“I always knew it existed as far back as I can remember because my Mum practiced Fertility Awareness when she was trying to conceive for the second time.”
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 Unfortunately, the majority are using the outdated and ineffective rhythm method.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.
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.
Lee-Anne, thanks so much for chatting with me! First off,where in the world do you call home? Thanks! I’m from Dartmouth, Nova Scotia, Canada
For those who don’t know you, can you tell us a little about yourself? I’m a data analyst by day and artist by night who did not get to this place in life by accident. I got sober and decided to turn my life around at 30 and have been accomplishing my goals ever since. Due to being diagnosed with endometriosis and a blocked tube, trying to conceive has taken me almost two years but my recent fibroid removal surgery has brought me much-needed optimism and I’m ready for the next chapter: motherhood!
Amazing! That sounds like an incredible journey. How did you discover Fertility Awareness? I always knew it existed as far back as I can remember because my Mum practiced Fertility Awareness when she was trying to conceive for the second time. She is a nurse who is also huge into the natural world so it was always ingrained in me to listen to your body and to love yourself.
Which protocol do you follow and why? I use the Symptothermal Method but when I first started charting about six years ago I only tracked cervical fluid. I’ve now evolved to tracking temperature, cervical fluid, mood, bodily symptoms, and cervical position.
What was your greatest challenge when learning to chart? Knowing what to record for days when you have more than one type of CM from morning to night.
What do you think is the greatest benefit that practising a FABM has brought to your life? I now understand that lifestyle changes like diet, exercise, and stress levels have a huge impact on my mood/PMS symptoms which makes me feel more in control in my life. Charting also helps me to see when something is out of wack in my body so that I can take the steps to fix it.
How has practicing a FABM impacted your relationship? Charting and researching all things FAM has improved my analytical mind greatly which translates to more confidence and articulation when it comes to my moods and cycles. I feel my fiance respects me more because of this.
Do you think FABM’s are growing in popularity, and if so, why? Yes because more information is getting out there around hormonal birth control and more women are seeing the negative consequences of this and researching other options. I also believe an increasing number of couples are waiting until they’re older and more settled in their careers before attempting to start their families which, in turn, can become more of a struggle which will naturally prompt them to look into FABMs.
What advice would you give to women who are interested in Fertility Awareness? Don’t let anyone, doctors included, tell you this method is bunk. It is literally the science of how women’s bodies work. Take your time and get curious about your body and your fluctuations- you’ll learn so much.
Thanks Lee-Anne! Where else can we find you? I have a youtube channel where I talk about all things alcohol recovery and share my trying to conceive journey:
Do you have a story to share? Positive, negative or somewhere in between – I would love to hear about your experiences with Fertility Awareness. Contact me using the form below.
The recent article by Cosmopolitan on Fertility Awareness-Based Methods was factually inaccurate and left a lot to be desired.
Yesterday, Cosmopolitan published an article titled ‘Do You Know Enough About Your Body To Use Fertility Tracking Apps?’ Unfortunately, the article was packed full of misinformation and displayed an astounding lack of understanding about how Fertility Awareness-Based Methods (and our bodies) actually work. Luckily for me, I see these types of articles so frequently that I no longer have a heart attack when I read them; however, it is of huge (huge!) concern that readers may subsequently make choices about their reproductive healthcare based on inaccurate information.
These days, I really do have to wonder why the writers behind these articles never think to contact a qualified Fertility Awareness professional to speak to a credible source before they press ‘publish’.
Anyway, without further ado – let’s count all the ways that Cosmo got it wrong (like – really, really wrong).
[In regards to Fertility Awareness-Based Methods] ‘You may have heard this referred to as something like fertility tracking or the calendar method, but all describe the same thing: avoiding pregnancy by tracking the days on which you’re most fertile and planning your sex life around those days’. Actually no, they don’t all describe the same thing. The Rhythm Method involves counting days of past cycles to make predictions about when you will be fertile in future cycles. This is problematic because there are many things that can cause our cycles to change each month. For this reason, the Rhythm Method has a very high failure rate and is not suitable for anyone who genuinely wants to avoid pregnancy. Thankfully, Symptothermal Methods involve zero predictions. Instead, they track cervical fluid and basal body temperature on a day-by-day basis so that you know whether or not you are fertile on any given day. Symptothermal Double-Check Methods are an exception to this – they actually incorporate a calculation (based on past cycles) as to when a user might first expect to see cervical fluid after menstruation. This calculation allows users to double check the opening of the fertile window (instead of just relying on cervical mucus). While calculation rules are indeed predictions, they act to make the method more conservative and are always overriden by actual physical observations. You can read more about the different types of FABMs by clicking here.
The Rhythm Method involves counting calendar days and is not the same as the Symptothermal Method.
‘”A healthy menstrual cycle is 28 days”, Dr Nate DeNicola, MD, an ob-gyn in Washington D.C. says’. A healthy menstrual cycle can actually range from around 24 – 38 days. In fact, only around 1 in 10 women consistently experience a menstrual cycle of 28 days in length.
‘”If your cycle’s not at least somewhat regular, then this probably isn’t going to work well for you because the chance of predicting the fertile window to avoid is pretty low” Dr DeNicola says’. Remember the bit above where we clarify that the Symptothermal Method doesn’t involve predicting fertile days? It doesn’t matter how irregular your cycle is, you can still track your cervical fluid and basal body temperature to know whether or not you are fertile on any given day. For those with extremely long cycles the same applies; however, it may mean you experience long periods of needing to use barrier protection such as condoms or a diaphragm (as opposed to the shorter fertile window in a normal length menstrual cycle).
“The chance of getting pregnant while solely using fertility awareness is 25 percent” This statement is so problematic I don’t even know where to begin!
It seems that Cosmo is perhaps using older figures from the US National Survey of Family Growth which showed an overarching 24% failure rate for all different types of Fertility Awareness-Based Methods. The US NSFG report was careful to note however, that over 80% of respondents to their survey were using the Rhythm Method. This means that the results don’t really tell us anything useful about the Symptothermal Method. For more information on effectiveness rates, I highly recommend visiting this fantastic blog by Dr. Chelsea Polis who is a reproductive health epidemiologist with the Guttmacher Institute: http://chelseapolis.com/blog/understanding-effectiveness-estimates-for-fertility-awareness-based-methods-of-contraception
Currently, the CDC states that there is a 2 – 23% chance of pregnancy with typical use of fertility awareness – but this depends on which method you use. The 2% failure rate is based on a 2007 study of the Sensiplan method, which is a Symptothermal Double-Check Method (if you remember previously, Symptothermal Double-Check Methods are a little more conservative than Symptothermal Single-Check Methods due to the inclusion of calculation rules to double-check the opening of the fertile window). The 2007 study was based on the results of following 900 women over the course of 17,638 menstrual cycles. These women were working very closely with Sensiplan instructors and were found to have a 1.8% typical use failure rate, and a 0.4% perfect use failure rate.
When discussing effectiveness rates of FABMs, we currently don’t have a large and robust pool of evidence to draw from. Moderate quality studies tell us that the Sensiplan method has shown a 0.4% perfect use failure rate. This is very promising! When it comes to typical use however, we really need larger retrospective population-based surveys to give us a wider range of demographics and a more accurate estimate of real-world experiences. While we have a typical use estimate of 1.8% for the Sensiplan method, this estimate is based on a prospective clinical trial which isn’t as well suited to delivering typical use rates. It’s also based on users who were working very closely with an instructor – not those who were self-taught.
Unfortunately, the user-base of FABMs doesn’t really provide large enough populations to study for accurate typical use rates of individual methods. Additionally, there isn’t much incentive for these studies to be carried out considering there’s no pharmaceutical company behind the scenes waiting to profit from a new drug. I often wonder who’s going to be willing to fund further studies on FABMs!
The main takeaway here is that the discussion around FABM failure rates is highly nuanced and hasn’t been done justice by Cosmo.
“Ovulation, or the fertile window, is usually described as a five day window” [Dr DeNicola]’ Contrary to this, most studies actually show us that the biological fertile window is around six days. Five days leading up to ovulation, and the day of ovulation itself.
‘The basal body temperature can be measured orally, vaginally, or anally with an accurate thermometer that measures in tenths of degrees’. This is a pretty big inaccuracy. Basal body temperature thermometers need to measure to two decimal places to be used with the Symptothermal Method – this is absolutely critical to ensure you’re picking up on the small shifts that occur after ovulation. If your thermometer only measures to the nearest tenth of a degree (that’s one decimal place) then it is not sensitive enough to be used for your charting practice. On top of this, while basal body temperature can be measured anally, I don’t know of a single person I’ve ever encountered who has done so. Most of us happily take our temperature orally each morning. You can find a list of recommended basal body temperature thermometers here.
Basal body temperature thermometers are highly accurate and need to measure to two decimal places.
‘Dr DeNicola says it doesn’t so much matter what time of day you take your temperature, but that you should always take it at the same time of day (like you would a birth control pill, for example).’ Basal body temperature (BBT) is your lowest core body temperature at rest, and it actually occurs around 4:30am each day. This is because your body temperature changes in a circadian rhythm – that is, it’s lowest in the early hours of the morning, and highest in the afternoon. The Symptothermal Method requires that you take your waking temperature (slightly different from true BBT) after at least 3 consecutive hours of sleep and at the same time each morning (give or take around 30 minutes). It’s very unlikely that you are going to get an accurate chart by taking your temperature at other times of the day (say lunchtime, or late afternoon), unless you’re having at least 3 consecutive hours of sleep prior. In addition to this, all effectiveness studies on the Symptothermal Method involved participants who were measuring their early morning waking temperature.
[In regards to cervical mucus] ‘Yes, I know, this is gross. Dr. DeNicola knows it, too. But such are the wonders of the human body’. Ok.. wow, thanks for telling your readers that their bodies and how they work are ‘gross’. Nice to know that a trusted medical professional (who actually looks at vulvas, vagina’s and cervixes all day) also thinks the same! This is classic body-shaming and an extension of menstrual taboo – where anything to do with our reproductive systems has to remain ‘hush-hush’ for fear of offending anyone. Heaven forbid we accept and celebrate the wonderful biology that allows the continuation of the human race! If you’re interested in checking out photos of real-life cervical fluid, click through to the cervical fluid gallery.
Cervical fluid is not ‘gross’. It is a normal, healthy, natural bodily function necessary for the process of conception.
‘If you haven’t caught on by now, even the most highly regular of cycles can go haywire, making it extremely difficult (if not impossible) to accurately guess when you’re ovulating, 100 percent of the time.’ Thankfully, none of us who use the Symptothermal Method are guessing as to when ovulation will occur! As mentioned above, the Rhythm Method (which is what most period tracker apps use) involves predicting and guessing when ovulation will occur. This makes it prone to a scarily high failure rate. The Symptothermal Method on the other hand, involves zero guesses or predictions – just checking in daily with your cervical fluid and basal body temperature to know whether or not you’re fertile – today.
‘If a fertility awareness-based method is something you’re truly interested in, Dr DeNicola urges you to please bring it up with your doctor. A good doc won’t ever shame your choices, even the ones that are statistically not great at preventing pregnancy.’ There are two parts I would like to break down here. First off, a doctor is actually not the best person to speak with if you’re interested in using a Fertility Awareness-Based Method. Why? Because most doctors receive little to no training on FABMs – at best they might hope for perhaps a pithy one-hour lecture. And as you can see from Dr DeNicola’s comments, it’s clear that this training was definitely not thorough enough. In fact, in a 2011 survey of United States Obstetrician-Gynaecologist physicians, 68% considered FABMs to be a poor option for most women. But when they were asked to estimate typical use effectiveness rates, the average answer given by these physicians was that 25% of couples practising a FABM would fall pregnant within a single year! This displays a clear lack of education about the different types of FABMs and their true effectiveness rates – and it is this lack of education which ultimately affects patients who have their earnest questions effectively ‘pooh-poohed’ and brushed aside.
So while I’m not surprised to read this recent article from Cosmopolitan, I’m certainly disappointed. Once again, the general public is left with inaccurate, incomplete and biased information to sift through when it comes to making decisions about Fertility Awareness-Based Methods.
Did you have to wade through misinformation when you were looking into using the Symptothermal Method? I’d love to hear your experiences in the comments section below!
I would like to preface this article by saying that there is no need to panic if you are a current Daysy user. Instead, this would be a good time to do a little research and re-evaluate whether you are still happy to continue using the device based on how seriously you are wanting to avoid an unplanned pregnancy. Considering we don’t see thousands of women complaining of unintended pregnancy, it is clear that the Daysy device has some level of effectiveness; however, what that effectiveness actually is remains unknown at this point in time.
This week, the study behind Valley Electronics’ claims of a 99.4% effective Daysy device has finally been retracted from the Journal of Reproductive Health. This follows a peer-reviewed scientific commentary by leading reproductive health researcher Dr Chelsea Polis which was published back in June 2018. Dr Polis’ commentary called for the Daysy study to be retracted due to grave methodological flaws which were inflating consumer confidence and potentially putting users at risk of unintended pregnancy. You can read more about the retraction in this Buzzfeed article and more from Dr Polis on her personal blog.
Unfortunately, Valley Electronics (the manufacturer of Daysy) had been aware of Dr Polis’ concerns since 2017 and had made no move to alert their users or amend any of their marketing materials. Following the publication of Dr Polis’ peer-reviewed commentary in June 2018, Daysy again made no further move to alert their customers or amend any of their marketing materials. In fact, their marketing materials have continued to reference a 99.4% effectiveness rating ever since – despite the fact that their study was under investigation to be retracted.
The original peer-reviewed commentary by Dr Polis referenced a number of issues that may have affected the accuracy of the findings of the Daysy study:
Users with less than 13 cycles’ use of the Daysy were excluded from the calculations. Within this group of excluded data were 10 pregnancies. We don’t know how this might have affected the effectiveness rates.
The survey behind the study only had a 13% response rate. This raised questions about selection bias – would those who had a bad experience with the Daysy device still be in conctact with the company, and if so would they want to participate in such a survey?
Daysy relied on users to self-report an unintended pregnancy – they didn’t objectively look at all the data to detect a pregnancy based on extended elevated temperatures.
The wording of the survey itself was slightly ambiguous and may have resulted in confusion.
The survey didn’t gather information to exclude users that were subfertile (i.e. post-hormonal birth control, postpartum or perimenopausal.
Importantly, Dr Polis’ has emphasised that many of these issues also apply to Daysy’s older studies which used to reference a 99.3% effectiveness rate. Because of this, the true effectiveness of the Daysy device currently remains unknown.
Essentially though, the main reason is that basal body temperature is not a predictive fertility biomarker – it only rises after ovulation has already occurred. Because sperm can survive up to 5-7 days in the reproductive tract in ideal conditions, we need to have advance warning that ovulation is approaching. Basal body temperature cannot provide this advance warning, as it only rises after ovulation has already occured. This means that Daysy and Natural Cycles are making educated guesses about when you might be fertile in your current cycle, based on data from your past cycles and other users. This is problematic because there are many external factors that can cause you to ovulate earlier or later than expected (such as stress, illness, travel, supplements, diet and lifestyle changes).
I recommend the Symptothermal Method of Fertility Awareness instead, which tracks both cervical fluid and basal body temperature. Cervical fluid is influenced by oestrogen levels, which rise in the lead-up to ovulation. In this way, cervical fluid can provide advance warning of ovulation, whereas basal body temperature cannot. If you are interested in learning the Symptothermal Method I recommend working with an instructor and you can find one here.
If you’re seriously needing to avoid pregnancy, it’s important to work with an instructor of the Symptothermal Double-Check Method. Why? Because as it stands, no studies have investigated the effectiveness of self-teaching the Symptothermal Method: the effectiveness of self-teaching currently remains unknown.
If you’re a big fan of femtech in your day-to-day life, there’s no need to resort to charting your cycles on paper if that’s not a good fit with your lifestyle. There are a number of free apps such as Kindara that you can use to record your charting observations, and the Tempdrop is a great option if you’re after a wearable thermometer that takes your temperature throughout the night. The key here is that this femtech is used to collect and chart your information – interpretation of that information remains up to you, the user.
Anecdotally, if you are absolutely certain that you wish to use either Natural Cycles or Daysy, it appears that Daysy has a much safer algorithm than Natural Cycles. The amount of unintended pregnancies and scares that I see with Natural Cycles users is truly concerning. If you are seriously trying to avoid pregnancy please steer very clear.
Ultimately, I believe both options are simply glorified and expensive thermometers dressed up in high-tech disguise; however, they can be useful tools for those who have no desire to learn to chart their cervical mucus – as long as those users are fully informed of the accurate effectiveness rates. In saying this, the real benefits of Fertility Awareness-Based Methods lie in the body literacy they provide – and Daysy and Natural Cycles come nowhere close.
Have you used the Daysy device or the Natural Cycles app? I would love to hear your experience in the comments below.
UPDATE July 2022: Before deciding to rely on a Fertility Awareness-Based Method (FABM) during the postpartum, it’s important to note that a 2022 systematic review found that “the current evidence base [for the effectiveness of fertility awareness-based methods for preventing pregnancy during postpartum amenorrhea and the transition to normal menses] is very limited and of mostly low quality”.
What does this mean? There is little scientific evidence for the safety and effectiveness of any type of FABM for pregnancy prevention during the postpartum. In addition, the evidence we do have is considered to be of low quality.
A special note: I would like to preface this article with the caveat that postpartum charting can be very challenging as it is a time of hormonal change and uncertainty while fertility slowly returns after birth. This can result in long periods of abstinence or barrier use that can be frustrating for some users. In addition, once-reliable fertility signs such as cervical fluid and basal body temperature can become confusing to track and special postpartum rules must be applied. For this reason, I don’t recommend that you learn a Fertility Awareness-Based Method for the first time during the postpartum period unless you will be working very closely with an instructor. You can find an instructor by clicking here.
Birth is a radically transformative event. If you’ve recently expanded your family by birthing a child you’re likely very aware of this! You may be navigating new challenges and demands as you grow into this new facet of your identity.
These challenges can be both mental and physical. Even if you’ve been cleared to resume intercourse by your healthcare provider you may be reluctant to “get back on the horse” as the saying goes. Every woman’s experience will be different but common causes of low libido centre around:
perineal healing,
c-section scar healing,
sleep deprivation,
body image issues,
mental health issues (such as PPD and/or PPA),
emotional overexertion (or a feeling of being “touched out”), and
vaginal dryness as a result of low oestrogen due to breastfeeding.
Or, perhaps you’re on the other side of the equation and have been back in the sheets since week three!
Either way, it’s best to tackle the issue of contraception early on so that when the time comes you and your partner have a game plan ready.
During pregnancy, ovulation is suppressed due to high levels of placental progesterone and oestrogen. High levels of these hormones have a suppressive effect on the release of luteinising hormone from the pituitary gland in your brain. Luteinising hormone is required for the maturation and release of an ovum (egg) from your ovaries; therefore, suppressed luteinising hormone = no ovulation.
How soon you begin ovulating after giving birth will depend on whether or not you choose to breastfeed, and for how long. Why is this? Because breastfeeding suppresses ovulation – in some situations. Read on for more information.
Please note that this page contains affiliate links, meaning, at no additional cost to you, I may make a commission if you click through and make a purchase. This commission helps to keep this website up and running so that I can continue to provide resources for women to learn about Fertility Awareness. You can read more about this in the Advertising and Affiliates policy here.
“I will not be breastfeeding”
As the saying goes – fed is best! Many mothers will end up using formula due to work schedules, health conditions, difficulties with breastfeeding and pumping, societal norms, lack of support or simply due to personal preference. If you choose not to breastfeed (or are unable to), you should be aware that your fertility will return much more rapidly than those who are breastfeeding. This also applies if you are unable to exclusively breastfeed (continue reading below for a definition of exclusive breastfeeding). If you are not breastfeeding, or only partially breastfeeding and you wish to use aFertility Awareness-Based Method (FABM) you will need to start charting your fertility biomarkers within two-three weeks of giving birth. This is because it is possible to ovulate as early as the fourth week postpartum if you are not breastfeeding! On average though, (if bottlefeeding) your first menstrual bleed is likely to return around eight weeks postpartum, with ovulation first occurring for 94% of women in their second menstrual cycle following birth. [1]
“I will be breastfeeding”
Many mothers will choose to breastfeed, especially with the World Health Organisation (WHO) recommending that infants be exclusively breastfed up until the age of six months. The WHO also recommends continued breastfeeding (in addition to supplemental foods) up until the age of two years. In Australia, the Department of Health recommends exclusive breastfeeding up until six months, with supplemental feeding continuing up until 12 months (and beyond if the mother and infant wish to continue). If you’re choosing to breastfeed, it may help to understand exactly how and why breastfeeding will affect your fertilty.
Prolactin – The Breastfeeding Hormone Prolactin is a hormone released by the pituitary gland in your brain. It causes your breasts to secrete milk. During pregnancy, prolactin levels steadily increase, but lactation is suppressed due to high levels of placental oestrogen. During the 48 hours after birth, oestrogen levels drop rapidly and lactation can finally begin in earnest. These high prolactin levels after birth will not be maintained or increased unless suckling occurs.
Suckling of a baby on the breast stimulates nerves within the areola. These nerves then send a message to the hypothalamus and pituitary glands to produce a surge of prolactin and oxytocin. The surge of prolactin creates more milk, while the surge of oxytocin stimulates the “let-down reflex” that brings milk to the nipple.
The surge of prolactin begins to dissipate within three hours unless the breasts are stimulated during this time with further suckling.
To establish a successful breastfeeding relationship with the baby, it is recommended that this suckling begins as soon as possible after birth – preferably within the first hour of life. The WHO have a number of other recommendations to promote successful breastfeeding such as immediate and uninterrupted skin-to-skin contact after birth. You can read these recommendations here and here.
How Does Prolactin Affect My Fertility?
Prolactin has a suppressant effect on fertility because it disrupts the ability of the pituitary gland to release Follicle Stimulating Hormone (FSH) and Luteinising Hormone (LH). FSH stimulates the growth of follicles within your ovaries (follicles are small fluid-filled sacs that each house an ovum). Around the middle of your menstrual cycle, a surge of LH matures one ovum (or occasionally two or more in the case of twins and triplets). [You can read more about multiple ovulation here]. The surge of LH simultaneously causes the matured ovum to rupture through the follicle and ovarian wall, to be collected by the waiting fallopian tube. In this way, both FSH and LH are crucial for the event of ovulation to occur. If these hormones are suppressed (as is the case when prolactin levels are sustained at high enough levels), ovulation cannot take place.
LACTATIONAL AMENORRHEA METHOD
Harnessing the contraceptive power of prolactin in the first six months after birth is known as the Lactational Amenorrhea Method (LAM). This natural method of contraception is proven over 98% effective [2] but it requires diligent adherence to three specific rules:
Baby must be less than six months old, and
Mother must not experience any vaginal bleeding after the first 56 days postpartum, and
Mother must be exclusively or almost exclusively breastfeeding.
If any of the above three criteria are not met at any stage, prolactin levels can quickly drop and ovulation could occur. Due to our modern lifestyles it is very difficult to fully meet all of the LAM criteria, and because of this, I highly recommend working with an instructor to ensure that your breastfeeding relationship meets the criteria of LAM. You can find an instructor to work with by clicking here.
I also recommend that if you wish to rely on LAM as postpartum contraception but you absolutely do not want to fall pregnant, that you chart your fertility in tandem to practising LAM from as early as possible after birth. It’s also a good idea to incorporate a concept known as ecological breastfeeding. Both postpartum fertility charting and ecological breastfeeding are covered in more detail below.
Menstrual Bleeding After Day 56:
This is defined as any bleeding after day 56 that lasts for two or more days and requires sanitary protection for at least one of those days. If this occurs, it means that fertility is returning and LAM no longer applies.
Exclusive Breastfeeding:
Breast milk is the only sustenance the baby receives – he or she does not receive any other liquids or solids that are not breast milk. (If it is medically necessary to provide baby with other liquids or solids, the parents must understand that the contraceptive effect will lapse).
The gap between breastfeeds should not exceed 4 hours during the day or 6 hours during the night. Reducing the frequency or duration of breastfeeds will reduce the effectiveness of LAM.
No pacifiers or dummies are used. Babies suckle for comfort, not just food – comfort suckling plays an important role in the secretion of prolactin.
Pumping breast milk (whether by hand or pump) has not been fully studied and will reduce the effectiveness of LAM.
The longer the duration of the breastfeed, the higher the level of prolactin that is released. Prolactin reaches higher levels during the nighttime hours – so once baby begins to sleep for longer periods at night, prolactin levels may drop low enough for fertility to return.
Exclusive breastfeeding cannot include pumping, pacifiers or dummies.
Unfortunately, the nature of LAM is such that it is not accessible to all women who would be interested in using it. In today’s society, many women have responsibilities and schedules that make it impossible to exclusively breastfeed for the first six months of infant life. In Australia, 11% of mothers have already returned to work at three months postpartum [3], and only 15% of babies are still being exclusively breastfed at the age of five months [4]. In the United States where there is no universal paid parental leave system, a whopping 58.6% of women have returned to work within three months of giving birth [5].
If you choose to partial breastfeed but cannot commit to exclusive breastfeeding, you will need to start charting your fertility biomarkers within two-three weeks of giving birth. Return of fertility may be quick or it may be delayed many months – during this time special postpartum charting rules will apply. It is highly advisable to work with an instructor during this time and you can find an instructor by clicking here.
Even for those women who could theoretically meet the requirements of LAM, the below meme might explain why not all choose to pursue this option!
What Happens When LAM No Longer Applies To Me?
At some point, you will no longer meet all three criteria to continue using the Lactational Amenorrhea Method. Perhaps your period returns before you reach the six month mark, or work commitments mean you can no longer exclusively breastfeed, or your baby begins to sleep through the night. Or perhaps your baby simply reaches six months of age and LAM no longer applies.
When LAM no longer provides natural infertility, most women are still in need of some form of contraception. The WHO recommends that couples wait a minimum of two years before trying for another baby [6]. This can be important to reduce the risk of adverse maternal, perinatal, neonatal and infant health outcomes.
How you choose to manage your fertility during this time will depend on how seriously you are wanting to avoid a pregnancy. Many women will already be planning their next pregnancy and will not be overly concerned on the spacing between births. Others will be at a life-stage where they are finished planning their family and don’t wish to fall pregnant ever again (and are perhaps looking into vasectomy or tubal ligation options).
Depending on your reproductive intentions, there are two natural methods available to you – FABM charting and ecological breastfeeding.
FABM CHARTING FOR THE POSTPARTUM
FABM charting needs to begin in the fifth month postpartum (or as soon as LAM requirements are no longer met).
If you’re covered by the Lactational Amenorrhea Method and are seriously wanting to avoid a pregnancy, it’s important that you begin charting your fertility signs at the fifth month postpartum (at least two weeks before you reach six months postpartum).
This is because ovulation can occur either before or after your first menstruation/bleed; in fact, approximately 60% of breastfeeding parents who are past six months postpartum will ovulate before they have their first period. If you are part of this 60% you will want to be tracking your fertility signs to avoid falling pregnant on your first postpartum ovulation! In some cases though, it can take around three cycles for fertility to fully return – the first cycle is sometimes anovulatory, followed by a cycle or two with a short luteal phase not supportive of implantation.
How soon your fertility returns will depend on how your breastfeeding relationship plays out. Remember, frequent suckling stimulates the release of prolactin which has a suppressant effect on ovulation. For those who abruptly wean with the introduction of solids after the six month mark, fertility can quickly return. For those who wean very gradually this process can sometimes take longer.
Introducing solid foods can hasten the return of fertility – it’s important to carefully chart signs of fertility when weaning.
This can be a confusing time for those who are using a FABM to chart – I liken the postpartum time to a kind of fertility “no-mans land“. This is because you no longer have the protection of the Lactational Amenorrhea Method, but you also don’t have regular, ovulatory cycles. It can mean long periods of abstinence or barrier-use (such as condoms) as you wait to try and catch your first ovulation.
In addition to this, postpartum charting presents two other unique challenges:
Cervical mucus can present differently due to breastfeeding
Waking frequently through the night with your baby can make it difficult to obtain an accurate basal body temperature reading
While you’re in this “no-mans land” or “cycle zero” as most refer to it, it is very important that you work closely with an instructor who is experienced in postpartum charting. You’ll need to be very confident at tracking a fertility sign that is influenced by oestrogen so that you can catch your first ovulation. This is because your temperature is only going to rise after ovulation has already occurred, which doesn’t offer you any protection against pregnancy considering sperm can survive up to 5-7 days in the reproductive tract. Once your temperature has risen it is too late to take back that unprotected sex from four nights ago!
If you’re only tracking BBT, you’ll need to be investing in a time machine!
Fertility signs that are influenced by oestrogen are your cervical fluid and your cervical position. Because oestrogen levels rise in the lead-up to ovulation, it is important that you are very confident in charting these signs.
Symptothermal Method or Billings Ovulation Method charting for the postpartum
If you’re using a Symptothermal Method, there are special FABM rules that must be used for the postpartum. Special rules are required because cervical mucus is often affected by breastfeeding. These rules help each individual person to identify their personal “Basic Infertile Pattern”. It is for this reason that I don’t recommend you attempt to self-teach a FABM during the postpartum. Instead, I recommend working closely with an instructor who can carefully guide you to learn postpartum charting rules.You can find an instructor by clicking here.
The Symptothermal Method relies on both cervical mucus and basal body temperature (BBT). BBT only rises in a sustained fashion after ovulation has already occurred. Because ovulation can be significantly delayed in the postpartum, this means that BBT is not a very useful fertility biomarker for this specific life stage. Instead, you are relying on fertility biomarkers that are influenced by oestrogen, such as cervical mucus and changes in the cervix itself. It can be beneficial to pay closer attention than usual to cervix tracking – in many cases where cervical mucus remains confusing, the cervix provides the first clue that fertility is returning. Again, I recommend working with an instructor to learn about cervix tracking as the position of your uterus can sometimes affect how your cervix will be positioned during the fertile window.
One of the strengths of the Symptothermal Method is that we are always cross-checking two separate biomarkers (mucus and BBT) against one another. This means that Symptothermal mucus-checking protocols are often relatively “basic” because they always have the added security of a BBT cross-check. However, this can be a weakness of relying solely on Symptothermal Method postpartum protocols that are often of quite a basic nature in regards to cervical mucus.
In fact, if ovulation is delayed due to breastfeeding, I recommend that you seek out a cervical mucus only method such as the Billings Ovulation Method. Cervical mucus-only FABMs have highly detailed mucus-only protocols that are more well-suited to the postpartum than Symptothermal protocols. You can find Billings Ovulation Method instructors in the Instructor directory.
Marquette Method Charting
If you feel as though charting with the Symptothermal Method or the Billings Ovulation Method during the postpartum will simply be too difficult for you, it may pay to look into the Marquette Method. The Marquette Method is fantastic for postpartum charting because it simply involves testing your urinary hormone metabolites each morning using a special fertility monitor that measures oestrogen and luteinising hormone. You can find a Marquette Method instructor by clicking here. The Marquette Method also has a dedicated and active facebook group that you can join for more information – click here to take a look. If you’re interested in using the Marquette Method, keep in mind that it is a Catholic organisation and religious content will likely feature in the learning materials. The Marquette Method has a very high effectiveness rating (on par with the Symptothermal Method) and the fact that it involves very objective digital urine testing can be a reassurance for users who definitely want to avoid a pregnancy.
The Marquette Method utilises the Clearblue Fertility Monitor 1 Count – however this method must be undertaken with an instructor as it involves off-label use of the monitor via a complex re-setting pattern.
Barrier Methods
Finally, if you have a strong preference for a natural method of contraception, but are struggling to maintain a FABM charting practise while coping with the demands of caring for a new baby, don’t forget that barrier methods are also an option. Condoms are generally the most popular and easily accessible. If you used a diaphragm prior to birth, don’t forget that you will likely need a re-fitting to a larger size after birth.
ECOLOGICAL BREASTFEEDING
For those who are less concerned about falling pregnant and simply wish to naturally space their next child, a practise known as ecological breastfeeding may be a suitable option. Ecological breastfeeding is a term coined by John and Sheila Kippley of the Catholic organisation Natural Family Planning International. It involves exclusive breastfeeding (as outlined for LAM), but also includes six other standards that must be met. These standards can also be used to bolster the effectiveness of LAM.
Ecological breastfeeding seeks to replicate the natural mothering techniques that have historically resulted in natural child spacing for indigenous cultures around the world.
The protocol encourages a very natural type of mothering and is said to extend amenorrhea (absence of periods) out until 14.5 months on average. Keep in mind that this is just an average – your period could return much earlier than this. For this reason, the method is not suitable for those who absolutely want to avoid an unplanned pregnancy.
The Seven Standards:
Breastfeed exclusively for the first six months of life
Pacify or comfort the baby at your breasts
No bottles or pacifiers
Sleep with your baby for night feedings
Sleep with your baby for a daily-nap feeding
Nurse frequently day and night and avoid schedules
Avoid any practice that restricts nursing or separates you from your baby
As you can see, it can be extremely difficult for a mother to meet these guidelines if she has responsibilities (such as a career or other small children) that will separate her from her baby. I don’t know very many mothers who have the option to nap with their baby every day!
While ecological breastfeeding has historically been used among indigenous cultures as a natural child-spacing technique, it is increasingly difficult to achieve in modern life.
However you choose to navigate the postpartum, rest assured you have a number of effective natural methods that you can turn to for contraception. A qualified Fertility Awareness Educator will be able to guide you toward the method that will be most suited to your individual situation. You can find a Fertility Awareness Educator by clicking here.
This online resource is not a substitute for qualified medical advice. Please ensure you discuss your postpartum contraceptive plan with a health professional and/or Fertility Awareness Educator to ensure you are receiving accurate guidance.
The below specific references have also been cited:
[1] Howie, P. W ., McNeilly, A. S., Houston, M. J., Cook, A., and Boyle, H. Fertility after childbirth: Post-partum ovulation and menstruation in bottle and breast feeding mothers. Clinical Endocrinology (Oxford), 17(4):323–332, Oct 1982.
Women are left feeling as though they have no effective non-hormonal or non-invasive contraceptive methods after reading the recent piece by the ABC.
Today, ABC Life published a journalism piece titled “Before You Try Fertility Awareness Methods For Contraception, Here’s What Doctors Want You To Know” which quoted statements from doctors Melissa Kang, Amanda Newman and Black along with editorial by Grace Jennings-Edquist. You can read it here.
The piece concerned me on multiple levels and I felt compelled to write this letter in the hopes that medical professionals are able to provide more accurate information in future. With growing rates of women interested in pursuing less-invasive forms of contraception, I think it is important that we can expect comprehensive, transparent and unbiased information about Fertility Awareness-Based Methods from our primary healthcare providers.
The editorial piece by the ABC focused disproportionately on negative aspects of FABMs, and did not provide accurate or comprehensive information about effectiveness rates. It also provided a misinformed picture of what everyday use of a FABM would look like for women, and displayed a lack of understanding about the importance of cervical fluid by seemingly focusing only on the importance of temperature.
Most disappointingly, it showed a distinct bias against FABMs and did readers a massive disservice by not allowing them access to all of the facts so that they might make their own fully-informed decisions.
My main concerns are outlined below as responses to specific quotes:
“The main drawback of these methods: They’re generally less effective than hormonal methods of birth control, because they’re just so damn hard to get right.”
The Symptothermal Method of Fertility Awareness is very simple and easy to use and learn – if you are a strong candidate for the method.
Success relies upon the accuracy of the method itself, the ability of the user to correctly apply the rules, and the willingness of the couple to adjust their sexual behaviour during the fertile window.
In addition, the largest study on the Symptothermal Method was based on those who were practising under the guidance of an instructor – learning with an instructor instead of self-teaching means that the Symptothermal Method need not be “damn hard to get right”.
Finally, we might do well to give women a little more credit for their intelligence. Surely it’s not just me that’s getting tired of this outdated rhetoric being dragged out every time it’s suggested that women might take charge of their own health and wellbeing? These sorts of attitudes seem very prevalent in the medical system where women are reporting gaslighting in disproportionate numbers, have been proven to have to wait longer than men in the ER and be less likely to receive pain killers, and where those with endometriosis are waiting up to seven years for a diagnosis.
With the right support, we are more than capable of learning how our fertility cycle functions. Checking your cervical fluid for 5 seconds when you go to the toilet and taking your temperature for 30 seconds in the morning is not a hard task and is a great fit with many lifestyles. Interpreting your charts does take time to learn but that’s why we have so many great instructors to work with. You can find an instructor to work with by clicking here.
Of course, the Symptothermal Method is not a good fit for every woman, but a good instructor will identify very early on if this is the case and can then recommend that you choose a hormonal or LARC (long acting reversible contraceptive) option.
“The effectiveness of fertility awareness methods is quoted between 75 and 99 per cent, but the sympto-thermal method is thought to be more effective,” says Dr Kang. “The exact rates aren’t really known.”
The symptothermal method has been proven (via a prospective clinical trial) to be up to 99.6% effective with perfect use. This study followed 900 women over 17,638 menstrual cycles and was published in 2007 in the journal of Human Reproduction. Participants were using the Sensiplan Symptothermal Method and were using it under the guidance of an instructor. You can read about this study here: https://www.ncbi.nlm.nih.gov/pubmed/17314078
Typical use rates are less clear. The typical use rate published in the above study was 98.2%; however, typical use rates should ideally be calculated via population based surveys so that they are better reflective of a larger swathe of user demographics and therefore more generalisable to everyday life. The typical use rates we use for most contraceptives are obtained from the U.S. National Survey of Family Growth (NSFG). Rates of use for individual FABMs are too low for the NSFG to provide statistically-accurate typical use rates for each method. Instead, the NSFG provides an overarching typical use rate for all FABMs. Unfortunately, over 80% of survey respondents actually reported using the Calendar Rhythm Method, meaning this overarching typical use rate is skewed downward (and obviously obscures the individual use rates of different methods such as the Symptothermal Method).
All this to say – exact rates for perfect use of the Symptothermal Method ARE known and they are shown to be up to 99.6% effective. Exact rates for typical use are estimated at 85% effective but this is an overarching figure that is skewed downward – as explained above.
“”The problem is that I don’t know anybody who’s perfect and you probably don’t know either,” says Dr Newman. For that reason, “if you don’t care if you get pregnant or not, it’s fine, it might delay it,” Dr Newman says — but she wouldn’t recommend it for women who certainly don’t want to fall pregnant.”
I find this statement problematic. I certainly don’t know a single person who is perfect! And yet all of us non-perfect humans are out here using contraception on a daily basis. While this is not such a huge issue for LARCs (long acting reversible contraceptives such as IUDs and implants) where typical and perfect use effectiveness rates are essentially the same, I wonder whether Dr Newman makes the same remarks about the Pill, the Vaginal Ring, the Patch, Condoms and Diaphragms? All of the above methods have typical use rates that are much lower than their perfect use rates and yet they are used by millions of non-perfect humans around the world every day. I find it problematic that medical professionals appear to hold FABMs to higher standards than they do other methods of contraception.
“And there is absolutely no doubt that if you really want to avoid an unplanned pregnancy, then natural methods are really not the way to go.” Dr Black agrees, adding: “They’re not cost-effective, those methods, because the cost of unintended pregnancy is very high and very frequent with those methods.”
This statement is reflective of a very strong bias against FABMs or “natural methods”. I would encourage Dr Black to educate him/herself about the actual rate of unintended pregnancy that users can expect when using the Symptothermal Method – as discussed in preceding paragraphs. When counselling patients on contraceptive options, it is important for medical professionals to remember that effectiveness rates are not the only points a patient will be considering. For many women who ‘really want to avoid an unplanned pregnancy’ – there will be other criteria that are just as important, such as avoiding side effects.
I can speak from personal experience here as a Symptothermal Method user who began using the method in 2016. It was absolutely out of the question for me to fall pregnant at that time, but I was also adamant that I did not want to have synthetic hormones circulating in my bloodstream, nor a foreign medical device inserted into my uterus. With all these factors taken into consideration, the Symptothermal Method was the best choice for me… just like it would be for so many other women who never get the chance to hear about it due to bias and lack of education from their primary healthcare provider.
“Fertility awareness methods are very hard to get right for women who have irregular periods — and irregularity can be caused if “you’re stressed, because you’re travelling, you’re unwell, you’ve got a cold or something,” says Dr Newman.”
FABMs work exactly the same way whether you have a textbook 28-day cycle or a 150-day cycle caused by PCOS. They still provide the same information – they alert you to the opening and closing of your fertile window and what you do with that information is up to you. However, long cycles will involve extended periods of either abstinence or barrier use (such as condoms), and this can be a very unattractive option for many couples. In this way, irregular cycles can be charted perfectly accurately with a FABM, but the couple should be comfortable with extended periods of condom use or abstinence. If using condoms for weeks or months on end (depending on the length of the cycle) is not an attractive option, then it would be advised that the couple should choose a different method of contraception.
“If you get icky about words like ‘mucus’ and ‘cervix’, these methods won’t be for you, as they require getting pretty up close and personal with your body.”
I don’t exactly have an issue with this statement as it is true that many women won’t be comfortable with the level of scrutiny required to accurately use the Symptothermal Method. What I do have an issue with is that the flipside of this statement was never offered – that cervical fluid is an absolutely fascinating hydrogel that provides a wealth of information about your fertility status. Understanding how this fluid changes throughout your cycle can provide women with a huge boost of confidence and body literacy. You can read about how cervical fluid works by clicking here.
Understanding how cervical fluid operates can also erase misguided concerns about “vaginal discharge” – many women spend years of their lives concerned that they have vaginal infections when they are really seeing perfectly healthy cervical fluid. Using a FABM can also mean reassurance for many women who might be curious or worried as to whether they are ovulating. Emphasising the incredible benefits of the level of body literacy that FABMs promote would have been a fair inclusion in this article. Instead, it seems the author chose to focus on the negatives – which really only apply to a small group of women who are uncomfortable with getting acquainted with their own cervical fluid.
“If a couple is highly motivated to use a fertility awareness method, “they need to learn to do this properly, and that means learning how to take your temperature accurately and every day,” says Dr Newman.”
This statement again shows a lack of understanding of the Symptothermal Method. The Symptothermal Method requires users to track both temperature and cervical fluid, and in fact it is cervical fluid tracking which can be most confusing for new users. In many cases, understanding how to track and chart cervical fluid is more important than temperature. This is because cervical fluid is influenced by rising oestrogen in the lead up to ovulation. It therefore acts as a warning to the user that ovulation is approaching. Temperature only rises after ovulation, meaning it is a great way to confirm that ovulation has already occurred, but doesn’t give the user any useful information prior to this. This is important because sperm can survive up to 5-7 days in the reproductive tract meaning you need to have at least this many days’ warning that ovulation is approaching.
“And keep in mind that fertility awareness methods involve abstaining from sex for the at-risk days.”
This statement only applies to those with a religious reason to avoid the use of barriers. The rest of us? We’re getting down and dirty with barrier methods of contraception during our fertile window – and enjoying stress-free unprotected sex during the rest of our cycle. Barrier methods of contraception can include condoms (male or female), diaphragms, cervical caps and more. For most of us, this is a very small price to pay to be able to enjoy unprotected sex during the rest of our cycle, free from any side effects of our chosen contraceptive. Those who practise a FABM are very aware that barrier use during the fertile window means that we are relying on the effectiveness of the barrier method as opposed to our chosen FABM during this time. In saying this, some studies appear to show that FABM users experience higher effectiveness rates than expected when using barrier methods. The largest study on the Symptothermal Method showed that barrier-users experienced a 99.4% perfect use effectiveness rate while abstinence-users experienced a 99.6% effectiveness rate.
Here’s hoping we will see a more informed and well-rounded piece on FABMs by the ABC in future. I would also hope that doctors Melissa Kang, Amanda Newman and Dr. Black will aim to provide less biased guidance to their patients when counselling on contraceptive options.
When using the Symptothermal Method of Fertility Awareness, a basal body temperature (BBT) thermometer is required. A BBT thermometer is a highly sensitive thermometer that measures accurately to two decimal places. This is important because the changes that you are looking to identify while charting can be as small as 0.2°C. Your basal body temperature is your lowest core body temperature achieved during rest and usually occurs around 4am in the morning. As most of us don’t want to be waking up at 4am every morning, we take our wakingtemperature a few hours later instead. Most women take their temperature orally, while others may opt to take their temperature vaginally.
When searching for a thermometer, you need to make sure that:
You purchase a BBT thermometer that measures accurately to two decimal places
You purchase a BBT thermometer and not a standard fever thermometer
(even though many standard fever thermometers will display two decimal places, they do not measure accurately enough to be used as a BBT thermometer)
You will find that most pharmacies stock BBT thermometers. If the pharmacist doesn’t know what you mean when you say you’re looking for a basal body temperature thermometer, try asking for an “ovulation thermometer”. Here on the Gold Coast my local pharmacy stocks the SurgiPack Ovulation Digital Thermometer for AU$20 and it’s as simple as walking into the pharmacy and grabbing one! You can also find these BBT thermometers on eBay Australia.
Otherwise, see below for a range of tried and true BBT thermometer options. You really don’t need anything fancy – you can spend as little as $8 and be all ready to go!
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The Mabis Basal Thermometer The Mabis is a fantastic and reliable entry-level digital BBT Thermometer for around $8 off Amazon. Keep in mind that it does not have an internal memory so cannot store more than a single temperature at a time. It also does not have a backlight so you’ll need to turn the light on in the morning to see your temperature.
The iSnow Digital Basal Thermometer The iSnow is a great step up from the Mabis at just over $25. It has a backlight so that you won’t need to squint or turn on a light early in the morning. It also has an internal memory that can store 60 temperatures, meaning you don’t need to record your temperature straight away – you can come back to it later that day, or in 60 days time! Last but not least it has a built in alarm clock and also comes in a large, robust case for safe storage.
The Femometer Vinca II The Femometer Vinca II is a premium option and is very well suited for charting with the Symptothermal Method. It’s best to grab their Vinca II model which includes a screen for you to see your temperature (earlier models required you to sync the thermometer with their app to see your temperature each day). In addition to this, the Vinca II allows you to select from three different options for the duration of time it will assess your BBT:
1.) Fast Mode (30 seconds)
2.) Normal Mode (1-1.5 minutes)
3.) Mercury Mode (3 minutes)
Mercury Mode is especially beneficial as the formal rules of many Symptothermal Methods do call for at least a 3-minute assessment of your BBT each morning.
With the Femometer Vinca II you can also adjust the beep volume either up or down, plus you can store up to 300 temperatures.
The Tempdrop Smart Thermometer The Temprop is an incredible piece of femtech! It’s a wearable device (worn on the upper arm in an armband) that takes your temperature multiple times throughout the night. It then puts those temperatures through an algorithm to tell you what your true basal temperature is each night. This means it’s a fantastic option for shift workers (hello doctors and nurses!) and postpartum/nursing mothers who tend to have very fragmented sleep. Read more about the Tempdrop and find a $10 discount code here.
The Wink Digital Thermometer The Wink thermometer (by the founders of the Kindara app) is no longer in production; however, you can sometimes still find one for sale second-hand. This thermometer was originally designed to sync directly with the Kindara app to easily input your temperature. While this sounds user-friendly and very convenient, I don’t recommend the Wink as the design is flimsy and many users report that it breaks easily. If you’re in the market for a second-hand BBT thermometer I would opt for a Tempdrop instead!
Wink – flimsy, and no longer in production.
The Daysy/Ladycomp/Babycomp Devices These devices were previously marketed heavily on social media and YouTube, where paid influencers would explain that they were using the devices as contraception. Valley Electronics AG (the manufacturer), advertised the devices as 99.4% effective with perfect use for accurate prediction of the fertile window based on temperature alone. Unfortunately, the real effectiveness of the Daysy/Ladycomp/Babycomp devices remains unknown. Their most recent study was retracted from the scientific literature due to a number of fatal flaws that meant the final figures were unreliable. Read more about the retraction here, which was finalised after leading reproductive health epidemiologist Chelsea Polis published a peer-reviewed commentary outlining the flaws of the study. In addition, their previous study advertising a 99.3% perfect use effectiveness rate has also been criticised as being flawed.
As a personal anecdote – Valley Electronics AG (aka Daysy) does not take kindly to criticism and doesn’t have the best track record of transparency with their clients. In fact, during the entire year that it took for the journal Reproductive Health to retract the 2018 Koch paper, Daysy continued to advertise their device as 99.4% effective. In this case, their pursuit of profit was placed above their customers’ right to accurate and up-to-date information about the device they were purchasing. Also concerning is the continued support that this company receives from high-profile figures within the FABM and natural health world.
The verdict? Use at your own risk. Anecdotally, if I had to choose between Daysy and Natural Cycles I would choose Daysy as their algorithm does appear to be a lot safer (despite the lack of quality research to support it). You can read more about why I personally do not recommend these devices here: 5 Reasons I Don’t Use Daysy or Natural Cycles
Daysy – true efficacy remains unknown.
Natural Cycles Natural Cycles is an app that claims to predict your fertile window with 93% accuracy (with typical use) based on temperature alone. My personal opinion is that using Natural Cycles is dangerous if you are seriously wanting to avoid a pregnancy. Anecdotally, not a week goes by that I don’t see women reporting unplanned pregnancies or being given “green” days during their fertile window. On top of this, the founder of the app (Elina Berglund) and one of the lead scientists behind the Natural Cycles’ studies (Kristina Gemzell) have both been quoted as saying this app is not a good option for those women who are seriously trying to avoid a pregnancy. You can read more about the reasons why I do not personally recommend Natural Cycles here: Natural Cycles’ FDA Approval: What’s The Big Deal?
Natural Cycles – a dangerous option if you are truly trying to avoid pregnancy.
Ava Woman Cycle Tracker Bracelet The Ava is a bracelet that tracks skin temperature at the wrist, pulse rate, breathing rate, heart rate, sleep and more. It is designed to assist those who are trying to conceive and is NOT approved as a method of contraception or for use by those who are trying to avoid a pregnancy. Some women decide that they would like to use the temperatures that their Ava bracelet provides, and combine these with cervical mucus charting. This is not advised for two reasons:
Wrist temperatures have not been proven accurate enough for use with FABMs.
The temperature readings that Ava provides are changed or smoothed via an algorithm that is based on other metrics such as breathing rate/heart rate and more. Therefore it is not accurate enough to be used as part of a FABM.
If you’re trying to conceive you’re better off learning to track your cervical mucus and cervix – these are physiological signs that actually warn that ovulation is approaching. BBT and heart rate only rise after ovulation – which is generally too late to be of any use if you are trying to fall pregnant. On top of this, the stats that Ava currently use are based off a small study of only 41 women, with one menstrual cycle each.
Ava – in the same category as Daysy and Natural Cycles.
The verdict on Daysy, Natural Cycles and Ava? In my opinion, they are overpriced thermometers that can put unaware users at risk of unintended pregnancy. I don’t believe they deliver true value for money.
Always remember that it’s best to work with an instructor to learn Fertility Awareness – an instructor will be able to guide you through all the nuances of accurately taking your temperature and the specific rules of confirming your temperature shift. They’ll also be able to help you develop a solid understanding of your cervical fluid, too. You can find an instructor here.
Daysy and Natural Cycles are right for some people, but they are not right for all people. To know whether these products are the right choice, customers really need to have been provided with adequate information through the education and healthcare systems as to how their fertility actually functions. Unfortunately, fertility awareness is barely covered by schools and GP’s, leaving a large majority of women with a substantial knowledge gap when it comes to their menstrual cycles. This means that companies existing within the femtech space are largely marketing to an uninformed audience who cannot critically evaluate the claims that are made about effectiveness.
In many ways, this is not the fault of companies such as Daysy/Natural Cycles, but the fault of the social structures in which they exist.
The below video is my personal opinion as to why I choose NOT to use these apps/devices.
Press play to join the conversation.
For those of you who prefer to read, I’ve included a brief summary below of the points I make in the video.
1.) Natural Cycles and Daysy/Ladycomp are temperature-only methoDS:
Your basal body temperature generally only shows a sustained rise *after* you’ve ovulated (due to the release of progesterone by the corpus luteum after ovulation). This means that your temperature does not give you any real-time information about the state of your fertility prior to ovulation (apart from telling you that you haven’t ovulated yet). If you’re trying to avoid becoming pregnant, you need to know at least six days prior to ovulation, that ovulation is approaching. This is due to the fact that sperm can survive for up to 5-7 days in the reproductive tract. Cervical fluid is your warning sign of approaching ovulation, due to the fact that cervical fluid is influenced by rising levels of oestrogen. Natural Cycles and Daysy/Ladycomp do not take cervical fluid into account. Instead, they predict your current cycle based on past cycles. This can be risky for those who experience an unexpectedly early ovulation.
2.) Temperature-only methods were superceded by the Symptothermal Method in the 1950s:
Temperature-only methods were used in the 1930s, before it was discovered in the 1950s that cervical fluid allowed a user to “see” oestrogen levels rising in real-time. For an in-depth overview of the transition and development of Fertility Awareness-based Methods see this post here:
3.) Effectiveness and research:
As of the date of publishing this article, the typical-use probability of an unintended pregnancy after 13 cycles of use are as follows:
To put this into perspective: If 5000 women are using each of the above contraceptive methods, after 1 year of use 415 Natural Cycles users will experience an unintended pregnancy, 135 Daysy users will experience an unintended pregnancy, and 90 Sensiplan users will experience an unintended pregnancy*. This is based on “typical use” – so users who are making mistakes and/or being careless.
*Note: Because these percentages have been taken from a range of different types of studies (including clinical trials and retrospective surveys), it is difficult for a comparison to be truly accurate – these figures are just to give you a rough idea.
Despite the concerns raised about the issues (both minor and major) with the Daysy and Natural Cycles studies, both companies continue to aggressively market their products to a primarily young demographic on social media. They often do this through the use of social media influencers who either happily receive a commission by referring their followers to purchase, or are paid to create a sponsored post. Natural Cycles especially concern me given the fact that their founder Elina Berglund is quoted as saying that the ideal user “is a woman in a stable relationship who is planning to have children at some point, and who would like a break from hormonal contraception ahead of trying.” Kristina Gemzell Danielsson is a professor in obstetrics and gynaecology at Karolinska Institutet and is one of the research scientists behind the Natural Cycles studies. She is quoted as saying that Natural Cycles is “not a good option for women who absolutely want to avoid a pregnancy”.
5.) body literacy:
Placing your fertility in the hands of an app or device is in some ways just another way of handing over your power and autonomy. What happens when you lose your phone or your batteries run flat? Without the deeper level of knowledge about how our fertility functions, we are stripping women of the chance to experience true empowerment and reproductive freedom. When Daysy and Natural Cycles only give users half the picture (temp-only as opposed to informing users of the importance of cervical fluid), they are simply keeping them tethered to an expensive product that provides a sense of security (however misplaced), at the expense of true body literacy.
conclusion
If Daysy and Natural Cycles are the right choice for you, you will know. Each person has the freedom to make their own choices when it comes to contraception and for some people, a temperature-only method will be an ideal fit for their lifestyle and their reproductive intentions. My hope is that the above video will help you to understand the full picture, so that you can provide truly informed consent about the Fertility Awareness-Based Method that is right for you.
“Many women would choose a natural option of birth control if they knew there was such a thing”
This week I was lucky enough to catch up with Aisha Mukooza, the co-founder of a 20,000-strong Facebook group called ‘Fertility Awareness Method of Birth Control‘. This Facebook group has played a key role in the education and support of a growing number of women and much of this is thanks to Aisha’s dedication in growing the group from scratch! Each week, this group hosts weekly learning activities and has a huge wealth of resources in their Files section. They also have a dedicated team of admins and moderators who are on-hand to guide new members through their learning journey.
I was curious to chat with Aisha to find out more about her background, her experience with Fertility Awareness, and what drove her to create such an incredible Facebook group.
Join the conversation!
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Aisha! Thanks for catching up. Can you tell us a little about yourself and where you are based? My name is Aisha Mukooza. I live in Virginia and have since I moved to the USA 11 years ago from Uganda. I work as a lab assistant at a local hospital and I’m currently going back to school to become an ultrasound technologist.
What was your experience of sexual health education in High School? I went to high school for a bit in Uganda but mostly in America. All I remember in High School (USA) was a woman counselor who was brought into the main hall of our school for juniors and seniors. She gave a serious lecture about STD’s, safe sex and relationships. One time. I don’t remember exactly what it was about but I do remember it being great. I already knew it all though thanks to a male family friend who had gone over STD’s and safe sex back in Uganda. In Uganda, there were many programs (including in schools) surrounding STD’s and safe sex due to the AIDS epidemic. The family friend I mentioned actually worked for such programs. It’s from him I learned what “STD” meant. What sex meant and what safe sex meant. One of the people in my life I am and will always be thankful to have met.
How did you first discover Fertility Awareness? I was never for anything that interfered with ovulation for long term so I was lucky that Kenneth also envisioned condoms as his long term birth control. Everything was great until about six months of dating when he started to experience burning and such. We concluded he was allergic. I discovered withdrawal perfect use and we started using that solely; however, he wasn’t keen on withdrawing long term. This led to pressure to get on birth control. I looked into the IUD and that scared me more than hormones to be truthful. I was not going on hormonal birth control and that led to unhappiness and negative thoughts. At some point I did contemplate breaking up but I figured I’d run into the same problem in the next relationship. I googled ‘natural birth control’ thinking there was no such thing. How wrong I was! I stumbled onto the LadyComp. It was expensive though and I wanted to make sure it truly worked. I didn’t know much about studies and such then so reviews were my best bet. Most positive reviews also suggested reading Taking Charge Of Your Fertility by Toni Weschler – I figured whatever increases the effectiveness, why not?! I borrowed the book from my local library, read the book, and was blown away! Amazed! And never looked back. I realized I didn’t even need a LadyComp anymore but rather a thermometer and paper charts.
[Editors note: The LadyComp is a device made by Valley Electronics – the same company that makes Daysy. Both devices predict when you are fertile using an algorithm that uses your basal body temperature. Apps and devices that rely on your temperature alone to tell you when you are fertile (such as Natural Cycles, Daysy and LadyComp) are not recommended and you can read why HERE]
What was the most surprising thing you learned about your body? That you can accurately track ovulation.
What made you start the Facebook group Fertility Awareness Method of Birth Control? To share the knowledge. The more platforms – the more the knowledge of Fertility Awareness is passed on.
How was the growth – did it grow fast right from the beginning or did it start off slowly? It started out slow with lots of engagement from the members. It grew slowly in the early days but once it got big, it started to grow even faster.
What’s the most memorable thing that’s ever happened for you in the group? A study on the group taught me and my fellow admins about the seriousness of consent. A member approached us about observing how women who use Fertility Awareness interact on social media. I was so excited about it without realizing that not everyone would want to be observed. It also lead to a feeling of mistrust from our members. We never went through with the study but it taught me a great lesson I will use forever. Lots of stress though!
Why do you think social media is so important for Fertility Awareness Based Methods? Like I said, the more platforms out there spreading the knowledge, the better. There are many women out there who would choose a natural option of birth control if they knew there was such a thing.
Any tips for people who are just starting out with a Fertility Awareness Based Method? I highly recommend to learn the method thoroughly. If there’s something essential that you don’t understand, there are Fertility Awareness Instructors so take advantage of that great option. Always follow the rules if you’re using Fertility Awareness for birth control. Once you get it, you can become over-confident and disregard the rules. In my experience as someone who’s seriously used Fertility Awareness for birth control, I can firmly say that it’s better to delay unprotected sex than worry you might have mistaken things and weren’t safe.
Where do you see the future of Fertility Awareness Based Methods? I’d like to believe that there are going to be more aids to help us accurately determine when the fertile window opens and to confirm ovulation happened.
Thanks for catching up Aisha! If you’d like to join Aisha and a community of over 20,000 women who practise Fertility Awareness, you can find the Facebook group here
“Can you spontaneously ovulate at different times throughout the menstrual cycle?”
It is a common question and the answer is thankfully no.
Our reproductive system actively stops us from ovulating on multiple occasions within a single menstrual cycle.
Ovulation is an event that occurs when a mature ovum bursts out of the follicle that houses it (simultaneously bursting out of the ovary, too). The human ovum has a lifespan of 12-24 hours, during which there is the possibility of the release of a second or third ovum – this is how fraternal twins/triplets are conceived. While multiple ova can be released during this 24 hours, this is still considered a single ovulation event. The lifespan of the human ovum means that a woman is fertile for a maximum of 48 hours every menstrual cycle (this does not take into consideration the lifespan of sperm).
The moment of ovulation. Did you know that healthy fallopian tubes are highly mobile, and if necessary can receive an egg from the opposite ovary?
The event of ovulation itself occurs around 24-36 hours after a surge in a hormone known as luteinising hormone (LH).
This surge of LH is released when the dominant follicle has grown large enough to secrete peak levels of oestrogen. Peak levels of oestrogen travel through the bloodstream to the hypothalamus, triggering it to release GnRH (gonadotrophin-releasing hormone) which causes the pituitary to deliver the surge of LH that triggers ovulation.
Once the ovum is released, the follicle that housed it develops into the corpus luteum – an endocrine gland around 2-5cm in diameter that secretes the hormone progesterone.
Progesterone has an inhibiting effect on the hypothalamus – it stops the release of further gonadotrophin-releasing hormone, which in turn means that the pituitary will not secrete any further LH. This means that even if subsequent follicles developed to a size large enough to secrete peak oestrogen levels, the pituitary is unable to trigger their release as it cannot secrete any further LH.
To summarise – once you have ovulated and the corpus luteum has formed – the ovaries are unable to release any further ova because progesterone in the bloodstream inhibits the secretion of LH from the pituitary gland.
Hypothalamic-pituitary-ovarian axis (HPO axis)
If this is the case, why do so many people think you can ovulate randomly at multiple times during your menstrual cycle?
The widespread yet misinformed belief that a woman can ovulate on separate occasions within a single cycle, can be traced back to a journalism piece titled “Women can ovulate more than once a month” by Gaia Vince and published in the NewScientist in July 2003. (You can take a read of it here)
Throughout the editorial, Vince cited a scientific study called “A new model for ovarian follicular development during the human menstrual cycle” by Canadian researchers A.R. Baerwald, G.P. Adams and R.A. Pierson. Unfortunately, Vince blatantly misreported the actual scientific findings of the study – likely for the sake of media sensationalism.
In fact, the results of the study were so misconstrued (not just by Vince but by many other news outlets also) that the lead researcher Roger Pierson was compelled to agree to an interview with the University of Saskatchewan to clear up the confusion. The interview, published by Saskatchewan’s own on-campus news was titled “A cautionary tale about research that touches a nerve”. (You can take a read of it here.) In it, Pierson is quoted as saying “That story claimed women ovulate two or three times a month and that’s simply not true.”
Roger Pierson: pioneering research into the wave model of follicle growth in humans. IMAGE: University of Saskatchewan
So what did Roger Pierson’s study actually find?
It turns out that Pierson’s study supports the existing knowledge that a woman experiences a single ovulation event per menstrual cycle. However, it was discovered that during the menstrual cycle there are numerous waves of follicular growth (whereas previously it was thought that there was only one wave of follicular growth). Journalists all over the world decided to exchange the term “multiple waves of follicular growth” with “multiple ovulations” – two entirely different concepts!
As Pierson points out in his interview with the University of Saskatchewan, it is only the final wave of follicular growth within the ovary that actually results in ovulation – meaning women really do only experience one ovulation event per menstrual cycle after all.
But what about superfetation?
Superfetation is extremely rare and remains to be definitively proven by science.
If you haven’t heard of superfetation I don’t blame you – it is extremely rare (a total of around ten reported cases in global history) and the scientific community generally states that further research is needed to either definitively prove or disprove its existence in humans. Superfetation refers to the condition whereby an animal becomes pregnant with another offspring, while already pregnant. This results in the mother carrying two offspring that are at different stages of development. If you’re interested in reading more about superfetation, the article “A review of the mechanisms and evidence for typical and atypical twinning” is a good place to start.
One theory for the mechanism of superfetation is that some women may have abnormally high levels of FSH (follicle stimulating hormone), which may resist the inhibitory effect of estradiol, progesterone and inhibin A during the first few days/weeks after implantation. Another theory is that some women may have a unique endocrine response to embryo implantation, resulting in levels of estradiol, progesterone and inhibin A that are too low to inhibit the release of FSH and LH from the pituitary. Both of these scenarios could result in an ovulation event after pregnancy has already occurred. You can read more about these mechanisms in the article “Unpredicted ovulations and conceptions during early pregnancy: an explanatory mechanism of human superfetation”
Conclusion? Superfetation remains to be definitively proven by science, and even if it were to be confirmed it is an extremely rare event that applies to pregnant women only.
The jury is in ladies and gents. Ovulation is an event that occurs once in a single menstrual cycle.
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It’s the age-old question that just won’t go away. From middle-aged mothers to experimenting teens, confusion reigns supreme when it comes to period sex and whether it carries a risk of pregnancy.
The short answer is a resounding YES: You can become pregnant after engaging in sexual intercourse while menstruating.
If you’re curious like me, you’ll want to know why. Remember, knowledge is power!
It’s time to tackle the mystery – does period sex really come with a risk of pregnancy?
We are only fertile for 48 hours every menstrual cycle; however, it takes two to tango and we need to take into account the lifespan of sperm. Sperm can survive up to 5-7 days in the reproductive tract thanks to the incredible properties of cervical mucus. (Not sure what cervical mucus is? Take a read of THIS article).
With the lifespan of the sperm and egg combined, there is a “fertile window” each menstrual cycle of approximately 6-9 days where intercourse could result in pregnancy.
This fertile window can occur earlier or later in your cycle, depending on when you ovulate. A rule of thumb is that ovulation always occurs 10-16 days prior to the start of your next period. These 10-16 days are known as the luteal phase.
There are a few scenarios where the fertile window can land on times of your cycle where you are experiencing bleeding, so let’s take a look!
Short cycles mean there’s a higher chance that the fertile window overlaps with your period.
SHORT CYCLES: If you regularly have short menstrual cycles, this means your fertile window occurs much earlier than the average. Due to this, period sex can very easily result in sperm sitting ready and waiting in your fallopian tubes just in time for the egg to be released! (This would be especially true if you experience quite a long period in combination with a short cycle). To provide an example, if you have a 23 day cycle, ovulation could be happening around day 9 (23 minus a 14 day luteal phase = 9). If ovulation is occurring on day 9, we then need to take into account the lifespan of sperm (up to 7 days), which takes us back to day 3 of the menstrual cycle as the opening of the fertile window – and it’s highly likely that you will still be menstruating on day 3. It’s important to note that the above are general figures and not necessarily applicable to your individual menstrual cycle.
An early ovulation is not the kind of surprise you’ll be wanting to throw a party for.
UNEXPECTEDLY EARLY OVULATION: If you’re reading this and thinking, ‘phew, I’m safe! I don’t have short cycles – I have average length cycles!” then I have bad news for you. As all Fertility Awareness Educators would say: “never predict future cycles based on past cycles“. The process of ovulation can often be delayed or brought forward seemingly randomly or even due to influences such as new supplements, different exercise regimens, new diets, illness, travel, stress, medication and more. So even if you consistently have 28 day cycles, there is no reason that ovulation cannot occur unusually early for you one day – and if this does happen after you’ve had unprotected sex during the last few days of your period, there is a chance that pregnancy may occur. This risk is even higher if you experience very long periods (say 7 to 8 days).
Ovulation nowhere on the horizon? You may be experiencing an anovulatory cycle.
NON-MENSTRUAL BLEEDING: The definition of a true period, is bleeding that follows 10-16 days after ovulation as the uterine lining sheds. Bleeding that was not preceded 10-16 days prior by ovulation, is known as non-menstrual bleeding.
Did you know that there is no guarantee that you will ovulate during each and every menstrual cycle? In fact, there is research to show that during our reproductive years, ovulation may not occur in an average of around 7% of menstrual cycles*. These figures are higher during the teen and pre-menopausal years.
Why is this so important? Because you could get a “period” at the end of a seemingly normal 28 day cycle, not realising that you never even ovulated and what you are experiencing is non-menstrual bleeding. Your ovaries may then gear up to finally ovulate successfully – just after you’ve had unprotected sex on days 1 or 2 of what you assumed was a true period!
Non-menstrual bleeding can also be common for people with polycystic ovarian syndrome who may go many months before their body successfully ovulates. This can lead to a build-up of the uterine lining. This thick lining can become unstable without the progesterone we would usually regularly release after ovulation. The destabilised lining can break down and cause bleeding that might be mistaken for a true period if you are not tracking your menstrual cycle.
*Researchers often refer to “non-ovulatory or anovulatory menstrual cycles” but this is a misnomer, because without the event of ovulation, the menstrual cycle cannot complete (because once ovulation occurs, menstruation will follow within 10-16 days, thus completing the full menstrual cycle).
Ovulation spotting is thought to occur due to a sudden drop in Oestrogen.
OVULATION-SPOTTING: Spotting or light bleeding around the time of ovulation is another type of non-menstrual bleeding. The reason that this occurs is hypothesised to be due to large fluctuations in hormone levels as you experience a peak of oestrogen which quickly falls, potentially leading to a small oestrogen-withdrawal spotting event. If you’re not tracking your cycles, this light bleeding could be mistaken for a light period – and if you were under the illusion that period sex was “safe” then you would have made the mistake of having unprotected intercourse right on the most fertile days of your cycle!
So, the next time you put a towel down to enjoy the benefits of period sex (like cramp and migraine relief), don’t forget to use protection!*
*If you’re wondering whether there’s a way to tell whether you’re ovulating each month, differentiate between all these different types of bleeding, and preempt an early ovulation as best as possible – you’ll want to dive deep into the Symptothermal Method of Fertility Awareness. You can find a guide to begin learning the Symptothermal Method here: Self-Teaching
FREE CHARTING
e-COURSE
Join me in the FREE Symptothermal
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cervical mucus, basal body
temperature, and charting for
birth control or conception.
Which protocol do you follow and why?
Do you think FABM’s are growing in popularity, and if so, why?
– however this method must be undertaken with an instructor as it involves off-label use of the monitor via a complex re-setting pattern.
by Sheila Kippley.
by Jane Knight, 
by Toni Weschler, and 
