As a Symptothermal Method Instructor, I am often floating in many corners of the internet at once! I am privy to conversations from a large swathe of different demographics across platforms such as Facebook, Instagram and Twitter. I love hearing from such a wide range of Fertility Awareness-Based Method (FABM) users who often reach out to chat via my DMs.

Without fail, one of the most common laments I hear is “I wish I had known about this at a much younger age – I can’t believe I only learned how my body worked in my 20s/30s/40s”. Oftentimes, the natural next iteration of this thought process is “I can’t wait to teach my daughter/teen/menstruating child about this information because I want them to have the empowerment and body literacy that I missed out on at their age”.

My response is sometimes a little tempered, for many reasons. I’ve decided to dive into some of the nuances involved in teaching teenagers about FABMs in this article. I hope that the points I cover will give parents and guardians pause for thought, and provide a basic framework of considerations that may help to provide safer experiences for teens who begin charting with a FABM.

 

Teenagers and menstruation in Australia

Here in Australia, a lack of education for teenagers on the menstrual cycle continues to result in menstrual taboos that have far-reaching consequences for girls and young women.

According to research by Plan International Australia, many boys and young men associated menstruation with words such as “messy”, “embarrassing”, “dirty”, and even “impure”.

Earlier research also found that almost a third of girls aged 10-14 were missing school and therefore falling behind in education due to embarrassment of being on their period and a fear of being teased.

In 2019, Libra was the first Australian menstrual product company to ever show a realistic depiction of period blood in a televised advertisement (#bloodnormal) – this was met with considerable controversy at the time due to the taboo that surrounds this normal bodily function.

This taboo can further be seen in research that shows that almost 70% of Australian girls would rather fail a subject at school than have their peers know that they are menstruating.

This data is devastating. Ongoing taboos are robbing girls and menstruators of their confidence, their dignity, and their education. Not only this, these taboos muddy their ability to feel carefree and spontaneous in their existence – how can we feel carefree when are living in fear of bullying regarding a natural, normal bodily function?

The state of menstrual taboos in Australia should not only concern us, but it should break our hearts. Women, girls and menstruators deserve better than this.

So, what’s the answer?

Education would be a great place to start.

How so? The same research mentioned earlier by Plan International Australia showed that 70% of boys who described their school education on periods as “good” also said that they felt comfortable discussing periods, indicating that education is key to breaking down these taboos.

 

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Considerations of teenage FABM charting

Like most things in life, FABMs for teenagers is a complex, multifaceted topic with nuanced pros and cons that differ for each individual user.

That said, there are some considerations which spring immediately to mind, that I think parents and guardians should be aware of before considering a FABM for pregnancy prevention for their teen:

1.) Lack of evidence: Most FABM effectiveness rates are based on studies done of people in regular times of fertility. This means there is less evidence as to the safety and effectiveness of FABMs for pregnancy prevention during phases such as the teen years, postpartum, post-hormonal contraception and perimenopause. In my opinion, this is truly the largest drawback of recommending FABMs for teenagers – we simply don’t have enough evidence as to the safety of doing so.

2.) Irregular cycles: Puberty can be considered a continuum of time during which the brain-ovary connection establishes and then stabilises. This connection is known as the hypothalamic-pituitary-ovarian (HPO) axis. Most teenagers will find that it takes time for ovulation to begin occurring regularly – and until it does, irregular cycles are common. This can be due to a mix of inputs including breakthrough bleeds, oestrogen-withdrawal bleeds, delayed ovulations, and short luteal phases. In essence, it takes time for the menstrual cycle to stabilise after puberty, and practicing a FABM during this time can be more difficult than usual.

3.) The prefrontal cortex: FABMs require a high level of user-involvement. Unlike “set it and forget it” contraceptives, using a FABM requires accurate daily observation of fertility biomarkers, accurate daily charting of findings into a paper chart or app, and modification of our sexual behaviour to prevent pregnancy during the method-identified fertile window. A high level of user-involvement may be less compatible with teenagers due to their underdeveloped prefrontal cortex. The prefrontal cortex is involved in rationality and impulse control and does not fully mature until around the age of 25. This may place teenagers at a higher risk of unintended pregnancy when relying on a contraceptive method that requires a high level of user-involvement.

4.) No protection against STIs: Unlike condoms, FABMs do not offer any protection against sexually transmitted infections (STIs). While abstinence is preferable from an STI protection perspective, sexually active teenagers should be educated on how to use condoms, and that they should be used during every sexual encounter. If your teen is sexually active and relying on a FABM for pregnancy prevention, condoms should still be utilised even if they are in a less-fertile or infertile phase of their menstrual cycle.

5.) Higher stakes: While an unintended pregnancy can be devastating at any age, the stakes are arguably higher for teenagers. Unintended pregnancy can have far reaching adverse social and economic outcomes which may negatively impact the life trajectory of teenagers. In addition, adolescent pregnancies can pose more health risks for the mother and infant than an adult pregnancy would.

 

Benefits of FABMs for teenagers

While the above considerations should be taken very seriously, there are also numerous and significant benefits to learning about how our bodies work as teenagers! Fertility Awareness-Based Methods (FABMs) bring empowerment, body literacy and insight into our own inner workings. They can provide the map that allows us to easier navigate our changing emotions and mental/physical capabilities across the different phases of the menstrual cycle. This information can be life-changing, and teenagers should have access to begin their learning process here.

With all that said, here are my recommendations if you have a teenager who is interested in learning how to chart with a FABM, or if you have a teenager who you feel would benefit from increased cycle and body literacy:

1.) Focus on charting for body literacy: Instead of focusing on using a FABM for pregnancy prevention, use this knowledge instead as a springboard toward body literacy. Many teenagers are lacking the most fundamental basics when it comes to understanding their reproductive anatomy and how their menstrual cycle works – this is where FABM education really shines.With basic education on anatomy, the menstrual cycle, cervical mucus and basal body temperature, teenagers can:

• Demystify cervical mucus
• Confirm whether ovulation is occurring
• Accurately predict the onset of their periods

Demystifying cervical mucus alone is hugely valuable given so many teenagers worry that something is wrong with them when they first begin to experience cervical mucus during puberty. Predicting the next menstrual bleed by watching for a luteal-phase temperature drop or counting days of the luteal phase empowers teenagers to prepare in advance for a bleed and allays some of the anxiety that surrounds an unexpected bleed (although breakthrough/withdrawal bleeding can still be common during puberty).

2.) Shine the spotlight on their cyclical nature: Puberty can be a disconcerting time of great change for teenagers who may begin dealing with uncomfortable physical and mental symptoms as their bodies change. It can be empowering for teenagers to understand that their moods and emotions and physical capabilities can be impacted by their menstrual cycle. For example, by tracking diligently they may notice that they are more likely to experience cravings, fatigue and irritability or sadness in the lead-up to their period. This knowledge can act as a roadmap for teens to navigate their cyclical nature. It also provides reassurance that these experiences can be very normal, especially while their cycles are regulating and ovulation gradually becomes more robust with greater levels of progesterone produced.

3.) Chart to monitor reproductive health: Charting can be a great tool for teens to stay on top of health issues during puberty. If issues such as heavy bleeding, amenorrhea, vaginal infections, consistently delayed ovulations and/or irregular cycles are present, using a FABM can encourage us to seek medical diagnoses and assistance. It’s better to be informed than not, and FABMs are a great way to keep on top of our reproductive health.

4.) Allow the HPO axis time to mature: It takes some time for the HPO axis to mature during puberty. During this time, it’s normal for teens to experience irregular cycles. Author Sarah E. Hill states that we have a blind spot when it comes to how the Pill impacts our brains by switching off our sex hormones. Is it possible that we benefit our teenage brain development by allowing our HPO axis to mature instead of shutting it down completely with the Pill? A fascinating topic to dive into and I recommend reading Hill’s book ‘This is Your Brain on Birth Control’ if you’re curious about this subject.

Where to from here?

If you would like your teenager to learn a Fertility Awareness-Based Method (FABM), there are a few things I recommend:

1.) Start out slow: Focus entirely on charting for body literacy to begin with. Begin by simply tracking menstruation dates, and then slowly layer in things like cervical mucus and sensation charting, secondary fertility signs (such as acne and bloating), and finally adding in basal body temperatures. Focus on how to use these biomarkers to predict when their next period will arrive, and how to understand themselves better as cyclical beings. Pregnancy prevention should not even be a part of the story, at least at the beginning. As your teenager grows and matures, you may want to introduce the concept of using a FABM for pregnancy prevention, but at least initially, the focus should simply be on body literacy.

2.) Hire a qualified instructor: If you do feel like your teenager is interested in learning how to rely on a FABM for pregnancy prevention, hire a qualified instructor of a specific method. Now is not the time to cobble together a rough method based on your own knowledge. Now is not the time to piece together snippets from podcasts, books, and social media. Maybe you are already an accomplished and competent FABM charter yourself, but maybe you’re not  – and the only way to find out for sure is either an accidental pregnancy or taking a FABM course to double-check your knowledge – I know which one I prefer! Personally, I think SymptoPro has one of the most comprehensive Symptothermal educator-training programs and I would feel safer referring teens to a SymptoPro instructor over some other method instructors. You can find SymptoPro instructors here: https://symptopro.org/services/learn.html

3.) Start early: Invest in some relevant books for your teenager to read and learn from at a younger age. Two great options are:

• What’s Going on in My Body? By Elisabeth Raith-Paula, and
• Cycle Savvy by Toni Weschler

4.) Look into teen-specific FABM education: You may be comfortable taking a teen-specific FABM course with your child.

*Some of these courses may provide general body literacy education, and not necessarily actual charting instruction.

*Some of these courses are provided by Catholic organisations. This means they are likely to focus on abstinence and general body literacy (as opposed to using a FABM for pregnancy prevention).

TeenFEMM classes: FEMM is a secular organisation; however, they are funded by and have links to anti-abortion groups/individuals, which some charters may be uncomfortable with. You can read more here if this is a concern: https://www.theguardian.com/society/2019/jul/29/us-federal-grants-femm-app-natural-birth-control

Mother-Daughter courses run by Fertility Science Institute (FSI): FSI was launched by FABM organisation Couple to Couple League (CCL). There are three courses to choose from depending on the age of your teen. CCL and FSI are Catholic pro-life organisations and are morally opposed to abortion, hormonal birth control, barrier methods such as condoms, and artificial reproduction technology such as IVF/IUI.

Cycle Show course by the Guiding Star Project: Guiding Star Project are a Catholic pro-life organisation and are morally opposed to abortion, hormonal birth control, barrier methods such as condoms, and artificial reproduction technology such as IVF/IUI. The Cycle Show is based on the teachings of the book ‘What’s Going on in My Body?’ by Elisabeth Raith-Paula.

Period Ready Parent-Teen eCourse by Bright Girl Health: A secular offering by Bright Girl Health Australia. Perfect for teens/tweens approaching their first period or navigating the first few years of menstruation. Designed to equip parents to support teens with body positivity and period pride. Includes comprehensive eBook, activity worksheets and video modules.

Body Talk Basics “Conversations About Puberty for Moms and Daughters”: A secular offering by Megan of Body Talk Basics. A gentle overview and introduction to an empowered puberty. Includes 3 hours of video modules, a workbook and a physical handbook.

 

 

This article is brought to you by Jessie Brebner, a Symptothermal Method Instructor from the Gold Coast of Australia. Jessie is a passionate advocate for Fertility Awareness as a gateway to improved health, body literacy and reproductive empowerment. Jessie teaches the Symptothermal Method to people who are trying to conceive, and to people who are seeking a highly effective form of natural contraception.

Disclaimer: I am writing this article from the depths of postpartum sleep deprivation. Please also keep in mind that I am not qualified or trained to interpret contraceptive effectiveness estimate research papers so I encourage you to read the latest systematic review for yourself to form your own opinions about FABM charting in the postpartum 😊

 

Last month (in June 2022), a new systematic review was published titled ‘Effectiveness of fertility awareness-based methods for pregnancy prevention during the postpartum period’. You may remember a previous systematic review that was published back in 2018 titled ‘Effectiveness of Fertility Awareness–Based Methods for Pregnancy Prevention’ – well, four of the authors of that 2018 review were also involved in this most recent systematic review. Those four authors are Rachel Peragallo Urrutia, Margaret E Greene, Emily Kennedy and Joseph Stanford.

I was made aware of this latest systematic review after Dr. Chelsea B. Polis shared a link to it in the popular Facebook group ‘Fertility Awareness Method of Birth Control’. Dr. Polis was one of the authors of the original 2018 systematic review, and is also known for having fought for the publics’ right to accurate information about the effectiveness of the Daysy fertility monitoring device. You can read more about this story by visiting this Instagram highlight.

Being currently postpartum myself, I was interested to read the latest systematic review for an updated perspective on the use of FABMs during this unique reproductive life phase.

For those not familiar with the postpartum period, the return of fertility after birth can be highly variable among different people, and is significantly affected by breastfeeding. The first postpartum bleed may or may not be preceded by ovulation, and it is not possible to predict when ovulation will first occur. The body may attempt multiple times over many months to ovulate, and once ovulation does return, cycles may remain irregular for some time. Breastfeeding can also contribute to erratic temperatures and changed cervical mucus patterns. All of these factors combine to create conditions that render FABMs difficult to apply to the postpartum. You can read in more detail about the hormonal and physical landscape of postpartum in relation to FABMs in this article: https://fertilitycharting.com.au/2019/03/31/postpartum-fertility-i-just-had-a-baby-now-what/

 

A little about my postpartum experience:

I gave birth to Sol in December 2021, and originally planned to learn the Billings Ovulation Method (B.O.M.) while in “Cycle 0”. Cycle 0 is the time from birth up until your first ovulation and true menstruation. For FABM users who are fully breastfeeding, cycle 0 can span many months (even over a year!). While the Symptothermal Method really shines for those in relatively regular cycles during times of regular fertility; it tends to have basic mucus protocols that sometimes lack some of the necessary nuance for the postpartum cycle 0. For this reason, I hoped to learn a cervical mucus-only type of FABM, and had my sights set on the B.O.M.

What I hadn’t factored in was the absolute intensity of the newborn phase with a colicky baby, a partner working 6 days a week, international travel restrictions keeping me separated from my family support system, a hefty dose of Covid sickness, a one-woman small business to keep afloat, and ongoing pain due to breastfeeding-induced Reynaud’s phenomenon of the nipple. It’s safe to say that learning the B.O.M. rapidly dropped completely off my to-do list.

Not to mention sex dropped rapidly off my to-do list, too!

In addition to this, most Symptothermal Methods only have postpartum protocols designed to accommodate simple “basic infertile patterns” of either continuing dryness, or continuing scant white mucus. My breastfeeding basic infertile pattern did not match either of these. This meant that if I didn’t learn the B.O.M., then I couldn’t even fall back on using the Symptothermal Method during cycle 0.

With all that said, my approach to charting in cycle 0 was to utilise what is known as coitus dependent contraception – contraceptive methods that are employed at each sex act to reduce the risk of pregnancy. So, this means things like barrier methods in combination with withdrawal. There are ways to maximise the safety and effectiveness of coitus-dependent contraceptives (and I teach this to clients in the Natural Contraception online course). Given the fact that ovulation returned for me relatively quickly (just over 3 months after having given birth), I didn’t mind utilising coitus-dependent contraceptives during this time.

After ovulation returned, I have been utilising coitus-dependent contraceptives during both Phase 1 and Phase 2 of my menstrual cycle, with unprotected sex reserved for Phase 3 only. This is due both to my reproductive intentions, and also because my charting practise remains a little sparse and ad hoc while I lack time and energy. Haphazard charting can put you at risk of missing the transition from Phase 1 to Phase 2 of the menstrual cycle, and for this reason I am currently choosing to utilise Phase 3 only. If the terms ‘Phase 1’, ‘Phase 2’ and ‘Phase 3’ are new to you – this is terminology which I teach clients in the Natural Contraception online course and is used to denote the infertile-fertile-infertile transition identified by the Symptothermal Method during regular ovulatory menstrual cycles.

Although I was personally too overwhelmed to learn a new FABM during the immediate postpartum, I was curious to delve into this systematic review. From my personal experience, I feel as though the postpartum time remains an underserved timespan of the reproductive life phases, and I was curious as to what the authors found on this subject.

 

Some key points from the systematic review:

So what did the systematic review find? Some key points are below. I also encourage you to read the systematic review for yourself, and you can find it here (although it is behind a paywall): https://www.sciencedirect.com/science/article/pii/S0010782422001573?dgcid=author

• There is a decided lack of evidence for the effectiveness of FABMs in the postpartum. The systematic review authors state that “The current evidence on the effectiveness of each fertility awareness-based method for postpartum persons is very limited.” Given the fact that in Australia, over 84% of women aged 45-49 have already given birth1, it is a shame that we lack evidence on the use of FABMs during this very common reproductive life stage.
• The systematic review authors searched huge databases of thousands of studies against a very strict inclusion criteria to ensure that they would only be assessing studies that accurately appraised the effectiveness of FABMs in the postpartum. Because of the strictness of this inclusion criteria, they were only able to assess four studies.
• Of these four studies, three were deemed of low quality and one was deemed of moderate quality.
• The Symptothermal Method (which I use and teach) was not included in the systematic review as no studies met the inclusion criteria. The 2007 Sensiplan study which is most often quoted by users of Symptothermal Methods could not be included because it did not meet all of the study inclusion criteria: “at least 50 subjects who enrolled prior to experiencing 3 cycles after childbirth and were using a specific fertility awareness-based method to avoid pregnancy; unintended pregnancy rate or probability calculated; postpartum amenorrheic and postpartum cycling individuals analyzed separately; and prospectively measured pregnancy intentions and outcomes”.
• The studies that were included showed a range of effectiveness rates that may or may not be acceptable to different individuals, depending on their reproductive intentions (how seriously they are needing to prevent a pregnancy).

Marquette Method, Bouchard 2012, United States, low quality study:
o Typical use effectiveness per cycle during the first 6 cycles postpartum:
 88%
o Perfect use effectiveness per cycle during the first 6 cycles postpartum:
 98%
(additional effectiveness estimates for different time frames are available in the systematic review)

Billings Ovulation Method, Labbok 1991, Kenya, low quality study:
o Typical use effectiveness during the first 12 months postpartum:
 81.5%
o Perfect use effectiveness during the first 12 months postpartum:
 85.9%
(additional effectiveness estimates for different time frames are available in the systematic review)

Billings Ovulation Method, Perez 1988, Chile, low quality study:
o Typical use effectiveness during the first 12 months postpartum:
 88.9%
o Perfect use not provided
(additional effectiveness estimates for different time frames are available in the systematic review)

Bridge to Standard Days Method, Sinai 2012, Peru, Guatemala, moderate quality study:
o Typical use effectiveness during the 6 months after the first postpartum bleed:
 88.2%
o Perfect use effectiveness during the 6 months after the first postpartum bleed (including use of condoms):
 96.3%

 

• The authors emphasise that the above individual FABM effectiveness rates cannot be directly compared to one another. This is because the studies themselves were all quite different, of relatively low quality, and the effectiveness estimates are for different postpartum timeframes.
• Individual study results may not be generalizable to higher-income countries as they were predominantly carried out in lower-income countries (such as Kenya, Guatemala, Chile and Peru).
• There is always some uncertainty as to the true effectiveness of FABMs in the postpartum because breastfeeding itself tends to reduce fertility due to the suppressant action of prolactin on the HPO axis.

 

My thoughts after reading this systematic review:

While I would love to see more high-quality studies into the effectiveness of FABMs for the postpartum, I suspect that one of the main contributing factors to the dearth of research to begin with may be funding issues. Research studies are often funded by companies who stand to benefit from data about specific products/services that they own or provide – this is important because studies are expensive, and companies hope to be able to recoup some of the costs involved in investigating the effectiveness of their products. Not many companies stand to benefit from more studies into FABMs, except for small-scale FABM instructors and FABM training organisations, who usually cannot afford to fund studies to begin with. This is especially apparent when compared to the pharmaceutical companies behind other contraceptive methods such as IUDs, insertables and hormonal pills.

This particular systematic review appears to have been funded in part by KNDR Healthcare. KNDR Healthcare is the company behind the Reply OBGYN reproductive health clinic in the United States. Reply OBGYN also provide FABM training in a range of methods including Marquette Method, the Billings Ovulation Method, Sensiplan (a well-known Symptothermal Method), and Listen Fertility which is their own in-house FABM method relying primarily on mucus observations, with optional temperature and OPK monitoring. It’s great to see this healthcare company investing back into FABM research. I would love to see more reproductive healthcare providers here in Australia also offering in-house FABM instruction as this might also increase the likelihood of funding for further studies on the effectiveness of FABMs.

At the end of the day, opting to rely on a FABM for pregnancy prevention during the postpartum is a decision that only you can make. This decision should take into account a range of factors such as your reproductive intentions (how seriously you are needing to prevent a pregnancy), whether you have the time and financial resources (some methods such as the Marquette Method are more expensive than others), whether you are comfortable relying on cervical mucus observations alone, whether you are in a safe relationship with a partner who shares your reproductive intentions, and whether you are comfortable relying on a FABM during the postpartum given the lack of quality evidence of effectiveness rates.

Perhaps one of my biggest takeaways is that the postpartum is simply a notoriously difficult time to chart our fertility biomarkers for pregnancy prevention – and we can see this reflected in these relatively low typical-use effectiveness estimates. I hope that in future we have more innovation in this area so that postpartum individuals have safe and effective biomarker-based contraception available to them without such big question marks over effectiveness estimates.

This systematic review definitely gives me some pause as to whether it is advisable to rely solely on a FABM for pregnancy prevention during the postpartum for those who are low on the reproductive intentions scale (i.e. they have a serious need to prevent pregnancy). Personally, I think that if I were to be postpartum again in future, I would most likely combine coitus-dependent contraceptives with the Marquette Method. I would also layer this with the added cross-check of basal body temperatures using the Tempdrop smart thermometer to circumnavigate the difficulties of getting an accurate BBT due to nighttime parenting. You can read more about the Tempdrop here. And yes – I would definitely seek out Marquette Method instruction *before* birth (because time is decidedly short for learning new things during the immediate postpartum – I have learned my lesson here! 😅).

Do you have any thoughts on this systematic review? I would love to hear them – let me know in the comments below how you feel about this new information.

This article is brought to you by Jessie Brebner, a Symptothermal Method Instructor from the Gold Coast of Australia. Jessie is a passionate advocate for Fertility Awareness as a gateway to improved health, body literacy and reproductive empowerment. Jessie teaches the Symptothermal Method to people who are trying to conceive, and to people who are seeking a highly effective form of natural contraception.

 

1. Australian Bureau of Statistics, (1981–2016), Census of Population and Housing

When I first tell people that I teach clients how to chart their menstrual cycles to conceive, the initial reaction is often “Is that really necessary? Don’t people just have sex and fall pregnant and it’s as easy as that?”

Unfortunately, this is a symptom of a health education system which drums into us from a young age that sex inherently always leads to pregnancy and that we are walking, talking fertility factories!

via GIFER

Unfortunately, many couples soon discover that the reality is quite the opposite. Each menstrual cycle, we only have a 6-9 day window of fertility during which pregnancy could result from unprotected sex. This takes into account the lifespan of both our partners sperm and the egg that we release at ovulation. When we break this down even further, the egg itself only lives for a maximum of 24 hours. This means there is a single 24hr window during which sperm need to be ready and waiting in our fallopian tubes to meet the egg released at ovulation!

On top of this, the average chance of conception in any given menstrual cycle is only 25-30 percent (and these figures drop quite dramatically after the age of 35).

So, how does charting our cycles help us in the context of these statistics? At the most fundamental level, charting our cycles allows us to know in real time whether we are fertile or not on any given day. Using a Fertility Awareness-Based Method (FABM) allows us to identify the opening and closing of the fertile window each menstrual cycle, and this information can be used to help us optimise the timing of any unprotected sex.

It’s important to note that FABMs do not allow us to pinpoint the opening and closing of our biological 6-9 day fertile window (as we cannot predict in advance when ovulation will occur). Instead, FABMs allow us to pinpoint this window with a buffer of at least several days on either side. In fact, Symptothermal Method users with an average 28-day cycle would likely see a chart with an average 11-day fertile window (somewhere within which lies the biological 6-9 day fertile window).

As shown in a study released in 2007 of 900 German women, the Symptothermal Double-Check Method was shown to be able to pinpoint the opening and closing of the fertile window in this way with up to 99.6% accuracy!

So, apart from allowing us to optimise the timing of unprotected sex, how else can using the Symptothermal Method be beneficial when we are trying to conceive?

 

Anovulatory “Cycles”
Did you know that it is possible to have a “period” even if your body failed to ovulate? These are known as anovulatory “cycles”. We put “cycles” in quotation marks because without ovulation, a full menstrual cycle has not occurred, and any bleed experienced is simply a breakthrough bleed or withdrawal bleed occurring during your follicular phase (and this follicular phase could extend weeks, months or even years before ovulation actually occurs).

In fact, a bleed is only a true period if ovulation occurred 10-16 days prior. So, without ovulation, any bleeding is not considered a true period.

The takeaway from the above is that the presence of a bleed (whether regular or not) does not prove or guarantee that ovulation is occurring.

Charting with the Symptothermal Method allows you to find out whether ovulation is occurring – and if not? It is time to dig deep to discover the root cause, because without ovulation it is not possible to conceive naturally.

 

PCOS or Long & Irregular Cycles
When you are experiencing irregular or long cycles, the old adage of “every woman ovulates on day 14” will be of even less use to you when you are trying for a pregnancy.

Thankfully, using the Symptothermal Method will allow you to obtain critical visibility on what exactly your body is doing each day. Because the Symptothermal Method relies on real-time observations of your fertility, you don’t need to have regular cycles to be able to use the Symptothermal Method to pinpoint when ovulation may be approaching.

In fact, one of my recent clients came off the Depo Provera shot and did not ovulate for around nine months. During this time, we were able to keep track of her cervical mucus and basal body temperature to know in real-time what her body was doing. The result? She was able to catch her first post-Depo ovulation on her chart – and fell pregnant!

 

Estimated Due Dates
Once you see those two lines on your home pregnancy test, your first thought may be something along the lines of “so when will baby be due?”. Your chart will be able to provide some helpful information here.

As always, a dating scan (ultrasound) in early pregnancy will provide the most accurate estimate of the gestational age of your baby (and therefore the estimated due date).

Despite this, some people prefer to decline this early dating scan. This leaves the doctor to calculate your due date using the first date of your last period. Unfortunately, these calculations are based on the idea that women all ovulate on cycle day 14.
If you ovulated much later than cycle day 14, then the estimated due date from your doctor will be much earlier than your true due date. This can result in unnecessary pressures of induction during the late stages of pregnancy, or unfounded concerns about your baby “measuring small for your dates.”

You can often avoid this by using your chart to calculate a more accurate estimated due date. Despite this, I like to remind clients that in reality only 5% of babies actually arrive on their due date.

 

Mental Health
It can be trying to face months on end of having sex every 2-3 days throughout your entire menstrual cycle (these are the official guidelines for couples who are not using the Symptothermal Method to track their fertility).

Using the Symptothermal Method means that you can avoid burnout and frustrations with a regimented sex life when trying to conceive. Once you have information each day about your fertility status (using cervical mucus and basal body temperature data), you can make the decision to have unprotected sex or take a break.

In the luteal phase, if you have been able to confirm ovulation using the specific rules of the Symptothermal Method, there are usually up to 14 days where pregnancy is not possible. When the egg you released is dead and gone, both you and your partner can take a break!

 

Progesterone Levels
Progesterone is our “pro-gestational” or “pro-pregnancy” hormone. Our ovaries only release progesterone in the two weeks after ovulation has occurred and adequate levels are critical for the lining of our uterus to be stable enough for the implantation of a fertilised egg.

If progesterone levels are too low, our uterine lining can begin to break down too early, not giving the fertilised egg enough time to implant. If the fertilised egg does manage to implant, low progesterone levels can also cause chemical pregnancy or early miscarriage.

It would make sense then that we would want to know in advance whether our progesterone levels are low to avoid the heartache of early pregnancy loss if possible. Unfortunately, the conventional approach often requires that you experience two or more recurrent miscarriages before your GP refers you for testing.

Charting your cycles can allow you to avoid this heartache by addressing low progesterone levels before they interfere with a pregnancy.

How exactly can charting do this? Most importantly, it allows us to see whether or not our luteal phase is of sufficient length (with ten days being the minimum here). We can also assess our temperatures, spotting patterns and cervical mucus patterns to deduce whether low progesterone may be an issue.

Our charts never act as diagnostic tools on their own; however, they can act as signposts toward issues that may warrant further medical testing. With the help of a trusted medical professional these issues can often be addressed with diet and lifestyle changes in addition to supplementation.

I highly recommend reaching out to your nearest Naturopath or Traditional Chinese Medicine provider as many of them are trained in interpreting fertility charts to address hormonal imbalance.

 

Cervical Mucus
Cervical mucus is vital for sperm survival, but you may be hard-pressed to hear this basic information from your GP. In fact, without adequate high-quality cervical mucus, sperm can die within minutes when exposed to the acidic conditions of the vagina.

When trying to conceive, cervical mucus is one of the most important pieces of the puzzle (one of the reasons I am very outspoken against the use of temperature-only apps and devices for those trying for a baby – and you can watch a video of my reasons here). If you have been charting for 3 or more cycles and are noticing that scant cervical mucus is a recurring issue, it’s potentially time to reach out for some assistance with balancing your hormones.

Because cervical mucus production is triggered by oestrogen, scant cervical mucus can occasionally signify low oestrogen levels. Low oestrogen levels can result from a large array of causes – many of which are usually addressable with the help of a functional medicine practitioner. There are also other causes of scant cervical mucus other than low oestrogen, and a trained Naturopath or TCM doctor will likely be able to work with you to investigate further.

 

Endometrial Thickness
The heaviness and length of our menstrual bleed can occasionally reflect basic information on the thickness of our uterine lining.

The thickness of the lining of our uterus plays a role in whether the implantation of a fertilised egg will be successful. If the lining is too thin, it can sometimes indicate (similarly to scant cervical mucus) low oestrogen levels.

On the other end of the spectrum, heavy or prolonged bleeding can occasionally signify too much oestrogen (or too little progesterone in comparison with oestrogen) or the presence of fibroids which can occasionally interfere with pregnancy.

A qualified Naturopath or Traditional Chinese Medicine doctor (in conjunction with your trusted GP), should be able to read your charts, make note of any signposts toward potential issues, and then have those issues thoroughly investigated.

 

The Verdict?
As you can see, charting your cycles when trying to conceive is one of the most valuable tools you can employ on your journey toward a baby. In addition to all of the above, a trained Naturopath or Traditional Chinese Medicine doctor will be able to glean much more additional health information from your charts, including potential thyroid issues (which can be directly correlated to early pregnancy loss).

While charting your cycles is not a magic panacea (and the act of simply recording cervical mucus and basal body temperature each day definitely will not cure or fix any reproductive health issues that you have), it can be the first step to taking note of what your body is trying to tell you. Our charts are never diagnostic tools on their own; however, they can act as signposts toward issues that we may want to investigate further.

Like a canary in the coalmine, our menstrual cycles often give us the first clues of any health issues that we may be facing. This is because reproduction itself is not necessary to your survival, and the act of ovulating and shedding then growing the uterine lining is a very energy-intensive process. When your body is facing other health issues or chronic stress, your menstrual cycle is often the first thing that your body begins to shut down so that it can focus on conserving energy to put toward your healing.

In fact, it is for this reason that the American College of Obstetricians and Gynaecologists (ACOG) released a committee opinion in 2017 designating that the menstrual cycle should be considered a fifth vital sign for girls and adolescents (the topic of shutting down teen menstrual cycles with synthetic contraception is a topic for another day!).

My key takeaway: If there is one thing that I recommend to any couple hoping to conceive, it is this: start to chart your cycles with the Symptothermal Method right away (preferably 3-6 months before trying to conceive). Oh, and reach out to your nearest qualified Naturopath or TCM Doctor to obtain a high-quality prenatal supplement (not one off the shelf of your nearest pharmacy – ask your Naturopath to tell you about the difference between folic acid and folate for an explanation).

Not sure where to begin? Check out the Chart To Conceive online course for a self-paced, 8-module learning program that has everything you need to dive right in. See you there!

This morning, I read an article titled ‘The Trump Administration Would Like To Talk To You For A Second About Your Cervical Mucus’. It outlined how Fertility Awareness-Based Methods (FABMs) were being taught by the U.S. Department of Health and Human Services at the expense of providing education and resources on hormonal contraceptives and long acting reversible contraceptives (LARCs). The writer was understandably angry about this, and as I read through the article I became angry too.

But my anger came from a different place. I’m angry about the ways that FABMs have been (and continue to be) appropriated by Church and State as a political and religious pawn to further specific agendas – and how this ultimately discourages onlookers from using FABMs in the first place. The association serves to alienate growing numbers of people who could potentially benefit from using a FABM, while simultaneously introducing suspicion around political bias.

To understand how this has come about, it’s helpful to establish that much of the original scientific research into FABMs came from Catholic OBGYN’s and scientists. This is because the Catholic religion teaches that the use of artificial contraception is a sin (and this was even more firmly established in 1968 with the release of Pope Paul VI’s ‘Humanae Vitae’). The researchers therefore had compelling personal reasons to vehemently pursue a natural method of birth control.

We have much to thank these early researchers for; however, the Catholic influence has continued to pervade mainstream perception of FABMs to this day, often to the detriment of credibility and availability. This persists despite FABMs being politically and religiously neutral. In fact, FABMs are available to all people with a uterus regardless of their race, gender, nationality, skin-colour, age, religious views, political views, occupation or relationship status. I would go so far as to say that FABMs provide a level of body-literacy which should be available to all from as early as high school biology classes. They are not the sole domain of the Catholic church.

Unfortunately, many supposedly secular organisations are in the insidious business of delivering the trojan horse of effective non-hormonal birth control (FABMs) to your door – before unexpectedly using their educational materials to further an anti-choice agenda.

Many supposedly secular organisations promote themselves as providing full and detailed facts and education about all different types of FABMs, but fail to provide honest information about the shortcomings of the science behind their resources. Other supposedly secular organisations are run by people who have in the past exposed a clear agenda to abolish all forms of hormonal contraception.

In fact, it would seem that many FABM education providers intentionally posit themselves as secular organisations as a way to claim neutrality and credibility; however, on closer inspection the upper echelons of their financial backers and directors are often a roll-call list of conservative religious and far-right political figures. It’s this intentional blurring of the lines between secular and non-secular which is most concerning.

My message to these organisations? Stop using FABMs as a trojan horse for the delivery of your religious beliefs on sex, contraception, abortion and marriage. If nothing else, providers with even an inkling of religious background must be ruthlessly transparent about their motives when it comes to teaching or promoting a FABM.

For FABMs to be taken seriously as a valid means of contraception, they must not be politicised. They must not be used as a vehicle for the non-consented delivery of religious beliefs and agendas.

For me personally, hormonal contraception was a wild ride of the worst variety, and I’m very glad that I am now using the Symptothermal Method instead (the Symptothermal Method is a type of FABM). However, I will fight tooth and nail for other people to have the right to choose to use hormonal birth control if that is what they prefer. FABMs should never be promoted by official sources at the expense of all other contraceptive methods.

To be clear, I am not anti-religion. There is much research to show that religion plays a pivotal role in the health and wellbeing of a great number of us. It provides people with hope, direction and community and its benefits should not be understated; however, I cannot stand back while my chosen contraceptive method is hijacked as a messenger of said beliefs.

 

This editorial is brought to you by Jessie Brebner, a Symptothermal Method instructor from the Gold Coast of Australia. Jess is passionate about providing education on the menstrual cycle and regularly blogs on the subject of Fertility Awareness-Based Methods and body literacy. You can find more from Jess on her Instagram @fertilitycharting

There are already enough barriers out there that stand in the way of learning about our menstrual cycles – and I don’t think the cost of Fertility Awareness-Based Method (FABM) instruction should be one of them! Unfortunately though, because FABM instruction is not covered by Medicare or private health insurance here in Australia, it remains a cost that must be paid out of pocket (and FABM instructors definitely need to be reimbursed for their time and expertise!). Here’s hoping that one day we’ll see subsidised FABM instruction – over in the United Kingdom, FABM instruction is covered in some instances under the NHS! I for one distinctly remember first learning about the Symptothermal Method and being desperate to work with an instructor … but I couldn’t afford one. However I didn’t let that stop me, and this article is a compilation of tips for cost-effective cycle charting on a budget!

While I want to encourage you that self-teaching is possible and can be cheap (or even FREE) – I also need to emphasise that effectiveness is higher when learning with an instructor. For instance, the most well-known study of the Symptothermal Method was based on users who were under the close supervision of qualified instructors of the Sensiplan protocol. This study showed that with perfect use, a 99.6% effectiveness was possible. Typical use rates were 98.2%. Subsequent criticisms of the study argue that the typical use figure may not be generalisable to the broader population due to the study design (a prospective clinical trial). In addition, these rates are based on users who were following a Symptothermal Double-Check Method – many popular self-learning books (discussed below) are Symptothermal Single-Check Methods which means they are likely to have a perfect use effectiveness closer to 98%.

However, the point of this is to say that we don’t have any effectiveness studies on the outcomes of self-teaching the Symptothermal Method. The effectiveness of self-teaching remains unknown and is highly likely to be lower than working with an instructor. Because of this, it’s important that you commit plenty of time to studying the method in depth if you need to self-teach. Plus, it’s crucial to avoid any unprotected sex for at least the first three cycles of charting while you are learning. Basically – if you’re strongly “TTA” (trying to avoid a pregnancy), then you need to take the learning process very seriously.

All that said, let’s dig in to my top 4 tips for charting on a budget!

TIP NUMBER 1

You’re going to need some sort of manual to learn from. By far, the most popular self-teaching resource is the book Taking Charge of Your Fertility (TCOYF) by Toni Weschler. While TCOYF isn’t a Symptothermal Double-Check Method, it is a fantastic resource absolutely packed with information about the reproductive system. In my opinion though, it can be a little overwhelming for new users – my go-to recommendation for self-teachers is usually to opt for the Sensiplan Handbook and Workbook instead. Sensiplan is a Symptothermal Double-Check Method and has a solid evidence-base for use.

For more details on the difference between Double-Check and Single-Check Methods click here.

TCOYF and Sensiplan aren’t your only options though. There are a number of other resources (whether online or in book-form) that are available to you. All of them are designed to be used with an instructor if possible, but you can still access them even if you haven’t signed up to work with an instructor. Keep in mind that some of these manuals do include religious content. Here are just a few of many:

Symptothermal Double-Check Methods:

• [Book] (not free) Celsius and Fahrenheit. Natural Contraception and Conception Course Handbook, by Jessie Brebner
• [Book] (not free) Celsius. Sensiplan Natural & Safe: The Handbook (must also purchase the Workbook), by Sensiplan
• [Book] (not free) Fahrenheit and Celsius. A Couple’s Guide To Fertility, by SymptoPro
• [Book] (not free) Fahrenheit. The Art of Natural Family Planning Student Guide, by Couple to Couple League
• [Book] (not free) Fahrenheit and Celsius. Natural Family Planning The Complete Approach, by Natural Family Planning International, Inc
• [FREE Online Manual] Celsius. NFPTA-UK Online Fertility Guides
• [FREE Online Manual] Celsius and Fahrenheit. Sympto Method Manual
• [FREE Online Manual] Fahrenheit and Celsius. Natural Family Planning The Complete Approach, by Natural Family Planning International, Inc

Sympothermal Single-Check Methods:

• [Book] (not free) Fahrenheit. Taking Charge of Your Fertility, by Toni Weschler
• [Book] (not free) Fahrenheit. Garden of Fertility, by Katie Singer
• [Book] (not free) Celsius. Justisse User Guide, by Justisse Foundation

Check out your local second-hand bookstore for a cheap copy of TCOYF, or head to your library to borrow it for free. For example, here on the Gold Coast of Australia I can see with a simple library catalogue search that there are three physical copies of TCOYF at different libraries within a 15km radius. In addition to this, you can even read TCOYF for FREE online by visiting archive.org (keep in mind that this is the old edition and some rules have slightly changed – but it’s still perfectly valid and very useful).

Tip Number 2

You are going to need somewhere to record your daily observations of cervical fluid and basal body temperature (and optional cervix tracking). Here, you have two options – you can either chart on paper or on a smartphone app. You’ll need to decide which is the best fit for your personal life.

If you would like to chart on an app, there are a few popular options:

FREE: Kindara app*

FREE: Lutea app

PAID: Read Your Body app

You can download and use Lutea or Kindara for FREE – that’s right, without paying a single cent. No monthly or yearly subscription costs or hidden fees. The free version of Kindara doesn’t have the option to track vaginal sensation (which is a really important part of all Symptothermal Methods); however, with the free version you get four “custom fields”. You can use three of these custom fields to set up your own version of vaginal sensation tracking.

Read Your Body app is the gold standard with full customisation options that make it suitable for all Fertility Awareness-Based Methods (FABMs). It requires a small yearly subscription which is definitely worth it if within your budget.

*Since the time of writing this article, Kindara has been bought by a new parent company. They no longer have a support team, and it’s unclear if/when Kindara app might be retired forever. This means that if you choose to use Kindara, it’s important that you back up your data regularly via their desktop portal.

If you’re wanting to paper chart – even this can be done on a budget!!

My website provides a range of beautiful FREE downloadable paper charts which you can access here.

You can also find a range of other downloadable printable paper charts at the below links. Remember, it’s best to use the chart that corresponds to the method you will be using:

• TCOYF Downloadable Printable Charts
• Sensiplan Downloadable Printable Chart
• NFPTA-UK Downloadable Printable Chart
• Sympto Downloadable Printable Chart
• SymptoPro Downloadable Printable Chart
• Natural Family Planning International, Inc Downloadable Printable Chart

If you don’t have a printer at home, most libraries have communal printers that you can use. Here on the Gold Coast, my local library allows me to print an A4 sheet in black and white for only 15c. Assuming you have around 13 menstrual cycles in a year that’s only a cost of $1.95 to paper chart each year.

Tip Number 3

You’re going to need a basal body temperature thermometer to successfully use the Symptothermal Method. In most pharmacies here in Australia, the cheapest option I have found is the SurgiPack 6335 Digital Ovulation Thermometer for $20. You can purchase it online for cheaper, but then you’ll also need to factor in shipping costs. If you’re wanting to purchase a thermometer off of Amazon, the cheapest option I have found is the Mabis Digital Basal Thermometer (although remember to factor in shipping costs). Many people use and love this thermometer.

Tip Number 4

Peer support! I cannot stress this enough. It is SO important to have the support of other people who are on the same learning journey. Peer support can connect you with people who are just starting out like you are. Plus, there are others who have been charting for years and have a lot more experience and wisdom to share with you (not to mention support when interpreting difficult charts). This is where social media platforms come in. My two absolute favourites when it comes to online communities are found on Facebook:

• Fertility Awareness Method of Birth Control, and
• FAM Support Group

Fertility Awareness Method of Birth Control is a large private Facebook group with over 20,000 members. They have a wide range of useful files, and plenty of very experienced members. While the group is in no way a substitute for qualified instruction, it is a great way to get plenty of peer support. You can even practise your newfound charting skills with weekly group practise posts.

FAM Support Group is a smaller Facebook group with around 600 members. For those who are looking for a bit more of an intimate vibe this group is a great option with plenty of highly experienced members (many of whom are instructors themselves).

These groups are not a substitute for learning with an instructor; however, they definitely provide an extra safety-net with a strong sense of community and a drive to promote perfect-use charting.

Conclusion: Charting doesn’t have to break the bank

If you use a free learning manual or book, with free online peer support, and use the free app Kindara – your only cost is a thermometer which you can grab for $20 at the nearest pharmacy.

If you’re ready to invest in working with an instructor (it’s an absolute game-changer if you are able to make it happen) simply head to the Find An Instructor page.

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. 

‘”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.

‘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.

‘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.

Secondly, as we discussed prior, the discussion around effectiveness rates is complex. However, the Sensiplan Symptothermal Double-Check Method has been proven up to 99.6% effective with perfect use. To say that this method is ‘statistically not great at preventing pregnancy’ is factually inaccurate and exhibits a clear and disturbing bias against natural forms of contraception.

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!

 

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.

You can read more about this latest 2022 systematic review here.

 

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 a Fertility 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:

1. Baby must be less than six months old, and
2. Mother must not experience any vaginal bleeding after the first 56 days postpartum, and
3. 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.

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

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.

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:

1. Cervical mucus can present differently due to breastfeeding
2. 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.

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.

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:

1. Breastfeed exclusively for the first six months of life
2. Pacify or comfort the baby at your breasts
3. No bottles or pacifiers
4. Sleep with your baby for night feedings
5. Sleep with your baby for a daily-nap feeding
6. Nurse frequently day and night and avoid schedules
7. 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!

In addition, almost all major health organisations (including Health Direct Australia and American Academy of Pediatrics) recommend against co-sleeping to reduce the risk of Sudden Infant Death Syndrome (SIDS). Interestingly, breastfeeding has been shown to reduce the risk of SIDS. The majority of SIDS cases also involve hazardous risk factors that are largely preventable. If you choose to co-sleep, the Australian Breastfeeding Association have a fact sheet of guidelines which you can access by clicking here. Unicef also have a guide for health professionals to discuss co-sleeping with their patients and you can read that guide here.

To read more about ecological breastfeeding you can click here for a pdf, or click here to purchase the book The Seven Standards of Ecological Breastfeeding: The Frequency Factor by Sheila Kippley.

 

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.

 

This article has been referenced from a number of sources including NFPTA-UK teaching materials, The Complete Guide to Fertility Awareness by Jane Knight, Taking Charge of Your Fertility by Toni Weschler, and The Seven Standards of Ecological Breastfeeding: The Frequency Factor by Sheila Kippley.

For further information, click here for a reading list of useful material on women’s reproductive health.

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.

[2] https://www.contraceptionjournal.org/article/S0010-7824(97)00040-1/fulltext

[3] https://aifs.gov.au/publications/timing-mothers-return-work-after-childbearing/results

[4] Australian Institute of Health and Welfare 2011, 2010 Australian National Infant Feeding Survey: Indicator Results. Canberra: AIHW. URL: http://www.aihw.gov.au/publication-detail/?id=10737420927

[5] https://www.census.gov/prod/2011pubs/p70-128.pdf

[6]https://apps.who.int/iris/bitstream/handle/10665/69855/WHO_RHR_07.1_eng.pdf;jsessionid=C5713FDEE2A70056E45196212478BB20?sequence=1

 

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).

In fact, Contraceptive Technology recently tweeted about this and you can read that tweet here: https://twitter.com/ContraceptTech/status/1102952910546259974

The overarching typical use effectiveness rate is estimated to be 85% for all FABMs as published in the most recent 2018 edition of Contraceptive Technology. You can read more about this in a blog post by Dr Chelsea Polis who is a leading epidemiologist with a special interest in the field of FABMs: http://chelseapolis.com/blog/understanding-effectiveness-estimates-for-fertility-awareness-based-methods-of-contraception

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.

Discover the eight key benefits to the simple act of charting your menstrual cycle.

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.

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!

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.

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.

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!

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!

 

Jess X