Your options in fertility awareness methods

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If you're here, chances are you already know a little bit about fertility awareness methods aka natural family planning.  So, enough with the introductions, let's get into this!

There are three big categories of fertility awareness methods:

• symptom based: you monitor changes in your cervical fluid pattern only to determine fertile days
• symptothermal based: layers basal body temperature monitoring with cervical fluid monitoring to determine fertile days
• symptohormonal based: to me, a more correct term for this category is hormone based monitoring because hormonal monitoring is the basis for these methods and some of the methods (like Marquette... we'll talk more about this below) use only at-home hormone tracking (via peeing on a stick) for ID'ing your fertile days

Cervical Fluid Only (Symptom Based) Fertility Awareness Methods

What's your cervix?

Your cervix is the organ that separates your vagina from your uterus (you can think of your cervix as a fence separating your vagina from your uterus).  And, just like a fence, there’s a gate in your cervix known as the cervical os (cervical opening).

During most of your cycle, that cervical os (gate) is closed preventing the passage of sperm and other things (viruses, bacteria, etc.) from passing from your vagina through your cervix and into your uterus.

That cervical os is closed during most of your cycle because the cervix itself is firm around the opening (keeping the opening small) and because the opening is plugged with cervical fluid.

Monitoring your cervical fluid to identify your fertile window

When your fertile window opens, your cervix transforms from hard (like the tip of your nose) to soft (more like the texture of your lips) and that fluid transitions from sticky, gummy, tacky texture fluid that creates a plug in your cervical opening to more liquid type qualities (creamy, stretchy, and more of it). 

The point of change for you, whether that’s from:

• dry to sticky or
• sticky to creamy or
• sticky to egg-white aka EWCM... egg-white cervical mucus

marks the opening of your fertile window.

What causes your cervical fluid to change?

Hormonal changes during your cycle cause changes in both your cervical fluid & also in your cervix itself (the texture and position/height of your cervix changes in response to hormonal shifts throughout your cycle).

Changes in the quality of your cervical fluid and in the quality of your cervix are symptoms of hormonal changes within your body, and this is why fertility awareness methods that use cervical fluid as part (or all) of fertility tracking are known as sympto- based methods.

Symptom Based (Cervical Mucus Monitoring) Fertility Awareness Methods

These changes in your cervical secretions are so reproducible from one cycle to the next and so typical for women in their fertile years that many fertility awareness methods rely on changes in your cervical fluid alone to determine the opening and closing of your fertile phase.

These methods are highly effective (the Creighton Model is the most effective of these at 99.5% effective!) and vary based on the protocol applied for determining fertile vs. infertile days.

Here’s a short list of cervical fluid only (symptom based) fertility awareness methods:

• TwoDay Method
• Billings Ovulation Method
• Creighton Model

Symptothermal Based Fertility Awareness Methods

Ovulation and your basal body temperature (BBT)

Once you ovulate, the leftover follicular hull (or shell) that housed this month’s egg begins creating progesterone. 

Progesterone's essential for creating a healthy uterine lining to receive a fertilized embryo, and in fact, many women who experience recurrent miscarriages have a deficiency in their progesterone levels during the second half of their cycle.

Energetically, progesterone’s a hotter hormone than estrogen. 

Even though estrogen & progesterone both are feminine hormones, estrogen is perhaps the most feminine of the feminine hormones in your body.

Progesterone has more masculine properties compared to estrogen (this ties into the Ayurvedic and TCM concepts of hormonal energetics and we’ll cover that more in a future post).

Progesterone's thermogenic properties raise your metabolic rate after ovulation, and this is seen by a thermal shift in your basal body temperature.

Your basal body temperature (BBT) is your waking temperature, a temperature least impacted by things like:

• When’s the last time you ate?
• When’s the last time you exercised?
• How strenuous did you exercise?
• Was there something in your day that triggered a stress response?

All of these things (and more) influence your body temp, so by taking your temperature first thing in the morning, you’re able to get a good idea of the effects of estrogen and progesterone alone on your body temperature.

Once you ovulate, it’s typical to see a "sustained thermal shift" of at least 0.3 degrees above your pre-ovulatory temperatures. 

Using your body temperature in a fertility awareness method

A number of fertility awareness methods incorporate cervical fluid monitoring combined with monitoring your basal body temperature to confirm ovulation. 

This gives you added reassurance of ovulation and is super helpful when you have a condition like PCOS and also when you see two “fertile quality” cervical fluid transitions in a single cycle, which is pretty common.

Two “fertile quality” cervical fluid patterns in a single cycle

Estrogen rises twice during your cycle, once ahead of ovulation during your actual fertile window and again about halfway through your luteal phase (the second half of your cycle). 

You’re not fertile during that second transition (progesterone suppresses other vital hormones necessary for ovulation), and the reason for the second “fertile quality” cervical fluid pattern is because it’s common for estrogen to rise again to levels that impact the quality of your cervical fluid during your luteal phase. 

The reason you aren’t fertile again at this point is because progesterone’s also high at this point (so two other reproductive hormones, FSH and LH are both low) and the egg for this cycle has already been released (and died).

However, if you’re a woman with PCOS, multiple estrogen surges are also common in each cycle, and you’re never sure which one corresponds with ovulation unless you’re also tracking your progesterone levels (either with basal body temp or at home hormone monitoring).

Symptothermal Based (Cervical Mucus Monitoring + BBT) Fertility Awareness Methods

Symptothermal based methods include:

• The method described in Toni Weschler’s book Taking Charge of Your Fertility (a great read, consider the audible version as you get a pdf download in addition to the audible), this symptothermal method is commonly abbreviated TCOYF
• Justisse Method
• NFPTA

Symptohormonal Based Fertility Awareness Methods (FAMs)

Rounding out your options for fertility awareness methods are the symptohormonal methods.  These use at-home monitoring of your urinary hormone levels to determine when you’re fertile and when you’re not in every cycle.

For me, this category should be split into two sub-categories:

• Symptohormonal methods
• Hormone monitoring methods only

We're going to start by talking about hormone monitoring methods only of FAMs.

Hormone Monitoring Only Methods

The Marquette Method (probably the most popular sympto-hormonal method... using sympto- fast and loose here :) has protocols that only include at home hormone monitoring (so, there’s no cross-checking your body temp or your cervical fluid making this a truly hormone monitoring only method).

Many women switch over to the Marquette Method during their post-partum phase because Marquette is blissfully simple to use and incredibly objective (there’s no second guessing yourself on how to categorize the quality of your cervical fluid that day).

Unlike cervical fluid only methods (which are free), hormonal based methods require an at-home hormone monitor and single-use test strips.  You’ll find out more about those monitors and at-home test strips in this article (link coming soon).

Symptohormonal Methods

FEMM and Boston Cross Check are two fertility awareness methods which really incorporate cervical fluid monitoring (&/or body temp monitoring) with at home hormone monitoring.

With both of these, there are different options for testing your hormones at home (whether with single use test strips like ovulation predictor kits alone or with an at home hormone monitor like Mira or ClearBlue or Inito (Apple only compatible) or Proov and single-use test strips specific to those monitors).

Choosing the fertility awareness method that’s right for you

There are a few key considerations when choosing a fertility awareness method.

Best fertility awareness method for normal cycles

Cervical fluid (symptom based) methods, symptothermal (cervical fluid + body temp), or symptohormonal methods are best for you if you have normal cycles (don’t have PCOS).  Check out the section below on best fertility awareness method for your lifestyle for more on choosing the best FAM for you.

Best fertility awareness method for PCOS

Symptothermal (cervical fluid + body temp) or one of the symptohormonal methods is best for you if you have PCOS.

Since you'll likely struggle to identify when you've ovulated vs. when your estrogen is surging without an egg being released, you'll likely be most comfortable with a symptothermal method or a sympto-hormonal method. 

Among the symptothermal methods, it's really your choice of which calls to you most.

Among the symptohormonal methods, it will depend on a few different factors (whether your ovulation days vary dramatically from cycle to cycle, whether you have frequent rises in LH ahead of ovulation). 

I still lean towards Marquette Method for the best symptohormonal method for women with PCOS because of the added estrogen monitoring for this method, which helps you tease out a true attempt at ovulation from a false attempt.

Best fertility awareness method when you’re discontinuing birth control, in perimenopause, or have low estrogen

If you have low estrogen or if you’re coming off hormonal birth control, a symptohormonal method (specifically Marquette Method) is likely best for you. 

The reason for this is because if you have low estrogen levels or you’re discontinuing hormonal contraception, you may struggle to see a change in the quality of your cervical fluid.  Hormonal birth control alters the function of your cervix including impacting the quality of your cervical fluid. 

Low estrogen can also make it difficult to detect a shift in the quality of your cervical fluid ahead of ovulation.

Best fertility awareness method when you have low progesterone or a thyroid condition or are a shift worker

Low progesterone, a poorly regulated thyroid condition, and shift work (especially frequent shift changes) can make it really difficult for you to confirm ovulation with a shift in your body temperature.

For you, either a symptom based (cervical fluid only) method or a symptohormonal method (whether that's FEMM, Marquette, or Boston Cross Check) would be best.

The best fertility awareness method for your lifestyle

One really important piece to selecting the right fertility awareness method for you is what time of day you enjoy getting it on.

For any cervical fluid only & also for any symptothermal method, you’ll have to wait until after 6 pm to know whether it’s a safe day or not for unprotected sex up until you’ve confirmed you’re past ovulation and your fertile window has closed for that cycle (so second half of your cycle is fair game any time of day).

For Marquette Method, you test your first morning urine. 

Typically, you know whether the day is safe for you to have unprotected sex or not even before you test your first morning urine (the Marquette Method protocol builds in a safety window to help ensure no positive surprises), so at best, you can get it on as soon as you wake up and pee, at worst, you have to wait a few minutes to get a reading and then know whether it’s fair game for unprotected sex or if you need to reach for those barrier devices.

How to choose the right fertility awareness method for you

In case you're ready to switch to a fertility awareness method but have no idea which one to go with, Rain Organica offers a self-guided class covering the basics of each of these fertility markers and providing an overview of 12 different fertility awareness methods.

The fertility awareness class goes in-depth into 6 different fertility awareness methods:

• Creighton Model
• Justisse Method
• Marquette Method
• Billings Ovulation Method
• TwoDay Method
• TCOYF (symptothermal method)

And, you'll receive a pdf download of standard protocols for 4 different fertility awareness methods:

• Marquette Method
• TCOYF (symptothermal method)
• Billings Ovulation Method
• TwoDay Method

You'll also access the Marquette Method breastfeeding (postpartum) protocol and be able to try your hand at reading charts for these methods (to help build your confidence in charting).

Plus, the class includes 1 year of charting support.

Discover more about the Fertility Awareness for Natural Contraception class here.

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