The Complete Guide to Fertility Awareness Methods

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Medically reviewed by Amy Fathman, DNP, FNP-BC

What are Fertility Awareness Methods?

A fertility awareness method (FAM) is a modern, evidence-based method of tracking one’s menstrual cycle, through observable biological signs unique to each woman, such as body temperature and cervical fluid (mucus discharge). FAM helps a woman know more about hormonal health and when she is naturally fertile and infertile.

For example, a woman can check for any cervical fluid or mucus discharge when she uses the restroom, take note of it, and determine if she’s in her fertile window or not.

By observing and charting biomarkers of fertility, you can be equipped to reach health goals with greater precision and meet family planning needs with high rates of effectiveness.

Fertility Awareness Methods and Natural Family Planning

Fertility awareness methods are commonly used as methods of natural family planning (NFP). They teach you when you are fertile and when you are not, at natural times in your cycle. By avoiding intercourse during periods of your cycle when you are fertile, you can use a FAM/NFP as a form of natural birth control, and at effectiveness rates that rival pharmaceutical birth control. For optimal effectiveness, NFP methods discourage the use of physical barriers and recommend abstinence from intercourse during the fertile time, while some methods of FAM allow it. You can also use these methods to achieve pregnancy if that’s your goal. By identifying when you’re in your fertile window and targeting these times to have intercourse, you increase your chance of getting pregnant sooner.

Which FAM/NFP is most effective?

For obvious reasons, women often want to use the “most effective method.” The most commonly used methods of FAM are as effective as the pill, with typical effectiveness rates ranging from 90% to 98%. But FAM/NFP efficacy often boils down to this: the method that works best for you — and that you use consistently. It is not one-size-fits-all. What’s great about FAMs is there are several different evidence-based options available for women to choose from.

No matter the FAM/NFP method you choose, optimal effectiveness will be the result of four key factors: good knowledge of the method, teacher support, motivation to avoid pregnancy, and the support of your partner.

Not sure which method is best for you? Take take our short Quiz on How to Choose Your Fertility Awareness Method! 

WATCH: OB/GYNs and women talking about the effectiveness of natural family planning methods (2 minutes). Click here to watch it in Youtube.

Can I use FAM/NFP if I have irregular cycles?

An irregular period is when a woman experiences one of the following conditions on a consistent basis: a) her period is shorter than 21 days or longer than 36 days, or B) varies by 5 or more days. It is actually a symptom of a larger, underlying issue. Some conditions that can cause irregular periods include prolonged stress, illness, over-exercise, extreme weight loss or gain, various thyroid dysfunctions, hormonal imbalances, endometriosis, and polycystic ovary syndrome (PCOS). You can still use FAM/NFP and learn to chart effectively to avoid pregnancy with these conditions. Most importantly, a physician trained in FAM/NFP can use your chart to diagnose and treat the underlying issue that causes the irregular cycles

What’s the best way to learn a method?

You can learn FAM/NFP from a book or an app. However, reputable FAM/NFP providers offer a network of trained instructors at your service. These instructors will help you feel confident with the following:

  1. Determining fertile and infertile days;
  2. That the steps involved in your charting routine are sustainable; and
  3. That your needs—whether health or family planning related—will be met.

Because of their experience in observing cycles and reading charts, they are also able to help you understand whether your charts shows optimal health or signs that you need further medical support.

WATCH: OB/GYNs explaining how you can benefit from charting your cycles (2 minutes). Click here to watch it in Youtube.

The Pros and Cons of FAM/NFP

After being trained on how to read your body’s natural signs of fertility with precision every day, you will enjoy the following benefits:

  • Say goodbye to side-effects associated with the use of pharmaceutical contraceptives
  • Feel more in tune with your body
  • Accurately predict when your period is coming as well as anticipate and manage cycle-related symptoms
  • Reduce fears of unplanned pregnancy by recognizing when you’re fertile or not
  • Share the responsibility of family planning with your partner (a great opportunity to connect and communicate more closely)
  • Find out now if you have infertility issues so you can work toward treating them
  • Be equipped for a lifetime of self-agency concerning your reproductive health

Here are some cost considerations in your decision:

  • Like any healthcare practice, there is a learning curve before it becomes a habit
  • The cost of learning varies from free to $500 depending on the method (some can be covered by insurance if done within a medical office)
  • You need to take a few minutes every day to pay attention to your body and chart the signs
  • You will need to abstain from sex during a few days during the cycle if you are looking to avoid pregnancy.  

Bottom line: while it takes some investment on your part, like anything worthwhile, the benefits in terms of health, knowledge and relationship satisfaction are a game changer for women who use these methods.

The benefits of FAMs for women’s health

One of the greatest advantages of using a fertility awareness method is how they can help identify hormonal imbalances and teach you more about your body than you ever could learn while on hormonal contraception. A physician well versed in fertility awareness methods can diagnose and treat most hormonal or reproductive health disorders that are the cause of irregular or painful cycles, pre-menstrual syndrome, infertility, recurring miscarriages and more.

Which FAM should I choose?

Whether your goal is to achieve greater health awareness or natural family planning (NFP), choosing the method that’s right for you can feel overwhelming. But it doesn’t have to be!

Here we’ve provided a brief breakdown of five of the most common evidence-based FAMs or NFP methods to help you make your decision. 

What follows is not an exhaustive list of methods or training organizations, but a quick overview of some of the most commonly used methods of fertility awareness: the FEMM, Sympto-Thermal, Creighton, Billings, and Marquette methods.

We’ve also provided some insight into how using each method might affect your daily routine, so that you can decide which fertility awareness method is best for you. Let’s get to it! 

(or take our Quiz on How to Choose Your Fertility Awareness Method! first)


General information: 

A great resource for women starting out with fertility awareness is FEMM. FEMM is a fast-growing women’s health program, charting system, and mobile app. FEMM is a method that uses cervical fluid as the primary biomarker, but also urine tests as an optional biomarker to confirm ovulation and therefore the end of fertility each month. FEMM users can also include basal body temperature readings in their charts if they wish—but cervical fluid is the only required and necessary observation.

FEMM is popular for its simplicity and user-friendliness, but it still maintains a sound scientific foundation. The FEMM charting app also matches its teaching and has a robust medical foundation. FEMM-trained medical practitioners can help diagnose and treat hormonal disorders, infertility, and other cycle related issues. 

What it looks like in your daily routine: 

Cervical fluid observations are required for using FEMM. That means every time you use the bathroom, you take notice of cervical fluid secretions. For those interested in using hormonal test strips, it is about a week of testing your urine with inexpensive ovulation predictor kits (“OPkits”) like these. And for those taking their morning basal body temperature, they can use a simple Basal Body Thermometer like this one, or they can invest in a more modern one like this or this and utilize Bluetooth technology. The Bluetooth thermometer can simplify the charting routine, but it does come with a higher price tag. Remember that both temperature and hormonal testing are optional for FEMM users. 

Our two cents: 

FEMM is a modern and easy to learn (and use) method that has a medical component should you need it. Many women like the flexibility of using their preferred biomarkers, and the fact that there is an app to use for charting. If you are interested in learning more about FEMM or finding an instructor, download their app here and visit the FEMM site here


General information:

The Sympto Thermal Method (STM) is one of the more common methods of fertility awareness, and is most often taught (in the United States) by an organization called the Couple to Couple League. STM tracks three different signs, which makes it popular because you don’t have to rely on one single observation. Users of this method monitor for changes in cervical mucus (sensation, consistency, stretchiness), basal body temperature, and optionally, cervical position and firmness (low/high, open/closed, soft/firm). Changes in the cervix and cervical mucus can tell you when you are fertile and when you are likely ovulating. Observing your basal body temperature confirms that ovulation has happened once you see a spike in temperature. 

What it looks like in your daily routine:

Sympto Thermal Method users are encouraged to check their cervical mucus every time they use the bathroom, so they don’t overlook any changes. This means wiping and looking at the toilet paper before and after using the bathroom each time. It can be helpful to test the mucus sample between your fingers to note the specific observations mentioned above, but whether you choose to finger test is up to you. Checking the actual cervix is also optional, and it is typically done at night. For some, checking their own cervix is a very reliable observation, but for others it just creates confusion. Again, it is completely up to the user. 

Taking your basal body temperature, however, needs to be consistent and done first thing every morning (or whenever it is that you wake from your longest sleep, say you’re a nurse on the night shift). Many users set an alarm to make sure their readings are consistent, but there is some leeway; if you’re taking your temperature within an hour of the same time every day, that is consistent enough. Whatever combination of signs you choose, all of these observations must be recorded on a chart or in an app, each day. (There are applications, such as the Couple to Couple League’s CycleProGo, and other software specific to this method) 

Our two cents:

The pros of the Sympto Thermal Method are that it incorporates the main components of every other method (making it one of the most effective FAMs), and information about it is readily available. This method also has some flexibility, given the range of fertility biomarkers it teaches you how to observe. If you are interested in STM, look for an in-person or online class through the Couple to Couple League or SymptoPro, the two major organizations which specialize in the teaching of this method.  


General information:

The Creighton method tracks cervical mucus, making observations that are similar to those made in the Sympto–Thermal method. However,  since cervical mucus  is the only biomarker tracked by Creighton, it is extremely important to be consistent and detailed in your mucus observations with this method. The Creighton recording system has over 18 codes to classify all types of normal and abnormal cervical mucus for accuracy in determining real-time fertility. Additionally, the Creighton chart comes with different colored stickers for marking days of menstruation, dry days, mucus, and fertile mucus, so a pattern or abnormality is easy to spot immediately. A further benefit of the Creighton method is that an accurate and detailed Creighton chart can be used by a Natural Procreative Technology (NaPro) doctor to diagnose important health issues, including infertility and hormonal imbalances.

What it looks like in your daily routine:

Because consistency and detail are key, Creighton users need to make mucus observations before and after each bathroom break, or anytime there is chance you might miss detection of cervical mucus, like around showers and workouts. Observations are done by noticing the sensation on the perineum when wiping, and then testing the sample between the fingers to get an accurate sense of color and consistency. Finger testing is crucial with Creighton, because the color and consistency of cervical mucus is often different during a finger test from how it appears on the toilet paper. Once the Creighton mucus-checking routine is established, observations become second nature, and it only adds about 10 seconds to your bathroom routine. Creighton protocols for timing intercourse (based on the couple’s family planning goals) range from any time of the day, to only at the end of the day on certain days, depending on phase of the cycle and the couple’s experience with the method. 

Our two cents:

Creighton is an attractive option for those who want an established, highly effective method of fertility awareness. Its association with NaProTechnology is attractive to anyone struggling with and seeking treatment for infertility or any menstrual irregularities. Learning this method can be more expensive than others because of the one-on-one nature of instruction, but many also see this kind of individualized approach as a benefit (and most instructors will teach virtually). Click here for more information about Creighton and to find an instructor.  


General information:

The Billings method is another cervical mucus-only method, although unlike Creighton, it doesn’t require any touching or finger testing of the mucus. Instead, Billings puts strong emphasis on the sensation of mucus at the vulva and requires users to mentally or physically note the sensations during the regular activities of the day. Users create their own personalized classifications to identify their own unique pattern of fertility signs in a way that makes sense to them. 

What it looks like in your daily routine:

Billings users pay attention to the sensation of mucus at the vulva as they go about their day, specifically noting feelings such as dryness, wetness, and slipperiness (although sensations are not simply limited to these three). Visual observations, like thickness and clearness, are also noticed, but this can be done during the users’ regular bathroom and hygiene routines and are secondary to sensation. In fact, Billings can be done without the visual observations, especially while learning the method, because the visual observations can sometimes be confusing. When trying to avoid pregnancy, it is recommended to only have intercourse in the evening on alternating days, after the daily sensations have been sufficiently observed and classified as indicative of an infertile period. Note that this requirement is only during the first half of the cycle (the follicular and ovulatory phases) and that during the second half of the cycle (the luteal phase, beginning on the fourth morning after Peak), intercourse is available every day, any time of day, until the woman’s next period begins. Check out the “4 simple rules” of Billings on their international website for a more thorough overview of the method. 

Our two cents:

Many couples very happily use Billings. We can recommend it to beginners because it is easy to learn—in fact, modified forms of the Billings method have been used to teach fertility awareness to people with low literacy in developing countries. Billings is a great option for someone who is looking for a no fuss, less regimented FAM option. Check out their US website for US teachers and loads of information. For teachers outside the US, go to their international website Billings LIFE.


General information:

Like FEMM, the Marquette method is a member of the Sympto Hormonal family of methods and a method with the strongest evidence of high effectiveness rates for avoiding pregnancy. Marquette uses a fertility monitor and urine test sticks (such as the ClearBlue monitor or the Premom hormonal test) to help determine days of low, high, and peak fertility by detecting surges in estrogen and luteinizing hormone. The monitor “learns” your individual cycle, and prompts you for urine tests on specific days based on its recordings of your previous cycles. Testing is done with a disposable test stick and the first morning urine. 

The ClearBlue monitor was originally designed to help achieve pregnancy, but researchers at Marquette University developed protocols to use it as a method of avoiding pregnancy as well. These protocols go beyond the instructions that come with the monitor, so it’s important to consult with a Marquette instructor if you’re looking to use the monitor for avoiding pregnancy. The monitor readings can be combined with other fertility biomarkers—like basal body temperature readings or cervical mucus observations—for increased accuracy. 

What it looks like in your daily routine:

Testing needs to be done in the morning within a pre-determined time window. The woman can urinate directly on the stick for 3 seconds, or dip the stick in a collected sample for 15 seconds. Testing is typically only required after menstruation has ended (although this depends on cycle length) through to the first peak reading. Readings will typically start with “low,” then change to “high,” and then to “peak.” Once you see peak you will know that ovulation is occurring or is likely to occur within 24 hours. If you are avoiding pregnancy, you continue to abstain on the first peak day and for an additional 4 days. Note: abstinence may begin while still getting “low” readings because sperm can live for 5 days, and the monitor can’t account for that, only the hormone shifts. This is why it’s important to follow the correct protocol to know when abstinence begins. A Marquette instructor will teach you the protocols in order to be able to use the method effectively.

Our two cents:

The Marquette method takes much of the guesswork out of classifying observations, and gives an objective idea of what your body is doing. It is simple and doesn’t require an action every day of the cycle. The monitor isn’t cheap and you’ll need to buy additional test sticks every couple of months. Second, it is possible for the monitor to miss the peak reading about 10 percent of the time. For this reason, many users also incorporate ovulation predictor test strips (OPkits) to be extra safe when avoiding pregnancy. Third, in a normal cycle, abstinence begins on a specific cycle day regardless of the monitor reading, which might create more days of abstinence than other methods. The general consensus seems to be that people are okay with an extra day or two of abstinence in exchange for confidence, peace of mind, and the objectivity of monitor readings when trying to avoid pregnancy. 

For more information check out the Marquette Method website.

WATCH: Couples sharing how natural birth control or NFP impacted their relationship (2 minutes). Click here to watch it in Youtube.

Take our Quiz to find your preferred method:

Now that you know some of the basics of each of these most common methods, do you have a sense of which fertility awareness method is best for you? If you’re still deciding, take our Quiz on How to Choose Your Fertility Awareness Method here!  

Additional Reading: 

Choose a Method 

What is a Fertility Awareness Method, and how do you start charting with FAMs? 

When You Really Shouldn’t Get Pregnant: 4 ways to Increase the Effectiveness of Your Fertility Awareness Method 

What’s the Best Postpartum Fertility Awareness-Based Method? 

CDC Changes Effectiveness Rating on Fertility Awareness Methods 

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