How do I know if my fertility awareness method will actually help me avoid pregnancy?

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When women first make the jump to using a Fertility Awareness Method (FAM) for family planning, one of the most common concerns is….will it work? After all, many hormonal contraceptive brands boast about their incredibly high efficacy rates of pregnancy prevention [1]. But a quick Google search of “Fertility awareness methods efficacy” breeds mixed results. There’s a good reason for that. Fertility Awareness Methods, by definition, put users in the driver’s seat. So while there’s more variability in efficacy, each individual gets to decide how important avoiding pregnancy is. And the good news? There are ways to maximize efficacy of FAMs to reach levels that rival their hormonal counterparts. These include proper education and support, utilizing a sustainable method, and informed risk management.

Working with a trained instructor

Working with an instructor trained in the FAM of your choice is the most important thing you can do to effectively avoid pregnancy. An instructor gives you standardized and customized education. Nothing beats having easy access to one individual expert who can give real-time feedback on your chart. Much of the work I do as an instructor involves supporting the learning curve, adding in (or sometimes taking out) biomarkers so that women can feel confident in what they are seeing, and of course being an emotional support beam for their fears, concerns, and questions.

An instructor also gives women who chart an objective view on their charts. I often tell people to chart what they actually see, not what they want to see. Learning to identify and describe subjective biomarkers like cervical fluid can be initially difficult so I help charters wade through differentiating the nuances.

It’s also incredibly important for you to like your instructor. If they make you feel uncomfortable or you simply don’t connect, you are unlikely to reach out with questions when you have them. It’s ok to try a few instructors. It’s ok to “meet and greet” an instructor before committing to classes with them. Working with an FAM instructor is not dating, but it is a special relationship that should feel comfortable and supportive.

Finding a method that works for and your lifestyle

Another big piece of what I do is tailoring biomarkers both short and long term. Sometimes a woman needs to use LH urine test strips (more on these here) while she’s riding the learning curve of a new method so she can cross check her cervical fluid observations with objective readings. Alternatively, another woman might use a thermometer to confirm ovulation with basal body temperature readings. Sometimes someone in transition, like postpartum, will use the Clearblue monitor, but once they are cycling regularly, they no longer need it. Customizing your method to what works for your life today is an excellent way to maximize efficacy. 

If a woman feels fairly confident in her cervical fluid but doesn’t want to use a thermometer every morning, or wants to forego the expenses associated with the Clearblue monitor, I work on ways to make charting just cervical fluid work for them. 

Simply put, the method that will work for you is the one you will use. Some people work better using an app. Some people prefer paper. Whatever you feel that you can commit to is what you should use. Femtech is making this easier and easier every year. There are a myriad of FAM tools like progesterone Proov strips, Bluetooth thermometers, and new hormonal monitors coming out. My hope is that these options continue to expand and price points drop as demand increases.

Contraceptives overpromise on eliminating pregnancy risk

Most people on hormonal contraception, especially long-active reversible contraceptives (LARCs) are unused to the idea of risk when it comes to family planning. After all, total risk avoidance is the lofty goal of using contraception in general, and LARCs in particular. In theory, the less user involvement there is, the closer both the perfect and typical user rate will be to each other, and to zero unplanned pregnancies.

To use an IUD perfectly, little is required of the user other than checking for the dangling strings periodically, though recent research suggests that IUD pregnancy prevention is not so foolproof as once thought. To use the pill perfectly, you have to take your pill on time every day. That requirement for same-time, every-day consumption of oral contraceptives largely accounts for the discrepancy between perfect use and typical use rates of pregnancy prevention. Women may forget to take their pill, refill their prescription, or bring their birth control with them on vacation, etc. 

Three components of FAM effectiveness

To avoid pregnancy using an evidence-based FAM, you need to do things. Charters need to 1) learn a method appropriately, 2) observe and chart their biomarkers daily, and then 3) actually act in keeping with their stated family planning goals. So if it’s a fertile day and avoiding pregnancy is important, couples need to actually follow through with avoiding the activities that, you know, lead to pregnancy. 

Every now then you may miss an observation, and that’s ok. We’re human. While consistency is vital, there are cushions built into most methods for when we aren’t perfect, and a trained instructor in your method of choice will help guide you in this area. Importantly, if you’re just getting started with charting a FAM (or learning a new FAM) and you haven’t yet ovulated in a particular cycle, you have to consider each day until ovulation as fertile. Once you learn your own body’s patterns of fertility and infertility, however, you’re likely to have some leeway in timing of intercourse even while avoiding pregnancy. 

FAMs are as effective as you want them to be

One of the beautiful things about Fertility Awareness Methods is that they are as effective as you want them to be, meaning that you get a chance to assess your comfort with risk each and every cycle. The most conservative way to use a method is to exclusively use what we call “phase 3,” or the postovulatory time, for intercourse. This is an extremely cautious use. For most people, such a conservative use is not necessary. But some couples can accept very little or no risk, and by waiting until after they have confirmed ovulation to have sex, they can nearly eliminate user or method error. Other couples confidently use pre-ovulatory days based on their familiarity with their biomarkers. And even still, some can use what I call “fringe” fertility days, accepting that a pregnancy is possible, but not as likely as when using peak days of fertility.

When I was in my early 20’s, I assumed that the desire to conceive was like a light switch—“on” or “off.” But as I’ve traversed through reproductive seasons, I’ve learned that pregnancy intention is often much more nuanced than that. Using a Fertility Awareness Method allows you to tune into your desire to avoid or achieve a pregnancy and necessitates really assessing how seriously you feel about it. Couples who have serious reasons to avoid pregnancy rarely take chances because that’s how seriously they need to avoid it. This sliding scale of desire to avoid pregnancy is also a reason why users of FAM have more children overall—many realize over the course of repeated monthly conversations that maybe they do want another baby.

Your method effectiveness primarily depends on you

At the end of the day, evidence-based Fertility Awareness methods are as effective as their users want them to be. If you learn a method, work with an instructor that you gel with and enjoy learning from, make sure to chart every day, and follow through in alignment with your family planning goals, your FAM of choice can certainly work for you. 

References:

Urrutia, Peregallo et al. “Effectiveness of fertility awareness-based methods for pregnancy prevention.” Obstetrics &Gynecology, vol. 132, no. 3 (2018): pp. 591-604. doi: 10.1097/AOG.0000000000002784

Additional Reading: 

Journal article describes how effectiveness of FAMs is often misrepresented

Yes, you can chart with a fertility awareness method while breastfeeding!

FAM Basics: What can charting your menstrual cycle tell you about your hormonal health?

4 strategies to use when sticking with your health goals gets tough

Is FAM really natural birth control? 

Unpacking the effectiveness range of FAMs given by the CDC

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