What’s In A Name?: Fertility Awareness (Based) Methods and Natural Family Planning

It’s somewhat embarrassing to admit, but I find it hard to bring fertility awareness up to people in real life who haven’t heard of it before. For me, the awkwardness is their reaction to the name and what they think it entails.

Something about “fertility awareness” evokes something for some folks that is akin to “hippy” or “new age” type of connotations.

On the other end, some folks will think that this term means the calendar method or the rhythm method. This is partially because most people don’t know about the new science of real-time fertility signs. The other reason people think this is because most people who claim to be practicing a fertility awareness method are still doing some kind of bleeding tracking focused method. It’s truly a small percentage of us who are using a evidence-based real-time fertility sign method like Sympto-Hormonal, Sympto-Thermal, or Cervical Mucus only methods.

“Fertility” evokes conception for many folks. It also isn’t the correct word. We can only know if we were truly capable of fertility that cycle retrospectively when a pregnancy occurs, or if the cycle was visibly fertile by counting the luteal phase. I’ve seen a researcher say the correct term might be “fecundity.”

“Awareness” makes me think of some type of campaign. And what does awareness mean?According to the OED, “knowledge or perception of a situation or fact.” This can sound like people are charting with their intuition, but we are not. Fertility awareness modern methods track tangible and measurable fertility signs (cervical mucus, basal body temperature, cervix) or hormone levels.

I also don’t want to tell people that I teach natural family planning. Something about “family planning” makes people assume that the method is only for those who want to conceive, but a part of family planning is avoiding a pregnancy too. Then, there’s the religious connotation. I’m not Catholic, and I don’t just encourage abstinence because of religious compulsion.

Then, there’s the word natural. Natural is an incredibly subjective term. Some folks will see it and think this also means the withdrawal or pull out method. In the context of charting, it does not include withdrawal. According to the OED, one of natural’s meanings is “existing in or caused by nature; not made or caused by humankind.”

With this definition, do urinary hormones methods become “unnatural”? The hormones themselves occur in the human body, but you can only measure them with help from a machine. I’m not arguing against natural family planning including hormone monitors, but I do wonder if it makes sense to use that terminology.

My favorite terminology is “fertility awareness based methods.” Something about the word “based” makes it sound more scientific in my mind. I’ve seen some educators adopt this language to be more inclusive.

I’ve seen Samantha Zipporah talk about “conscious contraception” as a way to classify fertility awareness. I like the term conscious. Something about it sounds more sophisticated than awareness. I’ve seen it used in a few older academic articles. You can read them here and here.

I’ve also seen it called “Natural Fertility Control” or “NFC.” You can read an article with this terminology here. Some people will feel uncomfortable with the term “control.” In some ways, it isn’t control, because there is always a small chance of unintended pregnancy with correct use, and a larger chance of unintended pregnancy with incorrect use. I do think the self-knowledge gives the user a level of control over their choices more than other methods do. After all, with correct use, you will always know when you are possibly fertile, and then can make your decisions accordingly.

What terminology do you like best?

Can I get pregnant on my period?

Many people think that having sex during menstruation cannot lead to pregnancy, but the answer is much more nuanced than that. It is possible to get pregnant during bleeding episodes, some of which may not be menstruation!

Was the bleeding truly menstruation?

Charting evidence-based fertility signs like cervical mucus, basal body temperature, and urinary tests are the best way to determine if you are ovulating. True menstruation should follow about 10-16 days post ovulation as indicated by a temperature shift or positive PdG test.

If you are not charting your cycle with a fertility awareness based method, your bleeding may not really be menstruation. Estrogen breakthrough bleeding may appear very similar to menstruation and is often indistinguishable without charting. This bleeding can be fertile, and pregnancy could result.

Day one of a true menstruation marks the beginning of the cycle.

Day 1 is true menstruation because it followed a proven luteal phase. The current cycle confirms the next bleed will be menstruation because of the positive progesterone tests. This app is Read Your Body.

How long are your cycles? Better yet, approximately when do you usually ovulate?

If your cycles were 26 days or longer for the last year, it is unlikely you will become pregnant with sex during the first five days of the cycle.

Dr. Josef Roetzer monitored 5,807 cycles. He observed only one pregnancy before day 6 of the cycle. Her cycles were 22-27 days long.

Dr. Roetzer estimates that using the first five/six days is 99.8% effective for avoiding pregnancy. It is important to note that all of his cycles monitored had a temperature shift preceding menstruation. If you do not have proof that you ovulated before a bleed, it becomes more likely to conceive during bleeding.

Another way to determine the last infertile day at the beginning of the cycle is to use Dr. Doering’s rule. Dr. Doering subtracted 7 from the earliest first high temperature in the last year. For example, Sarah’s earliest first high temperature was day 13. Day 13 – 7 = Day 6 as the last infertile day of the cycle. This rule is always crosschecked with cervical mucus. Sperm may survive up to 5 days in cervical mucus, and any presence that has not been determined to be infertile through instruction should open the fertile window. The Doering rule is more personalized than automatically assuming the first five/six days are infertile.

In Dr. Frank-Hermann’s double-check sympto-thermal study from 2007, all three method failures were from day 5 intercourse. This study used the first five day rule and Doering rule. This study yielded an efficacy of 99.6%.

So am I safe to have sex during my period? Ask yourself these questions.

  1. Did you confirm ovulation with basal body temperature, PdG strips, or a blood draw in the previous cycle?
  2. Are your cycles longer than 26 days on average? Have you ever had a peak day before day 13 of the cycle?

If the answer to both of those is yes, you can probably have safe sex up to day 5 of your cycle.

If your answer is no, then you have a possibility of pregnancy.

What if I want to be more conservative?

Some methods like Billings, FEMM, and Creighton suggest not having sex during heavy days of bleeding when cervical mucus cannot be observed.

If you have a history of short cycles (less than 26 days) or want to add an extra layer of protection onto the beginning of the cycle, I recommend beginning observing vulva sensation and cervical mucus as soon as your bleeding has lightened enough to no longer need a tampon, cup, or regular pad. If you need only a panty liner or are only experiencing light spotting, you should beginning checking your cervical mucus and sensation throughout the day. At the end of your day, if you have observed no cervical mucus or sensation outside of your determined infertile pattern, this day is safe for sex. (DO NOT DO THIS WITHOUT LEARNING A METHOD. THIS BLOG IS NOT ENOUGH INFORMATION TO AVOID PREGNANCY WITH ALONE).

What if I bleed for more than 5 days?

If your menstruation lasts longer than five days, you should follow the instructions from the paragraph above. It is NOT safe to consider past day 5 automatically available if you are bleeding. You need proof by using cervical mucus or urinary estrogen tests that your fertile window has not yet opened past day 5 of the cycle.

What if I randomly have a short cycle?

Checking cervical mucus is your best back up. Cervical mucus should appear when the fertile window is opening for most charters. Many methods suggest no longer considering menstruation safe once you enter peri-menopause (can occur up to 10 years before menopause) because cycles may shorten at this time. If you notice that your cycles have grown shorter than 26 days, you may want to become more vigilant and stop automatically considering the first 5 days safe.

Conclusion

For the majority of people menstruating, using the first five days of a true menstrual cycle will not result in pregnancy. For a very small percentage, it may. I recommend charting with a real fertility awareness method (Sensiplan, SymptoPro, FEMM, Billings, Marquette, etc) to determine if your bleeding is actually menstruation!

Works Cited

Boetze, Iosef. “Further Evolution of the Sympto-Thermal Methods.” International Review of Natural Family Planning 1 (1977): 139-150.

Raith-Paula, Elisabeth, et al. Natürliche Familienplanung heute. Springer Medizin Verlag Heidelberg, 2008.

Breastfeeding and return of fertility in natural family planning studies

During the postpartum period of time, fertility is in a unique state. For those fully breastfeeding, it may be months or years before they begin ovulating again regularly and with fertile cycles. This article talks about some of the data we have on what return of fertility looks like. This information may be of particular interest to those charting with a method of natural family planning or fertility awareness. Charting at this time may be difficult, and for highest efficacy should be done closely with a certified natural family planning educator.

Breastfeeding as Birth Control

Breastfeeding has been shown over numerous studies to have an effect on return to fertility and ovulation. Kennedy et al (1989) reviewed 10 studies from multiple countries to come to a consensus on what full-breastfeeding means.

  • Fully breastfeeding or at least partially fully breastfeeding
  • Fully breastfeeding meaning the infant gets all or as close to all as possible of their nutrition by suckling at the breast directly, no bottles or pumping
  • Small bites of regular food or water do not disqualify for full breastfeeding
  • No bleeding past day 56 postpartum until the 6 month mark postpartum.

Some methods suggest going no longer than 6 hours at night without breastfeeding. While this was not mentioned in the study, it is generally used as the standard in fertility awareness based methods to see if someone qualifies to rely on the lactational amenorrhea method (LAM).

LAM is 98% effective for avoiding pregnancy when all criteria is met up until 6 months postpartum. After that, efficacy drops precipitously.

What about ecological breastfeeding?

Ecological breastfeeding requires even stricter criteria and may delay fertility for much longer. Bleeding past day 56 does not disqualify someone for ecological breastfeeding. Ecological breastfeeding should not be confused with LAM! Ecological breastfeeding was coined by Dr. Sheila Kippley. You can buy her book here.

The criteria include:

  • Breastfeed exclusively for 6 months
  • Pacify your baby at your breast
  • No bottles or pacifiers
  • Sleep with your baby for night feedings
  • Sleep with your baby for a daily-nap feeding
  • Nurse frequently day & night. Avoid schedules.
  • Avoid anything that would separate you from your baby / prevent regular nursing

Symptothermal Method Studies on Breastfeeding

For the first part of this overview, I am going to cover a few symptothermal studies that followed breastfeeders from birth to return of fertility. Symptothermal charters record cervical mucus and basal body temperature daily in order to track their fertility and determine when the fertile window is opened and when it is closed.

In “Breastfeeding and the Symptothermal Method,” Kennedy et al. followed 73 women who charted with a symptothermal method in Australia, Canada, England. While this is a small sample size, the team collected a ton of data: 22,538 diary sheets, 9,428 urinary vials to measure hormones, and 1,600 follow-ups with the women (Kennedy 1995).

Kennedy et al. reported the following data regarding the wait to return of fertility:

  • Only 25% of first ovulations postpartum had “adequate luteinization.” This means over three quarters of first ovulations were likely infertile (Kennedy, 110).
  • In retrospect, up to 51% of possibly fertile days identified by sympto-thermal would not have lead to conception (Kennedy, 112). The study standard for this was 5 day sperm life.
  • They found that 94-99% of the time, the sympto-thermal method correctly identified when a day was really infertile. This means that around 1-6% of the time it didn’t identify a day that may have lead to pregnancy (Kennedy, 112).
  • They recorded four adequate ovulations with those fully breastfeeding for their first ovulation. This was defined as a 10 day or greater luteal phase with adequate progesterone levels. (Kennedy, 112).
  • Abstinence was expected per the rules for about 50% of the charted days included in the study (Kennedy, 113).

Bonus Information for Cervical Mucus Fans: Fertile mucus in this study was considered anything cloudy, opague, clear, translucent, stretchy, strands, wet, lubricative, moist, or unusually abundant.

Zinaman and Stevenson in the USA followed 25 women until they had 3 ovulatory cycles postpartum (1991).

They found the following data regarding return to fertility:

  • 20% of ovulations in the first ovulation postpartum during the first 6 months were considered fertile (ie a luteal phase longer than 10 days) (Zinaman and Stevenson, 2037).
  • Basal body temperature appeared inadequate to capture the first ovulation, occurring up to 4 days after the LH peak, but it improved in later cycles (Zinaman and Stevenson, 2037).
PercentageTime to Return of Fertility From Birth
25%Less than 200 days 
25%200 to 300 days
35%301 to 400 days
15%More than 400 days
Time to return of fertility among 25 breastfeeding women in Washington, DC. Created from page 2037 in Zinaman and Steveson (1991).

In an article in the International Review of Natural Family Planning, Parenteau-Carreau presents data collected from 43 postpartum women charting with the Serena Canada method.

Parentau-Carreau reports the following data on postpartum charting:

  • 65% of first bleeds were preceded by a thermal shift (35).
  • The collection of charts confirmed the theory that 4 high temperatures should be used postpartum, as there were instances of 3 raised temperatures that were not true shifts (36).
  • Among temperature shifts during the first 6 months postpartum, 75% lasted 8 days or more (37).
  • For babies who sucked their thumb or used a pacifier regularly, their mothers experienced return of fertility an average of 13 days earlier than those who only breastfed for soothing purposes (37).
  • The basal body temperature curve tended to become more steady or regular in the one to two weeks prior to the first ovulation (38).

What can we conclude from all this data?

  • Breastfeeding and meeting the criteria for LAM is highly effective for avoiding pregnancy in the first 6 months postpartum.
  • Most first ovulations postpartum are infertile (defined as a luteal phase less than 10 days long).
  • It is possible to chart during postpartum to avoid pregnancy.

What methods work best postpartum?

I recommend practicing either the Billings Ovulation Method or Marquette postpartum. I do not recommend sympto-thermal method because temperatures are not useful until fertility returns. I only recommend taking your temperature before the 6 month mark to those who are not breastfeeding. In addition, the sympto-thermal method offers less complex mucus patterns than Billings does.

Billings Ovulation Method involves charting sensation at the vulva and appearance of mucus to create a basic infertile pattern. It allows only alternate evenings of the basic infertile pattern for sex until return of fertility (IE ovulation) occurs. It is approximately 98% effective with correct use postpartum.

  • Subjective fertility signs (sensation and appearance)
  • Only alternate evenings for sex
  • Very affordable (Billings will work to set you up with a free instructor if you absolutely cannot afford one)
  • No re-occurring cost
  • One-time cost for instruction (ideally, please pay your educator if you can! Some instructors may charge after 1-2 years pass)

Marquette Method involves charting urinary hormones using the Clearblue monitor. This monitor reads estrogen and LH levels. This method is going to be more expensive than a cervical mucus only method, so I only recommend it to those who can afford approximately $30 USD a month or more postpartum. Unfortunately, the stick costs fluctuate up to $50 USD or so for 30 sticks, but I have seen them as low as $30 USD. Marquette is approximately 98% effective with correct use.

  • Objective fertility signs (monitor does the reading for you)
  • Any time of day sex when available
  • Expensive by some standards. Sticks cost twice as much in Europe. May not be available in some countries at all.
  • Re-occurring cost
  • One-time cost of the monitor ($50-$130 USD depending on if buying new or used)
  • One-time cost of instruction (unless you go over the year mark, you may need to pay twice)
  • I have heard that some instructors may offer scholarships, but you would need to contact individual instructors or organizations to learn their policies.

References

Kennedy, K; Rivera, R; McNeilly, A. (1989). Consensus statement on the use of breastfeeding as a family planning method. , 39(5), 0–496. doi:10.1016/0010-7824(89)90103-0 

Kennedy, K., Gross, B., Parenteau-Carreau, S., Flynn, A., Brown, J., & Visness, C. (1995). “Breastfeeding and the Symptothermal Method.” Studies in Family Planning, 26(2), 107-115. doi:10.2307/2137936

Parenteau-Carreau, S. (1984). “The Return of Fertility in Breastfeeding Women.” The International Review of Natural Family Planning. Vol. 8(1). pp. 34-38.

Zinaman, Michael; Stevenson, Wilma (1991). Efficacy of the symptothermal method of natural family planning in lactating women after the return of menses. American Journal of Obstetrics and Gynecology, 165(6), 2037–2039. doi:10.1016/S0002-9378(11)90575-4 

An Honest Review of Tempdrop (Revised Review 2021)

Are you looking to simplify your basal body temperature charting routine? Is getting up in the morning just too hard to remember to take your temperature? Read on!

There are currently a few wearable basal body thermometers on the market such as iFertracker, Ava, and Tempdrop. In this blog, I will review the Tempdrop device. If you decide to purchase, use this link and get 10% off the device.

Unboxing Tempdrop!

Tempdrop is a wearable basal body temperature thermometer that came onto the market in 2017. Rather than setting an alarm, you can simply put this thermometer on before bed. You wear it around your upper arm (and it may be worn in a bra as well). It needs 3 hours of sleep to determine your basal body temperature. The device uses an algorithm to find your true temperature, regardless of how many times you have gotten up or whether you had restless sleep this night.

This device is very popular with shift workers, breastfeeding folks, and other people who don’t get a regular amount of sleep and wake up at different times, or just to those who don’t want to set an alarm!

Tempdrop holds 24 hours of data, and it must be synced at least every 24 hours or you will lose previous data. After wearing it for 15 days (as of March 2020), the algorithm will kick in. (If possible you should back up temp with oral basal body temperature for the first 60 days if you are avoiding pregnancy. If not, use a different method of protection). By day 60, the device will only change and make improvements to the last 2 temperatures taken.

Once you wear it, you will need to sync it to an app to see your temperature. Tempdrop has its own app, but I highly recommend using Read Your Body (pictured below) instead! This app is customizable for every method and can be synced to Tempdrop.

My Experience with Tempdrop

Tempdrop is red and oral temperatures are blue! One perk of oral temperatures is that sometimes I can skip taking my temperature, while with Tempdrop you do wear it daily for best results.

I used the Tempdrop device for almost 12 months. I found my oral temps to be more predictable and more steady when observing my own trends over time. I get very steady or repeating temperatures with oral charts most of the time.

However, I am not a shift worker, so I will admit that I do not need Tempdrop like some people may do. I already have to wake up at the same time 5 days a week, and I don’t find it inconvenient to take my temperature on the weekend. My oral temperatures caught my shift earlier than Tempdrop did on two separate occasions. I have seen other people say that Tempdrop catches their shift sooner than oral temperatures, so this is really an individual thing.

I discovered that there were multiple other effective ways of charting without taking my temperature. If you really want to chart in shift work, irregular cycles, postpartum and you do not want to purchase the Tempdrop, I highly recommend considering learning a new method of fertility awareness like the Billings Ovulation Method (click here to learn about working with me) and Marquette method (click here to learn what charting with Marquette is like).

If you are dedicated to using a sympto-thermal method and can’t get accurate temperatures otherwise, and you have tried trouble shooting your routine (vaginal temperatures, pre-warming the thermometer before taking it, using longest stretch of sleep), then Tempdrop may be your best option. You can use my code for 10% off, and I will get a small kickback. Thank you for using my code!

Here is what the device looks like!

Which method of fertility awareness is right for me? A decision making tool

It can be hard to choose the right method for you. In this graphic, I have simplified the main signs, times of intimacy, and efficacies for the four methods that I am most familiar with.

As part of my charting journey, I have personally compared and charted with Billings, sympto-thermal, and Marquette. You can view my charting comparisons here.

The graphic is intentionally simplified. Method rules will vary, particularly if you are using a different protocol of the method or combination of signs. My Marquette example is for monitor-only rules.

Time of day for intimacy is very important to consider as a part of the decision making process. If you and your partner’s schedules don’t mix well, this may sway you towards another method!

Some couple like intimacy to feel spontaneous. If you never want to worry about time of day, Marquette is likely the best method to choose.

On the other hand, if you want your fertile window to be defined by cervical mucus, you may want to sacrifice any time of day sex for the flexibility of opening the fertile window that may come with using alternative evenings of the basic infertile pattern in Billings.

I recommend interviewing an educator and telling them your unique situation before committing to a method.

To find an instructor, I recommend using the Read Your Body Educator directory linked here. You can use it to find an instructor based on the fertility signs you want to chart, your location, price range, and more!

No dry days? You may qualify for a basic infertile pattern!

After menstruation, the majority of women will experience dry days. For these women, their basic infertile pattern is dry. Other women may experience a pattern of unchanging mucus, sensation, and discharge after menstruation. For women who experience this same UNCHANGING discharge, mucus, sensation pattern for three cycles in a row following menstruation, they may have a non-dry basic infertile pattern. The keyword here is unchanging; any changing pattern would not indicate a basic infertile pattern. This type of pattern should only be established under an instructor if someone is seriously avoiding pregnancy. For women who establish this pattern with a mucus-only instructor (either Billings or Creighton are options), this pattern has the same level of efficacy for avoiding pregnancy as a dry pattern. Some examples of this pattern may be continuous moist days, continuous sticky days, continuous white mucus, or others!

DO NOT try to use these days for unprotected sex without establishing it for a minimum of 3 cycles with an instructor (it may take longer than this). When using these days, intercourse should be rotated to every other day in the evening before bed. 

What causes this pattern? In cycles less than 35 days, it is caused by bits of the G mucus plug breaking off. While the plug is breaking off, it causes the visible mucus or sensation. However, the rest of the plug is still blocked. This means this time of the cycle can be considered infertile if an instructor works with you to make sure it is the G mucus plug breaking off. In cycles longer than 35 days, it can be caused by a combination of the G mucus plug breaking off and estrogen’s effect on the vaginal walls causing a sloughing effect. Read more about the types of mucus here.

Sympto-thermal methods like Taking Charge of Your Fertility also mention a “sticky” dry basic infertile pattern. Methods like SymptoPro claim that women do take on an elevated pregnancy risk when using these days. As sympto-thermal methods are not as strenuous on mucus observations as mucus-only, consider this risk when deciding to utilize this pattern. Again, ideally if someone is avoiding pregnancy, they should reach out to an instructor before using these.

In either of these cases, experiencing any dry days following menstruation means that you do not qualify for a basic infertile pattern of non-dry in regular cycles. This pattern needs to be re-established with an instructor following hormonal birth control usage or pregnancy. 

Irregular Cycles

For postpartum, perimenopausal, or people with cycles longer than 36 days, it is also possible to have a basic infertile pattern of non-dry after 14 days of the same UNCHANGING discharge, mucus, sensation. In addition, a combined basic infertile pattern is possible in the Billings Method. This should only be established with an instructor. For these transitions, the Billings Method is highly recommended. 

In both regular and irregular cycles, working with an instructor can help you get more safe days for unprotected sex if you are experiencing a non-dry pattern.

Review of Lactivism: How Feminists and Fundamentalists, Hippies and Yuppies, and Physicians and Politicians Made Breastfeeding Big Business and Bad Policy

I’m expanding my usual content to include book reviews of fertility, sexuality, birth control related materials. This is the first review in a series. The content will also be shared to my Instagram account.

Lactivism has been on my reading list for a while. As a fertility awareness educator, I run into a lot of breastfeeding glorification in online spaces. This book looks at breastfeeding from social and political perspectives. Jung outlines the ways that breastfeeding can be a privilege and how it should not be viewed as a moral imperative.

One of the most standout examples of breastfeeding related discrimination in the book is with WIC, a voucher system that lower income people who have a baby or are pregnant can use to purchase basics like milk, eggs, bread, and veggies. I was a cashier for close to 7 years, and WIC was always a really hard process due to the extreme restrictions on what can be covered by the vouchers. I often wondered the why behind WIC and who has access to what. Jung discusses how women who apply to WIC are pressured to breastfeeding exclusively if they want more food and benefits. What this pressure ignores is that mothers in the United States are not given maternity leave and may not be able to breastfeed exclusively for the suggested 6 to 12 months. In addition, all mothers may not be able to produce enough milk for their child or want to breastfeed exclusively if they have other duties (like providing for their family monetarily).

Jung also covers the pumping industry and workplace discrimination around pumping. I had no idea that the average pumping time to empty one breast is 30 minutes! She goes into detail about average pumping prices and time. This section is a must read if you are planning to pump at work.

On the flipside, Jung reviews the history of formula. This industry too is ridden with issues. One of the most shocking parts of the text discusses the promotion of breastfeeding over formula by organizations like La Leche League for mothers with HIV. Jung cites studies showing approximately 22% of babies in some cases have contracted HIV by 6 months of breastfeeding.

I highly recommend this book for anyone looking to learn about breastfeeding and formula from a more cultural angle. At 272 pages, it is a fairly quick read with all the eye-opening, suprising details about how organizations from WIC to La Leche League have promoted breastfeeding even when detrimental to mothers.

An Honest Review of Fitbit for Menstrual Cycle Tracking

You may know that the Fitbit app has some built in menstrual cycle tracking features, but many people do not know that it has other features that may be useful for menstrual cycle tracking. In this article, I will review the pros and cons of the Fitbit app as it relates to cycle tracking for people who ovulate. For context, I use a Fitbit Charge III.

The most basic feature that Fitbit offers for cycle tracking is recording bleeding dates of menstruation and then displaying a predicted fertile window based on average cycle length.

The pink bar represents the length of menstruation. The blue bar represents a predicted fertile window. The flower symbol represents predicted ovulation.

The user needs to remember to input menstuation each cycle. Once it is inputted, Fitbit will generate the blue fertile window. This fertile window should NOT be used for avoiding pregnancy, as it is only based on cycle length and not real-time fertility signs like cervical mucus or basal body temperature.

Once menstruation is entered, it will also begin a countdown until your next predicted menstrual cycle.

Countdown until menstruation in the app.

Unfortunately, I do not find this basic feature very useful for anyone who has any cycle variation. Even though my cycle length has increased over the last year, Fitbit has not automatically updated my cycle lengths. The app does not appear to be very adaptive without user input.

In addition to tracking bleeding the app offers options for:

  • Mood
  • Plan B (morning after)
  • Ovulation tests (better called luteinizing hormone tests)
  • Cervical mucus (Taking Charge of Your Fertility categories)
  • Cyclical symptoms like acne

It is rather disappointing that the app does not include options to mark pregnancy when it occurs, especially since we know that this changes daily calories burned and heart rate, to name just two effected areas of the app.

A really cool feature that I do like is the ability to show cycle trends like flow intensity and cramps. The same screen that displays this will also let you scroll through all past cycle lengths.

In the settings of this screen, you can also decide to toggle off predictions. For people avoiding pregnancy, I do recommend either ignoring or toggling off predictions in the Fitbit app. The app allows you to choose your current birth control method as well.

Outside of the designed menstrual cycle tracking features, I want to highlight resting heart rate as a potential exciting thing to track for those who are not taking hormonal contraception. Why do you need to not be taking hormonal contraception to utilize the heart rate feature for menstrual cycle tracking? Hormonal contraception suppresses ovulation, and ovulation changes our heart rate charts!

To learn more about resting heart rate and the menstrual cycle, read my previous post here.

You can see my heart rate falling during menstruation around April 10th, and then rise during my fertile window and luteal phase.
Menstruation began when my heart rate dipped below 70 on this chart. Ovulation likely occured around the third raised heart rate in this close-up.

Heart rate in people who are ovulating is at its lowest point during menstruation, rises during the fertile window, and continues to be elevated in the luteal phase.

When heart rate begins to drop again, this is an excellent way to predict menstruation will soon occur. For example, I have been tracking my heart rate in Fitbit for 2 years, and I always bleed when my heart rate dips back down to 70 beats per minute after my luteal phase!

I do think this feature is worth tracking for anyone interested in a more precise period prediction than cycle length. If you have Fitbit premium, you can also find a setting for sleeping heart rate under restoration. This may be more steady than resting heart rate for some individuals.

Lastly, I want to address Fitbit temperature for menstrual cycle tracking. Unfortunately, wrist temperatures are not a compatible parameter for fertility awareness when it comes to avoiding or achieving pregnancy. It can be incredibly erratic. When we track temperature, we want the temperature as closest to the core as possible.

Fitbit does not give precise temperatures, instead it gives deviations from a range. I likely ovulated near 18, 19, or 20 on the photo above. While Fitbit did detect a slight shift, it is not particularly clear, and it dropped back down.

As depicted above, my luteal phase the previous month was extremely undefined, and I could not determine a confirmed temperature shift with it.

For now, I do not recommend Fitbit for precise temperature tracking. Instead, I recommend a basal body thermometer.

Conclusion

Fitbit offers some really unique options for cycle tracking, but it should not replace your birth control or fertility awareness method. The heart rate feature may be useful for identifying cycle phases, but the temperature readings are not suitable for tracking cycle phases.

6 Cycle Comparison: Marquette Versus Billings Versus DOT Fertile Windows

Have you ever been curious what your fertile window would look like in multiple methods?

In this blog, I show 6 cycles with various fertility signs and method interpretation including: the sympto-thermal method (Sensiplan rules), Marquette method, the Billings Ovulation Method, and DOT (a calendar method that was recently purchased by Clue app and is a new FDA approved birth control). I chose to include representation for only studied methods of fertility awareness: sympto-thermal, sympto-hormonal, mucus-only, and calendar method.

All charts are from the Read Your Body app, a flexible app for all methods that I highly recommend!

Some things to know before reading:

  • Marquette allows sex any time of day within their rules. My calculation rule lasts until the end of day 7.
  • Sympto-thermal method allows sex any time of day during first 5 days of menstruation, but the first safe day in the luteal phase must be used in the evening. My calculation rule is day 5.
  • Billings Ovulation Method allows sex in the evenings only and on rotated days in the pre-ovulatory time of the cycle. Days of bleeding where mucus cannot be observed are not allowed. However, since you can have sex any time of day post-ovulation with Billings, sometimes cycle day 1 is available if you have sex before bleeding occurs.
  • DOT allows sex any time of day within their rules. It automatically opens my window on day 7.

Cycle 53

Consecutive Fertile Window for Expected Abstinence:

Billings: 8 days

Sympto-thermal: 12 days

Marquette: 12 days

DOT: 12 days

General remarks: This is an extremely standard cycle in length and mucus patch (the average person will have a 5 to 6 day mucus patch when charting). I believe this is a great example of what methods would look like for someone of the average cycle length.

Cycle 54

Consecutive Fertile Window for Expected Abstinence:

Billings: 9 days

Sympto-thermal: 21 days

Marquette: 15 days

DOT: 12 days

General comments: My average coverline is 96.8 to 97.0, so regardless of earlier high temperatures and some illness I felt confident marking this coverline and temperature shift. Due to continous long, clear-ish mucus, my sympto-thermal peak was extremely delayed. Billings is a sensation focused method so I was able to mark my peak at an earlier time and have less expected abstinence.

DOT gave me a very risky day on this one. It is possible I could have been ovulating near the safe day. However, that would have only left 9 to 10 days for implantation and I had spotting, so whether this truly could have ended in pregnancy is up in the air. Even with well-timed sex, pregnancy will not always occur.

Cycle 55

Consecutive Fertile Window for Expected Abstinence:

Billings: 6 days

Sympto-thermal: 12 days

Marquette: 12 days

DOT: 12 days

General comments: This small fertile window in Billings might look scary to some, but it is not possible to get pregnant when the cervical mucus plug is truly closed. I have about one cycle like this every 13 cycles. I was also using the Kegg device during this cycle which is placed internally and reads electrolyte levels to determine the fertile window. It gave me the same 3 day dip for a fertile window, so I feel even more confident that those days were truly dry. I am missing temperatures on this one because my thermometer glitched and would not give me readings on these days. Sex day 1 was allowed because menstruation didn’t start until 5pm.

Cycle 56

Consecutive Fertile Window for Expected Abstinence:

Billings: 8 days

Marquette: 11 days

DOT: 12 days

General Comment: This was an extremely heavy period so I had no period days available in Billings. Even though the other methods gave me available days, I couldn’t have used them due to the pain, so ultimately the other methods didn’t really help out on more safe days.

Cycle 57

Consecutive Fertile Window for Expected Abstinence:

Billings: 10 days

Marquette: 14 days

DOT: 12 days

Cycle 58

Consecutive Fertile Window for Expected Abstinence:

Billings: 9 days

Marquette: 11 days

DOT: 12 days

General Comments: Marquette monitor missed my peak on this cycle. It misses peak on up to 10% of cycles. I relied on meeting LH rules instead of the monitor. Sex day 1 was allowed because menstruation didnt start until 1pm.

Reflecting on What’s Best for Me

I’m currently on cycle 59 charting, and I have tried a ton of methods. Right now, my ideal method is Billings and LH tests as a bonus marker.

While it may appear that Billings gives less safe days in some instances, what is most important to me is having the smallest consecutive fertile window. Having less expected abstinence actually makes me more likely to follow the rules. I was completely unsatisfied with only being allowed period sex in the sympto-thermal method because I have period pain issues. That means that I basically had no safe days at all in reality before ovulation with sympto-thermal.

I originally felt very enthusiastic about Marquette method. However, after 6 cycles of using the Clearblue Fertility Monitor, I realized that it always caught my LH surge after the cheap LH tests. In addition, it missing my peak even once is frustrating for the cost of the product. For that reason, I have decided to stop using the monitor when I run out of tests. I can use a 15 cent LH test and get the period prediction aspect (LH is my most steady indicator).

The DOT app tends to give me a risky cycle whenever I ovulate late and have a shorter luteal phase. I do not rely on this for pregnancy prevention. Overall though, DOT has not given me many risky ways. I use it for long-term period prediction, and it is the most accurate period predictor I’ve ever used for planning months in advance.

What to Consider Before Switching Methods

1. Why are you unsatisfied with your current method? Is it the amount of safe days, or is it the routine that you don’t like?

2. Do you have medical needs that could be addressed by another method?

Sometimes the grass isn’t greener on the other side, but if you are like me and can’t have period sex or don’t want to have period sex, methods like Billings without calculation rules will almost always include more safe days if you are dedicated enough to learn the method and chart it accurately.

Folks in irregular cycles like in postpartum time or with PCOS may benefit from more flexible methods without calculation rules

*DISCLAIMER: DO NOT TRY TO LEARN FROM MY CHARTS. MY CHARTS ARE NOT YOUR CHARTS.

My Experience Becoming a Certified Billings Ovulation Method Teacher

I recently completed my teaching certification for the Billings Ovulation Method through the Billings Ovulation Method Association in the USA (BOMA). This is a cervical mucus / sensation only method that has been taught for over fifty years in over 120 countries.

I began this certification having been quite dissatisfied with my previous certification in the sympto-thermal method. I found the sympto-thermal method inadequate for irregular cycles or postpartum cycles, as well as for any cycles with continous mucus.

This certification 100% cleared up all doubts I had about being able to teach people in these situations! I love that Billing’s motto is “Keep it simple.” Ultimately, this certification gave me the confidence to give up temperature taking as a part of my fertility awareness routine.

First Step:

Before beginning the certification, I took an introductory class with my spouse in the method. This gave me about 6 months to try to apply the principles to my charts before beginning training. I had previously certified in a “Billings-based method” but learned quickly that authentic Billings is a different creature altogether.

I recommend that anyone who is going to train in this method learn to practice it first for at least 6 to 12 cycles under the guidance of an accredited teacher. Joining this program without learning the method first is going to leave you lost on your charts – when you should be confident in your charts before helping others.

Second Step:

The class began in December 2019 and ran through September 2020. We met once a month for approximately an hour (sometimes a little more or less). Inbetween meetings, we were expected to read one to two chapters of material and complete 5 or more worksheets that included chart evaluation and quizzes.

I really appreciated the live classes because my previous certification had no live component. I’m a strong believer that synchronous connection is really important for learning something new.

During class, we were shown PowerPoints and given time to ask questions about the homework. Hearing from long-term accredited teachers about different charting circumstances did wonders for my existing knowledge base. It was incredibly valuable.

Full disclosure: It is important to know that Billings was founded by and is primarily run by Catholics. These meetings often began with prayer or referenced God. Teachers are not required to teach the religious component of the PowerPoint. That means that Billings can be presented in a secular manner. The WOOMB International head organization notably does not include religious elements in their presentation of the method. The science of the method is solid regardless of any ideology attached to it.

Third Step:

The next step after passing an exam on the material was to begin practicum. Practicum is the supervised portion of the certification where you teach 6 to 10 clients minimum in the method while submitting charts and questios to a supervisor selected for you by the organization.

This graphic is how long it took me to finish the practicum portion of the course. Most people take 1.5 to 2 years to finish the program. I went a little faster because I taught larger group classes and had clients lined up before it began.

Practicum was the most enriching part of the experience, and I recommend that anyone who does the training utilize this time to your best advantage. I learned how to help people identify complex basic infertile patterns where they never have dry days. This was not possible in my previous method. I was able to support multiple postpartum women as well as folks with PCOS or who were trying to conceive. I learned so much by meeting with my clients and sending charts to my supervisor.

The follow-ups and classes in Billings are mandatory live meetings (video calling, phone call, or in-person). The follow-ups generally last 15 to 30 minutes depending on the client and how early they are in the process. Follow-ups and classes are required to be live, and this is based on what was done to reach efficacy in the Billings studies. We generally meet with clients seven or more times in the first 6 months, and then every 1 to 3 months. Some people may have more or less follow-ups depending on when they reach autonomy and things like cycle characteristics (postpartum people tend to meet up until the third ovulatory cycle after return of fertility.)

Fourth step:

After having enough clients in different situations (postpartum, trying to conceive, trying to avoid, regular and irregular cycles), I had a final meeting with my supervisor. Before this, I had to compile a document of every client chart. This was a bit laborious as the Billings charts cannot be exported to PDF without losing part of the chart. I had to screenshot segments of the charts and then re-assemble them. This meeting with my supervisor lasted about two hours, and we discussed all of my client charts and any corrections that needed to be made.

Following that, I was recommended for the final step. I recieved a mailed in exam that involved correcting a full paper chart and writing why I made those changes and what mistakes were originally made.

I turned in this exam to two graders. They then met with me and discussed the chart and any necessary corrections. They approved my certification at the end of the meeting.

The Future

Billings Ovulation Method teachers are required to do continuing education to maintain their certification. This is an investment of approximately $300 to $600 every three years. While this is costly, it is really important to attend further training where the teacher can see more advanced charting techniques and learn about health conditions, efficacy, and more!

My Final Thoughts

I would recommend this certification program to anyone who is interested in having an in-depth understanding of cervical mucus charting. The Billings Method teaches about things like the “pockets of shaw” and the cervical mucus crypts. My previous certification did not include close study of the patterns of cervical mucus. This program fundamentally changed my thinking about temperatures always being a necessary part of charting. I ended up dropping temperatures completely after 3 years of using basal body temperature.

Billings allows teachers to order all supplies, including digital materials, for clients. This means I do not have to produce my own materials, and it is super useful for quickly mailing clients what they need.

To make the most of out of this program, I recommend also reading the scientific studies on the side. Unfortunately, the program did not go into a lot of depth on the previous research studies. As someone in academia, I really like understanding all the different correct use and typical use statistics. I’m often questioned about efficacy, and I want to be able to answer people’s questions. If this also describes you, I recommend the following articles:

The Discovery of the Different Types of Cervical Mucus

Use-effectiveness and client satisfaction in six centers teaching the Billings Ovulation Method.

Field trial of billings ovulation method of natural family planning.

A prospective multicentre trial of the ovulation method of natural family planning

A Trial of the Ovulation Method of Family Planning In Tonga

A Response: In Defense of Truth in the Science of the Billings Ovulation Method

Misrepresentation of contraceptive effectiveness rates for fertility awareness methods of family planning