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Fertility awareness methods (FAMs)

Fertility awareness methods (FAMs) cover a diverse range of methods:

  • Calendar-based methods
  • Observation-based methods (using one or more indicators of fertility)
  • Technology-based methods which include urinary hormone test kits and monitors.

The effectiveness of these methods relies on the accurate identification of the fertile time and the couple’s ability to change their sexual behaviour at fertile times in the cycle. FAMs are considered the least effective method of contraception. For other methods of contraception that are much more reliable, please see our Contraception Overview section.

Fertility or menstrual apps for smartphones are not licensed in the UK for use for contraception and the use of them is not supported by the national Faculty of Sexual and Reproductive Health (FSRH), the Royal College of Obstetricians and Gynaecologists or FertilityUK (see https://www.fsrh.org/news/fsrh-fpa-and-fertilityuk-call-for-more-independent-research-on/).

Combining the methods above (ie. using calendar tracking and observation methods and technology methods together to identify fertile times) will increase its accuracy. Effectiveness from typical use is usually 70-80% effective. This means 2-3 in every 10 women using this method will be pregnant within a year.

We strongly recommend that to get maximum effectiveness, you should consult with an experienced FAM practitioner (see section below “For more information”).

The effectiveness of FAMs relies on a number of factors: The chosen method(s) and the reliability of the fertility indicators, the quality of instruction, the user’s ability to observe the indicators and follow the guidelines, the age of the woman, the frequency and timing of intercourse and whether barrier methods (or avoidance of sex) are used during the fertile time (the fertile time may be more than 1 week of the cycle). This explains why there is such a wide variation in effectiveness. See “Risks” section below for information on lifestyle changes that can disturb the charting of your fertility.

  • Methods of FAM

    This is an initial overview of the methods of FAM. For more detailed information on how to use these methods you should consult with an experienced practitioner and visit https://www.fertilityuk.org/. See the section “For more information” below.

    Waking temperature

    • The first indication of fertility is temperature change, which is very subtle and relies on you accurately recording your temperature when you wake up every morning.
    • In order to detect the subtle change, the temperature must be taken on waking, before getting out of bed, at the same time each morning and after sleeping for at least 3 hours. This means it cannot be used by people who have had disturbed sleep such as  working shifts, after a night out, or when travelling across different time zones.
    • Temperature needs to be recorded every day on a special chart (see section below “For more information”).

    Cervical secretions

    • The hormones estrogen and progesterone cause subtle changes in the cervical secretions throughout the menstrual cycle.
    • These secretions either encourage or prevent sperm penetration into the womb.
    • As ovulation approaches the secretions become wetter, more transparent and slippery – sperm can move rapidly through these highly fertile secretions. The last day of the wetter secretion is known as peak day – this is usually close to ovulation. Peak day can only be recognised retrospectively on the day following peak when the cervical secretions have become sticky or dry again.
    • The secretions are observed throughout the day and recorded on the chart in the evening (see section below “For more information”).

    Changes in the cervix

    • Cervical changes can give warning of the start of the fertile time. You need to be comfortable examining your own cervix for this to be useful. Your cervix is neck of the womb. You can feel it by putting a finger into your vagina and feeling for a lump that will feel like the end of your nose.
    • Just after a period, the cervix is low and easy to reach. It feels firm, and the cervical opening feels closed.  If you feel along the length of the cervix it feels quite long, and some women notice that it feels tilted to one side.  It is generally quite easy to reach at this stage. As the estrogen levels rise, the cervix rises higher up, becomes softer and shorter in length.  It is now harder to reach with the finger-tip and may feel straighter in position. The cervical opening feels slightly open. It takes almost a week for the cervix to change from its lowest closed position to its maximum height and openness.  After ovulation, under the influence of progesterone, the cervix changes back within about 24 hours to its low, firm, closed, tilted position.
    • The changes in the cervix can be recorded on the chart (see section below “For more information”).

    Calendar calculations

    • There is always a risk of pregnancy from intercourse in the early part of the cycle but a personalised calculation based on past cycle lengths can help to identify the start of the fertile time and improve the effectiveness of FAMs.
    • For this to be a helpful addition, you need to have an accurate recording of at least your last 12 cycles (ie. one year of accurate dates for your periods). Phone apps can be helpful for this part, though these are unregulated and should not be depended on alone.
  • Lactational Amenorrhoea Method (LAM)- Breastfeeding

    Exclusive breastfeeding (not using any other methods of feeding your baby) can be an effective contraceptive methods for the first 6 months of your baby’s life.

    How does LAM work?

    The hormone prolactin, which is produced towards the end of pregnancy, stimulates the the production of breast milk. It also effects the ovaries, preventing the release of an egg (ovulation). Each time the baby feeds at the breast, it stimulates the secretion of prolactin. The level falls again after 3-4 hours. Provided the baby feeds frequently the prolactin level remains high, the milk supply is maintained and ovulation is suppressed (this includes frequent feeding overnight).

    How effective is LAM?

    LAM is up to 98% effective if:

    • The baby is less than 6 months old
    • The mother is exclusively (or almost exclusively) breastfeeding day and night
    • Her periods have not returned

    CAUTION: Bleeding is a warning sign of fertility, but some women will ovulate before their first period, so it is possible to go straight from one pregnancy to another without having a period.

    What are the advantages of LAM?

    • It is safe for woman and baby
    • There are no physical side effects

    What are the disadvantages of LAM?

    • A number of factors can influence how effective LAM works including less frequent feeding (especially at night), baby sleeping through the night, introducing any other feeds (e.g. formula), using a dummy as a comforter, expressing milk, anxiety and stress or illness in mother or baby, age of the baby (it is not reliable after 6 months).
  • What are the advantages of FAMs?
    • Using fertility awareness makes you more aware of your fertility and can help to plan a pregnancy or avoid a pregnancy.
    • There are no physical side effects.
    • It can help you recognise normal and abnormal vaginal secretions.
    • It’s acceptable to all faiths and cultures
  • What are the disadvantages of FAMs?
    • It takes up to a year to learn to use effectively. During this time, people are encouraged to use condoms.
    • It is not deemed a very effective method of contraception (the least effective compared to all other types).
    • You have to keep daily records very accurately.
    • Some events, such as illness, lifestyle changes, stress or travel, may make fertility indicators harder to interpret. See “Risks” section below.
    • You need to avoid sex or use condoms during the fertile time.
    • Fertility awareness methods don’t protect you from sexually transmitted infections (STIs).
  • Are there any risks using FAMs?

    The risk of pregnancy for those not used to using FAMs is high. You should consult with an experienced practitioner if you are motivated to try this method of contraception, and it may take up to a year of tracking to be confident in your knowledge of your cycle.

    Any disturbance or change from normal routine can influence the various methods and should be noted on the chart.

    Some disturbances affect specific indicators of fertility whilst others cause more generalised disruption to the menstrual cycle.

    Disturbances include:

    • Alcohol
    • Late night, disturbed sleep, oversleeping (lie-in)
    • Holidays, travel, particularly air travel and crossing time zones
    • Shift work, particularly night shifts
    • Daylight saving / changing the clocks
    • Stress and anxiety
    • Rapid weight loss or gain
    • Intensive exercise
    • Illness: acute or chronic
    • Some bought or prescribed drugs and some herbal remedies
    • Abnormal vaginal discharge
    • Gynaecological conditions such as polycystic ovary syndrome (PCOS)

    Each woman’s response to disturbances will vary and some disturbances will be more prolonged than others. It may not be possible to interpret disturbed charts. 

  • For more information

    Fertility UK has some very helful and detailed information on FAMs, as well as downloadable charts to help you get started.

    https://www.fertilityuk.org/

    If you are motivated to use FAMs alone, it is highly advisable that you consult with an experienced practitioner. You can find your nearest practitioner here. This is a private service that you may have to pay for.

    Our national organisation, Faculty of Sexual and Reproductive Health, has also written national guidance (this is mainly for medical professionals but you may find this helpful information) https://www.fsrh.org/standards-and-guidance/documents/ceuguidancefertilityawarenessmethods/

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