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 (read on for the details).
And before we get started, it is possible to enjoy period sex withoutfallling pregnant. I teach all about this in the Natural Contraception video courses and coaching. My clients confidently confirm when they’ve passed ovulation, and identify if they’re having a true period. They also accurately track mucus so that they don’t get surprised with an early ovulation! 👀
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 ENJOY sex without fear of pregnancy with the Natural Contraception video course and coaching.
“I think a lot of people are afraid that it would ruin their sex lives”
This week I caught up with Georgie Breen to hear about how she discovered the Symptothermal Method. We chat about the challenges of finding an educator in Australia, the reactions from friends and family when they heard what method she was using, and the benefits that Georgie has found.
Join the conversation!
Some of the links in this article are affiliate links, meaning, at no additional cost to you, I may make a commission if you click through and make a purchase. For more information, please read the Advertising and Affiliates Policy here.
Thanks for catching up! Can you tell us a little about who you are and where you’re based? My name is Georgie Breen, I am 29 years old and I live in Dubbo, Australia. I work at a dairy factory and get up at 4:30am three times a week.
How did you originally discover Fertility Awareness-Based Methods? I found out about Fertility Awareness-Based Methods through the YouTube channel “FemmeHead”. I was checking out her reviews of some period products which then led on to her videos about Fertility Awareness. She led me to the book Taking Charge of Your Fertility by Toni Weschler, and the app Kindara. I’ve now been charting my menstrual cycle for about a year. I got married eight months ago and have been using the Symptothermal Method to avoid pregnancy for those eight months.
Did you encounter any challenges while you were learning the method? Yes. When I went looking for FABM Educators in Australia I was pretty disappointed. Australia really seems to be lagging behind, but I was glad to find an Educator through CatholicCare who was pleased with my knowledge and checked over my charts before I started using them to avoid pregnancy.
[Note] Most Fertility Awareness Educators are able to teach remotely via Skype / Zoom / Google Hangouts etc. You can find someone to work with on the Find An Instructor page.
What was the reaction from friends and family when you told them what you were using for contraception? When I started talking about it with friends, I found that the stories that came out were of people who had ‘kind of’ used Creighton, or ‘kind of’ used Billings, or ‘kind of’ tracked their cycle and ended up pregnant.
Note: Want to find out more about the different types of FABM’s? Read more HERE.
It seemed like Fertility Awareness was something to use if you were ‘kind of’ up for having a baby anyway. During most of their stories the women confessed that they ‘weren’t really being strict’ or that they subconsciously wanted a baby. That was a bit frustrating because there were no examples of women correctly following a proper method, and finding out if it actually worked. That’s where I found the community on Kindara to be such a support, and wealth of experience and knowledge. There were women on there who had used it for years – some who never wanted kids, and some who used it during and after having kids. I do feel like it can become a tricky subject to talk about because women who are happy with hormonal birth control can feel easily judged.
Do you think there are any misconceptions around FABM’s? Yes. FABM’s are centred around such a personal and intimate topic that I know a lot of people would be afraid to ask about it. I think a lot of people are afraid that it would ruin their sex lives. I think people are afraid that you can only have sex on a ‘safe’ day and that you can’t have spontaneous sex.
What has been the biggest benefit you’ve found? I love how it is a shared responsibility. It encourages communication between my husband and I. I love how much it has taught me about my body and how to listen to it.
Thanks for sharing Georgie!
Do you have a story you are ready to share about your experiences using Fertility Awareness-Based Methods? Contact me via the form at the bottom of this page to organise an interview.
“I was diagnosed with PCOS, hypothyroidism and Hashimoto’s after 9 months of charting”
This week I chat with Liza Patterson Blake on how the Symptothermal Method played a role in getting a diagnosis of PCOS, hypothyroidism and Hashimoto’s. Liza also shares how having a doctor as her father actually encouraged her to think critically about her contraceptive choices and lead her to discover Fertility Awareness in 2017.
Join the conversation!
Some of the links in this article are affiliate links, meaning, at no additional cost to you, I may earn a commission if you click through and make a purchase. For more information, please read the Advertising & Affiliates Policy here.
Liza, thanks for catching up! Can you tell us a little about yourself? I’m Liza, a woman in my mid-twenties and I currently live near Seattle, Washington. I’ve lived in a lot of places both in and out of the United States, and I claim Alaska as my true home. I have a Management Information Systems degree, and I absolutely love data, statistics, math, research and science. In my everyday life I love reading, writing, going to nerd conventions, horseback riding, hiking, exploring the world, crafting and coding. Fertility Awareness for me is really about having all of the data, and it’s even helped me to get enough data to discover that something was wrong with my body. I’ve been diagnosed with PCOS, hypothyroidism and Hashimoto’s disease. As someone whose two biggest medical problems in life had been 4 stitches in my eyebrow and being numbed for wisdom teeth removal, it was a bit of a surprising discovery to make!
Growing up, did you have any awareness of natural methods of contraception? Honestly, I didn’t know a ton about different methods of contraception. So no, I didn’t know anything about natural contraception other than hearing “NFP” a few times in books, etc. [NFP stands for Natural Family Planning – Fertility Awareness-Based Methods that require abstinence during the fertile window]
What was your experience of the school education system on reproductive health? I was really lacking in knowledge of female reproductive health until I was in my twenties. I knew basics, and I actually thought that I knew a lot. Looking back now, I had almost no idea about reproductive health in general but I did know quite a bit more than my friends. I took my health class in high school through distance ed, and I do think that I have that to thank for the knowledge that I did have – my schoolmates definitely didn’t learn as much in their classes as I did in mine.
What led you to discover Fertility Awareness? I was introduced to the concept that there’s a whole world of science out there for us to discover by my dad who is a doctor! When I was a kid, he always encouraged me to be aware of what my body was telling me because of my diet, sleeping and exercise habits. I was taught that there’s a time for medicine and there’s a time for our bodies to lead themselves where they should go. While he didn’t ever talk to me about Fertility Awareness, he did instill the thirst of body awareness into me which definitely helped to prepare me for my discovery of Fertility Awareness. My mom mentioned natural birth control to me one time around when I graduated from college, and that’s when I started to look into Fertility Awareness options, but I did research about it on my own.
What ultimately made you decide to choose to use a FABM instead of hormonal birth control/IUD? When I was 23 I caved to what some doctors had been telling me for years – that hormonal birth control would “solve” my irregular cycles, dizziness, nausea, headaches, heavy bleeding, pain, unwanted hair growth, acne, and everything else that was making my life harder to live. I hated how they made me feel: physically, mentally, emotionally. I do think it was the first time I had 2 “cycles” (I know better than to call them cycles now) in a row that were 30 days each in my entire life. I decided to take things into my own hands and did the research (one of my favorite things to do). The science is way more open to me than any form of hormonal birth control because I have the control. That really helped me to jump in and get involved in Fertility Awareness.
What was your learning process like? I have learned Fertility Awareness through a ton of study – studying books, articles, peer-reviewed papers and example charts. I started practicing Fertility Awareness in July of 2017. While I’m good at learning from technical information, I find that my cycles are irregular because of my PCOS and hypothyroidism, so I’m looking into taking a class where I can really focus on this and learn more specifically about my body.
What was the most surprising thing you learned about your reproductive system by learning a FABM? Before I started learning about Fertility Awareness, I had absolutely no idea what different types of cervical fluid meant! I was so delighted (I’m such a nerd lol) to learn that they were actually indicators of what was happening inside of my body. I love data like that.
Did you encounter any challenges in your journey? I’m so lucky to have my husband on board with this whole process – he loves that I am proactive about my health (sometimes he might think I’m a little too excited). However, he currently has no interest in learning absolutely any of the things that I know. It’s really frustrating to me because if I could know every piece of information available in the world, I would love to have it all…whether it’s relevant to me or not. He has learned a little, even if he doesn’t want to admit it. I also was diagnosed with PCOS, hypothyroidism and Hashimoto’s after about 9 months of charting, but it was one of the most difficult processes that I’ve been through. I went to my doctor with the suggestion of PCOS. He told me that I couldn’t have PCOS because the hair on my neck was just because of my genes and my cycles are only irregular because I’m overweight (I gained 35 pounds over 4 months with no lifestyle changes and haven’t been able to lose it no matter what I do, but the doctor was unwilling to consider that to be a symptom of something wrong in my body). I was so glad that my dad taught me that not every doctor was meant to be my doctor; if I thought that, I would have just stopped at this point and lived without a diagnosis. But I persevered and found another doctor. She took one look at me and the list of symptoms I had provided, including that I knew that I didn’t ovulate every time I bled because I practice Fertility Awareness, and told me she was almost certain that I had PCOS and she wanted to get to the bottom of it. When the first set of blood tests came back inconclusive, she ordered the ones that she would have had the first tests come back with abnormalities. The second set of blood tests found both problems – had she stuck to the routine blood tests, I would have remained without a diagnosis. Getting these diagnoses has really helped me know what to look for while charting so that I don’t just think I’m mysteriously having cycles that are 70-110 days long. But they also came from recognizing that something was abnormal in my charts and being able to discuss that with my gynecologist.
What is the most surprising benefit that practicing a FABM has brought to your life? I think that the most surprising benefit that I’ve gotten from practicing a FABM has definitely been peace of mind. Now that I know that my cycles truly are abnormal (and why), I can be aware of where I am in my cycle and accept each day as it comes. I have a lot of frustration because of the problems I’ve discovered in my body, but Fertility Awareness helped me identify what they are, which is the only good way to actually develop a well-researched plan of action. My life revolves around the need to know everything, and I know so much more about my body now than I ever have.
What would you do differently if you could go back in time to your teen self? If I could go back to my teenage self, I would provide every possible resource and sign up for a class to learn about Fertility Awareness. I think that it’s basic body literacy that every girl needs to have, and I hope to be able to teach at least some of the women and girls in my life to have an appreciation for all of the things their bodies can do.
Where do you see the future of FABMs? I love technology so much and I think that as more women learn the reality of Fertility Awareness-Based Methods – that they aren’t just writing down when you had your period on a calendar – that we’re going to get more and more tech supporting Fertility Awareness. Since I work in the tech world, it’s so exciting for me to see everything unfolding. Already, we’re seeing smart devices are starting to get interested in the idea of cycle tracking; hopefully they’ll take it one step further and add features to help women chart their cycles thoroughly. As far as my future with FABMs, I’d like to help spread the word and the thirst for knowledge to women – it doesn’t take a degree and it doesn’t take special equipment to understand your body. However, the people who do have degrees and equipment can definitely work with you to learn more and build the knowledge together. I’m hoping to get certified through an accredited program to teach a few people and bring more tech into the Fertility Awareness world.
Do you have any advice or tips for other women who are curious about starting to chart? You CAN do it, and it IS worth it. The knowledge and self-understanding that FABMs will bring to your life are worth the effort that it takes to learn the methods. Our bodies are full of science, and we should be embracing that instead of shutting it down. FABMs teach connections that are integral to understanding your body as a whole, and the amount of effort that it takes (5 minutes a day, max) is so minimal compared to the reward you’re getting. Find friends in the Fertility Awareness world, because that’s how women empower each other.
Lastly, where can we find you? You can find me over at solvingladylife.com where I write about Fertility Awareness and life hacks for women!
Thanks so much for sharing, Liza!
Do you have a story you are ready to share about your journey with Fertility Awareness-Based Methods? Contact me via the form at the bottom of this page to organise an interview!
First things first… let’s get clear on the term vaginal discharge! Vaginal discharge tends to imply that we have some kind of infection or pathological issue. In reality, the term ‘vaginal discharge’ refers to ALL types of fluid that are discharged from the vaginal canal. This can include:
skin cells that slough away from the vaginal wall,
healthy cervical mucus created by special crypts within your cervix
discharge caused by infection or disease
This article is concerned with cervical mucus (sometimes known as cervical fluid). Cervical mucus is technically a type of vaginal discharge (albeit, a very healthy one!). Cervical mucus is created by special crypts that line the inside of your cervix (your cervix is the bottom third of your uterus and is a thick, muscular tube that connects the inside of your uterus with the upper portion of your vaginal canal).
You’ve probably encountered cervical mucus before even if you weren’t actually aware of it at the time. You may have occasionally or frequently seen cervical mucus dried in the crotch of your undies, on the toilet tissue after you wipe, or even dangling out of you in a long string as you sit on the toilet after a bowel movement.
Tracking cervical mucus is a key part of most modern Fertility Awareness-Based Methods (FABMs), because the consistency of cervical mucus changes in response to different levels of oestrogen and progesterone.
Cervical fluid is a normal, healthy bodily function that all females experience.
Cervical fluid is a normal, natural, HEALTHY bodily function. And when I say the word “function” I mean it has a very specific purpose! It also follows a very predictable pattern of changes that align with specific phases of your menstrual cycle. If this is news to you, you’re not alone – unfortunately the vast majority of women have no clue about this incredible substance and the way it changes in response to different hormones. In fact, many women assume that they have recurring vaginal infections when they notice cervical mucus, and then resort to unnecessary douching and feminine washes in a misguided attempt to “clean” themselves. (On a side note: I do hope that everyone reading this is aware of the detrimental effect that douches and feminine washes can have on the natural pH level of your vagina).
Yes you read that right – it’s HEALTHY!
The primary purpose of cervical mucus is to protect, nourish, transport and filter … SPERM! And seeing as the female body only ovulates once in a single menstrual cycle, there’s no point in producing highly fertile cervical fluid for the entire month. Instead, cervical fluid increases in water content as your oestrogen levels rise the closer you get to ovulating. A typical transition could see your cervical fluid move from:
None at all after your period ends (dry), to
Sticky/tacky/moist, to
Creamy/smooth/white/wet, to
Slippery/stretchy/clear/lubricative (consistency of raw eggwhite), to
Watery, to
Dry again
The transition of cervical fluid throughout the menstrual cycle.
Lubricative cervical mucus of a consistency similar to raw eggwhite is considered the most fertile. For some people, the water content of this fluid is so high that they can no longer pick it up, and it simply appears like very watery, slippery fluid. After ovulation, your cervical fluid usually dries up for the rest of your cycle. It’s important to note that if you are using the Symptothermal Method of contraception, all cervical fluid prior to ovulation should be considered fertile. Yes, some types are (far) more fertile than other types, but in the follicular phase under the influence of oestrogen, they can all be hospitable to sperm. Don’t be fooled into thinking that you can only get pregnant when you’re experiencing cervical fluid that looks like raw eggwhite (although it is more likely).
Highly fertile cervical fluid often resembles eggwhite!
Let’s break down the four key functions of cervical mucus. Join the conversation!
PROTECT: Cervical mucus is alkaline. Your vagina is acidic. Sperm cannot survive in the naturally acidic pH of the vagina – in fact, in the absence of cervical mucus, your vagina is a bit of a sperm-killing machine! Cervical fluid provides a nice, safe alkaline substance to protect sperm from what would otherwise be an inhospitable environment inside your vagina.
Cervical fluid neutralises the acidic environment of your vagina!
NOURISH: Cervical mucus contains fructose which is an energy source for sperm. Sperm can survive on average up to 5 days (but on some occasions longer) in highly fertile cervical mucus.
TRANSPORT: The microscopic structure of cervical mucus is fascinating stuff. In the follicular phase of your cycle as your oestrogen levels rise in the lead-up to ovulation, the structure of your cervical mucus transitions to provide easier navigation for sperm. At its most fertile (when it appears as raw eggwhite), the mollecular structure of your cervical fluid mimics “swimming lanes” that allow for easy passage of sperm. In the luteal phase of your cycle under the influence of progesterone, your cervical fluid has a very impenetrable mollecular structure that creates a “plug” of sorts in the cervix to keep any further sperm out.
Swimming lanes to make things easier for your man’s “swimmers”…
FILTER: The molecular structure of “swimming lanes” in highly fertile cervical fluid also serves to filter out any sperm of low motility or abnormal morphology. Any sperm that are swimming sideways or backwards get trapped on the edges of the “swimming lanes” and in this way your cervical fluid is actively filtering out low quality sperm in favour of the strongest swimmers!
Cervical fluid actively filters sperm to help ensure the strongest reach the egg.
How impressive is that? Your cervical fluid literally protects, nourishes, transports and filters sperm. For so many people, this is a completely foreign concept. Plus, if you are on hormonal contraception you won’t see this transition of cervical fluid as your body is not cycling naturally through the normal reproductive hormones each month – in fact, many contraceptive methods work (in part) due to the way they thicken your cervical mucus and therefore create an impenetrable barrier for sperm.
So, spread the word. Because you never know which of your friends is out there freaking out over this weird vaginal discharge that looks like someone cracked an egg in their undies!
*Want to see photos of real-life cervical fluid from other women? Check out The Cervical Mucus Gallery – an educational gallery of real pictures of cervical fluid!
*Want to see what a cervix looks like? Head to The Beautiful Cervix project to find out!
Discover the eight key benefits to the simple act of charting your menstrual cycle.
Basking in the glow of those benefits!
Anyone who has been using a Fertility Awareness Based Method for long enough, knows that the simple practise of charting your menstrual cycle delivers boundless benefits when it comes to your health, your relationship and your lifestyle.
Fertility Awareness Based Methods allow women to accurately identify their fertile window by tracking primary fertility biomarkers such as cervical fluid, basal body temperature and urinary hormone levels. There are three main types of modern Fertility Awareness Based Methods, and they are:
Symptothermal Methods
Symptohormonal Methods, and
Cervical Mucus-only Methods.
If all of this is news to you, you might want to read about how the Symptothermal Method works HERE.
Regardless of which Fertility Awareness Based Method you choose to use, the benefits are numerous and life changing – so much so that many women who discover Fertility Awareness go on to enthusiastically raise awareness about these benefits among their friends, family and community!
Below you’ll find a list of some of the major benefits to practising a Fertility Awareness Based Method.
Join the conversation!
SAFE: FABM’s come with no side effects. You don’t need to worry about blood clots, depression, nutritional deficiencies, increased cancer risks, copper toxicity, osteoporosis, uterine perforation and more (the list goes on!)
AFFORDABLE: All you need is a basal body temp thermometer and (if you can afford it) at least three cycles of instruction from a qualified Fertility Awareness Educator. Some FABM’s rely solely on cervical fluid observations, meaning you wouldn’t even require a BBT thermometer.
You’ll be laughing too, once you realise how much coin you’re saving on Pill subscription costs!
HIGHLY EFFECTIVE: The Symptothermal Method (specifically the Sensiplan protocol) was the subject of a prospective longitudinal study that followed 900 women over 17,638 menstrual cycles to arrive at a 99.6% perfect-use efficacy and a 98.2% typical-use efficacy. These women were working closely with an instructor – which goes to show with the right support and high levels of motivation, a 99.6% efficacy is well within your reach.
HEALTHY: Using a Fertility Awareness Based Method means that you are able to visually pinpoint signs of hormonal imbalance on your charts. Hormonal health is complex, and it can be tough to get things functioning optimally sometimes. Charting can help to identify anovulation, delayed ovulation, short luteal phase, insufficient cervical fluid, PCOS, low progesterone, early miscarriage, irregular bleeding, vaginal infections, cervical anomalies, PMS or PMDD and more!
Hormonal health is complex and FABM’s can alert you to when things are a little “off”.
EMPOWERING: Developing body literacy through education is an incredible source of empowerment. When you understand the nuances of the menstrual cycle, and how your own patterns of hormonal fluctuation affect you both physically and mentally, you are able to start optimising your life! You can harness the power of your own cycle to maximise your output in terms of social life, career progression, nutritional requirements, self-care schedule, physical exercise, creativity, relationship and more – all based on the different physical and emotional states of your menstrual cycle.
Body literacy offers one of the most profound forms of empowerment available to us.
EQUAL RESPONSIBILITY: You no longer have to suppress your entire HPO axis and sex hormones to be sexually on-call 24/7. Your partner takes equal responsibility in the outcome of any sexual activity. Communication improves as you need to openly discuss your pregnancy intentions and/or non-intentions. Your partner develops an increased understanding of your menstrual cycle and a respect for your natural fluctuations in fertility.
Taking equal responsibility for contraception can provide a new level of intimacy.
BARRIER BACKUP: When using a FABM you are able to objectively decide whether or not you require a form of emergency contraception should you experience a barrier failure (condom breakage/diaphragm slippage etc). How? By knowing whether or not you were in your fertile window when the accident occurred.
EASIER CONCEPTION: FABM’s are just as effective for women who are tying to conceive as it is for those who are trying to avoid pregnancy. Using the Symptothermal Method you are able to pinpoint your fertile window with 98.2% – 99.6% efficacy. This means you are giving yourself the best possible chances of conception and hopefully avoiding months of stress and confusion due to ill-timed intercourse. And when you do conceive, using a FABM means you can better avoid miscalculated conception and due dates!
FABM’s can make it easier to conceive a child when you are ready to do so.
So there we have it. As contraceptive benefits go, this is a pretty impressive list! Have you found any other benefits to practising a Fertility Awareness Based Method? If so, I’d love to hear from you in the comments below!
You may have heard that Natural Cycles was given the green light by the FDA last week to market itself as an official contraceptive. Natural Cycles predicts when a user can/cannot become pregnant based on that user inputting their daily basal body temperature reading.
Understandably, the internet has been abuzz with proponents and sceptics alike debating the wisdom of approving such an app, while women in their hundreds have been chiming in with anecdotal experiences, both negative and positive.
However, after almost two years of tracking my own fertility to avoid pregnancy with the Symptothermal Method (cervical fluid and basal body temperature), you won’t find me recommending women to use an app such as Natural Cycles as their sole form of contraception.
Curious as to why? Below you’ll find the seven key reasons that I don’t personally recommend Natural Cycles to the women in my life.
Basal body temperature fluctuations were first noticed in female patients of a tuberculosis sanatorium.
1.) Using your basal body temperature (BBT) fluctuations to track when you are/are not fertile is not new.
It was first discovered by Dr William Squires in 1868 in a London tuberculosis sanatorium that the BBT of fertile women seemed to rise in the second half of their menstrual cycle. This was also noticed around the same period by Dr Mary Putnam Jacobi in Philadelphia; however, neither Squires nor Jacobi realised that this biphasic pattern was related to ovulation. It wasn’t until 1904 that Dutch gynaecologist Theodoor Hendrik van de Velde in Holland discovered that the rise was related to the event of ovulation. In 1928 he confirmed that it was due to the thermogenic effect of the hormone progesterone which is secreted by the corpus luteum after ovulation.
Also during the 1920s, Japanese gynaecologist Dr. Kyusako Ogino and Austrian obstetrician-gynaecologist Dr Herrmann Knaus were separately conducting research on ovulation and the timing of fertile days during the menstrual cycle. The Ogino-Knaus system was the precursor for the calendar rhythm method, which was publicised to American women in 1932 by Dr Leo Latz with the publication of his book The Rhythm of Sterility and Fertility in Women. Unfortunately, many of Latz’ fellow doctors were unhappy with this information being made available to the public and he was dismissed from the faculty of the Loyola University School of Medicine.
Fast-forward to 1935 and the research on both BBT and calendar/rhythm was eventually harnessed by a German Catholic priest called Father Wilhelm Hillebrand who was trying to help some of his parishioners who had serious health reasons to avoid a pregnancy. He at first advised his parishioners to use the Ogino-Knaus calendar/rhythm system; however, when three of the women fell pregnant almost immediately, Father Wilhelm Hillebrand went in search of better options and came across van de Velde’s research on BBT. He decided to combine BBT observations with the Ogino-Knaus calendar calculations and the Calculo-Thermal method was born.
Then, in the late 1940’s and 50’s, the cyclical changes in cervical mucus and their relationship to ovulation started to receive more attention. While cervical mucus had first been described in 1855 by London doctor W. Tyler Smith, nobody thought to link the changes in mucus to cyclic changes in fertility – cervical mucus was then promptly forgotten about for the next 100 years! However, this all changed in the late 1940s and 50s when a number of scientists revisited the role of cervical mucus in fertility (Erik Odeblad and John and Evelyn Billings being some of the more well-known). Around the same time, in 1953 New York obstetrician-gynaecologist Dr Edward F Keefe added daily mucus observations to the Calculo-Thermal method, and the Symptothermal Method was born. The Symptothermal Method was then further developed and promoted by Dr. Konald A Prem in America, and Dr Jozef Roetzer in Austria.
PHEW. This point turned into an essay but the gist of it is this: the temperature method of fertility awareness has been around since 1935 and was superseded by the more reliable Symptothermal Method (Cervical fluid + BBT) in 1953.
Natural Cycles does not appear to be as conservative as the original temperature-only method of Fertility Awareness.
2.) Natural Cycles doesn’t appear to be a very conservative temperature-only method of Fertility Awareness.
One of the pioneers of the temperature-only method of Fertility Awareness was a German doctor called Gerhard K. Doering who released research in 1967 that highlighted the importance of
Waiting until the evening of the third raised temperature, due to the fact that he documented a number of pregnancies where conception occurred from intercourse on the second raised temperature. This was also to ensure that the rise was not due to a fever or disturbance.
Using a rule (now known as the Doering Rule) to calculate the last “infertile” day after menstruation, based on the earliest thermal shift recorded during the last 12 consecutive cycles.
Unfortunately, I have seen a number of Natural Cycles charts where green days are given on the second raised temp, and green days are given that extend beyond where a Doering rule would have cut them off. This places the unsuspecting user at risk of unintended pregnancy (and unfortunately I have seen some of those pregnancy charts, too).
Basal body temperatures cannot warn of an impending early ovulation.
3.) Basal body temperature only rises AFTER you’ve ovulated. Taking your temperature every morning will not warn you that ovulation is approaching – this is especially dangerous if you experience an ovulation that occurs unexpectedly earlier than usual.
Cervical fluid is more important than BBT in the follicular phase because it is the only physiological sign (apart from cervical changes) that is affected by oestrogen. Oestrogen increases as ovulation approaches. In short, Natural Cycles cannot predict or protect you from an early ovulation, and nowhere have I seen them mention this in any marketing materials. You would need to be checking your cervical fluid every day (and using some form of Doering rule) to safeguard against an unexpectedly early ovulation.
Would an unintended pregnancy be devastating for you?
4.) Natural Cycles’ marketing materials don’t seem to mention that their app is not suitable for women WHO WOULD BE DEVASTATED BY AN UNINTENDED PREGNANCY.
If you visit the practitioner section of the Natural Cycles website, a flowchart advises that GP’s should direct these women to choose an IUD instead. Elina Berglund, the original creator of Natural Cycles and previous CERN physicist says 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”.
Trying to compare efficacy rates between different FABM’s can be difficult.
5.) Natural Cycles SAYS that they are more effective than other Fertility Awareness-Based Methods.
The abstract of the most recent Natural Cycles study states “This study shows that the efficacy of a contraceptive mobile application is higher than usually reported for traditional fertility awareness-based methods”. I guess this really comes down to semantics. What do you class as a “traditional” method of Fertility Awareness? I can certainly understand how Natural Cycles should be more effective than the Rhythm Method (calendar only), however that’s not exactly a high standard to beat! Moreover, it has been proven that using a Symptothermal Double-Check Method (cervical fluid, BBT and a calendar-based rule such as the Doering rule) is more effective than a single-check method (temp-only or cervical mucus-only). I have also seen on a number of occasions Natural Cycles quoting statistics from the CDC to ensure that their own statistics look incredibly effective in comparison to other FABM’s. The CDC unfortunately are required to lump together all FABM methods when calculating typical-use efficacy rates – this means that the high efficacy rate of the Symptothermal Method is obscured by the inclusion of the Rhythm method. You can read more about that on the FACTS website here: https://www.factsaboutfertility.org/petition-the-cdc-women-and-medical-professionals-need-accurate-information/
Essure – approved by the FDA and the subject of 27,000 complaints.
6.) Just because the FDA approved Natural Cycles, doesn’t mean I’LL BE leaping off MY seat to purchase a subscription.
Let’s not forget that the FDA also approved controversial permanent contraceptive implant Essure, which is now the subject of class action lawsuits and over 27,000 complaints of injury (many serious and irreversible). I’ll be taking this approval with a grain of salt.
Basal body temperature – only half of the picture.
7.) Natural Cycles only gives their users half of the picture.
When Natural Cycles uses language like “the app does the work for you and tells you exactly when to use protection, so you can learn about your body and cycle along the way” it is a contradiction in and of itself. If the app is doing all the work for the user, the user does not have the chance to develop any level of body literacy above a basic understanding that an ovulatory cycle should have a visibly biphasic temperature pattern. Additionally, Natural Cycles doesn’t mention crucial information about the importance of cervical fluid observations to avoiding (or gaining!) a pregnancy. In my book, this does not qualify as “getting to know your cycle.”
While I would not recommend Natural Cycles, I can also understand the relevance of the saying “A less-effective contraceptive used well, can sometimes be more effective than a highly-effective contraceptive used badly.”
For some women out there who are not inclined to use the Symptothermal Method carefully and correctly, Natural Cycles might be more effective. For some women with extremely regular cycles, Natural Cycles will probably work very well and may never present an issue. For these women, Natural Cycles can be a good gateway into discovering how Fertility Awareness works with your body. Alternatively, some women might simply like the user-interface of the Natural Cycles app, and may prefer to use it in conjunction with their existing Symptothermal Method knowledge.
However, I remain concerned about the women who will stumble across the Natural Cycles app and blindly place their trust in its predictions, without realising its potential shortcomings. If and when a percentage (however small) of these women experience an unintended pregnancy, it will more often than not reflect badly on the entire Fertility Awareness community – which is a shame considering the delicate journey to gain more mainstream awareness and use of modern FABMs.
Have you used Natural Cycles? I would love to hear your experiences (both good and bad!) below.
How effective is the Symptothermal Method, really?
This week has been quite a momentous one in the world of Fertility Awareness Based Methods (FABM’s), with the release of a large systematic review that comprehensively critiques the quality of a huge number of FABM studies. This is significant considering the fact that reliably high efficacy rates are often the main drawcard for women who are considering using a specific FABM. Additionally, these efficacy rates are often central messages contained in the marketing of Fertility Awareness Educators for their current and prospective clients.
The systematic review was published this Thursday in Obstetrics & Gynecology. You can read it HERE. The review, titled Effectiveness of Fertility Awareness-Based Methods for Pregnancy Prevention: A Systematic Review, took on the gargantuan task of evaluating the quality of, and efficacy rates quoted in, a total of 53 studies. These 53 studies span a wide range of FABM’s including Calendar, Cervical Mucus-only, Temperature-only, Hormonal, Symptohormonal, Symptothermal Single-Check and Symptothermal Double Check.
The researchers focused their review on prospective studies only; that is, they excluded all population-based surveys from their analysis. Well-constructed population-based surveys are generally known to provide a more accurate estimation of real-world pregnancy rates; however, they require very large sample sizes to arrive at statistically valid conclusions. Unfortunately, in the case of FABM’s, low national and global use rates (in comparison to other modern contraceptive methods), mean that many FABM’s have to be lumped together to provide a statistically valid overall pregnancy rate – and this overall pregnancy rate obscures the individual effectiveness rate for each FABM. This is currently most apparent with the effectiveness rates that are quoted on the CDC’s website HERE – in fact, the organisation FACTS (an association dedicated to educating medical professionals on the validity of FABM’s as contraception), currently has a petition live HERE calling on the CDC to report more accurately on individual FABM rates.
In contrast to population-based surveys, prospective studies are better suited to delivering perfect-use or method-use efficacy rates – and it was these prospective studies on a multitude of FABM’s that were the subject of the systematic review.
Considering most readers will be users of the Symptothermal Method, I have attempted to summarise the outcomes of the review’s analysis of the Sensiplan method studies – the main one being a study titled “The Effectiveness Of A Fertility Awareness-Based Method To Avoid Pregnancy In Relation To A Couple’s Sexual Behaviour During The Fertile Time: A Prospective Longitudinal Study” by Frank-Herrmann et al in 2007 (otherwise known as the Sensiplan study). You can find the Sensiplan study HERE. The Sensiplan study is what most people reference when they say that the Symptothermal Method has a perfect-use efficacy rate of 99.6% and a typical-use efficacy rate of 98.2%.
The systematic review only covered methods that were connected to a prospective study. It did not look at efficacy rates for Rhythm, DOT App, Creighton, Daysy, Ladycomp, Babycomp, Sophia, TCOYF, Couple To Couple League, Justisse, Symptotherm (and more). This is because these methods either:
Have not been prospectively studied
Have been prospectively studied, but the study was of “Low” quality.
A huge majority of self-taught Symptothermal Method users follow the protocol outlined in Toni Weschler’s book ‘Taking Charge Of Your Fertility”; however, Toni’s method is not linked to any prospective studies. TCOYF also lacks a double-check calculation-based rule to open the fertile window (users that are familiar with the TCOYF method will know that the fertile window opens with the first observation of cervical fluid). This means that it is likely to be less effective than Sensiplan, which is classed as a Symptothermal Double-Check method due to the inclusion of a calculation-based rule to double-check the onset of the fertile time in the pre-ovulatory phase.
In saying this, I will never stop recommending Toni’s book due to the incredible wealth of information contained within its pages – in fact, I have 3 copies, all but one of which are currently borrowed out to friends! However, I do think it’s important that women are aware that there are more conservative Symptothermal Methods available (such as Sensiplan), that are linked to prospective studies.
The systematic review identified a total of 53 prospective studies that collected information on pregnancy intentions and outcomes for at least 50 or more participants. They assessed these studies against a 13-section Quality Criteria Framework, designed specifically for this systematic review. Out of the 53 prospective studies, a total of 32 were ranked of low quality, 21 of moderate quality and 0 of high quality.
The Sensiplan study was deemed to be of “Moderate” quality by the team of researchers, and received a score of 7 out of 13 in terms of quality. The mean quality-indicator score of all 53 studies was 5.46.
Let’s break down the reasons why it wasn’t ranked as “High” quality.
Inclusion/Exclusion Criteria Sensiplan loses points by not specifying the total number of women who were invited to participate in the study. So we don’t know how many women declined to participate. This could raise concerns of selection bias – you probably wouldn’t want to participate in the study if you had had a bad experience with the method.
Exclusion of population not at meaningful risk of pregnancy Sensiplan included 2,625 cycles where no intercourse had been recorded, when they calculated the efficacy rates. This would likely skew efficacy rates upward. It’s unclear how major the impact of this might be.
Women in different states of fertility Sensiplan loses points because they included some breastfeeding women, and some women between the ages of 40-45. It’s reasonable to assume that fertility *may* have been lower in these women, and Sensiplan does not provide a sub-group analysis of separate efficacy rates for these women.
Teaching of method Sensiplan loses points because they don’t provide details on how their teachers are trained and certified, and what kind of teaching materials were actually used. Although they outline the number of encounters and reference the curriculum that is used, the teaching method would not be easily replicable simply from reading the study.
Statistical methods Sensiplan loses points here because although they provided a life-table analysis in their study, they did not exclude cycles where no intercourse occurred. This means that the efficacy rates might be skewed upward (as already stated in Point 2 above). Life Tables are preferable to the Pearl Index system, because they provide contraceptive efficacy rates for each month of the study, thereby showing how efficacy rates change over duration of use.
Attrition of participants Sensiplan reported that 6.7% of participants dropped out of the study after 13 cycles and they even reported the reasons why; however, they lose points for not discussing the demographic differences of the women who left the study.
The overall conclusion is that the Sensiplan study is intensive and “methodologically strong, but may have resulted in a highly select group of users, which should be considered with respect to generalizability of the findings.”
You may be wondering what these results mean for you as a real-life user of the Symptothermal Method! I am not a scientist so I can’t say for sure; however, I have compiled the following points which are my own personal takeaways on the issues raised regarding the Symptothermal Method:
There are no efficacy rates available for TCOYF users.
Marquette and Sensiplan are the most effective FABM’s according to current research; however, variability across the studied populations means that it is really not possible to make comparisons across methods.
Sensiplan is the most effective Symptothermal Method.
Sensiplan efficacy rates may have limited generalizability among different population demographics (differences in age, education, occupation, marital status, religion, no. of previous pregnancies, your family planning intentions, and variability of your cycle lengths).
Sensiplan efficacy rates may be skewed upward due to inclusion of cycles that did not involve intercourse.
There are no efficacy rates currently available for self-taught Symptothermal Method users.
As with any contraceptive method, it’s important that you assess the risks and benefits for yourself, to make an informed decision as to whether the method will be an appropriate fit for you. You may even want to take a look at the socio-demographic characteristics of the Sensiplan study participants – if you feel you differ substantially from the women who were studied, you may want to consider that the efficacy rates might not be generalizable to your own personal situation.
It will be interesting to see whether Sensiplan deliver an official response to the systematic review, as it would be useful to know just how dramatically the exclusion of cycles with no intercourse might affect the actual efficacy rates. However, I am also curious as to whether it is standard for contraceptive efficacy studies to exclude all cycles where intercourse did not occur, when calculating efficacy rates. For example, for studies of the copper IUD where ovulation still occurs, do researchers collect data on exact dates of intercourse so that they can exclude cycles where no intercourse occurred when calculating efficacy rates? Or is this standard relevant to FABM studies only?
I also am curious to know how efficacy rates for other modern contraceptive methods such as the Pill, IUD, Patch, Depo and Ring would stack up against the 13-Section Quality Criteria framework of this review. I suspect that most of these studies are likely of higher quality as they are more modern and funded by large pharmaceutical companies. For me, this raises the question of who is going to fund more high-quality studies on FABM’s? The only people set to financially benefit from more rigorous/high quality FABM studies would be Fertility Awareness Educators, most of whom work for fees that render their services largely voluntary, anyway. I would assume that FABM’s are really not on a level playing field when it comes to competing with studies paid for by manufacturers of medical devices and synthetic hormones!
At the end of the day, all of these questions are better suited to qualified researchers and public health professionals who are familiar with the field. We will have to wait to find out more. For FABM’s to be taken seriously by the medical community and general public, we absolutely require studies that inspire confidence and trust. In the words of the systematic review:
“Fertility awareness-based methods will continue to be relevant and important for many people for a variety of reasons; obtaining the best possible data, and documenting use in varying populations, is critical.”
My genuine hope is that this systematic review will place Fertility Awareness Based Methods firmly in the spotlight and with any luck, be the catalyst for the introduction of some high-quality studies into the field of FABM contraceptive efficacy estimation.
Do you have any thoughts on the systematic review? Have you read it? Please feel free to comment below with your initial thoughts, comments and concerns.
This is my personal summarisation of what I believe were the key points regarding the Symptothermal Method. Please take the time to read the review for yourself and form your own opinion.
When I mention to friends, family and colleagues that I use the Symptothermal Method of Fertility Awareness as contraception (and have done so successfully for a number of years now), I typically get a blank stare, followed by a *lot* of questions!
These questions normally follow a pretty predictable pattern. However, I realised that for every person asking me these questions out loud, there were probably 5 other people out there wondering them internally, with no one to ask.
I decided to gather some of the most common questions I get when I share my experiences with the Symptothermal Method, and address them all in one place – here, on my blog.
Join the conversation!
Confused? Read on for answers.
Firstly – what IS the Symptothermal Method? The Symptothermal Method is a form of Fertility Awareness. During each menstrual cycle, there is only a 6-9 day biological window during which pregnancy could result from unprotected sex. This time is known as the biological fertile window. The Symptothermal Method involves tracking cervical mucus and basal body temperature to identify this window (although the Symptothermal Method adds a buffer of at least several days on either side of the 6-9 day biological window).
With the Symptothermal Method, the presence of cervical mucus (in combination with some calculation rules) opens the fertile window, and a sustained rise in basal body temperature (combined with the drying-up of cervical mucus) closes the fertile window. Users follow a set of specific rules to check and confirm the opening and closing of the fertile window each menstrual cycle. This information can be used to avoid or gain pregnancy, and also offers valuable insight into your hormonal health.
How effective is it? The Symptothermal Method is evidence-based and research shows it to be up to 99.6% effective with perfect use, and 98.2% effective with typical use. However, when understanding these effectiveness rates you should take into account that they are based on users who were taught a Symptothermal Double-Check Method under the guidance of qualified instructors. Double-Check Symptothermal Methods employ the use of calculations to double-check the opening of the fertile window (instead of relying on cervical mucus observations alone).
At present, we do not have any effectiveness studies on self-taught charters, so we don’t know how effective it is to learn to chart without an instructor. Additionally, the typical use rate of 98.2% may not be generalisable to the wider public because it comes from a clinical trial where participants were under close supervision. The topic of effectiveness rates is actually very complex – I encourage you to read the full story on effectiveness rates here.
The most important thing to remember is that it is proven possible to achieve up to 99.6% effectiveness with perfect use. Working with an instructor of a Symptothermal Double-Check Method will help you achieve this, as will strictly applying the rules. Users who engage in risky behaviour or sloppy adherence to the rules will quickly discover that the method is very unforgiving of imperfect use.
A solid grasp of the rules and working with an instructor is recommended to get close to achieving a 99.6% effectiveness rate.
How long will it take me to learn? This will depend on how you choose to learn the method. If you’re self-teaching it’s recommended to abstain from sex or use a barrier method for at least the first full three cycles as you learn. I was personally self-taught but was in a long-distance relationship at the time, so I wasn’t often testing out whether the method worked. In fact, it wasn’t until I had been charting my cycles with the Symptothermal Method for an entire year that I started to feel confident with the method and my knowledge of the rules.
You can bypass this stage completely by working with an instructor – you can confidently enjoy unprotected sex right from the first cycle if you’re working with an instructor who can check over your charts and confirm that you’re not currently fertile. In addition to this, the upper limits of method effectiveness are based on women who were learning the method under the guidance of an instructor – so it’s always in your best interest to try and mirror those conditions.
How much is it going to restrict me having unprotected sex? Research shows that Symptothermal Method users with a hypothetical 28-day menstrual cycle would need to abstain from sex (or use a barrier method), for an average of 11 days each menstrual cycle. This would leave 17 days that could safely be used to have unprotected sex. Some of these days would likely fall on your period (meaning period sex). Keep in mind that period sex is not necessarily always safe for unprotected sex, you can read more about the risks of period sex here.
Navigating the transition from hormonal contraception to using the Symptothermal Method will look different for every couple. It may involve a reassessment of your sexual needs and wants, and it may take time to adjust to needing to abstain or use barrier methods during a significant portion of your menstrual cycle. Many couples find that the transition encourages a healthy intimacy where they learn and explore more about each other in the fertile window than they ever have before – it’s suprising what else is on the table when unprotected sex needs to be avoided! For other couples though, the transition is not a good fit with their sexual needs or lifestyle, and that’s ok too! At the end of the day, it is a big change and it can take some time to get used to.
It’s also worth noting that much of your decisions will depend on your reproductive intentions; that is, how seriously you are needing to avoid an unintended pregnancy and therefore what risks you’re comfortable with taking.
A qualified Symptothermal Method instructor has the tools to guide you through this transition in a way that simultaneously honours your reproductive intentions and the health of your relationship.
It takes self-control to avoid unprotected sex during the fertile window when your libido is often naturally higher.
Can I still use the Symptothermal Method if I have irregular cycles? Yes, you can absolutely use the Symptothermal Method if you have irregular cycles. The Symptothermal Method relies on daily cervical mucus and basal body temperature readings to pinpoint the opening and closing of your fertile window. Essentially, every day you ask yourself “Am I Fertile – TODAY?”, and your answer is based on your physical observations, which occur regardless of whether you have short, long or irregular cycles. The Symptothermal Method makes no assumptions about how your current cycle will unfold based on previous cycles*.
Am I fertile – TODAY?
What if I have really long cycles? As above, the Symptothermal Method can be used for long cycles as there is no prediction or guessing involved – it is simply a case of gauging your fertility status each day. However, if you have very long cycles you may sometimes face extended periods of barrier method use. This can be very frustrating for people who don’t enjoy using a barrier method of contraception! It may also lower the effectiveness of the method as you’ll be relying more often on contraceptive methods such as condoms and diaphragms. In saying this, charting your cycle using the Symptothermal Method will give you extremely valuable insight into your hormonal health. Many women find that charting allows them to identify and address the root causes behind their long cycles to start the journey towards better health. (And it’s amazing the progress you can make when the incentive of more unprotected sex is on the table!).
Long cycles can test your patience but can also be an indicator of underlying hormonal imbalances.
What if I don’t get as much cervical mucus as I see in all the pictures? Everybody is different and will produce different quantities of cervical mucus. As long as you experience enough cervical mucus to be able to clearly see the transition in colour, texture and consistency as you move closer to ovulation, there’s no need to worry.
However, if your cervical mucus is exceptionally scant you may want to have your hormones tested, especially if you’re trying to conceive. Good quality cervical mucus plays a crucial role in allowing the transport of sperm through the reproductive tract. If you’re not seeing much cervical mucus then it may indicate a hormone imbalance, as cervical mucus is directly influenced by oestrogen levels.
Things that can impact the output of our reproductive hormones can include our age, bodyfat percentage, over-exercise, undereating, egg quality and much more. In saying this, the most important thing is to stay hydrated and ensure an abundant diet of healthy foods! In many cases, scant cervical mucus can be vastly improved simply by upping your water intake and adopting a healthy diet.
There are also some supplements and medications that can assist to increase cervical mucus output and a qualified Symptothermal Method instructor is able to advise on this topic.
PS: Be sure to check out the Cervical Mucus Gallery to browse real-life pictures of cervical mucus!
Not everyone experiences “eggwhite” cervical mucus, and not everyone experiences enormous quantities of cervical mucus.
Is it easy to maintain in everyday life? This is probably the most surprising answer – YES! After the initial investment of time and energy spent learning the Sympothermal Method (often around 3 months), it genuinely becomes second nature. You can’t un-learn this knowledge! It takes all of about 5 seconds to check your basal body temperature before you get out of bed in the morning. And checking your cervical mucus every time you use the bathroom becomes a very easy habit to maintain – I mean, you’re already sitting there so why not! If you want something bad enough and are willing to put in the initial investment of time and energy then the reward is well worth the effort.
STM becomes second nature – after an initial learning curve of approximately three months.
Will it be a good fit with my lifestyle? This really depends on the individual who is asking the question. If you have a disruptive or chaotic lifestyle you may struggle as it does require habit and dedication. If you have a partner who places their sexual satisfaction above your right to choose a contraceptive method that works for you, then you may struggle also. If you don’t get 3 consecutive hours of sleep around the same time every night (shift workers and nursing mamas, I’m looking at you!), you may also struggle. This is because basal body temperature is core resting temperature and requires at least 3 hours of consecutive sleep at the same time, every day. Luckily, there are ways around this, one of which is a device called a Tempdrop. The Tempdrop is a wearable thermometer that measures your basal body temperature at multiple times throughout the night and has an algorithm that smooths out any disturbances. The result? You have an accurate record of your BBT each day, without having to wake up at the same time every morning! To receive $10 OFF Tempdrop, click the link below and apply the code TDLOVE29at checkout.
Heavy or frequent drinkers will also struggle as alcohol causes an artificial rise in basal body temperature. For those people that feel their basal body temperature will be too much of an issue, there are plenty of other Fertility Awareness-Based Methods other than the Symptothermal Method. These include Cervical Mucus-Only Methods (such as Billings), and Symptohormonal Methods (such as Marquette and Boston Cross Check). You can find out more about other methods and instructors on the Find An Instructor page.
The Symptothermal Method is still achievable with a busy lifestyle – it becomes a habit just like brushing your teeth.
Can I use a period tracker app to tell me when I’m fertile? This is a surprisingly complex question, with a complex answer! Generally speaking, absolutely not. A period tracker app is generally just that – an app that will roughly track your period and predict the date of your next period based on your last period. There are thousands of cheap apps available that all provide some version of period tracking. These apps should never be used to predict when you are fertile – especially if you’re currently trying to avoid pregnancy. If you would like a detailed explanation of why not to trust app predictions, click here. However, the short version is this: there are many, many variables that can cause you to ovulate earlier or later than your average, and earlier or later than the general average. On top of this variation in when you ovulate, many women can have a shorter or longer luteal phase than average. The luteal phase is the approx. 14 days between ovulation and your next period. If you’re inputting the start and end dates of your period into an app, there’s a high chance that the app is simply subtracting approx. 14 days off the start date of your period, to tell you when you’re likely to ovulate. This is really risky if you’re seriously trying to avoid becoming pregnant!
The only time that you might consider using an app to tell you when you are fertile based on your period dates alone, is when that app has undergone rigorous and independent clinical trials to ascertain its true effectiveness rating – and even then only if you are comfortable with the effectiveness rating and the increased risk involved.The only such app I know of is Dot which has been found to be 99% effective with perfect use, and 95% effective with typical use (although I have seen a number of charts now where Dot incorrectly estimated the fertile window). Dot only requires you to input the start date of each period. You can read more about Dot here: https://www.dottheapp.com/dot-research. I personally would not feel comfortable taking on this risk but acknowledge that others might be ok with the increased risk. If you want to use these apps you must understand that if the app miscalculates your fertile time because you ovulate earlier or later than expected – you will be placed at a very high risk of unintended pregnancy.
Other types of apps use basal body temperature to predict when you are fertile. These apps include Natural Cycles and Daysy. They are prone to the exact same shortcomings due to the fact that basal body temperature alone does not provide any real-time information to warn as to when ovulation is approaching. I personally would never use these apps/devices and you can read why that is here.
Apps aren’t all bad though! You can safely use an app like Kindara or Read Your Body to record your cervical mucus and basal body temperature observations, but you need to be interpreting those observations yourself, not relying on app predictions.
Apps can be useful tools for charting; just ensure to turn off app predictions in the settings.
*There are some calculation rules that are used in the Symptothermal Method (such as Minus 8/Doering Rules or S-Rules). Calculation Rules are what make Symptothermal Double-Check Methods so safe. While Calculation Rules are based on past cycles, they are used as safeguards and are always trumped by the presence of physical observations of cervical mucus and basal body temperature.
I hope this was helpful for you! If you have any additional questions please feel free to browse the many free resources on this website, or book in for a Virtual Consultation here.
Ok, that’s technically not true, but hopefully the headline caught your attention. I have in fact been using birth control, but it’s a form of birth control that you may not be familiar with. I hope this article changes that, and is useful for at least one person who reads it!
As of November 2016, I downed my last birth control pill, decided “screw this – there has to be a better way” and said a big ol’ SAYONARA to synthetic hormones. I did this primarily because:
I was dealing with increasing dark hyperpigmentation (melasma) on my face due to the hormones in the Pill (exacerbated by my lifestyle at the time which involved a lot of surfing in the harsh sun), and
I was experiencing thinning of my hair due to the Pill (it got worse after I quit, before it got better!), and
I was feeling like an emotional zombie – no highs, no lows, just a weird sense of disconnect from myself and the world around me – almost like looking through a pair of foggy glasses all the time, and finally
I was increasingly uneasy about how the synthetic hormones in the Pill were affecting my health and fertility on a deeper level. I was considering things like micronutrient absorption, bone health, heart health, breast health, and the artificial suppressing of my endocrine system.
Afterwards, the change was instantaneous and noticeable. I felt I returned to my mentally-present old-self immediately. A guy I worked with at the time literally asked me “What’s changed? You seem.. different somehow, and happier!”.
Sunshine and daisies
Anyway, I was still faced with the question of how the hell to avoid an unplanned pregnancy, so I started doing some research, spurred on by a conversation with a colleague. I’m not sure about your experience with rural NZ sex education, but unfortunately they never even scraped the surface of the complexities of the female endocrine and reproductive system, and its implications on our birth control choices. It was more a case of “here’s a horrific video of childbirth – don’t do the sex thing or you will get pregnant immediately and probably die of herpes”.
“Don’t do the sex thing”
For anyone who’s getting curious, I looked into a non-hormonal method of birth control called the Symptothermal Method (the STM). The STM is a form of Fertility Awareness that opens up a whole new world of insight into your health. It involves taking your basal body temperature (BBT) daily, and checking your cervical mucus multiple times daily too. These signs help you to track your full menstrual cycle and pinpoint the opening and closing of your “fertile window”. You can use this information to either avoid or achieve a pregnancy.
For those who are reading this in horror please rest assured that the method is based on scientific research. In fact, the research1 shows that the Symptothermal Method has a perfect-use effectiveness rating of 99.6%, and an actual-use effectiveness rating of 98.2%. To put that into perspective, the combined oral contraceptive pill is known to have a perfect-use effectiveness rating of 99.7% and an actual-use effectiveness rating of 92% (although researchers warn that these effectiveness rates cannot be directly compared to the Symptothermal Method due to differences in study designs). The topic of contraceptive effectiveness is very nuanced and I highly recommend that you take the time to read more about it here.
The only 100% effective contraceptive is abstinence! (sadly)
I’m not keen on boring you all with a human biology lesson, but it’s cool to point out a few of the basic scientific premises behind this method:
Cervical mucus will change2 in consistency, texture, appearance and volume throughout your cycle. Certain types of cervical mucus (that look like raw egg white) are considered highly fertile as they nourish and protect sperm on their journey. Other types of cervical mucus (sticky/tacky) are slightly less hospitable to sperm but can still assist sperm survival. On certain days of the menstrual cycle there may be zero cervical mucus present at all, meaning the naturally acidic pH of the vagina make survival difficult for sperm.
Your basal body temperature changes3 cyclically to reflect hormone levels throughout your menstrual cycle. Most importantly, once you have ovulated, a temporary endocrine structure in your ovary (the corpus luteum) begins to manufacture a hormone called progesterone. This coincides with a rise in your basal body temperature. Therefore, a raised BBT is an indicator that you have likely ovulated.
A person can only ovulate once4 in a cycle. It is possible to release multiple eggs during a single ovulation event. In fact, ovulation is considered a 24hour hormonal event (during which time multiple eggs can be released). Human eggs only live for 12-24 hours after ovulation. Therefore, the maximum amount of time that you could have an egg awaiting fertilisation is 48 hours.
Sperm can only survive5 on average up to 5-7 days within your body, dependent on the type of cervical mucus they encounter.
Therefore, with the combined life of the sperm and egg/s, you are only able to fall pregnant through unprotected intercourse during approximately 6-9 days of your menstrual cycle. This time period is known as the “fertile window”. Once you have ovulated and the unfertilised egg has been absorbed into your uterine lining, the fertile window closes and you cannot become pregnant.
Essentially, the Symptothermal Method allows you to ask yourself the question “Am I fertile TODAY?”. Your answer will be based on daily observations of temperature and cervical mucus*. You can then make a decision as to what kind of sexual activity you will engage in, depending on the outcome you are aiming for (avoiding pregnancy, or achieving pregnancy).
It’s probably obvious, but please note the Symptothermal Method does not offer any protection against the transmission of STI’s.
The menstrual cycle – the result of a complex dance of physiological processes
The effectiveness rates for the Symptothermal Method are based on couples using abstinence during the fertile window. However, the same study emphasises that there was no statistical difference in effectiveness rates for couples who chose to use a barrier method of protection during their fertile window – this is great news for those who have no religious/moral/ethical reasons to avoid using barrier methods!
This is all sounding straightforward, right?
Yup – clear as mud mate…
The Symptothermal Method can be a lot to take in initially. The above fertility signs can be difficult to pinpoint until you’ve spent at least 3 months to either work with an instructor (find one here!) or thoroughly teach yourself the method.
This is also where I butt in with a public service announcement: The Symptothermal Method is not the “Calendar/Rhythm” method. People who use a “Calendar/Rhythm” method track the length of previous cycles to make assumptions about their current or future cycles. This is a risky game of hormonal roulette because there are many lifestyle and environmental factors that can cause you to ovulate earlier or later than expected. These can include stress, travel, diet, illness, exercise and more.
It’s also important to note that the Symptothermal Method is not a miracle solution to any issues you may be facing with your own preferred method of contraception. The Symptothermal Method may not be suited to your lifestyle, your relationship, or your personality. And that’s ok! It is not as spontaneous, not as easy and not as convenient as simply popping a pill every day, having Nexplanon implanted or having a NuvaRing, Mirena or copper IUD inserted (all power to any woman who was brave enough to go through with an IUD insertion though). It means you do need to have self-control and a partner who is ok with using a barrier method during certain stages of your cycle.
You can choose to chart your fertility signs in an app or on paper/in a journal.
The Symptothermal Method may not be suited to you if you suffer from Endometriosis or severe Polycystic Ovarian Syndrome. For anyone dealing with these serious issues, hormonal contraception (such as the Pill) can occasionally play a role in allowing you to live a symptom-free life – and it should always be up to you to make that decision for yourself. For others with milder hormonal imbalances, hormonal birth control often conveniently masks the frustrating symptoms of those imbalances (such as acne, heavy bleeding, excessive mood swings etc). However, it doesn’t fix the root issue or “regulate your cycle”, it simply overrides your endocrine system with synthetic hormones. The root issue will usually resurface later down the track once the synthetic hormones are withdrawn (say, when you decide you want to try to conceive). In that regard, it’s worth noting that tracking your BBT and cervical mucus can help you to pinpoint certain hormonal/health issues you may have. This is because it provides clear, visual data on how your hormones are interacting at different points in your cycle.
In saying all of the above, the benefits for me personally are huge in terms of my own physical health and mental well-being. I have found a method of contraception that aligns with my outlook on:
environmental issues
female education and empowerment, and
the importance of respecting and caring for the body you’re living in
It gives me a pretty big sense of satisfaction and bodily peace. I no longer feel like the emotionless zombie I was on the Pill (not to mention the bloating, hair loss and hyper-pigmentation). I’m happy to ride the cyclical changes of mood and disposition that occur throughout my natural cycle and appreciate the highs and the lows as they come. I feel clear-headed and in control of my own body. Most of all, I feel empowered with the knowledge I’ve gained on how my reproductive and endocrine systems function.
Reproductive freedom tastes oh-so sweet!
Navigating your fertile years can be daunting. I’ve personally felt frustrated that as women we are often left with the responsibility of doing all the research, bearing the brunt of any side-effects, and experimenting with countless different methods on our mission to find the right contraceptive “fit”. This is even more frustrating when you realise that men are fertile “24/7” whereas the owner of the uterus is only fertile for a small window once every cycle! Either way, it’s undoubtedly a journey. However, I hope that my experience offers you a glimpse at an underutilised option in your “contraceptive toolbox”. I’m keeping an open mind myself; I acknowledge that what suits me now may not suit me in future. Mostly though, I feel lucky to be able to choose from so many options, and even more so to have stumbled across this method. I’m genuinely grateful that I live in an age and a country where information and educational resources are readily available to me if I decide to go looking!
~Useful sources and notes~
Please note that there are countless clinical trials and systematic reviews published in reputable medical journals to support the effectiveness and validity of the Symptothermal Method as pregnancy prevention. The below links are a very small snapshot into some of these studies.
Most people who argue a woman can ovulate more than once in a menstrual cycle will reference this article (“A new model for ovarian follicular development during the human menstrual cycle” by A.R. Baerwald, G.P. Adams and R.A. Pierson). Unfortunately this is because it was incorrectly reported in a sensationalist news article that summarised it as “Women can ovulate two or three times a month”. Read an interview with the lead researcher Roger Pierson here (“A cautionary tale about research that touches a nerve” published by University of Saskatchewan’s own On Campus News) who says that “That story claimed women ovulate two or three times a month and that’s simply not true“. In fact, if you read the original research article you will find that it supports the existing knowledge that women only experience one ovulation event per menstrual cycle. The researchers did however discover that leading up to a single ovulation event, a woman will have many waves of anovulatory follicular development. This culminates in one final ovulatory wave of development that produces one final ovulation event.
5Sperm lifespan within cervical mucus: There are many factors that will influence the period of time that sperm may remain alive within the female reproductive tract. These can include such factors as cervical mucus type at time of coitus, and morphology of the sperm itself (among many, many other factors).
Article on the timing of intercourse in relation to ovulation showing an average 6-day fertile period. (“Timing of sexual intercourse in relation to ovulation – Effects on the probability of conception, survival of the pregnancy, and sex of the baby” by A.J. Wilcox, C.R. Weinberg and D.D. Baird)
Article on sperm selection in natural conception which contains a comprehensive overview of current literature as a key research method, while comparing in vivo conception with assisted reproduction. Recently published in 2015. (“Sperm selection in natural conception: what can we learn from Mother Nature to improve assisted reproduction outcomes” by D. Sakkas, M. Ramalingam, N. Garrido and C.L.R. Barratt)
*Many people who practice STM also choose to check the position and openness of their cervix daily. Having 2-3 fertility signs to cross reference between, reduces the chance of error when interpreting the daily data you obtain from each indicator of fertility.
The above links to further information are live as at April 2018. Please note that I am not a medical professional and this blog is based on my own experience and understanding of STM and its application to my own life. Always do your own research, and speak with a registered medical professional if you have any reproductive health concerns.
Fitbit (the popular wearable technology company that allows users to track metrics such as activity, exercise, sleep, weight and more), has finally released their long awaited ‘Female Health Tracking’ feature this week. (And if you weren’t aware of this, well I don’t blame you for living under a rock – things are probably nice and peaceful under there).
However, the Interwebs have been abuzz with hype – from Coachmag, TechCrunch and VentureBeat, to Lifehacker, YourStory and Gizmodo. Basically, the new technology allows users to input data on the dates and details of their menstrual bleeding, along with basic cervical fluid observations. Fitbit then uses this information to predict the dates of your upcoming fertile window and your next period.
Wow. Sounds useful, huh?
To a point, yes. But I’ll argue that these sorts of predictions don’t really tell you a lot about your body with any certainty, and can actually cause more harm than good when users aren’t fully educated about the intricacies of the menstrual cycle.
In fact, this blog might have been more aptly titled ‘Why You Should Never Trust Period App Predictions Full Stop!’
Trust – is what you shouldn’t be doing with app predictions.
First things first. You can’t predict future cycles based on past cycles. Sure, you might see some pretty consistent patterns if you happen to be tracking aspects of your menstrual cycles such as:
calendar dates
colour, amount and consistency of menses (period blood)
basal body temperatures
cervical fluid observations
cervix height, openness and softness, and
lubricative vaginal sensations
However, there are many factors that can temporarily impact your menstrual cycle. These include diet, exercise, travel, stress, illness and more – and it’s not realistic to expect that Fitbit will be able to account for these temporary lifestyle factors when predicting your next fertile window or menstruation. For example, a stressful life event could cause you to ovulate far later than usual, or certain supplements and dietary changes could even cause you to ovulate much earlier than usual.
Travel – just one of the many situations that can cause a delayed ovulation.
Secondly, (and this point is slightly less relevant for users who will be inputting cervical fluid observations): Just because you’re inputting the start and end dates of each period, doesn’t mean an App can accurately predict your fertile window. Why exactly is this? Well, it boils down to the fact that most apps will assume you are ovulating approximately 14 days prior to the first day of your period. This 14 day timeframe is known as the luteal phase and is marked by a rise in Progesterone levels released by the Corpus Luteum after you have ovulated.
The problem with the assumption of a 14 day luteal phase is this: not everyone has a healthy luteal phase. You could have a textbook 28 day menstrual cycle, and an App would predict ovulation around Cycle Day 14. However, in reality you could be experiencing delayed ovulation followed by a short 7 day luteal phase. This would be easier to spot if you were tracking cervical fluid and basal body temperature, but for those users inputting dates only, Fitbit (or any app for that matter) is very unlikely to correctly predict your fertile window in this instance.
The above scenarios can all cause issues for people who rely on app predictions when trying to avoid an unplanned pregnancy or when trying to conceive a child. And the word ‘issues’ is really an understatement here when you consider the stress and stigma associated with an unplanned pregnancy, and the heartbreak associated with struggling to conceive a child.
Trying to understand your menstrual cycle based on app predictions is confusing business.
The good news is that using a method of Fertility Awareness completely eliminates the need for predictions of any sort. Why? Because every single day, you ask yourself the question ‘Am I fertile TODAY?’ Depending on the method of Fertility Awareness that you use, your answer will be based on a combination of cervical mucus observations, basal body temperature readings, hormone level tests and more. What your answer won’t be based on is app predictions generated from previous cycle dates.
So in short, Fitbit’s Female Health Tracking feature looks like it will offer you a nice way to record some basic observations about your menstrual cycle, but if you’re serious about trying to conceive (or avoiding a pregnancy), you won’t be wanting to implicitly trust their predictions. (Or the predictions of any other period tracker app).
Am I fertile – TODAY?
In fact, you’re better advised to invest your hard earned dollars in securing the services of a qualified Fertility Awareness Educator (find one here!) to teach you how to interpret your own biomarkers of fertility. You can then use this information to either avoid or achieve pregnancy (and that’s a whole other story altogether).
I’d love to hear whether you’ve taken a look at the new Fitbit Female Health Tracking feature – please share your thoughts below!
THE SEX-ED
YOU MISSED
Take the FREE Symptothermal Video Course to learn all about charting for
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