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.
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.
Did you confirm ovulation with basal body temperature, PdG strips, or a blood draw in the previous cycle?
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.
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!
Boetze, Iosef. “Further Evolution of the Sympto-Thermal Methods.” International Review of Natural Family Planning 1 (1977): 139-150.
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 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.
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:
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!
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.
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.
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.
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.
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.
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.
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.
Consecutive Fertile Window for Expected Abstinence:
Billings: 10 days
Marquette: 14 days
DOT: 12 days
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.
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.
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.
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.
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.
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.)
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.
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:
This article is for the husbands, boyfriends, spouses, or sexual partners of anyone using a form of fertility awareness for pregnancy prevention.
Charting cycles for pregnancy prevention is a big life change, especially for the female charter. While the charter has to learn to interpret their cycles, it is fundamental that they have a supportive partner in the process.
So, What is Fertility Awareness?
Fertility awareness involves tracking one or more bio-markers of the female cycle. These bio-markers include: cervical mucus, basal body temperature, cervical position, urinary hormones, and cycle start dates. The bio-markers are used to draw a fertile window. Fertility awareness has been studied scientifically for nearly a hundred years. There are a plethora of studies on the topic. Click here to read the 2018 Overview of FABMs. In general, you can expect approximately 98 to 99% efficacy across all modern fertility awareness methods.
Your partner will be tracking based on whatever method she chooses. A method is a way of categorizing bio-markers. For example, I teach the Billings Ovulation Method. This method tracks the bio-marker cervical mucus along with sensation felt at the vulva.
One of the first things you will learn when charting is that MALES ARE FERTILE 24/7. Females are fertile only cyclically, and on average the fertile window will be for less than 1/3rd of the female menstrual cycle.
In the beginning, there is sometimes a steep learning curve with tracking these signs. Your partner may forget to check cervical mucus at every restroom break or they may be erratic in taking their temperatures. Your role at this time is be supportive. If you are living with your partner, you can help remind her to take her temperature upon first waking (if they are choosing to chart this sign!) You may also want to take part in keeping the chart.
While it is relatively rare for the partner to help chart, it is encouraged that you learn how to help classify her fertility signs or read the chart if possible. In the very least, you need to learn to respect your partner’s fertile window and not expect to ejaculate inside the vagina in the fertile window. I’m being blunt here. You will get used to “TMI” with charting! You can learn to understand the cycle by taking a class together. This is a great activity for bonding, and so that you have more equal responsibility in your family planning.
An easy way to get involved in your partner’s charting routine is to use a paper chart. I keep a paper chart on the bedside table. It is always visible. My chart is pretty easy for my partner to read because the “baby” symbols mean possible fertility. You could do this with any method. Sit down together when you record the observations. Have your partner to explain what the fertility status of the day means.
But Why Would I Attend a Class or Learn About Charting if I’m NOT the Female Partner?
Because you want to be a good, supportive partner!
When you understand your partner’s chart, you understand the chance of pregnancy that you both have. This can prevent mistakes from occurring if there is more than one set of eyes on the chart. When you become attuned to your partner’s menstrual cycle, you will also begin to realize why their mood might change throughout the cycle. This is fantastic for relationship communication. Your partner is not perfect. They may make mistakes when charting. Two is better than one for catching these!!
How Will We Avoid Pregnancy in the Fertile Window?
One of the first things you will learn when reading a fertility awareness book or taking a class is that you are expected to abstain from penis-in-vagina sex in the fertile window.
The reason for this is simple: it is only possible to get pregnant in the fertile window.
If you have penis-in-vagina sex in the fertile window, there will always be a chance of pregnancy. If you are avoiding pregnancy, this means that sex in the fertile window could result in an unintended pregnancy.
During this time, it is suggested that the couple work on other aspects of the relationship. Go on dates, cuddle, talk, play games.
If you decide to break the rules by having sex, you should be prepared for the possibility of pregnancy.
For Catholics, this is the only “licit” option for the fertile window.
For non-Catholics, oral sex and sex involving hands is safe in the fertile window as long as no semen ever gets near the vulva or the vagina. If semen touches this area, pregnancy can occur.
To determine how you will proceed in the fertile window, you and your partner should place yourself on the intentions scale. In the context of fertility awareness, intentions means how open you are to pregnancy.
The basic possible intentions follow. Select which is most appropriate to you as a couple. TTA means “Trying to Avoid” a Pregnancy.
TTA Seriously Avoiding: For these people, an unintended pregnancy may be devastating, whether to health, the relationship, or finances. A pregnancy is being avoided very strictly. These people should adhere to the rules of their method as closely as possible.
TTA Regular Avoiding: For these people, pregnancy is being avoided and the rules are followed. A pregnancy wouldn’t be convenient, but it would not endanger their life.
TTA Loosely Avoiding: For these people, a broken rule isn’t the end of the world. They may do strategic risk-taking like breaking rules on the cusp of the fertile window, or using something like the withdrawal method in the fertile window. They are not actively seeking a pregnancy, but they are okay with some chance of it happening.
TTW Whatever Happens: For these people, pregnancy would be okay whenever it happens. They break whatever rules they want. They aren’t actively timing sex for the most fertile days, but it might happen.
TTCTrying to Conceive: For these people, the rules do not have to be followed. They actively try to have sex in the fertile window.
You and your partner should discuss this scale and decide where you land before utilizing the fertility awareness method for sex.
What If We Decide to Use Barriers in the Fertile Window?
Remember, while you are fertile 24/7, your female partner is not. It is really important that if you are avoiding pregnancy that you respect your partner’s fertile window.
Some couples decide to use condoms, the withdrawal method, or diaphragms in the fertile window.
The most likely time for a barrier to fail is in your fertile window. After all, you aren’t using them at the other times of the cycle.
I personally believe that a couple has the right to make an informed choice in the fertile window. In particular, the male partner should realize that he is the one putting on the condom or pulling out. If he fails to do either correctly, a pregnancy can result. If you use these methods, do the research and inform yourself about how to use them correctly and what their efficacy is. If you are okay with this risk, you can use barrier methods. At the point you use a barrier method – you are outside of correct use for the fertility awareness method. Always remember that. An unintended pregnancy would be classified as a user error or barrier method failure.
How Long Does it Take to Practice Fertility Awareness Confidently?
On average, you will want to do at least 3 to 6 cycles of follow-up with an instructor to be completely autonomous and confident in charting. When you work with an instructor, you may be able to start utilizing the method to avoid pregnancy as sooln as the first cycle charting! (This is assuming that your partner has been diligent in their charting).
If you have PCOS, are coming off hormonal birth control, or are breastfeeding, you may need close instruction for longer. The Billings Ovulation Method recommends following up until the third ovulatory cycle postpartum. This could take a year or more if fully breastfeeding.
To Male Partners:What Advice Would You Give Male Partners Who Are New To Fertility Awareness?
These responses are taken from a 2019 survey I did on the male partners of FAM users. Enjoy!
“At first it seems backwards since science has a simple fix for conception: hormonal birth control. Some women are fine on hormonal birth control. Some can be really crazy on it. With some women, it can even kill their sex drive. With mine, she becomes so crazy that it kills both of our sex drives. So we’re doing this weird fertility awareness thing. Here’s my advice if you have a woman like mine. Even though she’s so beautiful and sexy that you just want to risk ejaculating in her to possibly get her off, you can’t do it with this. Yes, it puts more pressure on you to wear a condom and/or pull out, but at least your wife isn’t batshit crazy. And she’s still horny. So it’s worth it. Plus you learn a lot about the female body because I guarantee she’ll keep you up at night telling you about it lol. So don’t complain. We’re still getting laid. Unlike our friends who’s wives are on the pill or IUD. It just puts more pressure on us to prevent a baby. If she gets pregnant again, it’s probably our fault with this. And I’m ok with that. War Eagle!”
“You will wish you had always known this information. Test your pre-cum under a microscope for sperm if you are going to use withdrawal.”
“Knowledge is power and pleasure.”
“To do the research to fully understand the anatomy and physiology which will give you confidence in trusting the fertility awareness method.”
“Good luck m’a friend.”
“Don’t be afraid to ask questions!”
“Be patient and understanding whilst always at least attempting to understand the technicalities surrounding the practice of the method.”
“Read as much information as you can and stay informed.”
“Trust your partner, but do some cursory research as well. You both need to understand it to trust it.”
“Learn the actual science (as in the research literature) behind these technologies. Much of the medical establishment unfortunately has both insufficient and badly-outdated knowledge about FAM. Also, such will only be successful if the couple are both wholly on-board and possess the necessary knowledge, discipline, and self-control to utilize the method(s) correctly, whether trying to conceive or to avoid.”
“Get ya woman on it like yesterday.”
“Talk to your significant other and learn from her.”
“Learn about which days are the best to get pregnant; if you want to get pregnant together there is a way to learn the best days with a good degree of certainty. I think other men could benefit from learning this information about their partner.”
“Learn how the world works, and use that knowledge.”
“Listen to your woman and trust what she says about her observations. It’s not like the guy is the one using the method, but it’s good to be aware of it.”
“If you think it’s burdensome, remember the health and relationship benefits far outweigh the daily minor inconveniences. Encourage your SO to do the research to make sure they’re doing it right as well.”
“Shut up, pay attention.”
“If you are concerned about the well being of your partner, you’re more likely to succeed in supporting her and have an involved role in fulfilling both your reproductive goals through fertility awareness.”
“Take a lesson yourself or attend one with your partner, you are only going to trust it if you understand how it works yourself. When you actually see that it makes sense, it’s not some weird alternative thing, you can trust it a lot more.”
This resource is a simple overview of the rules with examples. It links to other resources on understanding the female and male reproductive system. This is a good, fairly quick read for men who want to understand the basic rules.
Jessie discusses her symptoms that lead her to stop taking hormonal birth control. She then does a brief overview of how the fertility signs change throughout the cycle and how sperm life plays into fertility.
This also leans religious but may be useful for men who are having trouble adjusting to avoiding unprotected sex in the fertile window.
“Use of Natural Family Planning (NFP) and Its Effect on Couple Relationships and Sexual Satisfaction: A Multi-Country Survey of NFP Users from US and Europe.” Front Public Health. 2017; 5: 42. Published online 2017 Mar 13. doi: 10.3389/fpubh.2017.00042
This is a recent scientific article that studied the effect of NFP on relationships.
In the fertility awareness world, there are many misconceptions about mucus-only methods. While I cannot speak to mucus-only methods that I have not trained in, I can speak for what I have learned in training in the Billings Ovulation Method. There is so much history of the development of the method that I cannot touch on everything here. For those wanting to learn more, this document goes over some of the history of the method. Outside of that, WOOMB has many useful links.
First and foremost, the usual criticism leveled at mucus-only methods is that they have a low efficacy rating when compared to the sympto-thermal method. However, this is much more nuanced than it may appear at first glance. Let’s look at the most often quoted study for Billings.
This section of statistics is copied directly from a WOOMB International breakdown found here:
“1976-78 an independent trial was conducted by the WHO, in five countries (India, the Philippines, New Zealand, Ireland and El Salvador).
This study had two phases: 869 couples entered the three-month ‘teaching phase’, 725 couples continued in the 13-cycle ‘effectiveness phase’, with a total of 10,215 cycles in the entire study.
The teaching phase showed that in the first cycle of charting, 93.1% of women were able to record an identifiable ovulatory mucus pattern denoting fertility, and that by the third cycle of charting, 97.1% of women had an excellent or good interpretation of the method.
The results for the entire study were: 2.2 pregnancies/ hwy (per 100 woman years) – method-related pregnancy rate 22.3 pregnancies/hwy (per 100 woman years) – total pregnancy rate
The total Pearl Index – 22.3/hwy comprised: • Conscious departure from the rules of the method: 15.4/hwy. • Inaccurate application of instructions: 3.9/hwy. • Method failure: 2.2/hwy. • Inadequate teaching: 0.3/hwy. • Uncertain: 0.5/hwy.”
The first thing you should notice is that perfect use was 97.8%. This is pretty high. The second thing you should notice is that typical use includes people who knowingly broke the rules! All typical use always includes this. This statistic of 22.3% typical use failure is used to scare folks away from mucus only, especially when compared to one specific sympto-thermal trial by Sensiplan. However, the Thyma double check sympto-thermal had a 35% typical use rate in one trial. No method is impervious to bad typical use rates because this is dependent on how open someone is to pregnancy, as well as cultural factors. This is a flaw (depending on your perspective) of all FABM methods; someone can choose to achieve pregnancy because fertility is not suppressed.
The next thing to consider is that the older statistics of the Billings Method were based on a different peak rule, a very similar peak rule to which all sympto-thermal methods have adapted. As Billings continued to develop, the method was strengthened by over 850,000 hormonal assays completed by Dr. Brown which tested estrogen, follicule-stimulating hormone, progesterone, and luteinizing hormone. These tests were matched to Billings Ovulation Method charts. The method has been scientifically validated in over 10 total trials.
As the method was studied, the peak rule was changed to help women recognize patterns of fertility and infertility. They discovered when the specific peak rules were met, a changing and developing pattern of discharge and sensation <more specific rules apply to this>, ending at a slippery sensation felt at the vulva 《with walking sensation》and followed by an abrupt change to no longer slippery or wet, that a woman could detect a false mucus patch build up without the need for temperatures. Because of the science that Dr. Brown, Dr Evelyn and John Billings, and Dr. Odeblad verified through numerous studies, they were able to strengthen the mucus only method enough to no longer rely on temperatures without fear of double peaks. The most recent Billings study in China found a 100% perfect use rate and a 99.5% typical use rate when users were very strictly avoiding and highly motivated with the rules.
In short, the Billings Ovulation Method is very effective and for careful charters does not suffer the problem of false peaks. Again, I have barely scratched the surface of all the trials and science involved. I recommend researching Erik Odeblad and the pockets of shaw for more information.
So why do mucus-only methods get such a bad wrap? In the secular communities, I think there are a few main reasons.
1. The methods must be learned through a teacher. Learning these methods takes dedication and regular live (or online) meetings with a real person. Most folks don’t feel like making this effort or think they can’t afford it. Billings has a policy to never turn anyone away in need. Many do free services or payment plans when asked. There is also a charity associated with Billings that can sponsor Catholic couples to help them afford classes.
2. The next reason is that many sympto-thermal users have fundamental misunderstandings of what Billings is. As a certified sympto-thermal teacher and someone who has read about fifteen books on sympto-thermal, it is dissapointing how much of the original science of fertility and the cervix is left out of our materials. My mind was blown when I discovered how things really work when learning a mucus only. From the pockets of shaw to the functions of the cervical crypts, there is so much to learn that is not included in Taking Charge of Your Fertility. This does a great disservice to sympto-thermal charters.
3. Due to these misunderstandings, they think the method cannot be used by those with irregular cycles. They also may think that a non dry basic infertile pattern is not possible due to a misunderstanding of the science of the cervical plug and the effect of estrogen in the vagina.
Potential Cons of Mucus Only:
I do not say any of this to say that the Billings Method is right for everyone. It takes dedication and a willingness to follow the rules if strictly avoiding pregnancy. In addition, there are a few cons to mucus only.
1. A yeast infection or bacterial vaginosis would obscure observations and cause abstinence. However, arguably even a sympto-thermal user would need to abstain when they have an infection.
2. Women who are careless with mucus observations may end up with an unintended pregnancy. If you don’t want to track mucus carefully, this is not the right method for you. If you can’t follow the rules to safely have intercourse, such as evenings only during basic infertile pattern on alternate evenings in the pre-ovulatory time of the cycle, this method may be too restrictive for you.
3. A weak mucus patch that does not fulfill the stringent peak rules may cause more abstinence without a temperature shift to confirm. However, this often signals a potential health issue and should be investigated.
4. Mucus only methods do encourage abstinence when avoiding pregnancy. However, most sympto-thermals do the same. Anyone who is okay with an elevated risk due to barriers or alternative protected sex can always do what they want to do but should be prepared to face the consequences if a barrier method fails.
Mucus only methods can be highly effective choices for avoiding pregnancy. Recent trials of Billings consistently show 99% or better with perfect use. In some cases, they may reduce abstinence because they allow women to identify false mucus build ups that do not lead to ovulation and non-dry basic infertile patterns. For women who want to eliminate barrier method usage, they offer a way to identify fertility in real time when in irregular cycles due to PCOS, postpartum, or perimenopause. This eliminates much of the extended abstinence or barrier method usage that sympto-thermal users may experience.
I’ve been moderating a rather large Facebook group for fertility awareness charters for over a year and a half now (26,000 members and climbing, join here!), and before that I constantly scrolled through the Kindara community charts very regularly. These experiences in various FAM communities, as well as my certification as a FAM instructor, have alerted me to some common mistakes that new charters make. I outline what these are and how to avoid them in this post.
Mistake #1:Using a Fever Thermometer Instead of a Basal Body Thermometer
Many folks read Taking Charge of Your Fertility and see that we only chart to the first decimal place in Fahrenheit. Then they think that using a fever thermometer is okay since fever thermometers have only one decimal place. This is NOT true. We need the sensitivity of a basal body thermometer with two decimal places. If you are someone who has weak temperature shifts, it is even more important to have the right thermometer! Many people also miss that the original studies that the symptothermal efficacy is based on requires you to take your temperature for three minutes. Almost no fever thermometer does this, and even some basal body thermometers do not. Make sure that you have the correct thermometer that allows you to either take your temperature for three minutes or prewarm the thermometer.
Mistake #2: Overmarking or Undermarking Cervical Mucus Observations
I often see people overmark “watery” type mucus because the vagina is always moist. Other people will overmark “creamy” type mucus even though what they are seeing may be cell slough. While it is definitely better to assume fertility if you are uncertain, this can cause unnecessary abstinence. The solution to this problem is to work with an instructor. The efficacy of the method is based on working with an instructor anyways, and it is generally best to get a professional’s advice on your chart if you are seriously avoiding pregnancy. If you need an instructor, you can find one here.
I also see people undermark cervical mucus. This is the more dangerous of the two mistakes. Many people decide not to pay attention to wiping or walking sensation or view sensation as less important than their visible mucus. Since vaginal sensation is equal to cervical mucus, it is highly important that you also chart your sensation according to whatever method you are following. If there is any change in vaginal sensation, even if you do not see mucus, the fertile window should be considered opened in the pre-ovulatory time of the cycle.
Mistake #3: Following a Hodge-Podge of Methods
The fertility awareness method only works as a form of birth control when the rules are followed very carefully according to an established method. Simply beginning to take your temperature and marking mucus without reading a manual or taking a class is NOT enough for anyone who seriously does not want to get pregnancy. Do NOT rely on social media posts to learn how to chart. It is necessary to really learn what you are doing if you do not want an unintended pregnancy. You can find out about multiple methods by visiting my post on getting started.
Why did I choose to become a fertility awareness educator?
Fertility awareness is the sex education I wish I learned in middle school.
When women actually learn how their fertility works, they learn that getting pregnant is not as easy as the drop of a hat. We learn to appreciate and live with rather than work against our fertility.
Almost every person who I’ve seen read #takingchargeofyourfertility or take a FAM class comes out of the experience saying, “Why have I not always known this information? I wish I could have known this when I was younger!” Learning fertility awareness changed my life, and I know it can change yours too.
Do I believe FAM is the right method of birth control for every woman?
No, it is probably not.
But I do believe that every woman should be taught how to understand her own body. What she does with that information is up to her.
Fertility awareness gave me the ability to avoid pregnancy on my own terms. It gave my spouse more knowledge about my body and the changes I experience during my cycle. It has strengthened my relationship in more ways than I can name.
I am so excited to be offering this new course for those interested in learning the symptothermal method of fertility awareness. The method I teach is based on the rules studies by Sensiplan. You can read about this study here.
I found fertility awareness after 7 years on the pill, and it really rocked my world. When I started practicing it myself, I realized that it was a grave injustice that women are not taught about FAM. Practicing FAM has put me in touch with my body more than ever before. It healed some of the mind/body split that I had developed through years of resenting my period.
I teach a secular form of fertility awareness including information on barrier methods (condoms, diaphragms, etc). The NFPTA method has the same temperature rules as Sensiplan. I teach cervical mucus, cervical position, basal body temperature, and calculation rules (the doering rule and minus 20 and 21 rules). My distance course is offered on Moodle. It is a 4-week self-paced course that includes video charting examples and information on charting during all life circumstances (perimenopause, postpartum, postpill, and TTC). This class opens in December. Your partner is welcome to ask me questions and take the course along with you.
If you already have charting experience from reading TCOYF or the Sensiplan file (3 or more complete cycles), I will extend a discount to you if you decide to work with me. Reach out to me to find out more. I will also likely be holding a live introduction to FAM session in early December.
*Disclaimer: These methods only work as well as the user. Even with perfect use, there is still a .4% chance of pregnancy. Using a calculation rule is built into the efficacy, and ignoring calculations may result in unintended pregnancy. I will work closely with you so that you understand the rules, but it is ultimately on the user to follow them.
Many people come into FAM overwhelmed by all the data that they have to collect daily. It can be a bit of a turn off for those new to the method. They may wonder why they have to check their cervical mucus ALL day and then set an alarm on top of that.
When you first begin charting, it is vitally important to try to get the information down every day so that you can get into a habit and make sure that you are following the rules. Missing information will leave you with less complete charts that could leave you confused as to whether ovulation is confirmed or not.
However, once you have been charting for a significant amount of time and become confident, you can stop recording fertility signs once you have confirmed ovulation.
I am headed into chart number twenty-two successfully avoiding pregnancy with FAM, and I have been shortcut charting most of the time for about seven cycles now. I personally recommend confirming ovulation in 12 cycles before shortcut charting. This is so that you know how early you ovulate, your normal temperature levels, and how to tell whether something abnormal is going on in your cycle (ie sickness causing temperatures to be higher than normal or an abnormal cervical fluid dry up due to cold meds or some other medication).
Toni Weschler, author of Taking Charge of Your Fertility, recommends that women have several months of experience in the standard rules before taking any shortcuts. She offers some modified guidelines to follow and emphasizes that “contraceptive efficacy won’t be compromised as long as both your fertility signs have confirmed that ovulation has already been confirmed for that particular cycle.”
The Modified Rules
You don’t have to take your temperature during your period.Toni explains that these temps may be unreliable anyways. However, if you have short cycles with early ovulation, you may need those temps in order to confirm ovulation. If you have a temperature shift CD12 or sooner, you will need some period temps in order to have enough temperatures to draw a coverline.
You don’t have to take your temperature after you confirm ovulation with temperature rules. This means at least 3 high temperatures with a standard shift. If you have weak shift or a fall back rise, you must have the extra temperatures needed to fulfill those rules before you stop taking your temperature. Some people take their temperature again a day or two before they expect their period since it can (but not always) give an indication that menstruation is approaching.
You don’t have to check cervical mucus after you confirm ovulation. You will need to check until you meet peak rules (P + 3) and crosscheck this with 3 high temperatures before you can stop checking for cervical mucus. Again, if you have a weak shift or fallback, you will need to check until you meet the rules.
From the day after your period until the day you observe peak type fluid, you should check cervical mucus continuously throughout the day and follow all rules for mucus checks. However, you don’t have to check cervical mucus multiple times a day once you observe peak fluid. If you observe peak fluid first thing in the morning, there is no need to keep checking. You have already recorded your most fertile observation for the day.
Those are the basic changes when short cut charting.
Here is an example chart.
This woman does not take her temperatures during her period. She begins taking her temperature on CD6 when menstruation ends. She checks her cervical mucus multiple times a day and follows the rules for checking until CD11. On CD11, CD12, and CD13, she observes eggwhite mucus first thing in the morning and doesn’t check again. On CD14-CD17, she checks mucus multiple times a day because she knows she needs at least a 3 day dry up (P + 3) to confirm ovulation. On CD 15, she has her temperature shift. CD16 is above the coverline. CD17 confirms ovulation because it is at least .4 F above the coverline. Ovulation is officially confirmed with both peak and temperature rules met. She takes her temperature again on CD26 to see if she gets a temperature drop indicating that her menstruation may begin soon.
People Who May Want to Think Twice about Short Cut Charting
Not everyone is suited to short cut charting.
Charting for Health: If you are charting for health, you may want to record your signs every day. Odd cervical mucus patterns and temperatures can indicate health issues. If this is your goal for charting, short cut charting may not be right for you.
Using Tempdrop: Tempdrop says to wear the device every day. If you don’t, it could disrupt the algorithm. As far as I know, they do not recommend short cut charting at this time. If you use this device, you may not want to short cut chart if you are worried about being at risk of pregnancy.
You aren’t confident in charting: If you are not confident in your ability to chart, you should NOT short cut chart. You should be 100% confident in your abilities before attempting this.
You are sick: If you are sick, you may want to chart more diligently and stay protected if you are uncertain about your chart interpretation.
You are only charting one sign: You NEED two signs in order to short cut chart. If you pick just one, you may be putting yourself at risk of unintended pregnancy. Ovulation must be confirmed with two signs.