The Fertility Awareness Method blog.

And on that note, fasten your seatbelts.  Let’s talk.

This is something that I’ve been wanting and meaning to write about for almost a year.  It’s time.

This blog is going to be about contraception.  Girls, I encourage you to stick around.  Boys, I also encourage you to stick around.  However, if you are the type of boy whose blood pressure increases at the word “period” or anything involving the term “cervical,” feel free to excuse yourself and return when you feel more mature.

First of all, there are alternatives to the birth control pill.  Don’t let anyone tell you there aren’t, and don’t feel like you need to be on BCPs just because that’s what everyone does and the choice doesn’t even require thinking.  It does require thinking.  A lot of thinking.

If you aren’t aware, there are ethical concerns with the birth control pill.  I wrote a paper on it back in high school, and Mr. Smith brought it up at his contraception Bible study in February.  It’s not my purpose here to write a discourse on why you shouldn’t use BCPs, but know that if you are considering using them or you are on them now, you should look into the issues thoroughly (feel free to contact me if you need to) and make an informed decision.  And keep in mind that you will be held responsible for the choices that you make.

Besides the ethical issues, I think there are some other serious questions to ask about the Pill.  BCPs are hormones that you ingest to alter the hormone levels that would normally be present in your body.  Do you believe that God gave you hormones for a purpose?  Do you believe that they may serve a purpose in your body other than reproduction?  Do you think His idea of contraception is altering the hormones that He gave you?

Personally, I’m pretty sure that God knows what He’s doing.  Why did He give us hormones?  Well, a lot of reasons.  I don’t need to know all of them to be convinced that they serve a purpose in our bodies.  I know enough about human physiology to know that any time you change a biological mediator for a specific purpose, other functions of that mediator will be changed as well.  Ever heard of side effects of pharmaceuticals?  Ask around.  Women on the birth control pill complain of: weight gain, mood swings, irritability, vaginal dryness making sex painful, feeling “fuzzy,” like they can’t think, not feeling like themselves, and oh, a little thing called loss of libido.  If you lose your libido, tell me, what is the purpose of being on the pill?  All of this is not to mention the increased health risks that have been shown to be associated with BCPs, including blood clots.

All of this is to say, think about BCPs and consider all your options.

To you I present: A Better Option.  This is called the Fertility Awareness Method.

Before we even get into this, a clarification: THIS IS NOT THE RHYTHM METHOD.  If you think it’s the rhythm method, you don’t understand how it works.  The idea that all women have a 28-day cycle and ovulate on day 14 is a myth.  What do you call couples who use the rhythm method?  Parents.  The End.

The Fertility Awareness Method (FAM) is a natural form of contraception based on the biological signs of a woman’s body.  Using these same signs, FAM can also be used to achieve conception.  FAM has been scientifically evaluated in research studies over the course of several decades.  In the most recent prospective study which lasted for 20 years and involved 900 women, its efficacy as a form of contraception when used correctly was 99.4%.  What’s the effectiveness of the pill?  99.5%.  Well isn’t that interesting.

FAM offers an effective form of contraception for determined monogamous couples who don’t want to use barrier methods throughout the woman’s entire cycle (and who would, really).  However, FAM isn’t for everyone.  FAM is effective, but it has to be practiced diligently and according to the FAM rules, and is not forgiving of mistakes.  With that caveat, let’s learn what it actually is.

FAM is based on biology.  Let’s go back to 10th grade biology and revisit the female cycle.  The cycle begins with menstruation.  The blood lining of the uterus (endometrium) is shed, and this normally lasts for several days.  Then begins a period known as the follicular phase.  The length of this phase is highly variable.  During the follicular phase, eggs in the ovaries develop in sac-like structures called follicles.  Once one follicle is sufficiently mature, and with the correct amounts of various hormones, an egg bursts out of the side of the ovary and into the fallopian tube.  This is ovulation.

Following ovulation is the period when the egg is capable of being fertilized.  This is when pregnancy can occur.  The egg is viable for up to 24 hours.  After 24 hours the egg dies, and pregnancy is no longer possible.  The whole post-ovulatory phase is called the luteal phase (for the corpus luteum which is the remnants of the follicle which the egg burst out of), and generally lasts for 12-16 days.  If pregnancy is not achieved, the endometrium is again shed and the cycle starts over again.

With respect to pregnancy, what is the most important part of the cycle?  Ovulation.  Women are only capable of becoming pregnant for about six days out of their entire cycle.  Why six?  In ideal conditions, sperm can live for up to 5 days.  The egg survives for a maximum of 1 day.  Six days.  This is when women are considered fertile.  Men are fertile every day of their lives.  Thanks a lot, guys.

So, how do you not get pregnant?  Don’t have unprotected sex when you’re fertile.  Easy enough.

How do you figure out when you’re fertile?  This is where the biological signs of a woman’s body come in.  The woman’s body will tell her exactly when she is fertile, if she will only pay attention.  The biological signs are:

1. Basal body temperature.  This is the temperature your body assumes for basic survival.  When you are active and doing work, your temperature will be higher.  But when you are not active and are simply living, your temperature falls to your basal body temperature.  Essentially, it is the temperature of your body while you are sleeping.

Why does this matter?  Remember ovulation?  Following ovulation, the amount of the hormone progesterone shoots up and stays up for the length of the post-ovulatory luteal phase.  It’s produced by the corpus luteum (again, the remnant of the follicle that the egg grew up in within the ovary).  The increase in progesterone causes the basal body temperature to rise noticeably (usually 0.5 – 1 whole degree difference (F), which is a lot).

In FAM, you take your temperature each morning before getting out of bed.  By charting your temperatures throughout your cycle, you can determine when you have ovulated.  Temperatures from beginning to the end of a cycle will look something like this:

Notice how the temps stayed consistently low until ovulation (the vertical pink line), and then spiked up and stayed up during the luteal phase.  That’s biological sign #1.

2. Cervical fluid.  If you’ve never heard of it and are creeped out by the sound of it, don’t worry.  That’s “normal.”  For whatever reason our society has hush-hushed talk of cervical fluid such that most women grow to be full adults without knowing what it is.  Essentially, it’s a fluid secreted by the cervix throughout the cycle.  It’s that white stuff you’ve noticed but weren’t really sure what it was.  What seminal fluid is to men, cervical fluid is to women.

As a woman approaches ovulation, the consistency of the cervical fluid starts to change.  What starts out as dry (no cervical fluid) or a sticky, thick substance changes gradually to become creamy and eventually takes on the consistency of raw eggwhite when the woman is most fertile.  It is slippery and lubricative, and serves to shuttle sperm to the egg to facilitate conception. 

By tracking the consistency of cervical fluid throughout the cycle, it is possible to determine when ovulation is approaching.  After ovulation has occurred, the cervical fluid dries up to its pre-ovulatory state.  From beginning to end of the cycle, the pattern of cervical fluid looks something like this (short purple lines indicating “sticky” cervical fluid, medium indicating “creamy,” and tall lines indicating “eggwhite”):

Vaginal sensation is related to cervical fluid, and should also be charted throughout the cycle.  It progresses from dry or sticky to wet, and finally to lubricative.  This lubricative sensation indicates that the woman is fertile.

3. Cervical position.  This is probably the most foreign of all the FAM signs to most women.  It’s an optional sign, so you don’t have to chart it if you don’t want to.  But, when temps and cervical fluid are a little ambiguous, cervical position can help to clear up where you are in your cycle.

The cervix is the lowest portion of the uterus, with an opening that is the entrance to the body of the uterus.  Essentially, when you are infertile your cervix is low, firm and closed.  As you approach ovulation it raises up, becomes less firm and the cervical opening (os) begins to open.  At ovulation it is high, soft and open.  This allows the passage of sperm into the uterus, again to facilitate conception.

By tracking cervical position throughout the cycle, it is possible to determine when ovulation is approaching.  From beginning to the end of the cycle, the changes in cervical position look something like this (with the height and openness of the cervix indicated by the red circle, and the firmness indicated by firm/medium/soft below):

FYI, the red hearts indicate sex, and this is not my chart. 🙂

Okay, so we have temps, cervical fluid and cervical position.  By combining all three with several scientifically-proven rules, you can determine when you are infertile and when you are fertile.  Have unprotected sex when you’re infertile.  Use a barrier when you’re fertile.  Boom.  That’s contraception, baby.

If you are considering using FAM, you MUST read Taking Charge of Your Fertility.  This book is the Bible of FAM, and goes into much more detail than I am doing here.  For that reason I’m hesitant to list the rules of FAM, because if not followed properly FAM will not be effective.  However, for the purpose of completion, I will briefly summarize the FAM rules.

Pre-ovulation:

 1. First Five Days Rule.  You can consider yourself infertile for the first five days of your cycle.  For most women these days fall during their period.  As a result, for those of us in the Church this rule isn’t especially helpful because of the Biblical command to abstain from sex during your period.

2. Dry Day Rule.  You can consider yourself infertile on the evening of every dry day (dry/no cervical fluid or sticky cervical fluid, depending on what is normal for you).  This rule has the highest failure rate of the FAM rules (estimated 3-6%), and many women choose not to use it because of the potential for sticky cervical fluid to change to fertile eggwhite overnight.

3. Doring Rule and variations thereof.  This rule actually isn’t listed in Taking Charge of Your Fertility, but is one of the rules set up by the advocates of Natural Family Planning (NFP), the Catholic Church.  (FYI – the difference between FAM and NFP is that NFP requires abstinence during the fertile phase, while FAM allows for the use of barrier methods.) 

The rule I will prefer to use is a variation of the Doring Rule, and is the rule used in the 20 year study I cited earlier.  This is based on past cycle history of an individual woman, and as a result is most effective when the woman has charted for at least 12 cycles.  This rule says to determine the first fertile day, take the date of the earliest thermal shift in the last 12 cycles and subtract 7.  The Doring Rule is essentially one day less conservative, and gives you one more day of infertility.  I’d prefer to err on the side of caution, so I will use the variation.

Post-ovulation:

1. Three high temperatures and four days of cervical fluid dry-up.  After ovulation, you need to see three high temperatures (above the coverline, which is more detail than I plan to go into here) AND you also need to see four days of the cervical fluid drying up from fertile eggwhite-quality to sticky or dry/no cervical fluid.  These two conditions need to match before you can consider yourself safe.  If they don’t match, you need to wait for unprotected sex until they do.

That’s it.  I’ve probably made it sound more complicated than it really is simply because I wanted to explain it thoroughly.  It’s not complicated.  It’s not hard.  Yes, it does require diligence, and yes, it does require some effort.  But I think the effort will be worth it.

I’m in my 10th cycle of charting.  It’ll be a full year at the end of this cycle.  (Do you feel gross now that you’ve seen charts of my cycle history? :))  While Charlie and I are waiting until we’re married, and I haven’t been using FAM for contraception, it was SO worth it to start charting early.  Because I did, I am confident in FAM and in my ability to chart properly.  Not only that, but I’ve developed a precise awareness of what my body is doing every single day.  It’s no longer something of a mystery.  Plus, it’s helpful to know the exact day when I’ll get my period.  How handy is that?

Also, through online FAM forums, I’ve met women who have been successfully using FAM to avoid pregnancy for years.  Just because something isn’t well-known doesn’t mean it’s not true.  The plan of God?  Not well known.  True?  Yes.

I’m passionate about FAM.  I think it is a wonderful tool for women to use to become more aware of their bodies, and also to avoid or achieve pregnancy.  It’s natural.  It doesn’t involve hormones.  It lets your body do what it’s supposed to do.  And you can have confidence in its ability as a contraceptive, if you use it properly.  Additionally, because it helps you identify the date of ovulation, if you are having difficulties getting pregnant, charting will help you know exactly when you are most fertile and most likely to become pregnant.  It’s a win for every situation.

I think that’s all I have to say.  This was an epistle.  But I felt that this information needed to get out, especially to people in the church.  I’m obviously very open to questions or comments, so feel free.  We are fearfully and wonderfully made, and we do have options for contraception.