Fertility awareness methods (FAMs) rely on a woman's awareness of when she is most likely to conceive, with abstinence or use of barrier contraceptives during that time.
Women with religious or cultural reasons for not using contraception can use FAMs to avoid intercourse during fertile times. There are no medical contraindications to using these methods, and when used in reverse, FAMs can help a couple conceive a wanted pregnancy.
A couple must be highly motivated to avoid intercourse during fertile times, which can also be a time of increased libido. The signs of ovulation/fertile periods can be subtle, so it may take time to master these methods. Even women with regular cycles experience cycle variability, and these methods are not reliable in women with irregular cycles.
A woman records her cycles prospectively for 6 to 12 months to determine her cycle length. Using the longest and shortest cycle lengths during this time, and assuming that ovulation occurs 14 days before menses and that sperm can survive for 2 to 3 days, the fertile period is calculated. A simplified version of the calendar method, the Standard Days Method, eliminates the need for extended cycle evaluation before use. For women in whom most cycles are 28 to 32 days long, intercourse is avoided on cycle days 8 to 19 (Arevelo et al., 2002). CycleBeads are a set of color-coded beads that can be used to help a woman keep track of her cycles.
The ovulation method requires a woman to check her cervical mucus manually to detect the changes that occur during fertile periods, then avoid intercourse during these times. A simplified, TwoDay method requires that a woman ask herself two questions: "Did I notice secretions today?" and "Did I notice secretions yesterday?" If the answer is "no" for 2 consecutive days, it is safe to have intercourse (Arevelo et al., 2004).
Women must take their temperature each morning before arising and record it on a chart. This temperature can increase noticeably (by 0.4°-0.8° F) with ovulation and indicates times when intercourse should be avoided or barrier contraceptives used.
The symptomothermal method combines fertility awareness indicators (basal body temperature, changes in cervical mucus, libido, or cervical texture) to help a woman recognize her fertile days and avoid intercourse or use barrier methods during that time.
The postovulation method allows intercourse only after signs of ovulation have resolved.
The lactational amenorrhea method (LAM) refers to a specific set of circumstances under which a lactating woman does not ovulate and thus cannot conceive. This method is extremely effective, but only if all the following conditions exist (Kennedy and Visness, 1992; LevelA):
1. The woman is exclusively breastfeeding an infant with both day and night feedings, so that 90% or more of the infant's nutrition is from breast milk.
2. The infant is less than 6 months old.
3. The woman is amenorrheic (except for spotting during first 8 weeks postpartum)
Once these specific conditions no longer exist, other contraceptive methods should be considered.
Mechanism of Action
Lactation causes a surge in prolactin, which inhibits ovulation.
Breastfeeding provides excellent nutrition for infants and can aid in maternal weight loss, as well as decrease the risk for endometrial, ovarian, and possibly breast cancer.
It is important to understand that ovulation will often precede the first menses in postpartum women, leaving them susceptible to pregnancy. This risk increases with time since delivery (Zieman et al., 2007). Some women may find long-term breastfeeding difficult or inconvenient.
Was this article helpful?
For many years, scientists have been playing out the ingredients that make breast milk the perfect food for babies. They've discovered to day over 200 close compounds to fight infection, help the immune system mature, aid in digestion, and support brain growth - nature made properties that science simply cannot copy. The important long term benefits of breast feeding include reduced risk of asthma, allergies, obesity, and some forms of childhood cancer. The more that scientists continue to learn, the better breast milk looks.