Fertility Awareness Methods Explained

I learned about the fertility awareness method from a friend over six years ago. My immediate reaction was “I could never do that” — it didn’t seem safe enough, like a less “responsible” choice than something like taking the birth control pill or having an IUD. 

However, after experiencing so many unwanted side effects from all of the birth control methods I tried, I decided to give the fertility awareness method another look, and I’m so glad that I did. Initially, I was confusing it with practices like the rhythm method, not understanding that some fertility awareness methods have efficacy rates as high as 99.4% — the same as the IUD that was causing me so many problems. 

I learned a fertility awareness method from an instructor and never looked back. It has not only provided me with an effective and non-hormonal way to avoid pregnancy, but also greater self-knowledge, the ability to advocate for myself in medical settings through symptom tracking, and a more accurate understanding of my body and its cycles. I’m now becoming a fertility awareness instructor myself to be able to share this knowledge with more people. 

So what are fertility awareness methods? What does someone mean when they say they “track their cycles”? How effective are fertility awareness methods? And, if you’re interested in learning to chart your cycles, where should you start? 

What are fertility awareness methods (FAM)?

Fertility awareness methods “involve identifying the fertile days of the menstrual cycle, by observing fertility signs such as cervical secretions and basal body temperature.” It’s also sometimes called Natural Family Planning. These methods allow a person to identify the days during the month when pregnancy is possible, and then that information can be used either to avoid pregnancy or to achieve it. 

Regardless of fertility intentions, it also allows a person to confirm whether they are ovulating, hugely important to overall health. We can experience anovulatory cycles, where we see a bleed but ovulation does not occur. Missing or disrupted ovulation is an important sign from your body that something needs attention, so being able to spot anovulatory cycles—or confirm that ovulation happened—is an important insight into our health. 

The FAM basics 

The basic idea underlying FAM is this: people with uteruses can only get pregnant for about 5-6 days per month. Apart from those days, pregnancy is not possible. That’s because the egg released by our bodies each month only lives for 24 hours, but sperm can live in the body for up to 5 days in the presence of fertile cervical fluid (more on that later). Put those together, and there are 5-6 days when sperm can meet the egg and a pregnancy can begin. 

If we can identify those days, then we can either abstain from intercourse or use barrier methods during the days when pregnancy is possible, thereby making it nearly impossible for sperm to meet the egg. (Of course, we can also time intercourse on those fertile days if pregnancy is the goal.)

So how do we identify those fertile days? There are three major biomarkers we can track: cervical fluid, basal body temperature, and the LH surge. Cervical fluid (or cervical mucus) refers to the secretions made by our cervix that fluctuate throughout the cycle based on our changing hormones. We can learn to pick up patterns in our cervical fluid that let us know if our fertile window has opened and, therefore, pregnancy is possible. Its disappearance later in the cycle also helps us to know whether ovulation has occurred.

Basal body temperature helps us to confirm if we have ovulated because once ovulation has occurred, there is a noticeable rise in our basal body temperature which we can see when we chart our daily temperatures. LH tests—also called ovulation tests—are similar to pregnancy tests, but they’re designed to pick up the hormone LH (luteinizing hormone), which surges 24-36 hours before ovulation. 

Tracking these biomarkers—ideally cervical fluid plus either temperature or LH—gives us a very good idea of which days throughout the month are potentially fertile, as well as whether ovulation has taken place. Then, you would record your observations in either a paper chart or an app and make decisions from there, based on your fertility intentions. 

The many methods of fertility awareness

One of the confusing things about FAM beginners is that many different methods track different biomarkers (the signs our bodies give us about our days of fertility)—“fertility awareness method” is an umbrella term. Billings, for example, only tracks cervical fluid, while Sensiplan tracks cervical fluid and basal body temperature (these kinds of methods are called symptothermal methods). FEMM tracks cervical fluid and the LH surge through the use of LH strips (these are called Symptohormonal methods). There are many more. 

The most important thing is to pick a method that will work best for you, learn its rules (either on your own or with an instructor), and follow them consistently, charting biomarkers daily (either on paper or through an app). That’s the only way to practice fertility awareness safely and properly.

Breaking down common misconceptions about FAM

Fertility awareness methods are often seen as synonymous with things like the rhythm method—where a person counts the days of their cycle, assumes that ovulation happens on day 14, and avoids pregnancy for some days before and after that date. It’s not very effective, because our body’s cycles are hugely variable based on factors like stress, travel, illness, or hormonal changes. It’s not relying on real-time biomarker observations to determine when you’re fertile, so there is a huge margin for error. 

When someone says that they’re “tracking their cycle” but they’re really just relying on counting the days in their period-tracking app or relying on feeling like they “know when they ovulate,” they aren’t practicing a reliable form of fertility awareness. That requires someone to learn and follow a particular FAM method and make daily biomarker observations that are then recorded, either on paper or on an app, and interpret them in real-time. 

It’s also commonly assumed that FAM methods are ineffective, or less effective than other birth control methods. Of course, we can’t talk about all methods together, because there’s a lot of variability in rules and approach. However, a longitudinal study carried out on the Sensiplan symptothermal method, for example, followed 900 women across a collective 17,638 cycles who had learned the method with an instructor. They found an unintended pregnancy rate of 0.4%, meaning the method was 99.4% effective at preventing pregnancy. When done properly, FAM can be incredibly effective. 

The pros and cons of fertility awareness methods 

Fertility awareness methods have many benefits. They don’t carry any harmful side effects, they are very effective when done properly, they provide valuable self-knowledge about our health, and they can be very cheap to implement. They also can make getting pregnant easier if that is the goal.

FAM also involves both partners in the family planning process, as both people must understand when pregnancy is possible if they wish to avoid it, which can feel more equitable in a world where the person who can become pregnant is often seen as the one responsible for contraception. 

However, it does take investment—first of all, to learn a method, which takes time and could involve the cost of learning with an instructor (although it’s totally possible to learn on your own!). Then, it involves taking daily biomarker observations and recording them reliably. We’re all at different places in our lives, and this kind of commitment isn’t possible or desired for everyone. And if it’s not, another method might be best—remember that FAM is not something you can do halfway if you want to avoid pregnancy! There is room for human error that isn’t there in the same way for “set it and forget it” birth control methods like the IUD. 

Other people may have medical conditions that are best managed through a form of hormonal contraception and therefore not be able to use FAM. It’s best to consult with your doctor if you are using hormonal contraception to manage a medical condition before trying FAM.  

What about all of the tech for fertility awareness? What should I use? 

There are so many tools out there that can make tracking your cycle easier—but it’s important to remember that all you really need is a standard thermometer that measures two decimal points and a free printed chart and you’d be set for life. That’s one of the beautiful things about FAM. 

But taking your temperature with a regular thermometer also means that temperature readings should be taken at roughly the same time each morning, which can be a challenge for some people. Products like TempDrop are a wearable thermometer that takes your temperature during the night and doesn't rely on you waking up at the same time each morning. These tools can be helpful for some people, but they are costly.

What if I have PCOS or irregular cycles? Is this only for people with regular cycles? 

Not at all! Of course, irregular cycles can be more challenging to chart in the beginning, but it’s actually a great idea for people dealing with cycle-related conditions like PCOS to learn to chart to track their symptoms, determine if they’re ovulating, know their luteal phase length, and be able to share all of that data with their primary care provider. It can make us feel more confident self-advocating in medical settings or tracking progress from different interventions. 

You can also use FAM for contraception if you have irregular cycles, but it’s recommended to learn with an instructor who can help you interpret the sometimes confusing charting data. 

Top tips to get started with fertility awareness

The best way to get started with FAM is to survey the available methods and see what would work best for your lifestyle. If taking your temperature every morning is no problem, a symptothermal method like Sensiplan might be right for you. If that sounds like a drag, maybe a symptohormonal method like FEMM that uses LH testing would be a better choice. Once you’ve decided that, find an instructor who is teaching that method or pick up the handbook for that method if you’d rather self-teach. Then, practice for at least three months before relying on the method for contraception. If you feel confident, go forth! If you’re still feeling a bit nervous, booking a few sessions with a teacher might be the confidence boost you need to get going. 

For those of us with uteruses, our education about our bodies was often severely lacking. Learning fertility awareness can be a beautiful and empowering journey into greater body literacy and self-knowledge. I hope this broke down the basics of fertility awareness methods and offered some in-roads to get started down that path.

Thea Walmsley is a writer based in Vancouver, Canada focusing on menstrual health and body literacy. After struggling with chronic pelvic pain for years, she discovered fertility awareness, which gave her the knowledge and self-understanding to manage symptoms more effectively. She is now a fertility awareness teacher-in-training, using writing, teaching, and storytelling to share this knowledge more widely and help others advocate for their menstrual and overall health.