fertility awareness education – Leslie at Chart Your Fertility

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).

Percentage	Time 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

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

A Dive Into Resting Heart Rate and the Menstrual Cycle

I purchased a Fitbit device close to two years ago, and within months I noticed that my heart rate appeared to be correlating with the phases of my cycle. I’ve been charting resting heart rate since 2018, and I can say with confidence that it has lined up every cycle. This shouldn’t be too surprising because we already know that progesterone causes basal body temperature to rise, but heart rate does not exactly follow that pattern. Heart Rate also rises in response to high estrogen levels in the fertile window.

We have known about the possible connection between heart rate and the menstrual cycle for over a century, but in the last 50 years a few studies have taken a closer look.

Palmero (1991) studied 64 women for 3 consecutive months and created a PMS group versus a non-PMS group. They found that “in the premenstrual phase, PMS group showed significantly higher resting HR levels than NPMS group.”

Moran (2000) followed 26 women and found that “resting-heart rate was significantly higher in both ovulatory (P < 0.01) and luteal (P < 0.01) phases than in the menstrual and follicular phases.”

Shilaih (2017) followed 91 women and found that they “observed a significant increase in pulse rate (PR) during the fertile window compared to the menstrual phase (2.1 beat-per-minute, p < 0.01). Moreover, PR during the mid-luteal phase was also significantly elevated compared to the fertile window (1.8 beat-per-minute, p < 0.01), and the menstrual phase (3.8 beat-per-minute, p < 0.01).”

I want to highlight these last two studies in particular, because many of the other studies have an issue. Marco Altino explains why:

“The great majority of studies looking at HRV and the menstrual cycle collected one single data point during the follicular phase and one single data point during the luteal phase. I don’t have to tell you how little sense that makes, considering the high day to day variability in these parameters.”

This is an excerpt from his blog on heart rate variability in the menstrual cycle. Read the full blog here.

The 2017 study published in Nature by Shilaih, et al found that heart rate may rise up to 5 days before ovulation occurs. This means that heart rate could potentially be a used as a way to time intercourse for conception.

My results are so steady with resting heart rate that I dream of someone using it in a long-term study with other fertility signs. Wouldn’t it be cool if we could avoid pregnancy using heart rate too?

Below is an example of my results with resting heart rate. To convert my heart rate to fit in a fertility awareness app, I use a conversion. Essentially, one heart rate beat = .1 Farenheit change on my temperature scale. A heartbeat of 69 becomes 96.9, 70 becomes 97.0, 71 becomes 97.1 This preserves the original ratio, and it allows me to show the data with other fertility signs. For your own conversion, you may model this. If you have a lower heart beat rate, you can still convert, but you may need to do an additional equation.

My resting heart rate rose during the most fertile days of the cycle. Ovulation most likely occured on Cycle Day 15 or Cycle Day 16 on this chart. In addition, while I have not found evidence of this in the literature, I have observed that I tend to get a one day rise 3 to 4 days before the fertile window opens with cervical mucus. On this chart, that was Cycle Day 6.

A second example. Ovulation most likely occured on Cycle Day 14, 15 or 16. Heart rate rose on Cycle Day 14.

In conclusion, I believe that resting heart rate is a very unique sign to track, especially if you already use a wearable fitness tracker. I will note that a false heart rate rise can be caused by illness, alcohol or food close to bedtime, nightmares, and more! This is not dissimilar to what can obscure a temperature. I hope that in the future more studies are done so that we can see if heart rate can also be used for avoiding pregnancy purposes.

Selected Heart Rate Study Citations

Moran, V. H., Leathard, H. L., & Coley, J. (2000). Cardiovascular functioning during the menstrual cycle. Clinical physiology (Oxford, England), 20(6), 496–504. https://doi.org/10.1046/j.1365-2281.2000.00285.x

Palmero, F., Choliz, M. Resting heart rate (HR) in women with and without premenstrual symptoms (PMS). J Behav Med 14, 125–139 (1991). https://doi.org/10.1007/BF00846175

Shilaih, M., Clerck, V., Falco, L. et al. Pulse Rate Measurement During Sleep Using Wearable Sensors, and its Correlation with the Menstrual Cycle Phases, A Prospective Observational Study. Sci Rep 7, 1294 (2017). https://doi.org/10.1038/s41598-017-01433-9

A Day in the Life of a Billings Ovulation Method User

Have you ever wanted to know what it is like to chart with the Billings Ovulation Method? This blog attempts to give an overview of what it is like for one individual to chart with the Billings Ovulation Method (BOM) over a single cycle. I go through each day of the cycle and explain my overall charting habits. All times are just approximate. I get personal and discuss some challenges I experience with natural family planning. BOM involves tracking sensation felt at the vulva along with the visible appearance of cervical mucus as a person goes about their day to day activities.

Day 1: Record heavy bleeding. Heavy bleeding feels wet. Done! Users are not allowed to use heavier days in the Billings method when avoiding pregnancy. This is a true day one of a cycle because it was preceded by a Billings peak day.

Day 2: Record heavy bleeding. Heavy bleeding feels wet. Done!

Day 3. Record medium bleeding. Medium bleeding feels wet. Done!

Day 4: Very light bleeding. It is now possible to observe my basic infertile pattern of dry.

8am: I feel dry and see a small amount of blood.

10am: I still feel dry.

8pm: I still feel dry. I see no mucus. Sex is allowed in the evening of this day. We use this day.

Day 5: Extremely light bleeding. Technically this day is not allowed for intercourse since I used the day before and Billings method rotates alternative evenings. We use this day anyway #rulebreaker

Day 6: I feel dry. I do not see anything. I record this day as “possibly fertile” since I broke a rule and used the day before. Every day after intercourse gets this white stamp in the pre-ovulatory time of the cycle.

Day 7: My basic infertile pattern of dry is still there! I notice nothing the entire day in the bathroom and my vulva sensation is dry. Sex is allowed in the evening. I consider my evening 8pm because I go to bed around 9pm on average. We use this day.

Day 8: I feel dry all day and see nothing. However, this day is not allowed since Billings alternates days. We skip this day.

Day 9: I feel dry all day and see nothing. However, we do not use this available day because we are both tired. It happens!

Day 10:

9am: I feel a bit moist. I don’t see anything when wiping in the bathroom.

11am: Still feel moist. I do not see anything in the bathroom.

2pm: Still feel moist. I do not see anything.

4pm: Still moist. Nothing seen.

4:45pm: Walking to my car from work. Still moist!

8pm: Overall observation for the day is moist. I record it. The fertile window has opened. This is known as the point of change.

Day 11:

7am: I feel moist as soon as I walk to the bathroom. I see very scant clear mucus on the tissue.

I do not see or feel anything for the rest of the day.

8pm: Overall observation for the day is “moist, clear”

Day 12:

7am: I feel moist, but see nothing.

10am: I feel moist, but see something white.

8pm: The feeling remains the rest of the day. I record “moist, white” for the day.

Day 13:

7am: I feel dry.

11am: I still feel dry.

1pm: I feel wet sensation when walking to my office. This is a change, so I keep that in mind.

I feel damp the rest of the day. I never see anything in the bathroom. I record “wet” as the most fertile sensation that day.

Day 14:

6:30am: I immediately feel moist.

9am: I see long clear strings when wiping in the bathroom.

11am: I have a wet sensation when walking around.

3pm: I walk around my work place. I still feel moist.

5pm: I see clear strings again.

8pm: I record “wet, clear strings” on my chart.

Day 15:

7am: I feel a gush as soon as I wake up. I do not see anything in the bathroom.

9am: I see scant, clear mucus on the tissue when wiping.

11am: I feel very wet walking around my work place.

1pm: I do not see anything on the tissue.

3pm: I do not see anything on the tissue.

5pm: I feel wet sensation while making dinner.

8pm: I record “wet, clear” as my observation for the day.

Day 16:

7am: I do not feel or see anything when waking up.

9am: I still do not feel or see anything.

12pm: I go for a 20 minute walk. When I get back, I feel slippery sensation. I go to the bathroom and see copious amounts of long, clear mucus.

8pm: I felt slippery the rest of the day. I record “slippery, long clear” on the chart.

Day 17:

6am: I feel dry when waking up.

8am: I don’t see anything or feel anything.

11am: I don’t see anything or feel anything.

8pm: The day was nothing felt, nothing seen all day. I record dry. This means yesterday was my peak day because it was a changing and developing pattern ending in slippery followed by an abrupt dry up to no longer wet or slippery.

Day 18 and Day 19:

I have the same experience as day 17. I pay attention all day and observe no mucus or sensation.

Day 20:

Ovulation is expected to be over and the cervical mucus plug has re-closed for the cycle. Sex is available any time for the rest of the cycle until day one of menstruation occurs. I can chart, but it is not necessary to wait until the evening and observations are less important as sex may interfere at any time.

Day 28: I record heavy bleeding and the rules restart.

Real Talk: Diffulties / Obstacles With Billings Not Seen on the Chart

These are things that I find can be difficul in my own personal experience. I know that people in really long cycles or with other irregularities may have different issues than me.

Challenge One: Alternative evenings only can be a struggle, and it seems even harder for me right before the fertile window opens due to my mood at this time of the cycle. This follicular phase is much longer for me than my luteal phase on average, and this means alternative evenings is the rule for most of my cycle. If someone has a partner with a conflicting schedule, this can especially be offputting. I think anyone who is going to practice this method should consider whether this is practical for their lifestyle.

Challenge Two: Expected abstinence in Billings can be hard, and I have fairly short fertile windows on average. I originally practiced sympto-thermal, and I switched to Billings when I realized that overall consecutive abstinence was much less overall (for my own cycle, Billings: 9 days, Sympto-Thermal: 14+ days). I tend to break some rules still, but this is much more suitable for my fertility intentions level than sympto-thermal.

Look out for my next blog on “A Day in the Life of a Marquette User.”

Disclaimer: Do not try to learn how to chart from this post. Everyone has their own unique cycle and this is just an example of charting with Billings in a regular cycle. Please reach out to me if you would like to learn this method with me as your guide. Alternatively, you can find a teacher here.

In Defense of Mucus-Only Methods (Specifically Billings Ovulation Method)

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.

Conclusion:

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.

An Honest Review of Proov PdG Tests

Are you interested in testing your progesterone at home with Proov?

If you decide to purchase, use promocode: CHARTYOURFERTILITY for 30% off the original PdG tests or Proov and Confirm.

Proov tests check levels of the hormone metabolite PdG in the urine. Proov tests are an FDA approved product. People who are ovulating produce the hormone progesterone after ovulation. If you are a fertility awareness charter, you can use these tests to double check that ovulation has occurred along with your other fertility signs. If you are seeking to become pregnant, you can use these tests to help see if your luteal phase is sufficient to support a pregnancy.

Here are a few links on recent studies so that you can be more informed about using this product:

Proov is Clinically Validated

Study on Urinary Hormones and Progesterone

Study on Proov Combined with Fertility Awareness Methods

Study on Combining Proov with Clearblue

I have personally been using Proov since 2019. I can highly recommend this product. Proov has excellent customer service and is continually trying to improve their services and expand product options.

My most common day to get my first positive Proov is approximately 3 to 5 days after a positive LH test. I love having Proov as a crosscheck so that I can have an extra way to confirm ovulation. I like having a ton of data in my fertility awareness routine.

For those trying to conceive, the tests can be used around 7 to 10 days post ovulation (counting from positive LH test). If the tests are positive, this is a good sign that your progesterone is high enough when implantation is most likely to occur on days 7 to 10 post positive LH test.

I used it 7 to 10 days past my first positive LH test to see if my progesterone levels were high enough in the last part of my cycle. Ideally, for conception purposes, you want to see positive Proov tests on days 7 through 10.

These tests are also useful for people with irregular cycles or tough cervical mucus patterns because they can help you know if you have indeed ovulated.

The Proov Insight app can help you read your tests, including PdG, LH tests and the new Multihormone test! It recently updated to include numeric values. This makes the data even more meaningful! Some people struggle reading Proov, and the app is definitely useful for those people.

The app will give you an “ovulation score” based on whether your tests are positive during the days most likely for implantation. This ovulation score can help you plan to improve your health if you notice low PdG levels.

I highly recommend trying Proov if you are curious about your progesterone! For now, I have decided to make Proov a permanent part of my fertility awareness routine.

Use promocode CHARTYOURFERTILITY for 30%!

Top 3 Charting Mistakes When Beginning Fertility Awareness

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.

An Example of a Symptothermal Chart on Kindara

Why did I choose to become a fertility awareness instructor?

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.

If you want to learn FAM, I suggest getting an instructor. Check out this website for a list of instructors.

Now Opening Enrollment For December 2019 Fertility Awareness Course

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.

Moderating in Fertility Awareness Method of Birth Control, the largest English speaking, secular fertility awareness group on Facebook at 25,000+ members, lead me to becoming a certified instructor through the Natural Family Planning Teachers Association (NFPTA). Starting in February 2020, I am pursuing a certification through Bebo Mia as a fertility doula to support women who are TTC. Outside of the fertility world, I am training to be a librarian. I have taught at the college level since 2016.

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.

The best way to get in touch with me is through DM on my Instagram @chartyourfertility or through e-mail by completing a form on chartyourfertility.com. You can also follow me @chartyourfertility on Facebook.

A symptothermal method chart — An Example of Symptothermal Method Chart on Kindara

*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.