No Condoms, No Hormones, No Babies: A Guide to Natural Family Planning

Alexi Surtees, Ovary | February 23, 2017

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Every morning before I eat, drink, shower or even pee, I take my temperature and record it in an app. That’s because after tracking my period for over three years, I’ve started practicing FAM (Fertility Awareness Method), also known as natural family planning.

FAM is a way to track fertility that’s commonly used by women trying to get pregnant. It works the other way, too, though. More and more women are using subtle fertility cues to make informed decisions about when to have sex and what sort of protection to use. FAM’s a cost-effective form of contraception with no side effects, though I should note here that for it to be reliable, you must commit to actively tracking your fertility every day. It also requires an awareness and ability to read your own body. It’s certainly not for every woman (more on that below).

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How It Works

FAM isn’t as easy as simply tracking your periods. To determine when you’re ovulating (either the danger zone or go time, depending on your baby or no baby goals — you’re only fertile around six days per month), there are a number of physical cues to monitor.

The basal body temperature method is perhaps the easiest to use, and requires taking one’s temperature at the same time every morning before getting out of bed (a woman’s body temperature increases approximately 0.3 at ovulation).

The cervical mucus method requires checking your underwear and/or inserting two fingers in your vagina to notice cervical fluid, which increases in quality and wetness and resembles egg whites just before ovulation.

Or, you can observe changes in the cervix (the lowest part of the uterus) which feels different to the touch throughout the menstrual cycle. If you’ve never felt your cervix, read Clue’s guide. Around ovulation the cervix is soft (like your earlobe), other times it’s firmer (like the tip of your nose).

Since body temperature can be impacted by many factors — such as stress, sleep or alcohol — it’s typical for women to use a combination of the above methods to ensure reliability. As more attention is directed to improving non-hormonal birth control options, additional metrics may emerge. Recently, Clue piloted a study with Fitbit showing that resting heart rate changes during the menstrual cycle.

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Who’s Using FAM?

Women use FAM for all sorts of reasons; many find it attractive as an alternative to synthetic hormones. A study conducted by the CDC found 63% of 12,000 participants switched from the pill, an IUD or NuvaRing due to hormone-induced side effects such as depression, digestive issues, vaginal dryness, painful sex or lethargy. Others attribute the choice to their upbringing: natural beauty expert and FAM advocate Jessa Blades wasn’t given the option to go on the pill when she was younger due to her mother’s negative experiences with it.

If this is the first time you’re hearing about FAM, blame a lack of standardization and startling misinformation among educators, which increases the risk of misunderstanding and human error. Up until the 1980s, information about fertility awareness was only made available through Catholic sources. However, when used correctly, FAM is considered to be 95 to 99% effective, according to Bedsider and Planned Parenthood. London-based GP, Dr. Tamara Karni Cohen says, “If practiced accurately, FAM can be a hormone-free and effective method of birth control for certain women, typically in committed relationships. It’s important to note that it does not protect against STDs and STIs. Additionally, if you don’t have a 26 to 32 day cycle, it’s harder to know when your fertile days occur, increasing the risk of FAM not working. It requires extra awareness and training for women approaching menopause, have recently had a baby or use any medication that affects signs of fertility.” It also requires use of a barrier method or abstinence during fertile days. Effectiveness drops to 76 to 88% for couples that do not use the method correctly or consistently. Blades, who runs FAM workshops, adds, “It’s certainly not for every woman. There is no one-size-fits-all solution to contraception.”

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Listening to Your Body

FAM requires starting a conversation with your own body, a topic still mired in cultural taboos, especially around menstruation and women experiencing sexual pleasure.

Ashley Spivak, a reproductive health advocate and the cofounder of CYCLES + SEX, knows this well. FAM is a way to “pay attention to my body.” Blades views cycle tracking “as a monthly report card for your health.”

FAM is hormone-free and affordable, but presents a learning curve. For Spivak, it took almost six months to get a good grasp of it. “We are not taught body literacy and so at first there are questions about when to measure, what to measure, how to measure and then interpreting what that all means. I now trust it because I have so much data about my body.”

Women are seeking the help of apps like Natural Cycles, Clue, Kindara and Daysy, meant to correctly predict a woman’s fertile days. Getting it 100% accurate can be difficult given that every woman’s body and cycle is different. Using a fertility app, a woman is able to calculate her fertile window. Using apps in conjunction with FAM can be very effective. However, as cycles vary in length and are impacted by a variety of variables, these algorithms have limits and are not a replacement to actually reading your own body. Cycle Technologies reported that two out of three women between the ages of 18 to 39 surveyed in the U.S. say they would use a fertility app to prevent pregnancy if they were confident it would work.

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It’s Not For Everyone

For some, FAM can be a great option. For others, like those with irregular periods or who don’t yet feel comfortable reading their own bodies, it’s not ideal. FAM requires an active daily commitment. “It’s an ongoing conversation and relationship with yourself,” says Spivak.

It also opens the door for more open and honest conversations with your significant other; many women report feeling more deeply connected to their romantic partner when using FAM. Spivak explains, “there’s a pre-decision that has been made by both people before the actual moments of having sex. It requires being very clear with one another in order to be effective.” Katinka Locascio, FAM advocate and founder of Earth & Sky Healing who has used FAM with her husband for over a decade, says that his knowledge about her cycle allows them to make shared reproductive decisions, creating greater intimacy both psychologically and sexually. “I think it’s up to both partners to be aware of the responsibility,” explains Blades.

As more people become interested in the menstrual cycle (in case you missed it, ACOG just declared the menstrual cycle a fifth vital sign), and increasing resources support education and management of FAM and natural family planning, I believe we’ll see more people chart their cycle — whether for preventing pregnancy, trying to conceive or simply as a monthly report card for their health.

Ovary is a research platform and female community dedicated to improving the conversation around women’s health, hormones, fertility and productivity. Visit www.ovary.co for more information or follow us on Instagram @ovary.co. Ovary events take place in NYC, LA, SF and London. Illustrations by Maria Jia Ling Pitt.

  • Vera

    I think it’s important to note that natural family planning requires abstinence from sexual intercourse for about 1 week per month. This may prove challenging!

    • NFP differs from the Fertility Awareness Method in that couples practicing the FAM can just use a condom during her fertile days, while NFP couples would abstain.

    • YES! Really important point to clarify. Abstinence or use of a barrier method during fertile days is essential. Thanks for your comment.

  • Mary

    My uterus actually had a visceral reaction (pain felt in my lower abdomen) while reading this, as if to say, “joke’s on your for thinking you can control me.” I have never had a regular period in my life, or for that matter, any period in the past five years that I’ve had an IUD. This seems like a holistic (albeit complex) method that might work later on in life but since I’m still in my early 20s and have the emotional intelligence (and bank account) of a grasshopper, I can’t take any reproductive risks. I applaud you for you dedication to the method and for being so in tune with your body–that part I definitely need to work on.

    • CM

      I understand that your comment may have been in jest, but the method is definitely more about awareness than control… since there are literally only about 6 days of the month you can get pregnant, it’s just figuring out what those days are…

  • Sara

    My best friend used this method of contraception…and ended up pregnant. And she’s a nurse! If anyone would be able to monitor her body effectively, it would be her. So although I can certainly see the benefits of this method, I’m not sold on its effectiveness…

  • Thanks for posting about this here! I just started reading Taking Charge of Your Fertility (so informative and empowering!) and charting my temperature when I wake up. I’m interested to see what I’ll learn about my increasingly long cycles, and then take this information to my gyno after a few months of tracking.

    People may say that FAM/NFP doesn’t work, but my parents practiced NFP for going on 28 years and never had surprise pregnancies.

    I do take issue with this statement from the doctor, “Additionally, if you don’t have a 26 to 32 day cycle, it’s harder to know when your fertile days occur, increasing the risk of FAM not working.” From my reading and understanding, FAM doesn’t assume that every woman has a 28 day cycle. The maligned Rhythm method assumes a 28 day cycle, which makes it less effective for many women whose cycles are longer/shorter. FAM lets you know what’s going on with your body based on the actual signs and symptoms your body is giving in real time.

    • @Katie:disqus, thanks! Yes, ‘Taking Charge of Your Fertility’ by Toni Weschler is a highly recommended book for anyone looking to learn more. Thanks for adding to the conversation.

  • Lanatria Brackett Ellis

    I have been married for 7 years and the only time I was pregnant was when we wanted to get pregnant. This method is effective if you know your body and if your spouse knows their body as well. If you are asking, yes we have lots of sex and we are both very fertile but we are very conscious of when to have sex.I have always had irregular periods my whole life and this method works just fine. So, yea.I never wanted to get on birth control because I do not trust my reproductive system in the hands of Big Pharma. That’s not to say I judge people who do but I am not with how the artificial hormones in birth control can throw body rythym off.Mine is already a bit off and I like it that way lol.

  • BarbieBush

    UGH I want to do this a lot. This seems like the only way we as women can really have control over our bodies and our reproduction. I have done my own research and tried tracking before but am way too paranoid to give up the pill. I don’t like taking the pill and my body is soo sensitive I am nervous about an IUD or implant. I guess you just have to be very very aware and take all the pains to make sure it is right? I have a wonderful partner who I know would be with me in the awareness but the ways mentioned just don’t seem good enough. Maybe I am brainwashed my pharma companies…

    I just don’t trust this method. I think it is me being paranoid and seeing the comments here of people doing it well gives me hope. But I am NERVOUS to go this route. I really cannot be pregnant. I have a long term partner but the idea of a pregnancy is not in the cards for me right now or anytimeeeee soon. And with this TERRIFYING climate..the idea of possibly not having access to abortions makes me more nervous.

  • Suzy Lawrence

    One unwanted pregnancy and all this goes out the window. Congrats to those who have never been in that situation, but for those of us who I have I think the conversation becomes much more personal. Hormones can jack my body all the way to Mars before I rely on holistic birth control again.

    • Leah

      amen sister

    • freudianslippers

      PREACH.
      I had to get an IUD put in after my abortion because I was too afraid to even rely on the birth control pill.

  • Julie

    I love fertility awareness method but, full disclosure, got unintentionally pregnant using it. I had an abnormal cycle where my temperature spiked early due to being sick and stressed. I wasn’t following it as closely as I should have been. That being said, the difference in my body and energy levels being off hormonal birth control has made such a difference for me that I still won’t go back on it even having gone through, what I consider, the worst case scenario of using FAM as birth control. I fully encourage women who are sexually active to try getting off hormones and use a combination of both FAM and condoms during your pre-ovulation cycle. I would say though that you need to have some idea of how you would deal with any unintended outcomes.

  • kevynryan

    I did this, too! I use the Lady-comp.

  • Ebony-Maria Wimmler Levy

    So glad MR publishes informative articles like this. But for a Committee Opinion published in 2015, it’s misleading to write “ACOG just (!) declared the menstrual cycle a fifth vital sign”. It’s awesome they did though, as I agree it can be indicative of overall health.

    I think the sweet spot is definitely when one is relaxed about falling pregnant (or not). For me, this was shortly after I’d married and my husband and I were happy to try/not try. I never enjoyed the pill, so had been off it for several years before we met in any case. I’ve been pregnant 5 times in 5 years now (one 3 year old, 3 miscarriages and now viably pregnant again) and notwithstanding the challenges of that reproductive experience, I feel like it’s a very safe space to be in a committed relationship and open to the possibility of growing one’s family (but not obsessively).

    FAM worked for us in the two years after our son was born and we definitely didn’t want another baby right away, but I think I only trusted the process because if it hadn’t worked, for whatever reason, it wouldn’t have been the end of the world.

    It certainly wouldn’t have worked for me pre-marriage, when I dated a lot, was engaged three times, and pretty well a total imbecile and relationship-related mess. FAM thrives on stability, at least in my experience.

  • Serena

    While I find this really interesting I think it takes someone really self-aware and body-comfortable to get into that 95-99% safety zone. While my cycle was clockwork on 28 days, I still chose to stay on the pill for one hugely important benefit- the awful dysmenorrhea (sp?) and debilitating pain I would go through monthly for 24-48 hrs just wasn’t worth it. I’m so grateful for modern medicine and my
    magic pill. Plus, my skin has never been in better shape.

  • Marina

    Very interesting! Check out the latest innovation on this sector, a swedish app called Natural Cycles, the first one to be internationally certified as effective (just like a birth control pill)
    https://www.naturalcycles.com/en :)))))

  • Monica

    I’m kind of surprised after reading about all of the unintentional pregnancies in the other comments. I’ve been in a relationship for 5 years. He used condoms for a little bit, I went on birth control for a month, but we both hated those methods so we started doing this (unintentionally)/the pull out method. I know it has a bad rep but I’ve had 0 pregnancies coming up 6 years. My man knows his body well and pulls out well in advance, and my mom taught me to track my period since I first got it.

    • CM

      An X factor is the fertility rate of the couple… not to say that you and your partner are less fertile than others, lol, but it’s just easier for some people to get pregnant than others.

    • Grace B

      Same, five and a half years for us, now married.

  • Caroline Christina G

    My husband and I have been using FAM for 5 years (since we got married). We haven’t been able to conceive but recently saw an OBGYN who practices Naprotechnology (which is like FAM but more intense and looks at both the male and female to see what the issue is). It’s been a very rewarding experience as I initially blamed myself for not being able to give my husband the family that we wanted. We are now learning that we are both suffering from issues that affect our fertility and although it has been bittersweet, it has made us communicate on a level we didn’t know existed.

  • Olivia

    I’m all about the pull out method!!

  • belle

    I can’t help but think of “being in touch with your body” in this instance as a euphemism for “being personally responsible for monitoring slight changes in your vitals and feeling around for mucus in order to prevent a life-changing pregnancy for you AND your partner, God help us all.” Even if it had a 100% success rate, this method sounds pretty terrible…

    • CM

      I don’t think that sounds so terrible?

      • belle

        Different strokes, I guess…

  • Leah

    I did FAM for 6 months and got pregnant when I was trying to avoid it. I monitored everything I could about my body every day and yet still it didn’t work.

    Anyone intending to do FAM instead of hormonal contraception needs to be very aware of this outcome. Having an abortion was one of the most traumatic thing I’ve ever been through in my life. That was four months ago and I still don’t feel like my body or mind are over it.

    • ❤️

    • freudianslippers

      For what it’s worth – it’s been about a year and a half since I had my abortion and I finally feel normal again.. I promise, it gets easier <3

  • Fiona

    Thanks for posting this. I use NFP and have only gotten pregnant when open to it. I’m lucky in that my mucus is easy to read though. What I also find lacking from the conversation is the environmental factor and the effect of hormonal contraceptives on our water supply.

  • Marcus Pham

    I use to get my period about once or twice a year. I had been married for 4 years when I had decided that 30 was a good age to start having children. I used FAM to monitor to the quality of my discharge. That was the only way that I knew I was ovulating. And 3 months later, I got pregnant. I now have regular monthly periods after 2 children. My husband and I practice the pee right after sex birth control method.

    • Allthetime

      How on earth is peeing after sex birth control?

      • Marcus Pham

        That’s just it. I pee out his sperm. They’re probably really slow swimmers.

      • belle

        I just…..I don’t even know where to begin. I hope this is some sort of poorly executed trolling……

    • Fran

      You know the hole you pee from is not the same one where your husband’s penis goes, right?

    • belle

      Are you fucking kidding?

  • Alex

    Unplanned pregnancies can occur with any form of birth control. To dismiss a method out of hand simply because you or someone you know conceived while using it isn’t very fair.

    • It is a fact for that person. There is no 100% effective birth control. The one percent or twenty, is a pregnancy. So you could dismiss it out of hand, or just dismiss it after careful thought. Your choice.
      Oh yeah, it still is.

  • Tonia

    This is what my husband and I have always done and it has worked for us for 10 years, both in preventing pregnancy and in getting intentionally pregnant when we were ready to have a child. And yet, my doctor pushes hormonal birth control at me at EVERY visit. It’s very irksome to have to explain every time that yes, due to the chance of “user error”, the FAM method might not be as foolproof as hormonal birth control–but we are aware and accepting of that fact, and it has always worked great for us.

  • I believe NFP / FAM is a very good method to prevent a pregnancy, but in order to get correct results, you need to live a stable lifestyle.

    You need to take your basal temperature every morning at the same time for at least 5 minutes. I have read analog thermometers work more correctly than the digital ones.

    If you stand up before taking your basal temperature, your temperature outcome will be wrong and mess up your analysis. You have to take your temperature right after waking up (and always at the same time).

    You can’t 100% rely on the NFP method when you drink alcohol on party nights, sleep irregular or get sick.. Irregularites can mess with your basal temperature.

    Beside alI the things you have to think of, I do believe that it can work.
    But it should always be used combined with condoms / or a diaphragm to be on the safe side.

    There are a couple of days after the ovulation and before the start of the period, where it should be safe to have unprotected sex, BUT you must be 100% sure that you already had your ovulation.

  • Georgia

    I don’t really understand this method. The thing is, sperm is alive in women’s body for about 7, somewhere I read that even 10! days have been documented. While I have quite regular periods, maybe once a year some freak event causes a deviation of, say 21 day period, which means I am already fertile right after my previous menstruation. I have no way of knowing that this is coming 2-3 days in advance and have unprotected sex, and boom. This means that unprotected sex is barely ok only right before the period when bloating and cramps manifest themselves, and for that I don’t need an app nor any sophisticated tracking.

  • Kate

    I 100% respect women who are down to tackle FAM for all the reasons mentioned above. I really like that this article makes it clear that this isn’t for everybody though. You have to be honest with yourself and super responsible. The scariest part is being willing to accept that the consequences could be pretty major. I’m 25, in a serious relationship, and I’ve been lucky to never have issues with my pill. I also know that I never ever want children, and the pill makes it so that I can be pretty simple (phone alarm–> pill –> no babies). I’ll continue to be my fairly lazy and safe self, but cheers to all you humans who successfully use this method!

    From a curiosity standpoint it would be wicked to know how to monitor all these signs about myself though. Female bodies (heck, human bodies!) are cornucopias of knowledge! FAM sounds like it definitely heightens awareness about ones’ self which I find super interesting.

  • june2

    Aren’t sperm alive for at least a couple days in the vagina?

    You’d have to bookend the 6 day fertility week with say, 5 days on either end to be safe, giving you effectively, one week of safe sex per month. -_- That said, hormone remedies are not the answer for me (depression, yay!) so knowing my body along with insisting my partner use protection is the rule. Considering an IUD but not there yet.

    Also, herbs can be powerful if used correctly. I paid $75 years ago for a “day after” herbal recipe involving 3 ingredients (NOT pennyroyal), that I relied upon for years – it initiated my period within a day or two regardless of when I’d last had it. Women must take responsibility for knowing their cycles and for REQUIRING their partners use protection if they are not already. We are really not built for casual sex.

  • Ruth

    I went to Catholic school and a woman came to talk to us about this “natural family planning” – she had been using it since she had gotten married, and had already had two kids who were “planned by God” but presumably not by her and her husband. Not a great review, I must say.