Medical Protocol
Fertility Awareness-Based Methods of Contraception
Fertility awareness-based methods of contraception are techniques by which women can
understand how to avoid pregnancy. Although the same methods can be used by women to
assist in becoming pregnant, the following information is written to provide means of avoiding
pregnancy. Fertility awareness (FA) uses one’s natural and normal body functions to identify the
days in a menstrual cycle in which pregnancy is more likely to occur. FA can be effective in
preventing pregnancy when used correctly and consistently. It is safe and low cost. Women
may choose this method when other methods are contraindicated or unacceptable.
There are several methods of FA. Four of these methods include:
 Basal body temperature
 Ovulation/cervical mucus method
 Symptothermal method
 Calendar method
Whichever method is used, certain things are essential: initial training by a medical professional
or qualified counselor, and consistent use of the method. Users of FA will need to abstain from
unprotected intercourse for approximately 10-17 days in each cycle.
Efficacy
There are no randomized, controlled trials of FA methods. With perfect use, efficacy rates may
reach 90% depending on the method. Pregnancy rates for typical use can be considerably higher
with a failure rate of approximately 25%.
Basal Body Temperature
The temperature method of FA is based on the fact that most women have a slight increase in
their normal body temperature just after ovulation has occurred. A woman takes her temperature
every morning before getting out of bed and records this on a graph. In this way, she is able to
detect the increase in temperature which indicates that ovulation has occurred. Temperature will
usually rise approximately 0.4 degree Fahrenheit around ovulation and remain elevated until the
next menses. A woman must be instructed that temperature may be affected by fever, restless
sleep, varying work schedules, as well as other things. A woman using this method to prevent
pregnancy is instructed to not have sex from the end of her menstrual cycle until 3 days after the
increase in temperature is noted.
Ovulation/cervical mucus method
The ovulation method detects changes in the amount and /or texture of the cervical mucus. To
do this, a woman checks regularly for cervical mucus and learns to recognize the changes that
occur around the time of ovulation. Most women have little mucus just after menstruation
followed by mucus that is sticky or pasty. Just before ovulation, the mucus becomes wet and
slippery. After ovulation, the mucus becomes thick and there may be a feeling of dryness. The
Tapestry Health
Fertility Awareness-Based Methods of Contraception
8/2011
days in which women are instructed to not have sex start with the first signs of mucus and
continue until 4 days after the wet/slippery mucus has disappeared. This method may be affected
by menstruation, vaginal infections, sexual arousal, the use of lubricants and certain medications.
Symptothermal Method
The symtothermal method combines the temperature and ovulation/cervical mucus method. In
addition to taking one’s temperature every morning and checking for changes in cervical mucus,
a woman will also be instructed to be aware of other signs of ovulation such as pelvic cramps or
spotting. Abstinence from sex from the day of fist signs of fertility (fertile mucus) until the 3rd
day after the increase in temperature or the fourth day after the peak in mucus production.
Calendar Method
The calendar method is also called the rhythm method. A woman is instructed to record every
day of her menstrual cycle for 6 months. The first day of the fertile phase is found by subtracting
18 days from the length of the shortest cycle in the past 6 months. The last day of the fertile
phase is calculated by subtracting 11 days from the length of the longest cycle in the past 6
months. If the shortest cycle is 25 days and is subtracted by 18, the number would be 7. If the
longest cycle was 35 days and is subtracted by 11, the number would be 24. Abstinence from
sex would be advised between day 7 and day 24.
Another type of calendar method is the use of CycleBeads to monitor the days of the menstrual
cycle to calculate which days are most fertile and least fertile. CycleBeads are a string of 32
brown, white and red beads with a black ring that moves over each individual bead. Every bead
represents a day in a woman’s menstrual cycle. To use this method the woman moves the black
ring to the red bead on the first day of her period. And then, each day, she moves the ring to the
next bead. When the ring reaches the white beads, this is the beginning of the days during which
she is most likely to become pregnant. A woman not wanting to become pregnant should not
have unprotected sex during this time. When the ring reaches the brown beads, this represents
the time in which she is least likely to become pregnant. The cycle starts all over again when the
woman starts her next period. CycleBeads are intended to be used only by women who have menstrual
cycles between 26 and 32 days long (the first day of one period to the first day of the next).
Advantages
Effective when used correctly and consistently
No side effects
Immediate reversibility
Low or no cost
No devices, drugs, prescriptions or office visits
Acceptable to those with religious concerns related to contraception
Disadvantages
Requires diligence from both partners
Requires periods of abstinence or back-up contraception for approximately 1/3rd of the month
Requires accurate and consistent record keeping
More challenging or contraindicated for women with irregular menstrual cycles
No protection from sexually transmitted diseases
Tapestry Health
Fertility Awareness-Based Methods of Contraception
8/2011
Precautions
Recent menarche
Recent childbirth, abortion or miscarriage
Approaching menopause
Current breastfeeding
Recent discontinuation of a hormonal birth control method
How to Protect Against STIs and HIV
The only way to guard against getting sexually transmitted infections (STIs) is not to have sex or
to have sex only with partners who you know are free of infection. If you do have sex, you
should use a latex barrier, such as a male condom, every time. Latex condoms provide the best
protection against certain STIs, including HIV. Tapestry Health clinicians recommend using
latex barriers even in combination with other methods of birth control. The addition of
spermicide is not recommended as this may cause skin irritation and increase your susceptibility
to STIs.
If you have had unprotected sex within the last 5 days of your fertile menstrual phase and wish to
prevent pregnancy, Emergency Contraception is available to you and can significantly reduce
your risk of an unplanned pregnancy. Emergency Contraception is available at all Tapestry
Health Services sites.
References
http://www.americanpregnancy.org/preventingpregnancy/fertilityawareness
http://www.acog.org/publications/patient_education/bp024.cfm?
Tapestry Health
Fertility Awareness-Based Methods of Contraception
8/2011