What is Fertility Awareness/FAM?
Fertility Awareness refers to a collection of practices through which we can come to understand the menstrual cycle and gain an awareness of our reproductive health. Knowing the parameters of our cycle gives us clues about the health of our reproductive organs and our hormones, and can help us explore and discover what our body needs, in terms of nutrition, sleep, exercise, and stress management, for optimum health.
When we use the principles of Fertility Awareness as a daily practice, either to avoid or to achieve pregnancy, it is known as the Fertility Awareness Method (FAM). By charting our fertility signs—waking body temperature, cervical fluid observations, and cervical feel & position—every single day, we can know at all times whether we are in a fertile or infertile state, and can thus time intercourse/insemination depending on our desired outcome.
FABM? Sympto-thermal? What does it all mean? (And is this the rhythm method?)
First, let me establish something critical here: you are not fertile every day of your cycle. A person who produces sperm is fertile every day, but a person who produces eggs is not. You can only conceive during a handful of days out of each menstrual cycle. The goal of FAM, then, is to identify which days these are. And really, it's not that hard.
A Fertility Awareness Based Method (FABM) is any method based on the principles of fertility awareness, using real-time observations of fertility signs, sometimes in conjunction with calculations based on previous cycles. Some FABMs are sympto-thermal and some are sympto only.
A sympto-thermal method is any FABM that involves keeping track of your cervical fluid, cervical position and feel—this is the sympto part, since these are symptoms of the different phases of your cycle—and your waking temperature—the thermal part. The method that I teach is a sympto-thermal FABM.
The Knaus-Ogino Calendar Rhythm Method, also known as just the "rhythm method", is not a true FABM, since it does not rely on real-time observations. This method uses calculations based on past cycles, as well as generalized assumptions about cycle length and timing of ovulation, to prescribe when the fertile wave will happen in each cycle, regardless of whether or not it actually occurs at that point. This method may be fairly effective for people who have a very specifically-timed and regular cycle, but since most people don't have "textbook" cycles, overall this method, as any calendar-based method, has a significantly lower effectiveness rating than FAM (see below).
What's the difference between FAM and NFP?
Natural Family Planning (NFP) is a major branch of the FABM tree that is religious in origin and practice, whereas the FAM branch is secular. In general, NFP classes are taught to married heterosexual couples only, and, when avoiding pregnancy, the fertile wave is considered a time for complete abstinence from all types of sexual contact. In contrast, FAM is open to anyone wishing to learn, regardless of gender identity, sexual orientation, and relationship status. Practitioners are encouraged to make their own decisions during the fertile wave regarding whether to engage in complete abstinence, other types of sexual intimacy not involving genital-to-genital contact, or use of a barrier method or withdrawal, keeping in mind that using other contraceptive methods may increase the risk of unintended pregnancy, as these methods have their own failure rates.
How effective is FAM as contraception?
Different FABMs have slightly different ratings, due to the variety of practices out there and the rules involved in each, but overall they are greater than 95% effective. The most comprehensive study on a symptom-thermal method to date, a 2007 German study, found FAM/STM to be 99.6% effective with perfect use. That’s comparable to hormonal birth control! This study is considered the "gold standard," as researchers analyzed data from 900 women, who had all been trained in STM (with rules being almost identical to the type of FAM that I teach, by the way), over the course of 13 cycles. In this study, the typical use rating was 98.4%, which is still pretty high; compare this to the condom, which has a perfect use rating of 98% and a typical use rating of 82%.
What’s the difference between perfect and typical use? Perfect use means you’re following all the rules, all the time. Typical use is when you add in forgetfulness, misunderstandings, a bit of carelessness... But with the right education and some diligence, it’s not hard to be a perfect user!
It’s also important to note that this effectiveness rating is based on abstaining completely from intercourse and genital-to-genital contact during the fertile phase. Using a barrier or practicing withdrawal lowers the effectiveness slightly, as these methods have their own failures to take into account.
Does FAM offer protection against STIs?
No, FAM does not offer any protection against sexually transmitted infections (STIs), so if you’re at an elevated risk, this may not be the best method of contraception for you. However, you can still practice Fertility Awareness to track your cycles and increase your body literacy, even if you’re also using condoms or another barrier method!
How can FAM help me get pregnant?
By tracking when you’re most fertile, you can time intercourse or insemination optimally in conjunction with ovulation. Although this sounds really simple, most of us were not taught this most basic piece of information at any point along our reproductive journey.
If you have been trying to get pregnant unsuccessfully, charting your cycles can also give you clues about your hormonal health, often a main factor behind fertility challenges.
If assisted reproductive technology is part of your plan, you can use FAM as an adjunct, to help things along and be more empowered throughout the process. Unfortunately, many doctors have little knowledge of the physiology of ovulation and menstrual cycles, and don’t quite understand how to optimally time insemination to achieve pregnancy without the use of ovulation prediction/detection tests (which can be invasive and time consuming) and fertility drugs (which can be expensive and have serious side effects). Many medical fertility treatments are not tailored to individual cycle variation, and, despite all of their new and expensive technology, can fail due to poor timing, and can lead to unnecessary interventions, cost, and worry.
However you're planning on achieving pregnancy, knowing the parameters of your own cycle—when you enter your fertile wave, what your most fertile cervical fluid looks and feels like, and what a typical ovulatory pattern is like for you—is going to be an enormous asset to your reproductive journey. Wherever you are on that journey, getting to know your cycle is the first step toward a healthy pregnancy.
How can FAM help with my reproductive and hormonal health?
There are so many things we can learn about our bodies when we pay close attention to the stories told to us by our fertility signs: waking temperature, cervical fluid, and cervical feel and position. Their patterns give us clues as to us whether our hormones are working in concert or are out of whack; whether we are getting optimal nutrition or have some deficiencies to address; whether or not we are getting enough good-quality sleep; whether our stress levels are manageable or getting out of hand, and more. If you have a specific challenge you’re dealing with, such as hypothyroidism or PCOS, FAM can help you find some answers and lead you in the right direction toward achieving greater wellness. If you have experienced reproductive or sexual trauma and are wishing to gently reconnect with certain parts of your body, FAM can be a powerful and empowering healing tool.
Many people believe that the menstrual cycle should be the "5th vital sign," signifying that if the parameters of a cycle were considered as important as one's pulse, blood pressure, respiratory rate and body temperature, we'd be a long way toward a greater understanding and appreciation of the physiology of half of the population (who is currently vastly undervalued in Western medicine). Normalizing the incorporation of menstrual cycle and fertility-based knowledge into standard medical repertoire is an important goal indeed, and something that Fertility Awareness Educators worldwide are deeply invested in.
Whether your goal is to get pregnant, to avoid pregnancy, or simply to learn more about your body, finding out how your hormones are doing is always going to be a good move. If you're planning to procreate at any point in the future, it's important to know that having a solid foundation upon which to build and nourish a new life will make a lot of difference. There's no one-size-fits-all when it comes to optimum health, dietary choices, and lifestyle considerations, which is why working with knowledgeable practitioners can benefit you as you work on putting together the pieces of the puzzle of your overall reproductive health.
I'm queer and I don't need contraception. Why should I learn FAM?
Maybe you never really paid much attention to your menstrual cycles because you weren’t in relationships in which pregnancy was a concern, and now you’re wondering if everything is “working right.” Or maybe you have irregular cycles, and are wanting to figure out what’s behind that. Or maybe you are starting to think about having a baby, and overwhelmed by the world of assisted reproductive technology. Whatever your story, the Fertility Awareness Method has a lot to offer you.
If you're wanting to know more about your general reproductive or hormonal health, check out the above section. If you're wanting to achieve pregnancy, see the one before that for more details on how FAM can help!
My classes, workshops, and private consultations are open and affirming to all. If you are interested in learning more about your reproductive and sexual health, I am happy to work with you, and I will be inclusive of your family, partner/s, and whoever is involved along the way.