness ratings, due to the variety of practices out there and the rules involved in each. According to the frequently-updated manual, Contraceptive Technology, overall FABMs have an 85% “typically use” effectiveness rating, but sympto-thermal methods have a 98% typical use rating, and a 99.6% perfect use rating (more on typical vs perfect use below). Their comprehensive contraceptive method comparison chart is available here. (When viewing, keep in mind that they have turned the statistics around, and are displaying the failure rates, rather than the success rates!)

These high efficacy ratings come from what is considered the most comprehensive study on any FABM to date, a 2007 German study, which found a sympto-thermal method (called Sensiplan) to be 99.6% effective with perfect use*, which is comparable to hormonal birth control! In this study, researchers analyzed data from 900 practitioners who had all been trained in a very particular method (with rules being very similar to the type of FAM that I teach), over the course of 13 cycles. The typical use rating was 98.4%, which is still pretty high; compare this to the condom, which has a perfect use rating of 98% and a typical use rating of 82%.

What’s the difference between perfect and typical use? Perfect use means you’re following all the rules, all the time. Typical use is when you add in forgetfulness, misunderstandings, a bit of carelessness... it’s closer to how the average user will tend to practice over time But with the right education and some diligence, it’s not hard to be a perfect user!

*It’s important to note that this effectiveness rating is based on abstaining completely from intercourse and genital-to-genital contact during the fertile phase. Using a barrier or practicing withdrawal lowers the effectiveness slightly, as these methods have their own failures to take into account. However, in this same study, a subset of participants who used condoms during their fertile phase had a perfect use rating of 99.4%, only slightly lower than those who abstained.

Natural Family Planning (NFP) is a major branch of the FABM tree that is religious in origin and practice, having come out of the Catholic Church, whereas the Fertility Awareness Method (FAM) branch tends to be secular. The material behind both is based on the same general physiology and understandings/interpretations of our cycles, but the ways in which this information gets shared tends to be where we see the biggest differences.

In general, NFP classes are taught to married heterosexual couples only, and, when avoiding pregnancy, the fertile wave is considered a time for complete abstinence from all types of sexual contact.

In contrast, secular FAM is open to anyone wishing to learn, inclusive of gender identities and expressions, sexual orientations, and various family/relationship statuses. Practitioners are encouraged to make their own decisions during the fertile wave regarding whether to engage in complete abstinence, other types of sexual intimacy not involving genital-to-genital contact, or use of a barrier method, withdrawal, or herbal contraceptives, keeping in mind that using other contraceptive methods may increase the risk of unintended pregnancy, as these methods have their own failure rates.

While there is certainly a range of approaches within the greater FAM branch, the method I teach is strongly rooted in reproductive rights and reproductive justice. I approach this material as one piece in a much bigger puzzle of contraceptive options, and firmly believe that it is the birthright of those of us born with ovaries to hold sovereignty over our bodies and our reproductive processes, and to be able to manage our own fertility free from the confines of governmental and medical-pharmaceutical entities, if we so choose.

First, let me establish something critical here: you are not fertile every day of your cycle. A person who produces sperm is fertile every day (meaning that their sperm could potentially fertilize an egg at any time, on any day, during their decades and decades of reproductive maturity), but a person who produces eggs is not. You can only conceive during a handful of days out of each menstrual cycle. Thus, the goal of using FAM, either to avoid OR to achieve pregnancy, is to identify which days these are. And really, it's not as hard as you might think.

There are a few key hormones at play here: follicle stimulating hormone (FSH), estrogen, luteinizing hormone (LH), and progesterone. As the levels of these hormones change throughout each cycle, we see their effects show up in different ways. For instance, the rise of estrogen in the first part of the cycle leads to an increase in—and changes in consistency of—our cervical fluid; after ovulation, the rise of progesterone thickens and dries up that fluid. This is the pattern we’re looking for when we check our cervical fluid daily. Another important piece is that estrogen has a cooling effect on the body, whereas progesterone has a warming effect on the body. Progesterone levels only rise once ovulation has taken place, so this sudden rise in body temperature is what we’re looking for when we take our waking temperature each morning.

In terms of knowing specifically when you’re fertile or not, there is a very specific pattern of hormonal increase, involving FSH, estrogen, and LH, which must happen in a certain way in order to trigger ovulation, or the release of an egg from an ovarian follicle. The build-up of estrogen, which manifests as an increase in cervical fluid, tells us that we are nearing ovulation, but we can’t be 100% sure that ovulation has actually happened unless we also see our temperature rise.

We use the information we get from observing these changes, in conjunction with some protocols based on other things we know about the menstrual cycle, about the life span of an egg and the life span of sperm, and mix it all together on a chart that helps us to visualize and keep track of everything that’s going on. This information tells us whether or not we are fertile, or in other words, whether unprotected intercourse (or insemination for folks wanting to get pregnant without the use of a penis) could result in pregnancy.

The cycle tracking app business has really boomed in the last several years. There are SO MANY apps out there, some of which are advertised specifically to help with getting pregnant, some of which are more general “period trackers”, and even some that specifically claim to help you avoid pregnancy.

While these apps all have their little quirks and design/formatting differences, one thing remains that makes the vast majority of them unfit for use if you’re really trying to avoid pregnancy: they use algorithms to predict your fertile window and your next period. Why is that a problem? Well, when you’re serious about using FAM to avoid pregnancy, the thing that you really need to get good at is observing and interpreting your own real time fertility biomarkers, and if you have an app that is feeding you information based on average cycle length—nothing to do with your own cycle—that information is likely to be off and could be really confusing, causing you to distrust your own body’s signs in favor of the algorithmic predictions.

When I’m working with someone who wants to learn FAM to avoid pregnancy, I always have them start out charting on paper, because there are no algorithms trying to override your observations. Once you’re really comfortable interpreting your own charts, whether you keep charting on paper or switch to an app is up to you—but there is only one app at this time that I recommend using: Read Your Body. This app was actually created by sympto-thermal fertility awareness educators and is basically like a nice colorful comprehensive paper chart that fits on your phone; there are no algorithms or predictions. Two other things I really like about it:

• They never sell any of your data (as opposed to most other fertility/cycle tracking apps)

• They have method settings templates so that the language and specific tools used match with whatever method you’re learning. This can be really helpful considering how many different methods there are out there!

If your goals are to monitor your health or to get pregnant, the presence of algorithmic predictions isn’t quite as critical, but they can still fall somewhere on a spectrum from harmful to annoying, so I don’t recommend using any other apps for these purposes either.

No, FAM does not offer any protection against sexually transmitted infections (STIs), so if you’re at an elevated risk, this may not be the best method of contraception for you. However, you can still practice Fertility Awareness to track your cycles and increase your body literacy, even if you’re also using condoms or another barrier method!

By tracking when you’re most fertile, you can time intercourse or insemination optimally in conjunction with ovulation. Although this sounds really simple, most of us were not taught this most basic piece of information at any point along our reproductive journey.

If you have been trying to get pregnant unsuccessfully, charting your cycles can also give you clues about your hormonal health, often a main factor behind fertility challenges.

If assisted reproductive technology is part of your plan, you can use FAM as an adjunct, to help things along and be more empowered throughout the process. Unfortunately, many doctors have little knowledge of the physiology of ovulation and menstrual cycles, and don’t quite understand how to optimally time insemination to achieve pregnancy without the use of ovulation prediction/detection tests (which can be invasive and time consuming) and fertility drugs (which can be expensive and have serious side effects). Many medical fertility treatments are not tailored to individual cycle variation, and, despite all of their new and expensive technology, can fail due to poor timing, and can lead to unnecessary interventions, cost, and worry.

However you're planning on achieving pregnancy, knowing the parameters of your own cycle—when you enter your fertile wave, what your most fertile cervical fluid looks and feels like, what a typical ovulatory pattern is like for you, and what normal variation looks like—is going to be an enormous asset to your reproductive journey. Getting to know your cycle is the first step toward a healthy pregnancy.

There are so many things we can learn about our bodies when we pay close attention to the stories told to us by our fertility signs: waking temperature, cervical fluid, and cervical feel and position. Their patterns give us clues as to whether our hormones are working in concert or are out of whack; whether we are getting optimal nutrition or have some deficiencies to address; whether or not we are getting enough good-quality sleep; whether our stress levels are manageable or getting out of hand, and more. If you have a specific challenge you’re dealing with, such as hypothyroidism or PCOS/reproductive metabolic syndrome, charting your cycle can help you find some answers and lead you in the right direction toward achieving greater wellness. If you have experienced reproductive or sexual trauma and are wishing to gently reconnect with certain parts of your body, the practices around fertility awareness can be a powerful and empowering healing tool.

Many people consider the menstrual cycle to be the "5th vital sign," and indeed, if the parameters of one’s cycle were considered as important as one's pulse, blood pressure, respiratory rate and body temperature, we'd be a long way toward a greater understanding and appreciation of the physiology of half of the population (who is currently vastly undervalued in Western medicine). Normalizing the incorporation of menstrual cycle and fertility-based knowledge into standard medical repertoire is an important goal, and something that Fertility Awareness Educators worldwide are deeply invested in.

Whether your goal is to get pregnant, to avoid pregnancy, or simply to learn more about your body, finding out how your hormones are doing is always going to be a good move. If you're planning to procreate at any point in the future, it's important to know that having a solid foundation upon which to build and nourish a new life will make a lot of difference. There's no one-size-fits-all when it comes to optimum health, dietary choices, and lifestyle considerations, which is why working with knowledgeable practitioners can benefit you as you work on putting together the pieces of the puzzle of your overall reproductive health.

Maybe you never really paid much attention to your menstrual cycles because you weren’t in relationships in which pregnancy was a concern, and now you’re feeling ready to connect to your body in a new way, or you’re wondering if everything is “working right.” Or maybe you have irregular cycles, and are wanting to figure out what’s behind that. Or maybe you are starting to think about having a baby, and unsure of your options or overwhelmed by the world of assisted reproductive technology. Wherever you are, and whatever your story, Fertility Awareness can be a vital part of your journey.

If you're wanting to know more about your general reproductive or hormonal health, check out the above section (How can FAM help me with my reproductive and hormonal health?). If you're wanting to get pregnant, see the one before that (How can FAM help me get pregnant?) for more details on how you can track your cycle and increase your chances of success when it comes to insemination.

In my consultations and classes, I use inclusive terminology and don’t make assumptions about who you are and how you identify or express your gender and sexuality. It is really important to me to dismantle heteronormativity and cisnormativity in my work and in my community every chance I get. I recognize that the work around fertility awareness is rife with these normativities and assumptions, and I strive to create a space where more people feel included, welcomed, listened to, and taken seriously.

While it’s perfectly wonderful and useful to start learning about FAM while you’re using hormonal birth control (HBC) or have a copper IUD, these methods will prevent you from actually practicing. If you’re on HBC, your cycles are being suppressed by the synthetic hormones in your pill/patch/ring/shot/implant/hormonal IUD, so taking your temperature and checking your cervical fluid daily won’t tell you anything; your observations will be pretty much the same each day, not resulting in a noticeable fertility pattern of any sort. If you’ve got a copper IUD, you don’t have synthetic hormones entering your system and you may be ovulating, so charting your daily waking temperature could result in a noticeably biphasic pattern. But, the copper in the IUD interferes with your cervical fluid production, making it thicker and harder for sperm to penetrate, so observing your fluids won’t give you much useful information.

I get this question pretty frequently from people who want to take my class or work one-on-one with me, and are nervous about giving up the contraceptive method they’re accustomed to using. It can be a big deal to take that step, and I’m happy to support you through it! I always encourage my clients who are trying to avoid pregnancy to use condoms for a minimum of 3-6 cycles, depending on how quickly they are able to ascertain their fertile patterns. When used smartly, condoms are very effective and they won’t mess with your temperature readings or cervical fluid observations (just don’t use spermicidal condoms, as the chemicals on them can actually interfere with your fluids!). For folks who are already pros at using withdrawal, that can be a great option as well. As you learn to understand your cycle, you will be able to introduce unprotected intercourse at certain times sooner than at others.