Quick Takes on 5 Common Fertility Awareness Methods To Help You Choose the Best FAM for You

So, you have made the decision to use a fertility awareness method (FAM). What now? Like many people, you are probably wondering, “Which fertility awareness method is best?” But the better question to ask is really “Which fertility awareness method is best for me?” 

Whether your goal is to achieve greater health awareness or utilize natural family planning (NFP), choosing the fertility awareness 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. Once you understand the unique advantages and challenges of each method, you can choose the one that feels tailored to you. 

What follows is not an exhaustive list of methods or training organizations, but a quick overview of some of the most commonly used (and most highly effective) methods: the Sympto-Thermal, Creighton, Billings, Marquette, and FEMM 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!  

SYMPTOTHERMAL METHOD

General information:

The Sympto–Thermal method is one of the more common methods and is used by both NFP users and FAM users. It 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 can help you confirm 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 if you’re, say, 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 CycleProGo, and other software specific to this method!) 

Can you use this method in the postpartum period and while breastfeeding?

Yes! As with most methods, the protocols during postpartum and breastfeeding are different from times of “normal” fertility, and while it’s always a good idea to rely on an instructor for help, it’s especially important to consult an instructor during this time.  

Generally speaking, a postpartum woman is  considered to be infertile after she has a certain number of dry days (that is, days without any mucus). Patches of mucus can be sporadic—with a few days of mucus here, and a few dry days there—and temperature taking can be tricky with lots of night-wakings to take care of baby. As a result, this method may call for a lot of abstinence while avoiding pregnancy during this phase, especially if establishing a Basic Infertile Pattern (BIP) of mucus is difficult or impossible to do. However, with accurate and consistent charting, you can see your  first postpartum ovulation and know when to expect your first postpartum period. 

My two cents:

I personally decided against this method the moment I learned I would need to take my temperature every morning. Considering my strengths and weaknesses, I knew anything that involved the morning wasn’t going to be the best fertility awareness method for me. 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 the Sympto–Thermal Method, I would grab a copy of Taking Charge of Your Fertility, and look for an instructor through the Couple to Couple League or SymptoPro, which are two major organizations which specialize in the teaching of this method.  

CREIGHTON 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, mucus, dry days, and fertile mucus so a pattern or abnormality is easy to spot at a glance. 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. When used accurately, this method boasts of similar pregnancy-avoidance effectiveness rates to the Pill. 

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. 

Can you use this method in the postpartum period and while breastfeeding?

Yes! As with the Sympto-Thermal method, postpartum use of the Creighton method should only be done under the supervision of an instructor. During the postpartum period, many things can affect the cervical mucus, and instructor expertise is key for making the method as easy and effective as possible during this potentially confusing phase. A very basic summary of the Creighton breastfeeding protocol is to avoid sex (if trying to avoid pregnancy) any time your cervical mucus is different than it was the previous few days. This is because a change in cervical mucus could signal a return of ovulation—and therefore fertility. 

My two cents:

Creighton was the method I chose when trying to space babies number 2 and 3. I picked it because the details were impressive, and I felt confident knowing that everything had an explanation. I was attracted to the science and the association with NaProTechnology in case any problems were to arise. Learning this method was more expensive than others, but we were able to meet with an instructor one-on-one via Skype. If this method is also attractive to you, I highly recommend paying for instruction in it—which is essential advice for any method! You can click here for more information about Creighton and to find an instructor.  

BILLINGS OVULATION METHOD

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 website for a more thorough overview of the method. 

Can you use this method in the postpartum period and while breastfeeding?

Yes! Noticing changes in the sensations created by the cervical mucus can tell you when ovulation is coming. Again, this is definitely a time to work with an instructor. The official Billings website states, “you may notice a change in your Basic Infertile Pattern before fertility finally returns. For example, you may be dry for some months, then experience an unchanging pattern of discharge in the following months, until eventually, patches of mucus signal that fertility is returning.” 

My two cents:

I don’t have any experience with this method, but I do know couples who very happily use Billings and would 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.  I think Billings  would be a great option for someone who is looking for a no fuss, less regimented FAM option. Check out their website for loads of information. 

MARQUETTE METHOD

General information:

The Marquette method utilizes the ClearBlue fertility monitor and urine test sticks to help determine days of low, high, and peak fertility by detecting surges in estrogen and luteinizing hormone. The monitor 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 designed to help achieve pregnancy, but 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.

Can you use this method in the postpartum period and while breastfeeding?

Yes! In fact, many couples believe that the Marquette method is the best fertility awareness method to use while avoiding pregnancy postpartum before the return of ovulation. Couples enjoy the efficacy and objectivity of the monitor’s “low” readings as ok-for-sex days, and “high” readings as abstinence days. It is important to be in contact with an instructor during this time (see a pattern here?) because there are special instructions for using the monitor during this phase. In fact, there are two different Marquette protocols for urine testing depending on whether or not your period has returned, so good instruction is key for method success.  

My 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. There are some drawbacks though. First, the monitor isn’t cheap (although many have good luck with finding them second-hand), and you’ll need  to buy additional test sticks every couple of months. Second—and this is a significant concern—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 to be extra safe when avoiding pregnancy (which also adds to the overall cost of using this method). Third, in a normal cycle, abstinence begins on a specific cycle day regardless of the monitor reading (because of the whole sperm-life thing mentioned above), 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 and peace of mind when trying to avoid pregnancy. 

I love the Marquette method, but I personally wouldn’t use it without also knowing how to categorize my cervical mucus, which provides a good deal of information about one’s health in addition to being a fertility biomarker. The Institute for Natural Family Planning at Marquette University has general information on the method, and how to sign up for classes.  

FEMM

General information: 

Another great resource for women starting out is FEMM. FEMM is a growing women’s health program, charting system and app. FEMM is a Sympto-Hormonal Method that uses cervical fluid as the primary biomarker, but also utilizes LH urine tests as an optional biomarker to confirm ovulation and therefore the peak and end of fertility. Charters can also include basal body temperature if they wish—but cervical fluid is the only required and necessary observation. This method is popular for its simplicity and user friendliness, but it still maintains a sound scientific foundation. FEMM has a charting app to match its teaching and has a robust medical background where medical practitioners all around the globe can help diagnose and treat hormonal disorders, infertility, and other cycle related issues. 

What it looks like in your daily routine: 

Like nearly all of the other methods, cervical fluid observations are required. That means every time you use the bathroom, you take notice of cervical fluid secretions. For those interested in using the LH strips, it is about a week of testing your urine with inexpensive OPkits, like these. And for those taking their morning 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 they do come with a higher price tag. Both temperature and LH testing are optional for FEMM users. 

Can you use this method in the postpartum period and while breastfeeding? 

FEMM has a breastfeeding protocol and specific class which you can find on their site. It is encouraged that you work with an instructor during this hormonally turbulent time. Since cervical fluid is the main biomarker of FEMM’s method, it translates really nicely to the breastfeeding period where cervical fluid is one of the only things to reliably track. Many breastfeeding women feel that the simplicity of FEMM and ease of using the app help make this hormonal chapter more straightforward. 

My two cents: 

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

Now that you know some of the basics on 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!  

When this article refers to fertility awareness methods (FAM), or natural family planning (NFP), we are referring to Fertility Awareness-Based Methods, evidence-based methods of cycle charting which can be used as effective forms of natural birth control when learned by a certified instructor. 

This article was originally published on February 17, 2018 as written by Kathleen Taylor. It has since been updated by Natural Womanhood to offer more resources. Last updated December 5, 2020.    

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