This month, I’ve decided to do a deep-dive into wearable skin temperature trackers. It’s my hope that this Info Hub will be a helpful, comprehensive resource for you to browse through should you be interested in purchasing a wearable skin temperature tracker for Fertility Awareness Based Method (FABM) charting.
Without fail, one of the most common questions I get in my direct messages on social media is “what do you think about so-and-so wearable tracking/fertility device or app?”.
This is no surprise given the growing popularity of fertility tracking devices, and the saturation of the femtech* market, with more new products and innovations being released each year.
Disclaimers:
Details are correct to the best of my knowledge as at the time of writing this article in October 2022; however, the femtech industry moves quickly with constant innovation and device/app upgrades. Keep this in mind and always do your own due diligence if you’re interested in purchasing any sort of femtech device.
I am not a “tech writer”. I use very minimal technology in my own FABM charting practise. Not only that but I also prefer to paper chart, andI manufacture and sell beautiful charting journals which you can browse here. I’ve aggregated and summarised as much relevant info as I could find in this information hub, but I am not an authority or expert on emerging FABM charting technologies.
I am not trained in statistical analysis or study analysis, so where I link to/discuss studies you are reading my personal opinion. If you’re a FABM enthusiast statistician I’m sure you can glean some interesting insights from some of the studies mentioned!
In addition, this information hub barely scratches the surface when it comes to wearable temperature trackers and is simply designed as a springboard for you to do your own further investigation on any topics that interest you. If you see something that is incorrect or should be changed, please let me know in the comments below.
Alright, let’s dive in!
*The term “femtech” is short for “female technology”. It refers to tools, technologies, services and software that aim to address women’s/menstruators’ health issues.
Click on each of the headings below to learn more. Start at the top and work your way down.
Basal body temperature (BBT) thermometers are designed to pick up very small fluctuations in body temperatures. BBT thermometers are more accurate than standard fever thermometers.
Most Symptothermal Methods require that you use a basal body temperature thermometer that displays two decimal places.
Here are some important parameters to keep in mind when you are searching for a thermometer to use with Symptothermal Methods:
Measuring accuracy and tolerance: Measuring accuracy refers to how close your thermometer will measure to a known temperature. Measuring accuracy is usually stated as a tolerance which explains how far either side of a known temperature your thermometer might measure. BBT thermometers usually have an accuracy of +/-0.05°C / 0.1°F.
This means that if the known temperature is 36.53°C, your BBT thermometer may give you a reading anywhere between 36.48°C and 36.58°C.
Display resolution: Display resolution refers to how many decimal places your thermometer/device displays. Basal body temperature thermometers should have a display resolution of one hundredth of a degree (0.01°C / 0.01°F).
Precision: Precision refers to how consistent the results are when the measurement is repeated.
When it comes to charting with the Symptothermal Method, precision is more important than accuracy. A highly precise thermometer might be slightly inaccurate, but the error in accuracy will be repeated every day of the menstrual cycle, meaning that we can confidently identify our temperature shift (knowing that a shift is not caused by an imprecise thermometer reading, but by our true rise in temperature after ovulation).
In other words, even if your BBT thermometer is slightly inaccurate this will not affect your charts so long as your thermometer is precise, and the error is consistent across the entire chart.
Core body temperatures refer to internal temperatures from our core (usually obtained via oral, vaginal or rectal sites for FABM charters).
Distal skin temperatures usually refer to skin temperatures taken from the hands and feet (wrists are included).
Proximal skin temperatures usually refer to skin temperatures taken from closer proximity to our core (such as our upper arms/thighs and stomach).
Basal body temperature (BBT) is our core body temperature at its lowest state while we are in a state of rest. This usually occurs at around 4am each morning. Basal body temperatures are important for Symptothermal Method charters because they usually rise for two weeks after ovulation has occurred, until our next period begins. This rise in temperature is due to a hormone called progesterone, which we release in large quantities in the two weeks after ovulation. Charting our temperatures (in conjunction with our cervical mucus) helps us to confirm that ovulation has passed. To learn how to do this, visit the Instructor Directory or visit the Self-Teaching page on this website.
Waking temperatures (either oral, vaginal or rectal) are used as a close approximation of true basal body temperature for Symptothermal Method charters. Taking our temperature as soon as we wake up saves us having to wake up at 4am each day.
Progesterone released during the luteal phase causes our core body temperature to rise.
Melatonin is a hormone that helps us to fall asleep, and our bodies naturally produce more of it in the evening as darkness approaches.
The melatonin we produce sends signals to our distal skin regions (hands and feet) that create a rise in blood flow. This rise in blood flow is due to vasodilation (expansion of the veins that hold our blood).
With more blood flowing through these veins, we lose heat through the skin of our extremities.
The heat loss in our extremities gradually lowers our core body temperature during the night. Our core body temperature is usually lowest at around 4am in the morning.
During waking hours, our distal temperatures (hands and feet) are lower than our proximal temperatures (upper arms/thighs and stomach etc).
After we fall asleep, our distal temperatures rise significantly (via the process of vasodilation mentioned above). This rise causes distal temperatures to then match proximal temperatures closely throughout the night. After waking, distal temperatures then drop lower once again.
What does this mean for FABM charting? During the night while asleep, distal temperatures closely match proximal temperatures. Many FABM charters already successfully use proximal upper-arm temperatures via the Tempdrop device to accurately visualise and assess their temperature shifts. With the right technology, FABM charters will likely soon be able to successfully utilise distal skin temperatures for FABM charting, too.
This diagram is from a 2000 study published in The American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, titled “Functional link between distal vasodilation and sleep-onset latency?” You can see how distal skin temperatures are lower during waking hours, but then spike sharply at sleep onset to closely match proximal temperatures during the night.
True core body temperature tends to follow a general circadian rhythm which results in a smooth rise and fall of temperatures every 24 hours. Core body temperature is generally lowest at around 4am in the morning when humans are naturally in a deep sleep. Following this, it gradually rises throughout the day to peak at around 6-8pm before falling again.
Distal and proximal skin temperatures do not follow this same circadian rhythm. Instead, they share an inverse relationship during wake times, before slowly converging to rise rapidly as sleep commences, before dipping around 2am and slowly rising back up again by around 5-6am.
This diagram is from a 2000 study published in The American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, titled “Functional link between distal vasodilation and sleep-onset latency?” You can see how skin temperatures do not follow the same curve that we see with core body temperatures during sleep.
When we are charting our temperatures with a Fertility Awareness-Based Method, we are interested in identifying infradian rhythms, as opposed to circadian rhythms. Circadian rhythms refer to 24-hour cycles. The roughly 28-day process of the menstrual cycle is an infradian rhythm.
Skin temperatures do not mirror core body temperatures during a single 24 hour circadian rhythm cycle. Despite this, they are still influenced by our changing hormones across our infradian menstrual cycle. They show a shift from lower temperatures prior to ovulation, to higher temperatures after ovulation. This means they can still be used to identify temperature shifts with FABMs (although to what level of contraceptive effectiveness, we don’t yet have a lot of evidence).
Some studies that have explored the biphasic properties of skin temperature across the menstrual cycle include:
Chen W, Kitazawa M, Togawa T. Estimation of the biphasic property in a female's menstrual cycle from cutaneous temperature measured during sleep. Ann Biomed Eng. 2009;37(9):1827.
Kräuchi K, Konieczka K, Roescheisen-Weich C, Gompper B, Hauenstein D, Schoetzau A, et al. Diurnal and menstrual cycles in body temperature are regulated differently: a 28-day ambulatory study in healthy women with thermal discomfort of cold extremities and controls. Chronobiol Int. 2014;31(1):102–13.
Maijala, A., Kinnunen, H., Koskimäki, H. et al. Nocturnal finger skin temperature in menstrual cycle tracking: ambulatory pilot study using a wearable Oura ring. BMC Women's Health 19, 150 (2019).
Alzueta E, de Zambotti M, Javitz H, Dulai T, Albinni B, Simon KC, Sattari N, Zhang J, Shuster A, Mednick SC, Baker FC. Tracking Sleep, Temperature, Heart Rate, and Daily Symptoms Across the Menstrual Cycle with the Oura Ring in Healthy Women. Int J Womens Health. 2022 Apr 8;14:491-503.
What does this mean for FABM charting? Considering the Tempdrop device (measuring proximal temperatures), has been shown* to mirror core body temperature changes across the menstrual cycle, it's likely that other wearable skin temperature trackers (both distal and proximal), will be able to do the same. For instance, the Oura Gen3 Ring has been shown to produce comparable results to oral temping for Natural Cycles app users (read more about this in the Oura section below). It’s important to note that most wearable skin temperature thermometers will need to utilise multiple sensors and an algorithm to filter out environmental and movement disturbances to provide an accurate temperature each morning.
*Unfortunately, we do not have high quality clinical trial evidence of the accuracy of Tempdrop temperatures in the context of Symptothermal Method charting effectiveness. At present, we are relying more on the “social proof” of the many thousands of people currently using the Tempdrop to successfully identify biphasic temperature shifts during the menstrual cycle. The biphasic shift to a higher temperature is caused by the event of ovulation that occurs roughly 12-14 days prior to the onset of menstruation. Hopefully in future we will have more evidence not just on the Tempdrop but on all other skin-sensor wearables.
Skin temperatures are subject to higher levels of variability than our core body temperature. This is because our skin is more exposed to changes in environmental temperatures. Plus, the blood vessels in our skin are designed to rapidly contract or expand to conserve or release heat, thereby maintaining our relatively stable core body temperature.
What does this mean? Most skin temperature-collection devices will need to filter temperatures through an algorithm that also tracks data collected about:
• Environmental temperatures
• Your body position
• Your activity level
• Your sleep status
As an example, the Tempdrop thermometer provides data based on proximal skin temperatures and is worn under the armpit close to the axillary artery. It measures skin temperatures with one sensor, ambient environmental temperatures with another sensor, and utilises a 3-axis accelerometer to track your body position, activity and sleep status. Data is then filtered through an algorithm to provide the most accurate skin temperature reading from the night. Most other skin-wearable thermometers have a similar approach.
Now that you’ve read through all of the above topics, you will have a better understanding of the relationship between our core body temperature, skin temperatures (both proximal and distal), and how these can be used for FABM charting.
If you’re curious to know more about some of the available products when it comes to wearable skin-temperature tracking devices, read on! For each device mentioned below, I have outlined key features plus my own personal opinion on its suitability for use with Symptothermal Method charting.
Device:Tempdrop Price: From USD $200 Type of skin temperatures (proximal or distal): Proximal Skin site: Worn in an armband to collect underarm temperatures from near to the axillary artery. Time worn: Worn only while sleeping EMF exposure: The Tempdrop only emits EMFs while syncing with the Tempdrop app in the morning. EMFs are not released while being worn. Associated app: Tempdrop syncs directly with the Tempdrop app. To view your temperatures, you must sync your Tempdrop with the Tempdrop app. 3rd Party integrations: Once you sync your Tempdrop with the Tempdrop app to retrieve your temperature, you can also auto-retrieve it into these additional apps on your phone: Chart Neo app, Read Your Body app, and OvuView app Subscriptions required: None. You can choose to pay an annual subscription to the premium version of the Tempdrop app to access sleep data and automatic chart markings*. Type of temperature data: Absolute values Number of decimals: Two decimal places (.00) Data points provided:
Temperature
Sleep data
My take:
The Tempdrop has the most “social proof” of any wearable skin temperature tracking device. They have over 10,000 users in their Facebook group and have been in use by FABM charters since 2017 now. I personally have successfully used the Tempdrop throughout my postpartum charting journey and am very happy with it.
I like the fact that the Tempdrop is only worn at night as I don’t like wearing things during the daytime (the only jewellery that I can wear 24-7 is a necklace, and even then I prefer taking it off while I shower).
I like the fact that the Tempdrop is worn on the upper arm, as I don’t like wearing watches or rings while I sleep, because I sleep with my hands up near my face. This is just a personal idiosyncrasy though, and I’m sure most other people have no problem with watches and rings while sleeping!
I do sometimes wonder if the Tempdrop may be slightly *too* sensitive. In my personal experience, I believe it sometimes picks up the miniscule temperature rise that occurs during ovulation (there is a small amount of progesterone that is released during ovulation). With Sensiplan/NFPTA temperature rules (which make it relatively easy and straightforward to mark temperature shifts), I think this can sometimes result in a temperature shift being marked a day or two earlier than it would with oral temping. It’s possible that TCOYF charters (with their raised coverline), might not share this issue. Again, this is just my hypothesis based on a couple of my own personal charts. For Symptothermal Method users, cervical mucus observations should always be acting as a safety double-check regardless.
The Tempdrop device itself could probably benefit from some additional research and development to make it more user-friendly (especially when it comes to battery changes). I am glad that the algorithm no longer updates the most recent three temperatures, as this previously used to extend the time it takes to confirm a temperature shift in the luteal phase.You can read more of my thoughts about the Tempdrop here. I’m also an affiliate for the Tempdrop device and you can use my code TDLOVE29 to save 12% if you would like to purchase one.
At this point, I believe the Tempdrop remains the best choice for Symptothermal Method charters who cannot obtain oral/vaginal/rectal temperatures for some reason. That said, technologies are changing quickly - all it would take is for one of the other wearables listed here to begin showing accurate, absolute temperature values each morning and Tempdrop would have some serious competition (and I think that once BBRing is released, that will be the case!).
*I do not recommend anyone rely on automatic chart markings to evaluate their charts, especially if you are genuinely wanting to prevent unintended pregnancy. It's generally preferable to learn a method and understand how to mark your own charts.
Device:Oura Gen3 Price: From USD $350 Type of skin temperatures (proximal or distal): Distal Skin site: Worn in a ring to collect temperatures from the index, middle or ring finger. Time worn: Recommended to be worn continuously. The Oura Gen3 ring is only taken off to charge, and battery can last up to 7 days. Despite this, Oura states that you can choose to wear it only at night if you prefer. EMF exposure: The Oura Gen3 ring continuously emits low levels of electric and magnetic fields. The Oura Gen3 ring’s SAR level is 0.0003 W/kg. You can enable airplane mode inside the Oura app whenever you don’t need to look at your data (i.e. while you are sleeping). Associated app: Oura app 3rd Party integrations: Apple Health, Google Fit, Strava, Natural Cycles (keep reading for my thoughts on Natural Cycles). Subscriptions required: If you purchase a Gen3 Oura Ring, Oura Membership costs between 5.99 and 6.99 USD per month, depending on where you live in the world. Without a membership, you can still export your Oura data into CSV or JSON format from their web portal. Type of temperature data: Temperatures are shown as fluctuations (+/-) from your personal “baseline temperature”. This is less useful for FABM charting, as we need an actual temperature value to plot on the graph section of our chart each morning. Number of decimals: One decimal place (.0) Data points provided:
Temperature
Sleep data
Respiration/blood oxygen levels
Resting heart rate
Heart rate variability
My take:
I don’t really enjoy wearing jewellery on my hands (I almost never wear rings), so my immediate take is that it’s unlikely I would want to be wearing a ring 24-7. I also prefer products that I can buy outright, as opposed to subscription-based (especially with the cost of living rising a lot lately).
Interestingly, in Natural Cycles’ 510(k) premarket submission to the FDA to demonstrate that Oura temperatures are just as safe and effective as oral temperatures with the Natural Cycles app, they state: “Compared to the two-decimal place oral thermometer, the Natural Cycles algorithm provides additional 1.6 green days (not fertile) in the luteal phase of the menstrual cycle when the input temperature was from the Oura ring, without increasing the risk of unintended pregnancy”. I am interested to read more about this, but I cannot find the clinical study of the Oura Ring + Natural Cycles app. My initial reaction is that I am sceptical about this statement. Natural Cycles is already known for “confirming” temperature shifts a day or so earlier than Symptothermal Methods typically do (on the second day of a raised temperature for instance). For Oura Ring temperatures to then subtract an additional 1.6 days off the time it is taking Natural Cycles to confirm a temperature shift, gives me some pause for thought. Again, if you find this study please let me know – I searched high and low on the internet but could find no trace of it apart from its mention in Natural Cycles’ 510(k) FDA submission.
One thing that I do consider a drawcard is the absolute wealth of additional biometric information that Oura ring tracks and provides. If you’re going to spend a lot of money on a wearable device, this is definitely a beautiful premium option.
Overall, I think the Oura ring may have fantastic potential for future charters, provided they are able to begin delivering absolute temperature values (as opposed to fluctuation trends). This would mean FABM charters could use Oura temperatures in their chosen charting app or on their paper charts.
Studies (not an exhaustive list):
It is great to see a company such as Oura dedicating resources toward studying the accuracy of their device for menstrual cycle tracking. Despite this, I have found it difficult to access studies on exactly how accurate Oura temperatures are in comparison to oral waking temperatures for FABM charting. Data/studies that would be most relevant seem to be behind paywalls (Maijala et al., 2018) or I simply could not find them on the internet (Natural Cycles’ clinical study referenced in their 510(k) submission for FDA approval).
In saying this, Oura is the only company that is forthcoming with accuracy/precision figures on their website (this data is not available publicly for any other wearable skin temperature tracker that I researched). According to the Oura website, Oura is proven under laboratory conditions to be accurate to within 0.36°C (0.648°F). Remember that precision is arguably more important for FABM charting. Oura is proven under laboratory conditions to be precise to 0.13°C (0.234°F). It’s important to note that these are laboratory results and may not extend to real-world conditions.
It seems that if we really want reassurance of the comparability between Oura versus oral temperatures for FABM charting, we will need to engage in citizen science and make these comparison charts ourselves. This has definitely already begun in the FABM community, and as an example you can check out a comparison chart by Sensiplan teacher trainee Emma Lukkarila on her Instagram here.
Maijala A, Kinnunen H, Koskimäki H, Jämsä T and Kangas M. Comparison of menstrual phases with nocturnal temperature of the Oura ring and oral body temperature at wake-up. World Congress on Medical Physics and Biomedical Engineering; 2018; Prague, Czech Republic: IUPESM; 2018:312–313.
As far as I can see, this data actually compares Oura temperatures against oral temperatures, but is only available if you purchase the linked book for between AU $280 - $500. If anyone else has access to these findings I would be curious to read them: https://www.amazon.com/Congress-Medical-Physics-Biomedical-Engineering/dp/9811090378
Maijala, A., Kinnunen, H., Koskimäki, H. et al. Nocturnal finger skin temperature in menstrual cycle tracking: ambulatory pilot study using a wearable Oura ring. BMC Women's Health 19, 150 (2019). This study is full of interesting info, but three things that stood out to me were:
This study found that the accuracy of the Oura algorithm increased when the two study subjects with a BMI of over 30 were excluded from the calculations. Study authors state that a BMI of over 30 “is a potential confounder affecting distal skin temperature.” Other studies have shown that obesity causes distal temperatures to rise, to account for the insulating effect of a greater layer of subcutaneous abdominal fat. These higher distal temperatures allowed study participants to release heat and therefore regulate their core body temperature. Is it possible that a higher baseline distal temperature might mute the post-ovulatory rise in distal temperatures? I would love to see more studies on this in future (for both distal and proximal temperatures), as I have also heard some Tempdrop users speculate that their higher BMI may be impacting the accuracy of their temperature readings.
Interestingly, the study authors also mention that smoking can impact skin temperature values. As the study was rather small (only 22 participants total) and none of them were smokers, it’s unclear whether this would be relevant for FABM charters.
A third point which I found interesting is that distal skin temperatures showed a greater rise than oral temperatures in the luteal phase. Study authors state that the “Temperature difference [between follicular and luteal phases] was higher with skin temperatures than with oral temperatures.” On average, skin temperatures were 0.07 °C higher in the luteal phase. This gives me pause for thought as all Symptothermal temperature shift evaluation rules are based on oral/vaginal/rectal temperatures. It’s possible that the slightly higher rise in finger skin temperatures in the luteal phase might result in some temperature shifts being marked as “confirmed” earlier than they would with an actual FABM method. This is purely my own conjecture, but I think it would be an interesting topic for further study.
Grant, A.D., Newman, M. & Kriegsfeld, L.J. Ultradian rhythms in heart rate variability and distal body temperature anticipate onset of the luteinizing hormone surge. Sci Rep10, 20378 (2020).
This is probably one of the most interesting studies based on Oura temperatures that I have seen so far. Researchers found that changes over 2-5 hours in distal temperatures and heart rate variability predicted the onset of the luteinising hormone surge two days in advance for 100% of study participants. Fascinating! I imagine this could have notable benefit for real-time fertile window information for people who are trying to conceive, but would not provide enough advance warning of approaching ovulation for those trying to prevent pregnancy.
Alzueta E, de Zambotti M, Javitz H, Dulai T, Albinni B, Simon KC, Sattari N, Zhang J, Shuster A, Mednick SC, Baker FC. Tracking Sleep, Temperature, Heart Rate, and Daily Symptoms Across the Menstrual Cycle with the Oura Ring in Healthy Women. Int J Womens Health. 2022 Apr 8;14:491-503.
This study did not deliver any overly interesting data on Oura temperatures for menstrual cycle tracking, apart from showing that temperatures tended to be lower around ovulation, and then higher during the luteal phase (as expected). The study was not designed to test accuracy in comparison to oral temperatures and seemed to be more focused on sleep data.
Natural Cycles has studied Oura temps versus their oral basal temperatures and this is mentioned in their 510(k) FDA submission; however, I cannot find the actual clinical study. You can read their 510(k) submission here.
Device:BBRing by Femtek Price: First round on Kickstarter sold out, currently open to waitlist for next round of shipping. Price likely approx. USD $185 Type of skin temperatures (proximal or distal): Distal Skin site: Worn in a ring to collect temperatures from the index finger. Time worn: Only while sleeping EMF exposure: The BBRing can be worn in “offline mode” overnight, reducing exposure to EMFs. Specific SAR levels are not provided, but the Femtek website states that "Our device has passed all EMC testing for the markets in which we are able to ship to, and due the ability to use the device in offline mode overnight, our EMF testers weren’t able to pick anything up on our readers." Associated app: Basal Body Ring app 3rd Party integrations: Apple/Garmin health kit Subscriptions required: No subscriptions required Type of temperature data: Absolute values Number of decimal places: Two decimal places (.00) Data points provided:
Temperature data
Heart rate
Heart rate variability
My take:
The BBRing has the potential to be a great addition to the FABM charting toolbox, because it will provide absolute temperature values to two decimal places. This means that the data provided will hopefully be comparable with Tempdrop, and you won’t need to do any calculations/conversions to get an absolute value for your chart (like you would if you were relying on the Oura Gen3 Ring or the Apple Watch).
Again, I don’t personally enjoy wearing jewellery so I would probably prefer the placement of the Tempdrop on the upper arm as opposed to a ring on my finger; however, I appreciate that this device only needs to be worn at night time.
I also like the fact that this device is made by a small Australian company who is prioritising menstrual cycle tracking – this is not simply another large multinational corporation adding on temperatures as an afterthought to try and capitalise on the femtech market. Olivia Orchowski (the founder), reached out to me in mid-2020 with questions on BBT for FABM charting. She was very responsive and open to feedback that would benefit the FABM charting community.
I’m excited to test out the BBRing myself. I am hopeful that it could hold the perfect mix of affordability, accuracy, and user-friendliness for FABM charting.
PS: Be sure to expand the Oura Gen3 Ring info section to read about some interesting study findings that may have applicability to the accuracy of the BBRing, too.
Device:Apple Watch Series 8 / Apple Watch Ultra Price: From USD $390 / From USD $805 Type of skin temperatures (proximal or distal): Distal Skin site: Worn on the left or right wrist (dorsal side) to collect wrist temperatures Time worn: Can be worn continuously, or only overnight while sleeping if you are only wanting to use the Apple Watch for temperature tracking for charting. EMF exposure: EMF levels for the Apple Watch Series 8 are not yet available on the Apple website; however, I can see that the Apple Watch Series 7 has a SAR level of 0.40 W/kg. This is significantly higher than the Oura Gen3 ring’s SAR level of 0.0003 W/kg. Associated app: The iPhone Health App is used to access the nightly wrist temperatures. The Apple Cycle Tracking app is also available if you would like to make use of Apple’s period predictions. Unfortunately, Apple’s Cycle Tracking app doesn’t show a chart with enough detail to be used for FABM charting. 3rd Party integrations: There are a wide range of third-party apps that can be downloaded onto the Apple Watch. These include internet browsers, to sleep trackers, to heart activity trackers, to weather trackers, podcast players and so much more. Despite this, I am unaware of any 3rd party integrations that work with the Apple Watch temperatures for FABM charting. Subscriptions required: No subscriptions required Type of temperature data: Absolute temperature Number of decimals: Two decimal places (.00) Data points provided:
Sleep data
Temperature data
Blood oxygen data
Heart rate data
My take:
I like the fact that the Apple Watch does not need to be worn continuously, and it also does not require a subscription which is helpful given the rising costs of living. In addition, Apple provides temperatures with two decimal places.
The Apple Watch is not available to Android users, so is less accessible an option than some other femtech devices. It's also the most expensive wearable skin temperature tracking device that I investigated, which means it will be less accessible to those with less discretionary spending power
I don’t love wearing things on my hands/wrists at nighttime as I like to have my hands up near my face while I sleep, so I’m not sure whether this option would be suitable for me. I also am hesitant about the EMF levels which seem a little high in comparison with devices like the Tempdrop, Oura or BBRing.
At present, the Apple Watch Series 8 / Apple Watch Ultra doesn’t have much “social proof” for use with FABM charting, and therefore we don’t have much evidence as to how these temperatures might stack up against an oral/vaginal/rectal temperature chart.
So far, I have seen one chart comparing Apple Watch temperatures with oral temperatures, by charter Natalia Rodrìguez in the FAM Support Group Facebook group. The Apple Watch temperatures showed a slightly delayed temperature shift by only one extra day in comparison to oral temperatures; however, there were some missing oral temperatures around the time of ovulation so it is difficult to say how accurate this comparison is.
I think the Apple Watch Series 8 / Apple Watch Ultra may have potential for the future of FABM charting, provided that we begin to see some more evidence or social proof of the correlation between wrist temperatures and oral/vaginal/rectal temperatures. Importantly, there is some evidence that wrist temperatures may delay temperature shifts by around two days, and you can read more about that in the Ava Fertility Tracker bracelet section (again, it is not clear whether Ava studies would be relevant to Apple Watch Series 8, but we are working with the limited data we have at the moment!)
Studies (not an exhaustive list): Ongoing: The Apple Womens Health Study in partnership with the Harvard School of Public Health. This study utilises data from Apple Watch users (with their consent), to investigate the “relationship between menstrual cycles, health, behavior, and habits.” I think this is a fantastic initiative considering that so much remains unknown when it comes to the intersection of our health and our reproductive hormones as women and/or people who menstruate.
Unfortunately, I cannot find any studies specific to the comparison of Apple Watch wrist temperatures to oral waking temperatures.
Note: I have found that the high levels of radio frequency emitted by the Apple Watch when communicating with my iPhone, interfere with the function of my oral BBT thermometer. I have heard the same for other smartwatches such as the Garmin. I recommend keeping all devices in airplane mode if you are using your BBT thermometer in the morning.
Expand the Ava Fertility Tracking bracelet section to read about some alternative studies on wrist temperatures and menstrual cycle tracking.
Device:Ava Fertility Tracker bracelet Price: From USD $280 Type of skin temperatures (proximal or distal): Distal Skin site: Worn on the left or right wrist (dorsal side) to collect wrist temperatures Time worn: Worn only while sleeping. Must be worn for at least 4 hours. EMF exposure: It’s unclear from the Ava website whether the Ava Fertility Tracker emits EMFs while in use, and if so, what the associated SAR level is. Associated app: Ava Fertility app 3rd Party integrations: None that I am currently aware of Subscriptions required: No subscriptions required Type of temperature data: Absolute values Number of decimals: Two decimal places (.00) Data points provided:
Temperature data
Heart rate
Heart rate variability
Breathing rate
My take:
I like Ava as a company because they have always been focused on assisting women and/or people who menstruate with fertility tracking for conception. I prefer this to companies such as Apple or Fitbit who add on menstrual tracking years after introducing their products. It says to me that Ava are wholly focused on us as a user base, as opposed to other companies who see menstrual trackers as simply a subset of their total userbase. I also love that they don’t require a subscription to be able to use their device.
I remain a little sceptical as to whether the Ava device has an acceptable sensor configuration and algorithm to provide accurate enough temperatures for FABM charting. Continue reading for my thoughts on a study that demonstrates this.
As with many of the other Femtech devices covered in this Info Hub, it seems the case that citizen science will need to come to the rescue if we really want to see accurate comparison charts through a FABM lens.
Have you used the Ava bracelet and found that it provided accurate temperature readings in comparison to oral temperatures? Let us know in the comments below!
Studies (not an exhaustive list): Shilaih M, Goodale BM, Falco L, Kübler F, De Clerck V, Leeners B. Modern fertility awareness methods: Wrist wearables capture the changes in temperature associated with the menstrual cycle. Biosci Rep. 2018;38(6):BSR20171279.
Goodale BM, Shilaih M, Falco L, Dammeier F, Hamvas G, Leeners B. Wearable sensors reveal menses-driven changes in physiology and enable prediction of the fertile window: Observational study. J Med Internet Res. 2019;21(4):e13404. doi:10.2196/13404.
Zhu TY, Rothenbühler M, Hamvas G, Hofmann A, Welter J, Kahr M, Kimmich N, Shilaih M, Leeners B. The Accuracy of Wrist Skin Temperature in Detecting Ovulation Compared to Basal Body Temperature: Prospective Comparative Diagnostic Accuracy Study. J Med Internet Res 2021;23(6):e20710.
Study authors state that a cycle with a positive LH test was considered ovulatory; however, we know that in a small percentage of cases a positive LH test does not guarantee that ovulation will occur. Similarly, a cycle with only negative LH tests was considered anovulatory. Based on this criterion, 11% of cycles were deemed anovulatory.
Temperature shifts occurred almost two days later with wrist temperatures when compared to oral temperatures.
Study authors state that wrist temperatures rose to a larger extent (a mean of 11% higher) than oral temperatures in the luteal phase.
Study authors state that wrist temperatures were more sensitive than oral temperatures, and therefore showed a “higher true-positive rate”; however, wrist temperatures were apparently more prone to showing “false positive” temperature shifts in cycles where no LH surge had been detected.
My opinion after reading this study is that the Ava bracelet may be unsuitable for FABM charting. This is because temperature shifts will likely be delayed by approximately 2 days. In addition to this, Ava wrist temperatures are more sensitive and rise higher than oral temperatures in the luteal phase, which means that temperature shifts might be confirmed when oral temperatures would not be. Remember, Symptothermal Method rules have been established and studied based on oral/vaginal/rectal temperatures. It’s possible that these existing FABM rules may not be appropriate for the delayed/higher temperature curves created by the Ava bracelet. (Of course, it's also possible that these higher temperature shifts might be beneficial for some charters, especially those who have low progesterone and weak temperature shifts that are not well-served by existing FABM rules.)
Device: Fitbit devices (certain models/countries only) Price: From USD $100 (Fitbit Inspire 3 which is a tracker) to USD $300 (Fitbit Sense 2 which is a smartwatch) Type of skin temperatures (proximal or distal): Distal Skin site: Worn on the left or right wrist (dorsal side) to collect skin temperatures Time worn: Fitbit devices are designed to be worn continuously; however, I believe you can choose to wear them at night only if temperatures are all you are interested in. EMF exposure: I have searched through the Fitbit website and cannot find details of whether Fitbit devices emit EMFs while in use, and if so what the associated SAR levels would be. There are numerous discussions of this topic on Fitbit community support boards, and moderators seem reluctant to disclose actual levels. Fitbit community board moderator "SilviaFitbit" says "The radiation emitted from all Fitbit devices is minimal. It is safe to use your tracker while pregnant.The Fitbit's power output is extremely low: about 0.5% - 1% of the output power of a cell phone. As for our Bluetooth-enabled devices, a good deal of research has been done in the field of Bluetooth radiation dangers to humans, and the general consensus is that the 800MHz to 2 GHz radiation output of a Bluetooth device is negligible". Associated app: Fitbit app 3rd Party integrations: Fitbit devices are compatible with a wide range of 3rd party apps such as Strava, Peloton, Mindbody, Lumosity, MyFitnessPal and more. Despite this, I am unaware of any 3rd party FABM apps that can harness Fitbit skin temperatures for charting. Subscriptions required: You can access your average nightly skin temperatures without a premium subscription; however, if you would like to see the full fluctuation of your temperatures through the night, you will need a premium subscription. A premium subscription costs US $9.99 per month. Type of temperature data: Like the Oura Gen3 Ring and the Apple Watch Series 8/Ultra, Fitbit devices provide skin temperature changes as fluctuations (+/-) from your personal “baseline temperature”. Fitbit calculates your baseline temperature based on up to 30 nights’ worth of previous temperatures. Fluctuation trend data is less useful for FABM charting, as we need actual temperature values to plot on the graph section of our charts each morning. The Fitbit website states that temperature information is not available in all markets. Number of decimal places: One decimal place (.0) Data points provided:
Resting heart rate
Sleep data
Oxygen saturation
Temperatures
My take:
I like that the Fitbit Inspire 3 (at approximately USD $100) is the most affordable wearable skin temperature tracker on this list, meaning it will be accessible to a wider range of people. In addition, a premium subscription is not required to access daily temperature information.
I don’t really like to wear rings or watches to bed, because I keep my hands up by my head while I sleep and I find that jewellery on my fingers/hands interferes with my sleep. That said, the Fitbit Inspire 3 is a much more slimline design in comparison with the Apple watches, which is a drawcard for me.
Unfortunately, just like the Oura Gen3 Ring and the Apple Watch Series 8 / Ultra, the Fitbit app only provides users with fluctuation trends when it comes to daily temperatures. This means that the Fitbit lacks any “social proof” for use with FABM charting because it doesn’t provide actual temperatures which can be used on a chart.
I have personally tested the Fitbit Inspire 3 band and it provided extremely erratic temperatures that were wildly inaccurate on my chart (using the formula further down this page to obtain actual temperatures from the Fitbit fluctuation trends). Due to this, I do not recommend anyone spend money on this device to use for FABM charting.
Studies: Expand the Ava Fertility Tracking bracelet section to read about some studies on wrist temperatures and menstrual cycle tracking that may have relevance for Fitbit devices.
If you’ve read this far, you’ve now learned how different types of temperatures differ across 24hr and infradian menstrual cycles, and how this might impact FABM charting. You’ve also learned more about the features, pros and cons of some of the main wearable skin temperature trackers available on the market today.
But what about some of the more common frequently asked questions? Expand each of the headlines below to learn more about how to get absolute temperatures, whether your device displays enough decimals for FABM charting, how accurate your sleep data is, how the placebo and nocebo effect might impact you, and more.
Finally, how does using a wearable skin-temperature tracker impact the effectiveness of your chosen Fertility Awareness Based Method? This is arguably the most important question that this entire article addresses, so please take the time to read this section thoroughly.
Devices such as the Oura Gen3 Ring and Fitbit (various models) do not deliver actual temperature values. Instead, they calculate your “baseline temperature” and then provide you with fluctuation trends as a +/- from this baseline.
With the Oura Gen3 Ring, you do have the option of downloading the Natural Cycles app to be able to see your absolute temperatures; however, a lot of Symptothermal Method charters prefer not to use Natural Cycles app.
Is it too much to hope that these devices might provide absolute temperature values in future? I have read some opinions on the internet that the reason these devices don’t offer absolute temperatures, is that it is too easy for people to compare them against oral/other temperatures and then worry that perhaps the devices are not as accurate as they would have hoped.
Thankfully, FABM charters don’t generally need our temperatures to be perfectly “accurate”. Instead, what we are looking for is precision. We are looking at the overall pattern of our chart to identify temperature shifts. It doesn’t matter whether temperatures are slightly “out” by a certain amount, just so long as that error is consistent across every day of the whole menstrual cycle.
Accuracy: How close a measurement is to the true value. Precision: How consistent results are when measurements are repeated.
If you have your heart set on using a wearable device like the Oura Gen3 Ring or a Fitbit you will need to find a way to extract absolute temperature values to use on your chart. It's possible that you might be able to do this by assigning a random temperature reading as your “baseline temperature”. As an example, I would assign 36.5°C as a random baseline. Each day, my device will provide me with a figure for how much my temperature has deviated from the official baseline. I would then need to either add or subtract this figure from 36.5°C to provide an absolute temperature value for that day.
For example, if your Oura ring tells you that your temperature is “-0.3°C” you would subtract 0.3 from 36.5 for today’s temperature value of 36.2°C. Alternatively, if your Oura ring tells you that your temperature is “+0.6”, you would add 0.6 to 36.5 for today’s temperature value of 37.1°C.
In this way, you will be able to plot temperature values on your FABM chart. Remember, we don’t need temperatures to be perfectly accurate, we simply need them to be measured consistently each day so that we can identify the temperature shift caused by ovulation.
There are two caveats to this approach.
The first is that it’s possible that your device may update your “personal baseline” temperature without letting you know (in fact, Fitbit directly states on their website that your personal baseline is based on a rolling average calculation of your 30 most recent nights of data). I am imagining that changes to your "personal baseline" could occur for many different reasons over the span of several weeks or months. For example, you stop/start a new thyroid medication (which can impact core temperatures). Alternatively an effect might be seen if you implemented lifestyle changes (for example fasting/increased caloric intake/increased energy output/decreased energy output) that can impact your metabolism and core temperature. I am of the opinion that it is very likely that this could occur, and if so it will impact the precision of all subsequent temperatures on that particular chart.
Secondly, even with manual calculation of daily temperatures based on fluctuations from your personal baseline, Oura and Fitbit Celsius charters may still be lacking a second decimal place. Read on for more information on how the number of decimal places can impact FABM charting.
Finally, remember that you will be operating well outside of “perfect use parameters” if you decide to take this approach to obtain temperatures for your Symptothermal Method chart. Read on to learn more about effectiveness estimates.
To take your temperatures with the Symptothermal Method, you will need to use a basal body temperature thermometer that is accurate to +/-0.05°C or +/-0.1°F, and displays two decimal places. This is important because the shifts that occur around and after ovulation can be very small, and it’s important that we are able to accurately identify them on our charts.
When it comes to charting your temperatures, you will plot rounded temperatures on the graph section of your chart. Most Symptothermal Methods require that you round your raw temperatures to the nearest 0.05°C/0.1°F (Fahrenheit charters will use scientific rounding, while Celsius charters use a slightly different rounding technique).
Does your device display your daily temperature to two decimal places? It may be that your wearable device has been proven to take highly accurate temperatures in clinical settings, but when it comes to the public app interface, they are only sharing a single decimal place with you.
This specific situation is an issue for Celsius charters, who need to be able to chart to the nearest 0.05°C, which is not possible if your device only displays a single decimal digit.
Body Mass Index (BMI) is a number that provides information about a person’s weight and height. It’s useful to note that while BMI does provide some basic information, it also lacks context about things like bone density, muscle mass, overall body composition, and racial differences.
So, always take information based on BMI with a grain of salt, and consider whether the information may/may not apply to you personally.
If you have a higher BMI, I have heard anecdotal stories from other Symptothermal Method charters who have struggled to gain accurate skin temperatures using devices such as the Tempdrop, and believe it may be due to their weight. I’ve heard this from around 3 separate people at this point (not a huge number, but enough to pique my interest!).
Interestingly, there may be some truth to their suspicions regarding BMI and skin temperatures. A 2019 study titled ‘Nocturnal finger skin temperature in menstrual cycle tracking: ambulatory pilot study using a wearable Oura ring’ found that the accuracy of the Oura algorithm increased when the two study subjects with a BMI of over 30 were excluded from the calculations. Study authors state that a BMI of over 30 “is a potential confounder affecting distal skin temperature.”
A 2009 study titled ‘Adiposity and human regional body temperature’ showed that obesity causes distal temperatures to rise, to account for the insulating effect of a greater layer of subcutaneous abdominal fat. These higher distal temperatures allowed study participants to release heat and therefore regulate their core body temperature.
Is it possible that a higher baseline distal temperature might mute the post-ovulatory rise in distal temperatures, and therefore make it difficult to identify an accurate temperature shift? I would love to see more studies on this in future (for both distal and proximal temperatures), and in the meantime it is something that those with a higher BMI may want to keep in mind.
There’s some evidence that sleep data from many wearable devices may not be as accurate as we would like to believe.
Usually, sleep studies are performed under laboratory conditions using an assessment technique known as polysomnography. According to the Mayo Clinic, “polysomnography records your brain waves, the oxygen level in your blood, heart rate and breathing, as well as eye and leg movements during the study.”
Because wearable devices are currently limited to far less data points than are available in clinical sleep studies, it’s no surprise that accuracy may be lacking.
For example, Oura’s own website states that their sleep data only agrees with laboratory polysomnography results 79% of the time!
Additionally, a 2021 study tracked the accuracy of eight separate wearables/associated sleep analysis apps (Apple Watch Series 3, Beddit Sleep Monitor 3.0, Fatigue Science Readiband, Fitbit Ionic, Garmin Vivosmart 4, 2nd generation Oura smart ring, Polar A370, and the WHOOP Strap 2.0). The study found consistent trends across all devices showing failure to accurately determine the amount of time that the wearer was awake as opposed to asleep. Interestingly, the Oura and Fitbit were found to be the most accurate of these studied devices/apps.
These results may be because it is very difficult for wearable devices to differentiate between when you are simply laying quietly in bed with a lowered heart rate trying to fall asleep, versus when you actually are asleep. This can result in overestimation of the total sleep time.
Have you heard of the placebo effect? The nocebo effect is the opposite of the placebo effect. It describes the situation where someone is more likely to experience a negative outcome if you are expecting (or worried about) a negative outcome.
Have you ever woken up feeling great, but then check your wearable sleep data to see that you barely got any deep sleep the night prior, and you suddenly feel a bit more tired?
Alternatively, do you ever wake up exhausted, but then check your Oura App to see a high “readiness score”, and suddenly pep up a little bit?
I think it’s important to be cognisant of the way that femtech can impact our daily experiences in this way, especially if the sleep data that we are receiving is inaccurate.
There’s a lot to say for simply waking up and listening to what your body is telling you (as opposed to what an app is telling you about your body).
In our fast-paced digital landscape we are bombarded daily by information from all corners of the Internet. A 2012 consumer report by Roger Bohn and James Short of California University found that U.S. consumers were taking in 34GB worth of information each day - a decade later this number is now likely much higher. This is more information than many of us would have been exposed to in an entire lifetime just a few hundred years ago.
Now, wearable biometric tracking devices are also contributing to the sheer amount of information we are receiving each and every day. Information overload is well known to contribute to feelings of anxiety, overwhelm, powerlessness and mental fatigue.
If you are someone who struggles with the effects of information overload in our digital landscape, consider opting for a tried-and-true oral basal body temperature thermometer instead. This can be a breath of fresh air for many people. Remember, you know yourself best; if this is the case you can usually find an affordable $20 thermometer from your local pharmacy (and you can find a list of recommended BBT thermometers here).
Not only will you enjoy some respite from the onslaught of digital information, but you will be able to rest easy knowing that oral/vaginal/rectal temperatures are the only ones that have been proven safe and effective for FABM charting in clinical trials.
You’re operating closer to perfect use parameters if you choose a standard BBT thermometer over a wearable skin-temperature tracker.
Historically, clinical trials on the contraceptive effectiveness of the Symptothermal Method have assessed basal body temperatures collected from oral, vaginal or rectal sites only.
To meet perfect-use parameters for the Symptothermal Method you need to be relying on oral, vaginal or rectal temperatures. Other temperature collection sites have not been assessed in clinical trials for accuracy when used as a part of the Symptothermal Method.
This means that if you choose to rely on any wearable skin temperature collection device (including the popular Tempdrop), you are now operating outside of perfect use parameters and heading more toward typical use effectiveness rates (although by exactly how much, it is difficult to say).
Depending on how seriously you are needing to prevent a pregnancy, this may or may not be acceptable to you and your partner. This is a situation where you need to be clear on your reproductive intentions and your specific situation.
If it’s important to you to continue using a Symptothermal Method and attain BBT readings closer to your actual core temperatures, consider investigating internal temperature wearables. These include devices such as Ovolane, Trackle, OvuSense and iButton. Many of these are more popular in European markets.
Pictured are some of the internal temperature sensor wearables available on the European market. Some of them may provide fertility predictions in their associated apps. As always, if you're seriously wanting to prevent pregnancy it's best to manually interpret your temperature shifts using the FABM rules of your chosen method.
Given that the Tempdrop smart thermometer has a large user base of well over 10,000 users, and has been in use within the FABM community since 2017, many people (myself included) generally have a good level of trust in the accuracy of temperatures provided. I personally use the Tempdrop myself and am satisfied with the charts I receive; it has made postpartum charting a breeze for me. Not everyone shares this good experience though; in fact some charters report that they have struggled to get accurate readings with their Tempdrop. You can read more about the pros and cons of the Tempdrop here. Other wearable skin temperature trackers do not yet share the same social proof for FABM charting that the Tempdrop does.
My recommendation is that if you wish to rely on skin temperatures (from any wearable device!) for use with your chosen FABM, you should spend at least the first three menstrual cycles’ of use comparing your skin temperatures against your oral, vaginal or rectal temperatures. Even after confirming that the temperatures follow the same pattern and you are able to confirm temperature shifts on (or around) the same day, it’s still important to note that you are still operating outside of perfect use parameters. Ensuring you are cross-checking against cervical mucus with a Symptothermal Method likely adds some safety, but is still outside of perfect use parameters. If you're seriously trying to avoid pregnancy, I definitely would not recommend using skin temperatures with a "temperature-only FABM" (such as Natural Cycles).
In saying all of the above, I encourage everyone to experiment … for science! If experimenting with different forms of femtech means you find ways to make your chosen FABM more accessible and convenient – more power to you. Convenience usually means that you are more easily able to stay compliant with the data collection requirements of your FABM, which is beneficial for effectiveness.
So, the bottom line is (as always), you do U-terus. As long as you are making informed decisions based on accurate information, you’re on the right track.
Have you found this Info Hub helpful? Do you have any thoughts to add? Let me know in the comments below; I love hearing what others think about the latest FABM topics.
As a Symptothermal Method Instructor, I am often floating in many corners of the internet at once! I am privy to conversations from a large swathe of different demographics across platforms such as Facebook, Instagram and Twitter. I love hearing from such a wide range of Fertility Awareness-Based Method (FABM) users who often reach out to chat via my DMs.
Without fail, one of the most common laments I hear is “I wish I had known about this at a much younger age – I can’t believe I only learned how my body worked in my 20s/30s/40s”. Oftentimes, the natural next iteration of this thought process is “I can’t wait to teach my daughter/teen/menstruating child about this information because I want them to have the empowerment and body literacy that I missed out on at their age”.
My response is sometimes a little tempered, for many reasons. I’ve decided to dive into some of the nuances involved in teaching teenagers about FABMs in this article. I hope that the points I cover will give parents and guardians pause for thought, and provide a basic framework of considerations that may help to provide safer experiences for teens who begin charting with a FABM.
Teenagers and menstruation in Australia
Here in Australia, a lack of education for teenagers on the menstrual cycle continues to result in menstrual taboos that have far-reaching consequences for girls and young women.
In 2019, Libra was the first Australian menstrual product company to ever show a realistic depiction of period blood in a televised advertisement (#bloodnormal) – this was met with considerable controversy at the time due to the taboo that surrounds this normal bodily function.
This data is devastating. Ongoing taboos are robbing girls and menstruators of their confidence, their dignity, and their education. Not only this, these taboos muddy their ability to feel carefree and spontaneous in their existence – how can we feel carefree when are living in fear of bullying regarding a natural, normal bodily function?
The state of menstrual taboos in Australia should not only concern us, but it should break our hearts. Women, girls and menstruators deserve better than this.
So, what’s the answer?
Education would be a great place to start.
How so? The same research mentioned earlier by Plan International Australia showed that 70% of boys who described their school education on periods as “good” also said that they felt comfortable discussing periods, indicating that education is key to breaking down these taboos.
Almost 70% of Australian girls would rather fail a subject at school than have their peers know that they are menstruating.
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Considerations of teenage FABM charting
Like most things in life, FABMs for teenagers is a complex, multifaceted topic with nuanced pros and cons that differ for each individual user.
That said, there are some considerations which spring immediately to mind, that I think parents and guardians should be aware of before considering a FABM for pregnancy prevention for their teen:
1.) Lack of evidence: Most FABM effectiveness rates are based on studies done of people in regular times of fertility. This means there is less evidence as to the safety and effectiveness of FABMs for pregnancy prevention during phases such as the teen years, postpartum, post-hormonal contraception and perimenopause. In my opinion, this is truly the largest drawback of recommending FABMs for teenagers – we simply don’t have enough evidence as to the safety of doing so.
2.) Irregular cycles: Puberty can be considered a continuum of time during which the brain-ovary connection establishes and then stabilises. This connection is known as the hypothalamic-pituitary-ovarian (HPO) axis. Most teenagers will find that it takes time for ovulation to begin occurring regularly – and until it does, irregular cycles are common. This can be due to a mix of inputs including breakthrough bleeds, oestrogen-withdrawal bleeds, delayed ovulations, and short luteal phases. In essence, it takes time for the menstrual cycle to stabilise after puberty, and practicing a FABM during this time can be more difficult than usual.
3.) The prefrontal cortex: FABMs require a high level of user-involvement. Unlike “set it and forget it” contraceptives, using a FABM requires accurate daily observation of fertility biomarkers, accurate daily charting of findings into a paper chart or app, and modification of our sexual behaviour to prevent pregnancy during the method-identified fertile window. A high level of user-involvement may be less compatible with teenagers due to their underdeveloped prefrontal cortex. The prefrontal cortex is involved in rationality and impulse control and does not fully mature until around the age of 25. This may place teenagers at a higher risk of unintended pregnancy when relying on a contraceptive method that requires a high level of user-involvement.
4.) No protection against STIs: Unlike condoms, FABMs do not offer any protection against sexually transmitted infections (STIs). While abstinence is preferable from an STI protection perspective, sexually active teenagers should be educated on how to use condoms, and that they should be used during every sexual encounter. If your teen is sexually active and relying on a FABM for pregnancy prevention, condoms should still be utilised even if they are in a less-fertile or infertile phase of their menstrual cycle.
5.) Higher stakes: While an unintended pregnancy can be devastating at any age, the stakes are arguably higher for teenagers. Unintended pregnancy can have far reaching adverse social and economic outcomes which may negatively impact the life trajectory of teenagers. In addition, adolescent pregnancies can pose more health risks for the mother and infant than an adult pregnancy would.
Benefits of FABMs for teenagers
While the above considerations should be taken very seriously, there are also numerous and significant benefits to learning about how our bodies work as teenagers! Fertility Awareness-Based Methods (FABMs) bring empowerment, body literacy and insight into our own inner workings. They can provide the map that allows us to easier navigate our changing emotions and mental/physical capabilities across the different phases of the menstrual cycle. This information can be life-changing, and teenagers should have access to begin their learning process here.
With all that said, here are my recommendations if you have a teenager who is interested in learning how to chart with a FABM, or if you have a teenager who you feel would benefit from increased cycle and body literacy:
1.) Focus on charting for body literacy: Instead of focusing on using a FABM for pregnancy prevention, use this knowledge instead as a springboard toward body literacy. Many teenagers are lacking the most fundamental basics when it comes to understanding their reproductive anatomy and how their menstrual cycle works – this is where FABM education really shines.With basic education on anatomy, the menstrual cycle, cervical mucus and basal body temperature, teenagers can:
Demystify cervical mucus
Confirm whether ovulation is occurring
Accurately predict the onset of their periods
Demystifying cervical mucus alone is hugely valuable given so many teenagers worry that something is wrong with them when they first begin to experience cervical mucus during puberty. Predicting the next menstrual bleed by watching for a luteal-phase temperature drop or counting days of the luteal phase empowers teenagers to prepare in advance for a bleed and allays some of the anxiety that surrounds an unexpected bleed (although breakthrough/withdrawal bleeding can still be common during puberty).
2.) Shine the spotlight on their cyclical nature: Puberty can be a disconcerting time of great change for teenagers who may begin dealing with uncomfortable physical and mental symptoms as their bodies change. It can be empowering for teenagers to understand that their moods and emotions and physical capabilities can be impacted by their menstrual cycle. For example, by tracking diligently they may notice that they are more likely to experience cravings, fatigue and irritability or sadness in the lead-up to their period. This knowledge can act as a roadmap for teens to navigate their cyclical nature. It also provides reassurance that these experiences can be very normal, especially while their cycles are regulating and ovulation gradually becomes more robust with greater levels of progesterone produced.
3.) Chart to monitor reproductive health: Charting can be a great tool for teens to stay on top of health issues during puberty. If issues such as heavy bleeding, amenorrhea, vaginal infections, consistently delayed ovulations and/or irregular cycles are present, using a FABM can encourage us to seek medical diagnoses and assistance. It’s better to be informed than not, and FABMs are a great way to keep on top of our reproductive health.
4.) Allow the HPO axis time to mature: It takes some time for the HPO axis to mature during puberty. During this time, it’s normal for teens to experience irregular cycles. Author Sarah E. Hill states that we have a blind spot when it comes to how the Pill impacts our brains by switching off our sex hormones. Is it possible that we benefit our teenage brain development by allowing our HPO axis to mature instead of shutting it down completely with the Pill? A fascinating topic to dive into and I recommend reading Hill’s book ‘This is Your Brain on Birth Control’ if you’re curious about this subject.
Body literacy can be incredibly empowering for teenagers.
Where to from here?
If you would like your teenager to learn a Fertility Awareness-Based Method (FABM), there are a few things I recommend:
1.) Start out slow: Focus entirely on charting for body literacy to begin with. Begin by simply tracking menstruation dates, and then slowly layer in things like cervical mucus and sensation charting, secondary fertility signs (such as acne and bloating), and finally adding in basal body temperatures. Focus on how to use these biomarkers to predict when their next period will arrive, and how to understand themselves better as cyclical beings. Pregnancy prevention should not even be a part of the story, at least at the beginning. As your teenager grows and matures, you may want to introduce the concept of using a FABM for pregnancy prevention, but at least initially, the focus should simply be on body literacy.
2.) Hire a qualified instructor: If you do feel like your teenager is interested in learning how to rely on a FABM for pregnancy prevention, hire a qualified instructor of a specific method. Now is not the time to cobble together a rough method based on your own knowledge. Now is not the time to piece together snippets from podcasts, books, and social media. Maybe you are already an accomplished and competent FABM charter yourself, but maybe you’re not – and the only way to find out for sure is either an accidental pregnancy or taking a FABM course to double-check your knowledge – I know which one I prefer! Personally, I think SymptoPro has one of the most comprehensive Symptothermal educator-training programs and I would feel safer referring teens to a SymptoPro instructor over some other method instructors. You can find SymptoPro instructors here: https://symptopro.org/services/learn.html
3.) Start early: Invest in some relevant books for your teenager to read and learn from at a younger age. Two great options are:
4.) Look into teen-specific FABM education: You may be comfortable taking a teen-specific FABM course with your child.
*Some of these courses may provide general body literacy education, and not necessarily actual charting instruction.
*Some of these courses are provided by Catholic organisations. This means they are likely to focus on abstinence and general body literacy (as opposed to using a FABM for pregnancy prevention).
Mother-Daughter courses run by Fertility Science Institute (FSI): FSI was launched by FABM organisation Couple to Couple League (CCL). There are three courses to choose from depending on the age of your teen. CCL and FSI are Catholic pro-life organisations and are morally opposed to abortion, hormonal birth control, barrier methods such as condoms, and artificial reproduction technology such as IVF/IUI.
Cycle Show course by the Guiding Star Project: Guiding Star Project are a Catholic pro-life organisation and are morally opposed to abortion, hormonal birth control, barrier methods such as condoms, and artificial reproduction technology such as IVF/IUI. The Cycle Show is based on the teachings of the book ‘What’s Going on in My Body?’ by Elisabeth Raith-Paula.
Period Ready Parent-Teen eCourse by Bright Girl Health:A secular offering by Bright Girl Health Australia. Perfect for teens/tweens approaching their first period or navigating the first few years of menstruation. Designed to equip parents to support teens with body positivity and period pride. Includes comprehensive eBook, activity worksheets and video modules.
This article is brought to you by Jessie Brebner, a Symptothermal Method Instructor from the Gold Coast of Australia. Jessie is a passionate advocate for Fertility Awareness as a gateway to improved health, body literacy and reproductive empowerment. Jessie teaches the Symptothermal Method to people who are trying to conceive, and to people who are seeking a highly effective form of natural contraception.
Disclaimer: I am writing this article from the depths of postpartum sleep deprivation. Please also keep in mind that I am not qualified or trained to interpret contraceptive effectiveness estimate research papers so I encourage you to read the latest systematic review for yourself to form your own opinions about FABM charting in the postpartum 😊
Last month (in June 2022), a new systematic review was published titled ‘Effectiveness of fertility awareness-based methods for pregnancy prevention during the postpartum period’. You may remember a previous systematic review that was published back in 2018 titled ‘Effectiveness of Fertility Awareness–Based Methods for Pregnancy Prevention’ – well, four of the authors of that 2018 review were also involved in this most recent systematic review. Those four authors are Rachel Peragallo Urrutia, Margaret E Greene, Emily Kennedy and Joseph Stanford.
I was made aware of this latest systematic review after Dr. Chelsea B. Polis shared a link to it in the popular Facebook group ‘Fertility Awareness Method of Birth Control’. Dr. Polis was one of the authors of the original 2018 systematic review, and is also known for having fought for the publics’ right to accurate information about the effectiveness of the Daysy fertility monitoring device. You can read more about this story by visiting this Instagram highlight.
The latest systematic review was recently released in June of 2022.
Being currently postpartum myself, I was interested to read the latest systematic review for an updated perspective on the use of FABMs during this unique reproductive life phase.
For those not familiar with the postpartum period, the return of fertility after birth can be highly variable among different people, and is significantly affected by breastfeeding. The first postpartum bleed may or may not be preceded by ovulation, and it is not possible to predict when ovulation will first occur. The body may attempt multiple times over many months to ovulate, and once ovulation does return, cycles may remain irregular for some time. Breastfeeding can also contribute to erratic temperatures and changed cervical mucus patterns. All of these factors combine to create conditions that render FABMs difficult to apply to the postpartum. You can read in more detail about the hormonal and physical landscape of postpartum in relation to FABMs in this article: https://fertilitycharting.com.au/2019/03/31/postpartum-fertility-i-just-had-a-baby-now-what/
A little about my postpartum experience:
I gave birth to Sol in December 2021, and originally planned to learn the Billings Ovulation Method (B.O.M.) while in “Cycle 0”. Cycle 0 is the time from birth up until your first ovulation and true menstruation. For FABM users who are fully breastfeeding, cycle 0 can span many months (even over a year!). While the Symptothermal Method really shines for those in relatively regular cycles during times of regular fertility; it tends to have basic mucus protocols that sometimes lack some of the necessary nuance for the postpartum cycle 0. For this reason, I hoped to learn a cervical mucus-only type of FABM, and had my sights set on the B.O.M.
I gave birth to Sol in December 2021.
What I hadn’t factored in was the absolute intensity of the newborn phase with a colicky baby, a partner working 6 days a week, international travel restrictions keeping me separated from my family support system, a hefty dose of Covid sickness, a one-woman small business to keep afloat, and ongoing pain due to breastfeeding-induced Reynaud’s phenomenon of the nipple. It’s safe to say that learning the B.O.M. rapidly dropped completely off my to-do list.
Not to mention sex dropped rapidly off my to-do list, too!
In addition to this, most Symptothermal Methods only have postpartum protocols designed to accommodate simple “basic infertile patterns” of either continuing dryness, or continuing scant white mucus. My breastfeeding basic infertile pattern did not match either of these. This meant that if I didn’t learn the B.O.M., then I couldn’t even fall back on using the Symptothermal Method during cycle 0.
With all that said, my approach to charting in cycle 0 was to utilise what is known as coitus dependent contraception – contraceptive methods that are employed at each sex act to reduce the risk of pregnancy. So, this means things like barrier methods in combination with withdrawal. There are ways to maximise the safety and effectiveness of coitus-dependent contraceptives (and I teach this to clients in the Natural Contraception online course). Given the fact that ovulation returned for me relatively quickly (just over 3 months after having given birth), I didn’t mind utilising coitus-dependent contraceptives during this time.
After ovulation returned, I have been utilising coitus-dependent contraceptives during both Phase 1 and Phase 2 of my menstrual cycle, with unprotected sex reserved for Phase 3 only. This is due both to my reproductive intentions, and also because my charting practise remains a little sparse and ad hoc while I lack time and energy. Haphazard charting can put you at risk of missing the transition from Phase 1 to Phase 2 of the menstrual cycle, and for this reason I am currently choosing to utilise Phase 3 only. If the terms ‘Phase 1’, ‘Phase 2’ and ‘Phase 3’ are new to you – this is terminology which I teach clients in the Natural Contraception online course and is used to denote the infertile-fertile-infertile transition identified by the Symptothermal Method during regular ovulatory menstrual cycles.
Although I was personally too overwhelmed to learn a new FABM during the immediate postpartum, I was curious to delve into this systematic review. From my personal experience, I feel as though the postpartum time remains an underserved timespan of the reproductive life phases, and I was curious as to what the authors found on this subject.
There is a decided lack of evidence for the effectiveness of FABMs in the postpartum. The systematic review authors state that “The current evidence on the effectiveness of each fertility awareness-based method for postpartum persons is very limited.” Given the fact that in Australia, over 84% of women aged 45-49 have already given birth1, it is a shame that we lack evidence on the use of FABMs during this very common reproductive life stage.
The systematic review authors searched huge databases of thousands of studies against a very strict inclusion criteria to ensure that they would only be assessing studies that accurately appraised the effectiveness of FABMs in the postpartum. Because of the strictness of this inclusion criteria, they were only able to assess four studies.
Of these four studies, three were deemed of low quality and one was deemed of moderate quality.
The Symptothermal Method (which I use and teach) was not included in the systematic review as no studies met the inclusion criteria. The 2007 Sensiplan study which is most often quoted by users of Symptothermal Methods could not be included because it did not meet all of the study inclusion criteria: “at least 50 subjects who enrolled prior to experiencing 3 cycles after childbirth and were using a specific fertility awareness-based method to avoid pregnancy; unintended pregnancy rate or probability calculated; postpartum amenorrheic and postpartum cycling individuals analyzed separately; and prospectively measured pregnancy intentions and outcomes”.
The studies that were included showed a range of effectiveness rates that may or may not be acceptable to different individuals, depending on their reproductive intentions (how seriously they are needing to prevent a pregnancy).
Marquette Method, Bouchard 2012, United States, low quality study:
o Typical use effectiveness per cycle during the first 6 cycles postpartum: 88%
o Perfect use effectiveness per cycle during the first 6 cycles postpartum: 98% (additional effectiveness estimates for different time frames are available in the systematic review)
Billings Ovulation Method, Labbok 1991, Kenya, low quality study:
o Typical use effectiveness during the first 12 months postpartum: 81.5%
o Perfect use effectiveness during the first 12 months postpartum: 85.9% (additional effectiveness estimates for different time frames are available in the systematic review)
Billings Ovulation Method, Perez 1988, Chile, low quality study:
o Typical use effectiveness during the first 12 months postpartum: 88.9%
o Perfect use not provided
(additional effectiveness estimates for different time frames are available in the systematic review)
Bridge to Standard Days Method, Sinai 2012, Peru, Guatemala, moderate quality study:
o Typical use effectiveness during the 6 months after the first postpartum bleed: 88.2%
o Perfect use effectiveness during the 6 months after the first postpartum bleed (including use of condoms): 96.3%
The authors emphasise that the above individual FABM effectiveness rates cannot be directly compared to one another. This is because the studies themselves were all quite different, of relatively low quality, and the effectiveness estimates are for different postpartum timeframes.
Individual study results may not be generalizable to higher-income countries as they were predominantly carried out in lower-income countries (such as Kenya, Guatemala, Chile and Peru).
There is always some uncertainty as to the true effectiveness of FABMs in the postpartum because breastfeeding itself tends to reduce fertility due to the suppressant action of prolactin on the HPO axis.
My thoughts after reading this systematic review:
While I would love to see more high-quality studies into the effectiveness of FABMs for the postpartum, I suspect that one of the main contributing factors to the dearth of research to begin with may be funding issues. Research studies are often funded by companies who stand to benefit from data about specific products/services that they own or provide – this is important because studies are expensive, and companies hope to be able to recoup some of the costs involved in investigating the effectiveness of their products. Not many companies stand to benefit from more studies into FABMs, except for small-scale FABM instructors and FABM training organisations, who usually cannot afford to fund studies to begin with. This is especially apparent when compared to the pharmaceutical companies behind other contraceptive methods such as IUDs, insertables and hormonal pills.
This particular systematic review appears to have been funded in part by KNDR Healthcare. KNDR Healthcare is the company behind the Reply OBGYN reproductive health clinic in the United States. Reply OBGYN also provide FABM training in a range of methods including Marquette Method, the Billings Ovulation Method, Sensiplan (a well-known Symptothermal Method), and Listen Fertility which is their own in-house FABM method relying primarily on mucus observations, with optional temperature and OPK monitoring. It’s great to see this healthcare company investing back into FABM research. I would love to see more reproductive healthcare providers here in Australia also offering in-house FABM instruction as this might also increase the likelihood of funding for further studies on the effectiveness of FABMs.
Reply OBGYN is based in North Carolina in the U.S. and offers FABM instruction alongside gynaecology and obstetrics services.
At the end of the day, opting to rely on a FABM for pregnancy prevention during the postpartum is a decision that only you can make. This decision should take into account a range of factors such as your reproductive intentions (how seriously you are needing to prevent a pregnancy), whether you have the time and financial resources (some methods such as the Marquette Method are more expensive than others), whether you are comfortable relying on cervical mucus observations alone, whether you are in a safe relationship with a partner who shares your reproductive intentions, and whether you are comfortable relying on a FABM during the postpartum given the lack of quality evidence of effectiveness rates.
Perhaps one of my biggest takeaways is that the postpartum is simply a notoriously difficult time to chart our fertility biomarkers for pregnancy prevention – and we can see this reflected in these relatively low typical-use effectiveness estimates. I hope that in future we have more innovation in this area so that postpartum individuals have safe and effective biomarker-based contraception available to them without such big question marks over effectiveness estimates.
This systematic review definitely gives me some pause as to whether it is advisable to rely solely on a FABM for pregnancy prevention during the postpartum for those who are low on the reproductive intentions scale (i.e. they have a serious need to prevent pregnancy). Personally, I think that if I were to be postpartum again in future, I would most likely combine coitus-dependent contraceptives with the Marquette Method. I would also layer this with the added cross-check of basal body temperatures using the Tempdrop smart thermometer to circumnavigate the difficulties of getting an accurate BBT due to nighttime parenting. You can read more about the Tempdrop here. And yes – I would definitely seek out Marquette Method instruction *before* birth (because time is decidedly short for learning new things during the immediate postpartum – I have learned my lesson here! 😅).
Do you have any thoughts on this systematic review? I would love to hear them – let me know in the comments below how you feel about this new information.
This article is brought to you by Jessie Brebner, a Symptothermal Method Instructor from the Gold Coast of Australia. Jessie is a passionate advocate for Fertility Awareness as a gateway to improved health, body literacy and reproductive empowerment. Jessie teaches the Symptothermal Method to people who are trying to conceive, and to people who are seeking a highly effective form of natural contraception.
1. Australian Bureau of Statistics, (1981–2016), Census of Population and Housing
When I first tell people that I teach clients how to chart their menstrual cycles to conceive, the initial reaction is often “Is that really necessary? Don’t people just have sex and fall pregnant and it’s as easy as that?”
Unfortunately, this is a symptom of a health education system which drums into us from a young age that sex inherently always leads to pregnancy and that we are walking, talking fertility factories!
Unfortunately, many couples soon discover that the reality is quite the opposite. Each menstrual cycle, we only have a 6-9 day window of fertility during which pregnancy could result from unprotected sex. This takes into account the lifespan of both our partners sperm and the egg that we release at ovulation. When we break this down even further, the egg itself only lives for a maximum of 24 hours. This means there is a single 24hr window during which sperm need to be ready and waiting in our fallopian tubes to meet the egg released at ovulation!
On top of this, the average chance of conception in any given menstrual cycle is only 25-30 percent (and these figures drop quite dramatically after the age of 35).
So, how does charting our cycles help us in the context of these statistics? At the most fundamental level, charting our cycles allows us to know in real time whether we are fertile or not on any given day. Using a Fertility Awareness-Based Method (FABM) allows us to identify the opening and closing of the fertile window each menstrual cycle, and this information can be used to help us optimise the timing of any unprotected sex.
It’s important to note that FABMs do not allow us to pinpoint the opening and closing of our biological 6-9 day fertile window (as we cannot predict in advance when ovulation will occur). Instead, FABMs allow us to pinpoint this window with a buffer of at least several days on either side. In fact, Symptothermal Method users with an average 28-day cycle would likely see a chart with an average 11-day fertile window (somewhere within which lies the biological 6-9 day fertile window).
As shown in a study released in 2007 of 900 German women, the Symptothermal Double-Check Method was shown to be able to pinpoint the opening and closing of the fertile window in this way with up to 99.6% accuracy!
So, apart from allowing us to optimise the timing of unprotected sex, how else can using the Symptothermal Method be beneficial when we are trying to conceive?
Anovulatory “Cycles”
Did you know that it is possible to have a “period” even if your body failed to ovulate? These are known as anovulatory “cycles”. We put “cycles” in quotation marks because without ovulation, a full menstrual cycle has not occurred, and any bleed experienced is simply a breakthrough bleed or withdrawal bleed occurring during your follicular phase (and this follicular phase could extend weeks, months or even years before ovulation actually occurs).
In fact, a bleed is only a true period if ovulation occurred 10-16 days prior. So, without ovulation, any bleeding is not considered a true period.
The takeaway from the above is that the presence of a bleed (whether regular or not) does not prove or guarantee that ovulation is occurring.
Charting with the Symptothermal Method allows you to find out whether ovulation is occurring – and if not? It is time to dig deep to discover the root cause, because without ovulation it is not possible to conceive naturally.
PCOS or Long & Irregular Cycles
When you are experiencing irregular or long cycles, the old adage of “every woman ovulates on day 14” will be of even less use to you when you are trying for a pregnancy.
Thankfully, using the Symptothermal Method will allow you to obtain critical visibility on what exactly your body is doing each day. Because the Symptothermal Method relies on real-time observations of your fertility, you don’t need to have regular cycles to be able to use the Symptothermal Method to pinpoint when ovulation may be approaching.
In fact, one of my recent clients came off the Depo Provera shot and did not ovulate for around nine months. During this time, we were able to keep track of her cervical mucus and basal body temperature to know in real-time what her body was doing. The result? She was able to catch her first post-Depo ovulation on her chart – and fell pregnant!
Estimated Due Dates
Once you see those two lines on your home pregnancy test, your first thought may be something along the lines of “so when will baby be due?”. Your chart will be able to provide some helpful information here.
As always, a dating scan (ultrasound) in early pregnancy will provide the most accurate estimate of the gestational age of your baby (and therefore the estimated due date).
Despite this, some people prefer to decline this early dating scan. This leaves the doctor to calculate your due date using the first date of your last period. Unfortunately, these calculations are based on the idea that women all ovulate on cycle day 14.
If you ovulated much later than cycle day 14, then the estimated due date from your doctor will be much earlier than your true due date. This can result in unnecessary pressures of induction during the late stages of pregnancy, or unfounded concerns about your baby “measuring small for your dates.”
You can often avoid this by using your chart to calculate a more accurate estimated due date. Despite this, I like to remind clients that in reality only 5% of babies actually arrive on their due date.
Mental Health
It can be trying to face months on end of having sex every 2-3 days throughout your entire menstrual cycle (these are the official guidelines for couples who are not using the Symptothermal Method to track their fertility).
Using the Symptothermal Method means that you can avoid burnout and frustrations with a regimented sex life when trying to conceive. Once you have information each day about your fertility status (using cervical mucus and basal body temperature data), you can make the decision to have unprotected sex or take a break.
In the luteal phase, if you have been able to confirm ovulation using the specific rules of the Symptothermal Method, there are usually up to 14 days where pregnancy is not possible. When the egg you released is dead and gone, both you and your partner can take a break!
Progesterone Levels
Progesterone is our “pro-gestational” or “pro-pregnancy” hormone. Our ovaries only release progesterone in the two weeks after ovulation has occurred and adequate levels are critical for the lining of our uterus to be stable enough for the implantation of a fertilised egg.
If progesterone levels are too low, our uterine lining can begin to break down too early, not giving the fertilised egg enough time to implant. If the fertilised egg does manage to implant, low progesterone levels can also cause chemical pregnancy or early miscarriage.
It would make sense then that we would want to know in advance whether our progesterone levels are low to avoid the heartache of early pregnancy loss if possible. Unfortunately, the conventional approach often requires that you experience two or more recurrent miscarriages before your GP refers you for testing.
Charting your cycles can allow you to avoid this heartache by addressing low progesterone levels before they interfere with a pregnancy.
How exactly can charting do this? Most importantly, it allows us to see whether or not our luteal phase is of sufficient length (with ten days being the minimum here). We can also assess our temperatures, spotting patterns and cervical mucus patterns to deduce whether low progesterone may be an issue.
Our charts never act as diagnostic tools on their own; however, they can act as signposts toward issues that may warrant further medical testing. With the help of a trusted medical professional these issues can often be addressed with diet and lifestyle changes in addition to supplementation.
I highly recommend reaching out to your nearest Naturopath or Traditional Chinese Medicine provider as many of them are trained in interpreting fertility charts to address hormonal imbalance.
Cervical Mucus
Cervical mucus is vital for sperm survival, but you may be hard-pressed to hear this basic information from your GP. In fact, without adequate high-quality cervical mucus, sperm can die within minutes when exposed to the acidic conditions of the vagina.
When trying to conceive, cervical mucus is one of the most important pieces of the puzzle (one of the reasons I am very outspoken against the use of temperature-only apps and devices for those trying for a baby – and you can watch a video of my reasons here). If you have been charting for 3 or more cycles and are noticing that scant cervical mucus is a recurring issue, it’s potentially time to reach out for some assistance with balancing your hormones.
Because cervical mucus production is triggered by oestrogen, scant cervical mucus can occasionally signify low oestrogen levels. Low oestrogen levels can result from a large array of causes – many of which are usually addressable with the help of a functional medicine practitioner. There are also other causes of scant cervical mucus other than low oestrogen, and a trained Naturopath or TCM doctor will likely be able to work with you to investigate further.
Endometrial Thickness
The heaviness and length of our menstrual bleed can occasionally reflect basic information on the thickness of our uterine lining.
The thickness of the lining of our uterus plays a role in whether the implantation of a fertilised egg will be successful. If the lining is too thin, it can sometimes indicate (similarly to scant cervical mucus) low oestrogen levels.
On the other end of the spectrum, heavy or prolonged bleeding can occasionally signify too much oestrogen (or too little progesterone in comparison with oestrogen) or the presence of fibroids which can occasionally interfere with pregnancy.
A qualified Naturopath or Traditional Chinese Medicine doctor (in conjunction with your trusted GP), should be able to read your charts, make note of any signposts toward potential issues, and then have those issues thoroughly investigated.
The Verdict?
As you can see, charting your cycles when trying to conceive is one of the most valuable tools you can employ on your journey toward a baby. In addition to all of the above, a trained Naturopath or Traditional Chinese Medicine doctor will be able to glean much more additional health information from your charts, including potential thyroid issues (which can be directly correlated to early pregnancy loss).
While charting your cycles is not a magic panacea (and the act of simply recording cervical mucus and basal body temperature each day definitely will not cure or fix any reproductive health issues that you have), it can be the first step to taking note of what your body is trying to tell you. Our charts are never diagnostic tools on their own; however, they can act as signposts toward issues that we may want to investigate further.
Like a canary in the coalmine, our menstrual cycles often give us the first clues of any health issues that we may be facing. This is because reproduction itself is not necessary to your survival, and the act of ovulating and shedding then growing the uterine lining is a very energy-intensive process. When your body is facing other health issues or chronic stress, your menstrual cycle is often the first thing that your body begins to shut down so that it can focus on conserving energy to put toward your healing.
In fact, it is for this reason that the American College of Obstetricians and Gynaecologists (ACOG) released a committee opinion in 2017 designating that the menstrual cycle should be considered a fifth vital sign for girls and adolescents (the topic of shutting down teen menstrual cycles with synthetic contraception is a topic for another day!).
My key takeaway: If there is one thing that I recommend to any couple hoping to conceive, it is this: start to chart your cycles with the Symptothermal Method right away (preferably 3-6 months before trying to conceive). Oh, and reach out to your nearest qualified Naturopath or TCM Doctor to obtain a high-quality prenatal supplement (not one off the shelf of your nearest pharmacy – ask your Naturopath to tell you about the difference between folic acid and folate for an explanation).
Not a month goes by where I don’t get a question or a comment along the lines of “I’ve heard that you can spontaneously ovulate when the moon is in the same phase as it was when you were born… is that true?” As it seems there are a lot of people wondering the same thing, let’s dive into the research!
NATAL LUNAR CYCLES
To answer the question of whether the moon causes random ovulation, it’s helpful to establish where this concept originated. In fact, it all stems from a method known as “Natal Lunar Cycles” created in 1956 by Dr. Eugen Jonas, a psychiatrist from Slovakia. Dr. Jonas was a devout Catholic. When laws legalising abortion were passed in nearby Hungary in 1956, he decided to investigate whether there was a way to help women avoid unplanned pregnancies (and therefore the need for abortion). Throughout much of history, humans have connected the moon with female fertility due to the similarity of their cycles (the textbook menstrual cycle is 28 days long, and it takes around 29.5 days for the moon to orbit the earth). Dr. Jonas gravitated toward this theme in his search for answers.
Dr. Jonas formulated a theory that women had two separate fertility cycles:
The usual and expected ovulation cycle (ovulation occurring roughly in the middle of the menstrual cycle), and
A lunar cycle
Jonas theorised that women could ovulate at spontaneous times outside of their usual time of ovulation, and this was likely to occur when the moon was in the same phase as it was at their birth. For example, if you were born two days before a waning crescent moon, then you could expect to always be highly fertile two days before the waning crescent moon (regardless of where that might fall in your current menstrual cycle).
Calculations were done in advance to identify where these “lunar fertile” days would fall throughout the year. Dr. Jonas would then advise his patients to abstain from sex for at least four days around this time. Usually, it was specified to avoid the three days leading up to the “lunar fertile” day, and the “lunar fertile” day itself, as well as a full 13 days identified by the Rhythm Method. This totalled at least 17 days of abstinence out of every menstrual cycle!
Jonas also developed calculations that were supposed to assist with gender selection and avoiding foetal abnormalities.
Dr. Jonas claimed his method (combining lunar fertile days with the Rhythm Method) showed a 97.8% effectiveness (although I can’t find any record of the studies that are supposed to support these findings anywhere online).
Dr. Eugen Jonas, a Czech psychiatrist.
WHAT IS THE RHYTHM METHOD?
To really understand Dr. Jonas’ method, it’s important to understand the Rhythm Method. The Rhythm Method is an outdated relic of the 1930s, where women predict their fertile days based on the lengths of their previous 12 menstrual cycles. The Rhythm Method has only low-quality scientific studies to support it, and an estimated effectiveness rate of around 80% which is generally unacceptable by today’s standards. The Rhythm Method assumes that every woman will ovulate approximately 14 days before her next period, every menstrual cycle. This assumption (and the lengths of your previous 12 cycles) is used to determine when you should avoid unprotected sex.
Why is it so ineffective? In a nutshell, humans are not robots: there is wide variation among women, and even for the same woman when it comes to our menstrual cycles. Many of us have a luteal phase that is significantly shorter or longer than the 14 days assumed by the Rhythm Method, and many things can cause us to ovulate earlier or later than we have in the past 12 months.
As it turns out, Dr. Jonas’ method doesn’t actually follow Rhythm Method rules, but it does apply “rhythm method thinking” by assuming that every woman will ovulate on day 15 of her menstrual cycle. Jonas’ method states that the user must abstain from sex for a full 13 days around this assumed day of ovulation: “Starting from this ovulation day [cycle day 15], add six days before and six days after this ovulation day.”
When combined with the four days of abstinence required around the “lunar fertile” day, that’s a total of 17 days of abstinence required each menstrual cycle!
It’s no surprise that Dr. Jonas had some level of success with his method when you consider the sheer number of days that his users were having to abstain from unprotected sex.
It’s no surprise that Dr. Jonas’ method had some level of success given the large number of days that users had to abstain from sex.
HISTORICAL CONTEXT
Dr. Jonas developed his method in 1956 at a time when the importance of cervical mucus was only just being realised by the medical establishment. Cervical mucus provides real-time insights into our hormones because it changes in sensation, colour, amount and texture in response to our hormones. You can read more about cervical mucus here. The value of basal body temperature in confirming ovulation had already been known since the 1930s so it’s unclear why Dr. Jonas didn’t utilise this information. Instead, in a rather bizarre choice for a Catholic, Jonas decided to pursue the field of astrology for answers to a question that would have been better served by biology.
The Symptothermal Method itself was officially born in 1953 when Dr. Edward F Keefe added daily mucus observations to the existing Calculo-Thermal Method. With the spread of knowledge around cervical mucus, methods such as the Rhythm Method gradually lost favour as practitioners realised that we could monitor our fertility in real-time (as opposed to making “best-guess” predictions that left us open to error).
Natural forms of contraception evolved away from calendar/rhythm methods with the discovery of cervical mucus and basal body temperature as real-time indicators of fertility.
THESE DAYS
Thankfully, we now have very solid evidence of the way our reproductive biology functions each menstrual cycle and are no longer at the mercy of haphazard lunar predictions or the ineffective Rhythm Method. The myth of multiple ovulation is well and truly de-bunked ((you can read about that here). Plus, we have a fantastic longitudinal European study that established a 99.6% perfect use effectiveness rate for the Symptothermal Method.
This 99.6% effectiveness rate would have been completely unattainable if Dr. Jonas’ theory had a single shred of credibility.
In fact, in the entire 20 years of this longitudinal prospective clinical trial, not a single method error pregnancy was ever recorded during the luteal phase after ovulation had been confirmed by Symptothermal Method rules.
BUT WHAT ABOUT SUCCESS STORIES?
For the Symptothermal Method charter, it can be very frustrating to hear anecdotes along the lines of “I know I ovulated on the Friday, and we had sex the following Thursday and ended up pregnant – I know for certain that I ovulated twice!”
In these cases, I always say “Interesting! Can you show me your chart?”. I have never once had anyone show me a chart.
Invariably, most people with stories like this were not charting with any reliable method but simply noticed some “ovulation pain” or saw a positive OPK test and assumed that this meant they had definitely ovulated. [Hot tip: Neither mittelschmerz nor a positive OPK test are a guarantee of ovulation].
In other cases, the woman was relying on mucus observations alone and assumed that seeing eggwhite cervical mucus guaranteed that ovulation was occurring. [Hot tip: highly fertile peak type mucus is an indicator of high oestrogen levels – however this does not guarantee that ovulation will occur].
Without a chart which shows a sustained temperature rise and a dry-up of cervical mucus that meets the specific rules of the Symptothermal Method, these anecdotes prove nothing (except that the person telling them does not have a sufficient understanding of their cycle to make any claims about multiple ovulation).
IN REAL LIFE
As a seasoned charter and a certified Symptothermal Method instructor, I’ve actually put Dr. Jonas’ theory to the test myself. I sent my beautiful mother a Facebook message and asked her to dig out my birth certificate and confirm for me the exact time of my birth, 30 years ago! (Wow, time flies!). I used a simple calculator available freely on the internet to find out my “lunar fertile” days and then I compared them to my past 12 menstrual cycle charts.
What do you know? The majority of those supposedly highly fertile days fell firmly in my menstrual or luteal phases – and I can tell you I’ve had plenty of unprotected sex during those times that definitely have not resulted in a pregnancy. (Please keep in mind that it is possible to conceive from period sex. These were the times specific to my own unique cycle that were identified as safe days using the Symptothermal Method.)
Mostly, this experiment made me feel sad when I thought of the women who may have tried to do the same thing by actually paying Jonas. He has multiple websites that all seem to offer different services, one of which is providing dates of “good vitality” for women who have suffered miscarriages and foetal abnormalities. This comes in at a cost of around AUD $80 and stinks of predatory behaviour.
My lovely mum humoured me by sending through the actual time of my birth – thanks mum!
BUT WHAT ABOUT THE ~TIMING~ OF OVULATION?
While the moon cannot cause you to experience two ovulations in a single menstrual cycle, there is some evidence that the luminescence and gravimetric cycles of the moon may influence the timing of menstruation (and therefore ovulation).
A 2021 study looked at data from 22 women, who had each recorded period onset dates for an average of around 15 years. The researchers found that menstruation occurred more often around the new moon and full moon than would be expected to occur by chance.
Luminescence (light) appeared to impact the timing of ovulation for some women, some of the time.
The same was found for apogee and perigee dates, when the moon is closest to or farthest from earth and exerting maximal or minimal gravitational force.
These impacts were temporary, meaning menstruation start dates would cluster around new moon/full moon and apogee/perigee dates for some time, before drifting away again. However, this was occurring more often than would be expected to occur due to chance.
The researchers hypothesise that human reproductive behaviour may have been syncronous with the moon in ancient times. They also hypothesise that our modern lifestyle and increasing exposure to artificial light may now be inhibiting the display of these ancient menstrual onset patterns.
CONCLUSION
There’s much we don’t know in this world, and science certainly does not have all the answers. There is definitely some interesting research out there about the impact of light on our fertility! However, if Natal Lunar Cycles were a valid hypothesis then the Symptothermal Method would be vastly less effective than it has been proven.
The verdict? The moon will not cause you to spontaneously ovulate. Natal Lunar Cycles is a now-outdated theory that will only result in unnecessary abstinence on your part (or unfounded hope if you are trying to conceive).
This morning, I read an article titled ‘The Trump Administration Would Like To Talk To You For A Second About Your Cervical Mucus’. It outlined how Fertility Awareness-Based Methods (FABMs) were being taught by the U.S. Department of Health and Human Services at the expense of providing education and resources on hormonal contraceptives and long acting reversible contraceptives (LARCs). The writer was understandably angry about this, and as I read through the article I became angry too.
But my anger came from a different place. I’m angry about the ways that FABMs have been (and continue to be) appropriated by Church and State as a political and religious pawn to further specific agendas – and how this ultimately discourages onlookers from using FABMs in the first place. The association serves to alienate growing numbers of people who could potentially benefit from using a FABM, while simultaneously introducing suspicion around political bias.
To understand how this has come about, it’s helpful to establish that much of the original scientific research into FABMs came from Catholic OBGYN’s and scientists. This is because the Catholic religion teaches that the use of artificial contraception is a sin (and this was even more firmly established in 1968 with the release of Pope Paul VI’s ‘Humanae Vitae’). The researchers therefore had compelling personal reasons to vehemently pursue a natural method of birth control.
We have much to thank these early researchers for; however, the Catholic influence has continued to pervade mainstream perception of FABMs to this day, often to the detriment of credibility and availability. This persists despite FABMs being politically and religiously neutral. In fact, FABMs are available to all people with a uterus regardless of their race, gender, nationality, skin-colour, age, religious views, political views, occupation or relationship status. I would go so far as to say that FABMs provide a level of body-literacy which should be available to all from as early as high school biology classes. They are not the sole domain of the Catholic church.
Unfortunately, many supposedly secular organisations are in the insidious business of delivering the trojan horse of effective non-hormonal birth control (FABMs) to your door – before unexpectedly using their educational materials to further an anti-choice agenda.
Many supposedly secular organisations promote themselves as providing full and detailed facts and education about all different types of FABMs, but fail to provide honest information about the shortcomings of the science behind their resources. Other supposedly secular organisations are run by people who have in the past exposed a clear agenda to abolish all forms of hormonal contraception.
In fact, it would seem that many FABM education providers intentionally posit themselves as secular organisations as a way to claim neutrality and credibility; however, on closer inspection the upper echelons of their financial backers and directors are often a roll-call list of conservative religious and far-right political figures. It’s this intentional blurring of the lines between secular and non-secular which is most concerning.
My message to these organisations? Stop using FABMs as a trojan horse for the delivery of your religious beliefs on sex, contraception, abortion and marriage. If nothing else, providers with even an inkling of religious background must be ruthlessly transparent about their motives when it comes to teaching or promoting a FABM.
For FABMs to be taken seriously as a valid means of contraception, they must not be politicised. They must not be used as a vehicle for the non-consented delivery of religious beliefs and agendas.
For me personally, hormonal contraception was a wild ride of the worst variety, and I’m very glad that I am now using the Symptothermal Method instead (the Symptothermal Method is a type of FABM). However, I will fight tooth and nail for other people to have the right to choose to use hormonal birth control if that is what they prefer. FABMs should never be promoted by official sources at the expense of all other contraceptive methods.
To be clear, I am not anti-religion. There is much research to show that religion plays a pivotal role in the health and wellbeing of a great number of us. It provides people with hope, direction and community and its benefits should not be understated; however, I cannot stand back while my chosen contraceptive method is hijacked as a messenger of said beliefs.
This editorial is brought to you by Jessie Brebner, a Symptothermal Method instructor from the Gold Coast of Australia. Jess is passionate about providing education on the menstrual cycle and regularly blogs on the subject of Fertility Awareness-Based Methods and body literacy. You can find more from Jess on her Instagram @fertilitycharting
By the time we’re out of our teens, most of us are “old hands” at dealing with periods, cramps, ibuprofen, blood stains, sourcing tampons at last minute and scrabbling for a spare liner amongst the crumbs in the bottom of our handbags! Maybe some of us have even ventured into the world of menstrual cups (gasp! yes they’re a thing now ladies), while others are starting to think about whether they’re ovulating and how to time sex to achieve pregnancy (turns out that’s harder than we thought it was). But how much do we really know about the inner workings of our uterus and our menstrual cycle?
When it comes down to it – no matter how much of a Period-Pro you are, there’s always more to learn! Scroll down to take the Period Quiz now to discover your Period IQ. Compare your score with your friends to see whether you need to head back to sex-ed classes!
The Period Quiz is brought to you by Jessie Brebner, a Symptothermal Method teacher from the Gold Coast of Australia. Jess is passionate about educating women on the superpowers of their menstrual cycles. Take the Period Quiz now!
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The good news? You’ve got some learning to do. The even better news? Learning about your period is FUN! Here’s a good place for you to start right now: Your Menstrual Cycle Is More Than Just A Bleed. Plus, it’s helpful to pass on the knowledge you learn to raise awareness of the power of periods among your friends.
Don’t forget to sign up to the mailing list below for plenty of useful info and free downloads.
The Period Quiz is brought to you by Jessie Brebner, a teacher of the Symptothermal Method of Fertility Awareness. Jess is based on the Gold Coast of Australia and is passionate about educating women on the superpowers of their menstrual cycle. Jess teaches women how to chart their cycles for natural contraception, to conceive easier, and as a way to keep tabs on their reproductive health.
50 – 90% NOT BAD GIRL, NOT BAD!
Considering sex-ed classes probably only taught a fraction of what you just covered you are nailing it! But don’t rest on your laurels, now is the perfect time to get up to scratch on hormones, periods and fertility. Plus, it’s helpful to pass on the knowledge you learn to raise period awareness among your friends.
Don’t forget to sign up to the mailing list below for plenty of useful info and free downloads.
The Period Quiz is brought to you by Jessie Brebner, a teacher of the Symptothermal Method of Fertility Awareness. Jess is based on the Gold Coast of Australia and is passionate about educating women on the superpowers of their menstrual cycle. Jess teaches women how to chart their cycles for natural contraception, to conceive easier, and as a way to keep tabs on their reproductive health.
90 – 100% WOAH NELLY.
You really know your stuff – who taught you!? Don’t rest on your laurels though, there’s always plenty more to learn! Plus, it’s helpful to pass on your knowledge and raise awareness of the power of periods among your friends.
Don’t forget to sign up to the mailing list below for plenty of useful info and free downloads.
The Period Quiz is brought to you by Jessie Brebner, a teacher of the Symptothermal Method of Fertility Awareness. Jess is based on the Gold Coast of Australia and is passionate about educating women on the superpowers of their menstrual cycle. Jess teaches women how to chart their cycles for natural contraception, to conceive easier, and as a way to keep tabs on their reproductive health.
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Your menstrual cycle should be 28 days long. True or False?
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Is the period we get on the Pill a real period?
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How long should a period last?
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When during the menstrual cycle are you most fertile?
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How long are women fertile for each menstrual cycle?
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What is the lifespan of sperm?
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Can you fall pregnant from having sex on your period?
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What’s the best way to time sex if you want to conceive?
Recently, The Guardian released an article titled “Women Don’t Need To Bleed: Why Many Women Are Giving Up On Periods”. Many professionals within the Fertility Awareness-Based Method (FABM) community were concerned at how harmful the article was, and I want to delve into exactly how so! The above video is my response to The Guardian’s article – if you would prefer to read about why your menstrual cycle is more than just a bleed – continue reading for the transcript of the video.
The article was authored by Nicola Davis, who outlined how increasing numbers of women are choosing to use methods of contraception such as the combined oral contraceptive Pill continuously, to completely banish their period, and with it all uncomfortable symptoms such as bloating, cramping, mood swings and acne.
To begin with, I want to make sure that readers understand the definition of a true period: A true period is a bleed which follows approximately 14 days after ovulation. This means that if you’re not ovulating, you’re not having a true period. Instead, you’re having what’s known as a withdrawal bleed. A withdrawal bleed occurs when the lining of the uterus sloughs away in response to the “withdrawal” of hormones (in this case, the synthetic hormones of the Pill).
Most contraceptives work by inhibiting ovulation, which means that if you’re on these methods of contraception, you’re not even having a true period. On top of this, there’s no good reason for you to have a withdrawal bleed each pill packet. It’s simply done because that’s the way it’s always been done (and yes there is some evidence that this is because the original developers of the Pill wanted the method to seem more natural and therefore more acceptable to the Pope).
A true period occurs approximately 14 days after ovulation. If ovulation did not occur around two weeks prior, then the bleed is a withdrawal bleed.
All this aside – if you’re already on hormonal contraception that inhibits ovulation, then you’re not experiencing a true period anyway – so sure, go ahead and take those pill packets back-to-back because the bleed you’re experiencing really has no benefits for you.
However, here’s where we come to the interesting stuff: the article by The Guardian COMPLETELY missed the mark by saying that menstruation is pointless.
In fact, there’s a quote in there by Dr Anne Connolly, the clinical lead for Women’s Health for the Royal College of GPs, who says there is no health benefit to them: “Ninety-nine per cent of women don’t need to bleed.” Judith Stephenson, the Margaret Pyke professor of sexual and reproductive health at University College London, even goes so far as to say “In some ways, it seems like one of God’s great design faults … It is not helpful to have these periods – in fact, if you don’t have them, one of the biggest benefits would be reducing iron deficiency anaemia.”
Both of these medical professionals are completely missing the fact that menstruation is not the main event of the menstrual cycle.
Menstruation is simply a flow-on effect of ovulation. Ovulation is the true main event of the menstrual cycle – and ovulation has significant health benefits. This is because ovulation is the way that we make our female sex hormones, oestrogen and progesterone. Ovulating regularly has health benefits for your heart, bones, breasts, mood, libido, energy, insulin response, thyroid, skin, hair and so much more.
Ovulation is the main event of the menstrual cycle.
For example, ovulation is incredibly important for bone health and during our teens and twenties is our only chance to build up a good bone mineral density. Oestrogen and progesterone play a role in bone health, and if we take contraception that stops us from ovulating during this time, we’re missing out on the chance to build up some of our bone mineral stores for the future. This can increase our risk for osteoporosis in old age.
As another example, progesterone has natural benefits for your mood and low progesterone is linked to anxiety and depression. If you’re not ovulating, you’re not making progesterone and therefore don’t get to enjoy this natural protection.
Also, regular ovulation has huge benefits for heart health – and this is one of the reasons why postmenopausal women are at an increased risk of heart disease.
I’m not a medical professional so I do encourage you to do your own research on the health benefits of ovulation. The above are just a few examples. The key takeaway here is that ovulation is a natural mechanism of the body and has many benefits that go well beyond reproduction.
It’s also worth noting that the synthetic hormones in the Pill are NOT the same as the natural sex hormones that your body produces when it ovulates – they don’t have the same benefits (and in many cases actually cause unfortunate side effects instead).
Oftentimes these articles roll out this idea that in the past, women hardly had any periods because we were so busy being pregnant cavewomen – and therefore we should really suppress our periods because we’re having too many periods compared to our cavewomen ancestors. This article by The Guardian is no exception! What they fail to mention though, is that pregnancy involves massive levels of the hormone progesterone which has huge health benefits. Outside of pregnancy, the only other time you’re going to make progesterone is when you ovulate. If you’re not ovulating, you’re not making progesterone.
Therefore if you decide to suppress your menstrual cycle entirely, you’re not replicating the conditions of pregnancy; rather, you’re replicating the hormonal profile of a chemically castrated or post-menopausal woman! In addition to all of this, our menstrual cycles are actually now considered a fifth vital sign of our health. By taking hormonal contraception, we completely suppress the messages that our menstrual cycle is trying to communicate.
It’s a bit like seeing the oil light go on in your car – and it glares in your eyes a bit when you’re driving at night and it’s just all a bit inconvenient, so you tape a piece of paper over the light so that it doesn’t bother you anymore. Meanwhile, your oil levels are getting lower and lower and your car is rapidly heading toward a breakdown.
The same happens when you take the Pill to cover up your menstrual cycle issues. It’s a bandaid.
The Pill doesn’t fix anything. If you have PCOS or endometriosis or fibroids – they’re all still there, under the surface, and in many cases progressing silently in the background! (And yes, the Pill can play a vital role in allowing women to suppress the painful symptoms of conditions such as endometriosis and dysmenorrhea, but this should always be undertaken with the knowledge that it is not fixing anything).
Where at all possible, it’s always preferable to address the root cause of your pesky period problems instead of sweeping them under the rug – after all, they’re your fifth vital sign.
I think we also need to quickly touch on this quote: ‘Experts also stress that stopping periods won’t affect future fertility. Dr Anne Connolly says “When you stop taking the hormones, they get flushed out of your system very quickly, and your periods will return to what they were before you started taking the pill,”’
This is actually a little misleading. Yes, the synthetic hormones of the Pill are very quickly flushed from your system; however, your system itself now needs to kick-start a complex endocrine messaging process that’s been suppressed for however many years you’ve been on the Pill – and this doesn’t necessarily happen straight away. In fact, one study showed that it took 9 months before all the participants had regained their menstrual cycles.
In addition to this, the Pill is known to deplete a number of nutrients that are vital to foetal development during the early stages of pregnancy – so you really don’t want to fall pregnant immediately after coming off the Pill, even if your fertility does return straight away.
I fully support the Pill being available to us all (I have personally used it myself in the past and I’m very aware and grateful for the ways in which the Pill was central to the feminist movements that allowed us access to education, politics and the workforce). However, I think we need our health practitioners to be a little more honest about the mechanisms by which the Pill works, and how exactly those mechanisms may affect our health both now and in the future.
“My cycle would be one of the first indicators that it was time to slow down and engage in some serious self care”.
It’s estimated that 3% of sexually active women in the United States use a Fertility Awareness-Based Method to avoid pregnancy – that’s over 1.1 million women! Unfortunately, the majority are using the outdated and ineffective rhythm method. Here in Australia, data from 2012-13 indicates that approximately 1.4% of sexually active women are using some form of Fertility Awareness-Based Method to avoid pregnancy. Other data indicates that this number could be as high as 2.8% of sexually active women.
The good news is that more and more women are placing their bodily autonomy and hormonal health as first priority and we are likely to see these numbers increase dramatically over the coming decade (especially as femtech advancements bring natural fertility management further into the public eye).
Join the conversation as I chat with people around the world to hear their stories and experiences with Fertility Awareness-Based Methods.
Rebecca, thanks for catching up! Please introduce yourself and tell us who you are! I’m Rebecca—in my late twenties, married and a mom of one. I live in Southwestern Ontario, Canada. My education has largely centred around community development and regional planning and I have worked in non-profit development and the promotion of affordable housing.
How did you first hear about Fertility Awareness-Based Methods? I first heard about Fertility Awareness-Based Methods in college through some people within my church, as many FABMs are used for naturally family planning and reproductive and gynecological health monitoring within Catholic circles. One friend in particular was telling me about how empowering it was to learn how her cycle worked and how this impacted her self confidence and body image. The more I looked into it, the more I wondered, “Why the heck aren’t women and girls taught this information more widely?” The following year, I worked with an amazing doctor and Billings Educator to learn to chart my cycle. We used to meet up in a coffee shop in my little university town to go over my charts and geek out over cervical fluid!
What FABM do you currently use and what do you love about it? I started charting using the Billings Ovulation Method and used that method for about three years. When I relocated to my current city and got engaged, my husband decided he wanted to learn about charting as well to walk the journey with me, so we looked up classes in the area. This lead me to Creighton, which is similar to the Billings Ovulation Model but uses a standardized system for denoting the cervical fluid observations. What set Creighton apart for me was the availability of NaPro Technology—a women’s health science that monitors and maintains a woman’s reproductive and gynecological health. It provides medical and surgical treatments that cooperate completely with the reproductive system instead of suppressing or circumnavigating it. NaPro doctors—family physicians, ob/gyns, endocrinologists and the like—are actually trained to read Creighton charts to aid in their diagnoses. The opportunity to have medical practitioners that could ‘read’ my charts really sealed the deal for me and convinced me to make the switch.
Can you tell us what has been the most major benefit for you of using a FABM? The power that comes from knowing what is going on in my body is real, especially when it came to monitoring stress in seasons of life where I was really hustling: competing in college sport; pulling all-nighters working on my master’s thesis, planning a wedding etc. Oftentimes, my cycle would be one of the first indicators that it was time to slow down and engage in some serious self care.
How has using a FABM impacted your health? Charting my cycle has helped me manage painful periods. I’ve largely used diet and exercise to improve things but there are a ton of ways to replenish the body, rebalance hormones, and treat more all-encompassing gynecological conditions like PCOS and endometriosis. Further, I’ve really struggled with generalized anxiety in certain seasons of life and am currently learning more and more about how my reproductive hormones play into that. I am enthused at the prospect of helping my body rebalance in the most gentle and efficient way possible in the postpartum period by charting my cycle and tailoring my diet and exercise to meet my body’s needs right now.
How has using a FABM impacted your relationship? Gosh, I can’t say enough about FABMs in terms of strengthening my relationship with my husband. Let me tell you, if you can discuss cervical fluid with your partner, you can discuss anything. Ha! I’m blessed that my husband was on board with using FABMs to plan our family since the very beginning. I think one of the reasons it’s worked well for us is because it’s really enhanced our communication. The Creighton Model is unique because it is both an effective means to avoid pregnancy as well as a very efficient means to achieve pregnancy, depending on which set of instructions are used. As such, using this method has led us to discuss our family planning goals each and every month, assess our mental and physical health, finances and so forth and take stock of our lives together. This has had super positive impacts on our communication and ensures shared responsibility for our family and each others’ well-being. Furthermore, charting my cycle with Creighton has allowed us to achieve pregnancy simply, date the pregnancy accurately, and investigate a previous miscarriage to ensure it wasn’t a sign of hormonal imbalance.
What has your experience been like with mainstream health professionals when discussing FABM’s? My use of a natural method has been met with skepticism at times but thankfully I’ve never had any of my healthcare providers push hormonal methods of contraception on me. In fact, while some have certainly understood it to be the “rhythm method” and advised me to not be surprised by an unexpected pregnancy, I’ve also been lucky enough to have others on my healthcare team express genuine interest in learning a natural method themselves and even start comparing notes about Toni Weschler’s “Taking Charge of Your Fertility”. So, I genuinely feel that women themselves are driving changes as they look for more holistic options and that the tide is beginning to turn.
If you could give advice to anyone who is just starting to look into Fertility Awareness, what would you say? It is definitely worth it! Take stock of your lifestyle and do your research before choosing a method, as they do vary in both their efficacy rates, but also which biomarkers are tracked and at which time of day. I think it’s worthwhile to learn how to chart your ovulation cycle the old-school way [on paper] instead of starting with an app. This will allow you to truly understand how your body works and take ownership of your data. Lastly, I’d recommend learning alongside a FABM instructor; they’ll be able to walk with you through your first few cycles and help you gain confidence in the method.
Where do you see the future of FABM’s? I am so thrilled about the surge of interest in FABMs and really do feel this is the beginning of a women’s health revolution. So much so that I want to be a part of it and have begun studying the Creighton Model FertilityCare System in the hopes of becoming a certified Practitioner. Women need to know this information and I hope to one day see it taught in schools as part of the Health Education curriculum.
Thanks Rebecca and where can we find you to follow your journey? You can find me sharing my journey in fertility appreciation and the road to become a Creighton Practitioner at @charbelfertilitycare on Instagram.
There are already enough barriers out there that stand in the way of learning about our menstrual cycles – and I don’t think the cost of Fertility Awareness-Based Method (FABM) instruction should be one of them! Unfortunately though, because FABM instruction is not covered by Medicare or private health insurance here in Australia, it remains a cost that must be paid out of pocket (and FABM instructors definitely need to be reimbursed for their time and expertise!). Here’s hoping that one day we’ll see subsidised FABM instruction – over in the United Kingdom, FABM instruction is covered in some instances under the NHS! I for one distinctly remember first learning about the Symptothermal Method and being desperate to work with an instructor … but I couldn’t afford one. However I didn’t let that stop me, and this article is a compilation of tips for cost-effective cycle charting on a budget!
While I want to encourage you that self-teaching is possible and can be cheap (or even FREE) – I also need to emphasise that effectiveness is higher when learning with an instructor. For instance, the most well-known study of the Symptothermal Method was based on users who were under the close supervision of qualified instructors of the Sensiplan protocol. This study showed that with perfect use, a 99.6% effectiveness was possible. Typical use rates were 98.2%. Subsequent criticisms of the study argue that the typical use figure may not be generalisable to the broader population due to the study design (a prospective clinical trial). In addition, these rates are based on users who were following a Symptothermal Double-Check Method – many popular self-learning books (discussed below) are Symptothermal Single-Check Methods which means they are likely to have a perfect use effectiveness closer to 98%.
However, the point of this is to say that we don’t have any effectiveness studies on the outcomes of self-teaching the Symptothermal Method. The effectiveness of self-teaching remains unknown and is highly likely to be lower than working with an instructor. Because of this, it’s important that you commit plenty of time to studying the method in depth if you need to self-teach. Plus, it’s crucial to avoid any unprotected sex for at least the first three cycles of charting while you are learning. Basically – if you’re strongly “TTA” (trying to avoid a pregnancy), then you need to take the learning process very seriously.
All that said, let’s dig in to my top 4 tips for charting on a budget!
You’re going to need some instructions; and there’s plenty to choose from!
TIP NUMBER 1
You’re going to need some sort of manual to learn from. By far, the most popular self-teaching resource is the book Taking Charge of Your Fertility (TCOYF) by Toni Weschler. While TCOYF isn’t a Symptothermal Double-Check Method, it is a fantastic resource absolutely packed with information about the reproductive system. In my opinion though, it can be a little overwhelming for new users – my go-to recommendation for self-teachers is usually to opt for the Sensiplan Handbook and Workbook instead. Sensiplan is a Symptothermal Double-Check Method and has a solid evidence-base for use.
TCOYF and Sensiplan aren’t your only options though. There are a number of other resources (whether online or in book-form) that are available to you. All of them are designed to be used with an instructor if possible, but you can still access them even if you haven’t signed up to work with an instructor. Keep in mind that some of these manuals do include religious content. Here are just a few of many:
Symptothermal Double-Check Methods:
[Book] (not free) Celsius and Fahrenheit. Natural Contraception and Conception Course Handbook, by Jessie Brebner
[Book] (not free) Celsius. Sensiplan Natural & Safe: The Handbook (must also purchase the Workbook), by Sensiplan
[Book] (not free) Fahrenheit and Celsius. A Couple’s Guide To Fertility, by SymptoPro
[Book] (not free) Fahrenheit. The Art of Natural Family Planning Student Guide, by Couple to Couple League
[Book] (not free) Fahrenheit and Celsius. Natural Family Planning The Complete Approach, by Natural Family Planning International, Inc
[FREE Online Manual]Fahrenheit and Celsius. Natural Family Planning The Complete Approach, by Natural Family Planning International, Inc
Sympothermal Single-Check Methods:
[Book] (not free) Fahrenheit. Taking Charge of Your Fertility, by Toni Weschler
[Book] (not free) Fahrenheit. Garden of Fertility, by Katie Singer
[Book] (not free) Celsius. Justisse User Guide, by Justisse Foundation
Check out your local second-hand bookstore for a cheap copy of TCOYF, or head to your library to borrow it for free. For example, here on the Gold Coast of Australia I can see with a simple library catalogue search that there are three physical copies of TCOYF at different libraries within a 15km radius. In addition to this, you can even read TCOYF for FREE online by visiting archive.org (keep in mind that this is the old edition and some rules have slightly changed – but it’s still perfectly valid and very useful).
When it comes to recording your cervical fluid and basal body temperature – will you choose paper or an app?
Tip Number 2
You are going to need somewhere to record your daily observations of cervical fluid and basal body temperature (and optional cervix tracking). Here, you have two options – you can either chart on paper or on a smartphone app. You’ll need to decide which is the best fit for your personal life.
If you would like to chart on an app, there are a few popular options:
You can download and use Lutea or Kindara for FREE – that’s right, without paying a single cent. No monthly or yearly subscription costs or hidden fees. The free version of Kindara doesn’t have the option to track vaginal sensation (which is a really important part of all Symptothermal Methods); however, with the free version you get four “custom fields”. You can use three of these custom fields to set up your own version of vaginal sensation tracking.
Read Your Body app is the gold standard with full customisation options that make it suitable for all Fertility Awareness-Based Methods (FABMs). It requires a small yearly subscription which is definitely worth it if within your budget.
*Since the time of writing this article, Kindara has been bought by a new parent company. They no longer have a support team, and it’s unclear if/when Kindara app might be retired forever. This means that if you choose to use Kindara, it’s important that you back up your data regularly via their desktop portal.
Here you can see at the bottom of this Kindara chart, this person has used their custom entries to set up vaginal sensation tracking.
If you’re wanting to paper chart – even this can be done on a budget!!
You can also find a range of other downloadable printable paper charts at the below links. Remember, it’s best to use the chart that corresponds to the method you will be using:
If you don’t have a printer at home, most libraries have communal printers that you can use. Here on the Gold Coast, my local library allows me to print an A4 sheet in black and white for only 15c. Assuming you have around 13 menstrual cycles in a year that’s only a cost of $1.95 to paper chart each year.
Buying a basal body temperature thermometer doesn’t need to break the bank.
Tip Number 3
You’re going to need a basal body temperature thermometer to successfully use the Symptothermal Method. In most pharmacies here in Australia, the cheapest option I have found is the SurgiPack 6335 Digital Ovulation Thermometer for $20. You can purchase it online for cheaper, but then you’ll also need to factor in shipping costs. If you’re wanting to purchase a thermometer off of Amazon, the cheapest option I have found is the Mabis Digital Basal Thermometer (although remember to factor in shipping costs). Many people use and love this thermometer.
If you are going to self-teach, it is vital that you surround yourself with other women who’ve been there before and bring plenty of experience to the table.
Tip Number 4
Peer support! I cannot stress this enough. It is SO important to have the support of other people who are on the same learning journey. Peer support can connect you with people who are just starting out like you are. Plus, there are others who have been charting for years and have a lot more experience and wisdom to share with you (not to mention support when interpreting difficult charts). This is where social media platforms come in. My two absolute favourites when it comes to online communities are found on Facebook:
Fertility Awareness Method of Birth Control is a large private Facebook group with over 20,000 members. They have a wide range of useful files, and plenty of very experienced members. While the group is in no way a substitute for qualified instruction, it is a great way to get plenty of peer support. You can even practise your newfound charting skills with weekly group practise posts.
FAM Support Group is a smaller Facebook group with around 600 members. For those who are looking for a bit more of an intimate vibe this group is a great option with plenty of highly experienced members (many of whom are instructors themselves).
These groups are not a substitute for learning with an instructor; however, they definitely provide an extra safety-net with a strong sense of community and a drive to promote perfect-use charting.
Conclusion: Charting doesn’t have to break the bank
If you use a free learning manual or book, with free online peer support, and use the free app Kindara – your only cost is a thermometer which you can grab for $20 at the nearest pharmacy.
If you’re ready to invest in working with an instructor (it’s an absolute game-changer if you are able to make it happen) simply head to the Find An Instructor page.
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