2022 was a unique year to be a woman. TikTok trends left you asking questions like, “Are my hormones imbalanced? What is hormone imbalance? Are my birth control pills causing infertility?”
While the birth control pill and the IUD (Intrauterine Device) can be incredibly helpful for some women, many others have started turning towards the fertility awareness method, or FAM, as a form of birth control, family planning, or to simply feel better within their bodies.
What is the fertility awareness method?
“Fertility awareness-based methods use the biological signs of ovulation to help users understand when ovulation is approaching and thus pregnancy is possible, [it also indicates] when ovulation has happened and the opportunity for pregnancy has passed for that cycle,” explains Vienna Farlow, Holistic Reproductive Health Practitioner & Justisse Method Certified Fertility Awareness Educator; and owner of The Cuntsultant.
According to the CDC, there are two main types of FAM, one that focuses on your unique menstrual calendar and one that is informed by your cervical mucus and basal temperature.
Dr. Minkin, clinical professor at the Department of Obstetrics, Gynecology, and Reproductive Sciences at Yale Medical School, explained how symptom-based FAM can work:
“Fertility awareness type testing is based on checking the cervical mucus to see if it thins out, which in general happens around the time of ovulation. Another variety is to check basal body temperatures [because] right before you ovulate, your temperature goes down a bit, and after you ovulate, it goes up a bit.”
Tracking symptoms and your menstrual calendar can be beneficial whether you’re trying to conceive or simply hoping to understand your body’s cycle better.
What's the difference between the fertility awareness method and the rhythm method?
If you're choosing to abide by the fertility awareness method, it's important to understand what it is and isn't. For instance, a common misconception is that FAM and the "rhythm method" are the same.
“It's important to note that fertility awareness is not the same thing as the rhythm method — fertility awareness considers what is happening day by day in the menstrual cycle, whereas the rhythm method assumes how the cycle will progress based on previous cycles,” explains Farlow. “Since ovulation doesn't always happen on the same day in each cycle, not paying attention to the signs of ovulation can lead to unintended pregnancy.”
Another often overlooked detail is that FAM’s accuracy is sensitive to changes in someone’s menstrual cycle, whether it varies by a single day or multiple days.
“In general women will ovulate about 14 days before their next period, so some folks will calculate their shortest cycle, and then their longest and avoid sex in the window that they might be ovulating,” explains Dr. Minkin. “With a 25-day cycle you ovulate around day 11 (counting the first day of your period as day 1) in a 35-day cycle you ovulate around day 21. So for someone like this, who goes from 25 to 35-day cycles, they should probably avoid having sex in general from about day 9 to about day 23, so that's not giving them a lot of good days.”
Farlow dedicates her career to educating people on fertility awareness methods to close the knowledge gap and empower women to choose a birth control or family-planning method that works best for them without being limited in their options.
“Since efficacy is based solely on your ability to observe, interpret, and act on the signs you see, you need to feel confident in your understanding of times of fertility,” explains Farlow. “It can take several cycles to start feeling confident and a qualified educator can guide you through this process. Fertility awareness also takes a great deal of personal responsibility and dedication. You can't learn everything about your cycles overnight or even over a week and in most cases, you'll need to make observations and track them daily.”
What are the potential disadvantages of the fertility awareness method?
Noticing your menstrual cycle over a series of months can help you determine whether FAM is a good option for you in the long run. Taking special notice of when you ovulate month after month is one of the most important details, explains Dr. Minkin:
“...Some women will ovulate early one month or later the next and sperm can hang around in the body for up to a week, so if you happen to have sex a couple of days before you ovulate, you may have sperm hanging around which can get you pregnant and similarly even if you are a couple of days post-ovulation, the egg could remotely be fertilizable.”
You’ll also want to determine whether you have the time and emotional bandwidth to track your body’s symptoms daily.
Farlow suggests that the fertility awareness method isn’t the best option for anyone who isn’t able to check and track their symptoms regularly.
“If you find your observations are confusing or you're not confident in how you're using the method, then you should consult with a qualified educator to see if this can be clarified or find another contraceptive option,” encourages Farlow. “If you're not seeing any signs at all of ovulation, then it's important to check with your doctor to understand what might be going on. Additionally, if your partner is unwilling to work with you to use the method appropriately, this method may not work for you.”
For those curious about trying FAM after being on hormonal birth control, it’s important to give your body time to reset and normalize. You’ll be able to gather more accurate information about your cycle once your hormones have settled and your body is on your “regular” cycle, whatever that may mean to you.
Is the fertility awareness method effective in preventing pregnancy?
On the most important question, “Can FAM replace hormonal birth control?” our experts had differing opinions, rooted on the same premise — you know yourself best.
“In these days of ultra-strict anti-abortion laws, no one who really doesn't want to conceive should use any of these methods — we have some [other] very reliable methods.,” explains Dr. Minkin. “[But,] if you are someone who wants to get pregnant… then these types of methods are fine. No matter your birth control method, it’s always best to keep pregnancy tests on hand. If you think you might be pregnant, using a test like First Response will give you reliable results up to 6 days before the first day of your missed period. I [also] always recommend speaking with your ob-gyn health care provider for further guidance.”
Farlow adds: “With proper education and personal dedication, fertility awareness can be used to replace hormonal birth control. Fertility awareness can also be used with or without barrier methods or with a combination of barrier methods and withdrawal. You'll also know better when to use emergency contraception if you have an ‘oops.’ One common misconception is that fertility awareness does not work for people with irregular cycles. While it can be more challenging in some ways, you can definitely learn how to track your cycle and use that information to avoid pregnancy with an irregular cycle. Since fertility awareness is a day-by-day method not based on predictions, it can be used to reliably understand when ovulation is happening, even when it's irregular. This information is incredibly useful because it can help the user finally make sense of their cycles. Like all methods, fertility awareness does have a failure rate that varies based on how accurately you use the method.”
The more information you can gather about your body, the more agency you can feel in the decisions you are making for your own health and fertility. Farlow suggests books like Fix Your Period by Nicole Jardim or Period Repair Manual by Lara Briden as additional reading for those interested in learning more about FAM.
Vivian Nunez is a writer, content creator, and host of the Happy To Be Here podcast. Her award-winning Instagram community has created pathways for speaking on traditionally taboo topics, like mental health and grief. You can find Vivian @vivnunez on Instagram/TikTok and her writing on both Medium and her blog, vivnunez.com.