Fertility Awareness Methods

Fertility awareness methods (FAM) are used to help someone determine when they are most fertile each menstrual cycle to prevent or plan a pregnancy.

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The aim of FAM is to recognise when ovulation is approaching (fertile phase begins) and when it has passed (fertile phase ends).

The various methods use different signs to determine the beginning and end of the fertile phase. Those wishing to prevent pregnancy can use this information to avoid unprotected vaginal sex during their fertile phase.

Each method can be used alone, but if you combine different methods you may be able to more confidently determine your fertile phase.

Factors to consider when using FAM:

• Ovulation occurs only once in each cycle.
• Menstruation occurs 11-16 days after ovulation.
• The egg lives 12-24 hours.
• Sperm may live for up to 7 days in the uterus and fallopian tubes – this means that if you have sex as much as 7 days before ovulation you may still get pregnant.

What can be done on fertile days to avoid pregnancy?

• Avoid sex completely.
• Avoid vaginal intercourse only (e.g. have oral sex).
• Use a barrier method during sex (e.g. condom or diaphragm).

• Can be used by most ovulating people who are able to commit to the time and effort necessary to understand and use it correctly.
• Those with regular cycles may have more success in avoiding/achieving pregnancy with FAM.
• FAM cannot be learned or used while taking hormonal contraception (e.g. the pill, hormonal IUD) because they cause temporary changes in the natural menstrual cycle.

Effectiveness of FAM can vary depending on whether one method or a combination of methods is used.

It is more effective for avoiding pregnancy when used consistently and correctly, with no vaginal sex during the fertile phase. If you decide to have sex during the fertile period, you can use barrier methods in order to reduce the chance of pregnancy.

To ensure you are using FAM correctly, you should talk with a specialised educator, take a class or read a book on the specific method/s. There are also many apps available to assist with tracking menstrual cycles, but their ability to predict the beginning/end of the fertile phase should not be relied on.

If you are worried that you have miscalculated your fertile time and had unprotected vaginal sex during an unsafe time, you may want to consider emergency contraception.

Different methods of emergency contraception are available, such as emergency contraceptive pills and the copper IUD. Emergency contraception is most effective when used as soon as possible after unprotected sex, so visit a doctor, pharmacist, or ring the Sexual Health Helpline as soon as possible.

• Estimates when ovulation will happen based on a record of past cycles.
• After tracking the length of their cycles, preferably over a period of at least six months, a person uses this data to calculate their first and last fertile days.
• Unprotected vaginal sex should be avoided during this fertile phase each cycle.

As cycle length can vary considerably, the calendar method is very unreliable and is not recommended to be used on its own. The main use of this method is to provide a double check with another FAM on when fertile days may start.

• Identifying the start and finish of your fertile phase by monitoring changes in your cervical mucus.
• As oestrogen levels rise approaching ovulation cervical mucus becomes clear, slippery, more watery and elastic. These changes mark the beginning of the fertile phase. Unprotected vaginal sex should be avoided at this time to prevent pregnancy.
• After ovulation the mucus once again becomes dry and sticky and there may be a dry sensation at the vulva.

Vaginal infections or surgery of the cervix which interfere with production of mucus may affect the use of this method. Semen (cum) can also interfere with mucus readings.

• Uses the Basal Body Temperature (BBT) to identify your fertile period, this is the temperature of the body after at least three hours of rest.
• The temperature must be taken every morning immediately after waking and before getting out of bed, smoking, eating or drinking. A digital thermometer is recommended because it measures small temperature changes accurately and quickly.
• Before ovulation the BBT will be relatively lower. After ovulation, the BBT usually rises several tenths of a degree, and remains up until the menstrual period begins. Individuals will need to determine their personal pattern of temperature shifts.
• When using this method alone to avoid pregnancy, unprotected vaginal sex should be avoided from the end of menstruation until at least three days of higher temperatures have been recorded.

Other factors can influence BBT affecting the accuracy of this method (e.g. fever, taking drugs, disturbed sleep, travel, stress, and electric blankets).

Other body signs used to determine ovulation may include:

• Cervix changes – position, softening or opening.
• Slight pain or feeling of heaviness in the lower abdomen in the area of the ovaries, often on one side or the other.
• Slight and temporary bleeding (spotting)
• Breast tenderness.

LAM is the use of breastfeeding as a contraceptive method. Breastfeeding has an effect on the production of hormones that reduces the probability of ovulation, which reduces the chance of pregnancy.

This method can be used by those:

• who are fully breastfeeding (no artificial feeds, supplements or solids) and
• whose baby is less than 6 months old and
• who have not had any bleeding (other than during the first eight weeks following the birth).

• No health risks or side effects.
• Can be used to prevent or plan a pregnancy.
• Can be quite effective if used correctly.
• Acceptable to those with religious or cultural concerns about birth control.
• Can be low cost.

• Learning FAM takes time and effort.
• Using FAM requires a commitment to keeping careful note of daily body changes.
• Even with correct use, the failure rate is often higher compared to other methods.
• Sexual partners must be prepared not to have vaginal sex or use a barrier method during the fertile time to avoid pregnancy.

FAM does not protect against sexually transmissible infections (STIs).