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Natural, or fertility awareness based methods (FABMs), properly learned from a trained professional, can be a practical and effective way approach to either achieving or preventing pregnancy. With modern FABMs, a woman learns to track observable physical signs each day that reflect what’s happening with hormones inside her body.

If the woman’s reproductive cycle is healthy, the complex orchestration of her hormones will result in ovulation – a sign of fertility and health. If there are abnormalities in her cycle, a woman may be able to detect these through charting with FABMs and work with specially trained medical professionals to address these in a more comprehensive way.

There are five different types of FABMs each with features that can accommodate the lifestyle and unique needs of different women or couples.

Here’s a breakdown of the types of methods.

Cervical fluid methods

The Billings Ovulation Method or Creighton Model involve observing only cervical fluid secretions on a daily basis. With Billings, women focus more on noting the sensation and they use their own words to describe their observations, so it takes less time to learn and is easier to use.

With the Creighton Model, women use a standardized recording system to track both the sensation and visible appearance of their cervical fluid secretions. As such, it may take longer for the woman to learn, but it is easier for trained consultants to interpret charts and use that information to address a range of women’s health concerns.

By observing the changes in cervical fluid secretions, women are also able to identify when they may be fertile and when they are not, so these methods can be used to help couples conceive or prevent pregnancy.

Cross-check methods

With the sympto-thermal (STM) and sympto-hormonal methods (SHM), women cross check their cervical fluid observations with a secondary sign, either their basal body temperature or urinary hormone measurements. This cross-check can give couples more confidence when it comes to identifying their potential days of fertility.

The STM is one of the most widely used methods, since there are many apps that allow women to track their cervical fluid plus basal body temperature.

The most commonly known SHM is the Marquette Method, which involves the use of the Clear Blue Fertility monitor to check urinary hormone levels, in combination with cervical fluid observations to identify the women’s potential days of fertility. The monitor provides a more objective measurement, which may make it easier to use but it also makes it more expensive.

Another method that integrates urinary hormone measurements is Fertility Education and Medical Management and focuses on using female cycle charting to monitor and manage common women’s health concerns.

When your cycle is regular

The Standard Days Method is a simple method that may be used by women with regular cycles, between 26 and 32 days in length. This method identifies a fixed fertile window. It is inexpensive and very easy to learn, but provides less information about the women’s actual fertility signs which reflect her underlying hormonal health.

When you’re breastfeeding

The lactation amenorrhea method has been shown to be very effective, but may only be used by women who are exclusively breastfeeding, have not had a return of their menses and gave birth less than six months ago.

What to consider when picking a method

- The number of signs or biomarkers you wish you track

- The amount of time you have to learn a method

- Whether you prefer to learn online or in-person

- The availability of teachers in your area

- If you have an irregular sleep cycle or are breastfeeding

Once you have selected the best method for you, step two is to learn the method in accordance with the guidelines that have been shown to be effective. For the Billings Ovulation Method, Creighton Model, and sympto-thermal methods, this means learning from a trained instructor. The Marquette method has been shown to be effective if women learn via in-person or online instruction. The Standard Days Method and lactation amenorrhea method can also be learned online or in a brief counseling visit.

The next step is to start tracking your signs. You can chart your cycle on paper or via an app. There are almost 100 apps on the market available for women to track their fertility signs, but many do not follow the guidelines of evidence based FABMs or they include a disclaimer saying they should not be used to prevent pregnancy.

Check out our review to find out which apps may be best to use.

Marguerite Duane, MD, MHA, FAAFP, is the Executive Director of Fertility Appreciation Collaborative to Teach the Science (FACTS).

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