What is the Fertility Awareness Method?

If you're trying to conceive, or even if you're not but you don't use contraceptives such as birth control, it's super helpful to understand when you're most fertile and when you aren't. The goal of the Fertility Awareness Method (FAM) is just that, to track your cycle and ovulation to best predict how fertile you are on any given day.

FAM can include a number of different methods for tracking the menstrual cycle and fertility, including:

  • Calendar: for women with regular cycles, sometimes just noting the last menstrual period can give you a sense of when you're most fertile, this is usually the method that most women start with.
  • Temperature: by taking your basal body temperature (BBT) each morning and entering the values on a chart, it shows trends about what your hormones are doing and when you ovulate.
  • Symptoms: vaginal discharge often increases around ovulation because the cervix produces more fluid, referred to as cervical mucus. Observing these changes also gives clues as to when you're ovulating. Cervical position, and for some women ovulation pain, are also indicators that are observed.
  • Hormonal tests: there are urine and saliva tests available that can quite accurately tell you when you're ovulating.

I use FAM with several of my patients, but in very different capacities. For example, a woman who is actively trying to conceive and has been for a while may use every one of these methods to pinpoint exactly when her egg finally drops each month. Whereas, a women who wants to better understand her cycle but is not trying to conceive may just use the calendar method to observe trends throughout her cycle and try to notice when she's ovulating.

 

So when are you most fertile?

Sperm can live in the female reproductive tract for up to 5 days, which means sex well before you actually ovulate can result in pregnancy. Therefore, it's less helpful to think of the day of ovulation as peak fertility, and more realistic to think of the 7 days surrounding ovulation as your fertile window (5 days before, the day of, and the day after ovulation.)

Keep in mind, signs of ovulation don't occur until just days before ovulation, so the fertile window can open well before you know ovulation is about to happen. Therefore, FAM relies more on observing and predicting fertility patterns rather than getting a definite yes or no answer in the moment as to if you're fertile, especially if you're just starting out.

Some women's ovulation is quite predictable, occurring roughly on the same day every cycle. Some women's ovulation is not, meaning it can move around more drastically, sometimes as much as a week or more from when it occurred last cycle.

The length and regularity of your menstrual cycle is a rough indicator of which camp you fall in, for example, if you have a 28 day cycle on the dot every single month, your ovulation probably happens regularly too. If your cycle has quite a bit of variance - 26 days this month, 35 days next month, etc. - then your ovulation likely moves around with it. With a few cycles of using FAM under your belt, you start to get a sense of which you are, and therefore if you're fertile window is more of a fixed or floating one. 

 

Who is FAM right for and who is it not right for?

FAM can be used by any women who is not currently taking hormonal medications, however, if you're on birth control pills, an IUD (even the "non-hormonal" ones,) or using hormonal medications for a procedure such as IVF, then FAM won't be able to effectively tell you much about your hormones and/or ovulation, and is therefore not recommended for use.

If you aren't on hormonal medication and you're trying to conceive, FAM can be incredibly effective for helping you to get pregnant. If you plan on using FAM for birth control, however, it should be chosen with caution, it's not the best choice for all women.

For women with regular cycles and fixed fertile windows FAM works wonderfully, whether you're trying to conceive or avoid getting pregnant, sometimes just the calendar method alone can be effective enough at avoiding or achieving pregnancy. Still, for those wishing to avoid pregnancy, I often suggest using FAM in conjunction with other forms of contraceptives, such as barrier method, abstinence, or avoiding penile-vaginal intercourse during the fertile window, especially when you first start using FAM and you're still getting used to when you're fertile window is. Some women feel comfortable using withdrawal (aka "pull and pray") with their partner during their fertile windows, but it's not advised if you truly wish to avoid pregnancy.

For those with a floating fertile window who are trying to conceive, FAM is one of the few options for actually spotting ovulation when it happens or is about to happen in order to time intercourse for conception. Especially women with long menstrual cycles, such as those with PCOS who sometimes have 60+ day cycles, I've seen many of them use FAM to spot ovulation, time intercourse, and get pregnant.

It's a much trickier roll of the dice, however, for those with floating fertile windows who are trying to avoid getting pregnant, since the fertile window can open days before any ovulation signs have presented themselves. Although FAM can be helpful for these women to better understand their cycles and hormonal patterns, women with irregular cycles and ovulation patterns aren't often recommended to use FAM solely for contraceptive purposes.

For these women, once again, using it in combination with barrier method, abstinence, or avoiding penile-vaginal intercourse during potentially fertile phases can be much more effective for avoiding pregnancy. Especially if using temperature charting and/or hormonal tests to pinpoint ovulation, the beginning part of the cycle (when you get your period until you ovulate) has much higher potential for you to be fertile, whereas the second half of your cycle (a few days after you ovulate until when you get your period again) has a much lower potential to get you pregnant.

Keep in mind, high levels or stress, changes to your routines/schedules, travel, illness, diet, and lots of other factors can cause one of your cycles to deviate from your usual patterns, which means FAM is not the most effective form of birth control. Especially for teens, women in their 20s, or women with a history of being hyper-fertile, it may not be the right choice of contraceptive.

Consult with a healthcare professional who is trained in FAM to help decide if it's right for you before incorporating it into your routine. Often midwives, sexual/reproductive health educators, and acupuncturists and/or herbalists who specialize in fertility and reproductive health are trained in teaching and working with the Fertility Awareness Method, but ask specifically before booking an appointment.

 

Want to know more?

I've worked with hundreds of women who are trying to conceive or to better understand their menstrual cycle and reproductive health. Time and time again I've found FAM is one of my most effective tools for doing that. If you'd like to work with me, I'd be happy to walk you through FAM step by step and help you to find which methods works best for you.

If you're up to doing some reading, Taking Charge of Your Fertility by Toni Weschler is considered the FAM bible, I always have 2 copies on hand in my clinic for loaning out to patients!