Birth Control Behavioral Methods (cont.)
Fertility Awareness Method
Women who use the Fertility Awareness Method (FAM) monitor body temperature and cervical signs of pregnancy similarly to those who practice NFP. However, women using FAM may either avoid intercourse or use a backup nonhormonal method of birth control, such as a condom, during the fertile period.
Women using FAM monitor 3 primary fertility signs: basal body (waking) body temperature, cervical mucus, and cervical position.
Basal body temperature before ovulation is considered to range from 97-97.5°F. After ovulation, temperatures rise to about 97.6-98.6°F and remain elevated until the next period begins, about 12-16 days later. Temperatures usually rise within a day or so after ovulation, so the rise in temperature generally means that ovulation has already occurred. A basal body temperature chart can be obtained from 4women.gov.
Cervical mucus qualities are also charted throughout the menstrual cycle. Cervical mucus qualities during the menstrual cycle are designated as absent, dry, sticky, creamy, or egg-white. A woman is most fertile when her cervical mucus has the consistency of a raw egg-white. During this time the cervical mucus is clear and elastic.
The cervix becomes softer near the time of ovulation, and this change facilitates the passage of sperm upward through the uterus to the fallopian tubes. The cervix also moves forward during this time because of the effects of estrogen on the ligaments that suspend the uterus.
For maximum effectiveness, FAM users follow 4 rules:
- Intercourse is allowed in the first 5 days of the menstrual cycle (beginning with the first day of menses) if an obvious temperature shift occurred 12-16 days previously.
- Prior to ovulation, intercourse is allowed the evening of every dry cervical mucus day.
- Intercourse can resume the evening of the third consecutive day your temperature rises to postovulatory levels (i.e. after the thermal shift).
- Intercourse can resume the evening of the fourth consecutive day the day of peak cervical mucus production and elasticity.
Intercourse is not considered "safe" for avoiding pregnancy unless all of these rules are followed. It is recommended that 2 full cycles be charted before relying on this method.
FAM has advantages and disadvantages.
- How effective: If a couple takes chances and has intercourse without backup contraception during the fertile period, their odds of pregnancy increase dramatically. In August, 2002, the FDA reported a failure rate of 20 pregnancies per 100 women per year for periodic abstinence. This figure did not differentiate for particular types of periodic abstinence. ACOG lists a higher failure rate for periodic abstinence of 25%. Again, this figure did not differentiate for method of periodic abstinence.
- Advantages: No harmful effects from hormone usage can occur. FAM methods can also be used to achieve pregnancy.
- Disadvantages: Complete abstinence is necessary during the fertile period. This method requires discipline and systematic charting. The method is not effective with improper usage. For maximal effectiveness, a woman or couple should be trained by a medical professional or qualified counselor. A relatively high failure rate has been reported. This method does not protect against STDs.
Other Methods of Periodic Abstinence
Several other methods of periodic abstinence exist.
- Rhythm method: Couples who practice the rhythm method, also called the calendar method, decide when to abstain from intercourse based on calendar calculations of the past 6 menstrual cycles. However, allowances are not made for the normal variations in the menstrual cycle that many women experience. This method is not as reliable as the symptothermal method of NFP or FAM.
- Cervical mucus method: Also called the ovulation method, the cervical mucus method involves monitoring cervical mucus only, without also recording basal body temperature or menstrual history. The safe period is considered to be any dry mucus days just after menstruation and the 10 or 11 days toward the end of the cycle. Days of menstrual bleeding are deemed infertile; however, conception may infrequently occur occur during menstruation. Vaginal infections, sexual excitement, lubricants, and certain medications can significantly diminish the accuracy of cervical mucus assessment.
- Basal body temperature method: This method involves monitoring basal body temperature only, without also recording cervical mucus or other signs. Sex is avoided from the end of the menstrual period until 3 days after the increase in temperature.
Medically Reviewed by a Doctor on 3/2/2016
Francisco Talavera, PharmD, PhD
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