Fertility Awareness

We provide information regarding the Fertility Awareness or Rhythm Method. How it works, its effectiveness, and the things to take into account.
Fertility Awareness


Fertility awareness-based methods are a form of natural family planning. These methods require you to keep track of your menstrual cycle to determine the days that you can get pregnant. The difficult part is determining when those days are. We give you a few options to monitor your fertility and help you determine the days you can get pregnant. For women with irregular periods, including teens, this may not be the best option. [9]

Types of Fertility Awareness:

Standard Days (SDM): you can use this method if your menstrual cycle is between 26 and 32 days long. You will need to record your periods and determine when you cannot get pregnant.[3]

TwoDay (TDM): for this method you need to observe cervical discharge to see when you are fertile.

Cervical Mucus: your body makes a specific goo when you are most fertile. This method is about tracking your cervical mucus.[8]

Body Temp (BBT): for this method, you chart your body temperature every morning to determine whether or not you are ovulating.

Symptothermal: your body has many signs indicating that you can get pregnant. This method tracks several of them at once. This includes how open your cervix feels.

Lactational (LAM): breastfeeding naturally suppresses fertility. This method works if you have just had a baby. But for this method to work you need to be exclusively breastfeeding your baby.

Quick Facts

  • Fertility awareness-based methods are inexpensive. They are also hormone-free.
  • Effectiveness: fertility awareness methods are notvery effective. They are best when practiced perfectly.
    • Perfect use:


    • Typical use:


  • Side effects: none
  • Effort: high. Daily tracking is required to use fertility awareness-based methods correctly.


You want to get to know your body better. Fertility awareness methods can be used for birth control. They are also a good way to know your body better. You will notice changes and better understand your menstrual cycle.

You would not mind getting pregnant. Failure rates are high if you do not use this method correctly. If getting pregnant would be a problem for you and you are not very good at fertility awareness tracking, choose another method. If you still want to try it, use a backup method, like condoms, every time you have sex while you are learning.

Total self-discipline. Both you and your partner need to agree to follow this method. You also need to know your body really well.

You are okay with not having sex, or using another method. With this method you will need to track the days you can get pregnant each month. On those days, you will need to either avoid sex or use a non-hormonal method of birth control. If you are not okay with not having sex, or using another method of birth control, do not use fertility awareness-based methods.

You want a method with no side effects. This method does not add additional hormones to your body. Many people who use this method want something that does not affect their bodies.

No prescription necessary. If you do not want to use hormones, this is one option

How To Use

Fertility awareness-based methods are simple. Track your menstrual cycles and do not have sex on the days that you can get pregnant. If you have sex on those days, use an alternate method, like a condom – male or female – or diaphragm.

You can track your cycle with several different methods. Using two or more will help you be more accurate. You will need to observe changes in your body and calculate where you are at in your menstrual cycle. This will take a lot of effort and commitment. Before you choose this method, make sure you understand what you will need to do. Be prepared to not have sex for seven days every month, or to use a second method on those days.[5]

Standard Days Method. This will only work if your menstrual cycle is between 26 and 32 days. Learn more about this method.[3]

TwoDay Method. You will check to see if you have cervical secretions every day. If you notice any secretions, yesterday or today, you can get pregnant. Do not have sex on those days. If you decide to have sex, use another form of birth control. Get more info here.

Cervical Mucus Method. You need to check your cervical mucus on a daily basis. You can get pregnant from the onset of your secretions (when your cervical mucus is clear, stretchy, slippery, and wet) until 3 days after it stops. Use this method with Symptothermal Method or Standard Days method.[8]

Body Basal Temperature Method (BBT). You will take your temperature every morning before you stand up. Write it down on a chart. Use this method with Symptothermal Method or Standard Days Method.[1]

Symptothermal Method. This method combines multiple fertility awareness-based methods to predict the days you can get pregnant. It usually tracks body basal temperature and cervical mucus. You can get more information here.

Lactational Amenhorrea Method. You can use breastfeeding to prevent pregnancy for up to 6 months after having a baby. This works only if you meet all three criteria listed below:

  1. No menstrual bleeding since your baby was born.
  2. You only breastfeed your baby (no other foods or liquids given).
  3. You feed your baby at least every 4 hours during the day and every 6 hours during the night.

You can learn more about LAM here.

Side Effects

Everyone is different. What you experience may not be the same thing as another woman.

The Positive:[7]

  • Completely free – except for the price of a basal thermometer or CycleBeads
  • No prescription necessary
  • No hormones added to your body
  • No hormones, so you do not have to worry about side effects. Your only worry is the possibility of getting pregnant.
  • This method helps you learn more about your body and how it works

The Negative:[5]

  • You need to spend time planning, and record-keeping.
  • This method requires self-control.
  • Requires abstinence (or use of an alternate method) for at least one week per menstrual cycle
  • You and your partner need to participate.
  • The Calendar Method and the Standard Days Method do not work for women with irregular periods
  • If you have recently stopped using an hormonal method, you need to use a non-hormonal method for a few months. Hormones effect your cycle, which will make fertility awareness-based methods ineffective initially. Use a non-hormonal method while you learn to track your menstrual cycle.
  • Hard to stick to the plan if you are drunk


[1] FPA the sexual health charity. (2015). Your guide to natural family planning. Retrieved from https://www.sexwise.fpa.org.uk/sites/default/files/resource/2017-08/natural-family-planning-your-guide.pdf

[2] Manhart, et al. (2013). Fertility awareness-based methods of family planning: A review of effectiveness for avoiding pregnancy using SORT. ACOFP American College of Osteopathic Family Physicians. Retrieved from https://www.sympto.org/data/Fertility_awareness-based_methods_of_family_planning_2013.pdf

[3] Marstona, C. A., & Church, K. (2016). Does the evidence support global promotion of the calendar-based Standard Days Method® of contraception? Elsevier. Retrieved from https://www.contraceptionjournal.org/article/S0010-7824(16)00005-6/pdf

[4] Peragallo, et al. (2018). Effectiveness of Fertility Awareness–Based Methods for Pregnancy Prevention: A Systematic Review. The American College of Obstetricians. Wolters Kluwer Health, Inc. Retrieved from https://www.replyobgyn.com/wp-content/uploads/2019/01/ACOG_Urrutia-Systematic-Review.pdf

[5] Reproductive Health Access Project. (2019). Fertility Awareness. Retrieved from https://www.reproductiveaccess.org/wp-content/uploads/2014/12/nfp.pdf

[6] Smith, A. (2019). Fertility Awareness Based Methods (FABMs): Evaluating and Promoting Female Interest for Purposes of Health Monitoring and Family Planning. University of Arkansas: Theses and Dissertations. Retrieved from https://scholarworks.uark.edu/cgi/viewcontent.cgi?article=4837&context=etd

[7] Society of Obstetricians and Gynaecologists of Canada. (2015). Canadian Contraception Consensus Chapter 4: Natural Family Planning. JOGC Journal of Obstetrics and Gynaecology Canada. Retrieved from https://www.jogc.com/article/S1701-2163(16)39375-6/pdf

[8] Thijssen, et al. (2014). ‘Fertility Awareness-Based Methods’ and subfertility: a systematic review. FAcTs VieWs Vis Obgyn. Retrieved from https://www.researchgate.net/publication/267872637_’Fertility_Awareness-Based_Methods’_and_subfertility_a_systema-tic_review

[9] The American College of Nurse-Midwives. (2018). Fertility Awareness Methods. Journal of Midwifery and Women´s Health , 63. Retrieved from https://onlinelibrary.wiley.com/doi/epdf/10.1111/jmwh.12906

[10] World Health Organization. (2016). Selected practice recommendations for contraceptive use. Geneva. Retrieved from https://apps.who.int/iris/bitstream/handle/10665/252267/9789241565400-eng.pdf?sequence=1

[11] World Health Organization Department of Reproductive Health and Research and Johns Hopkins Bloomberg School of Public Health Center for Communication Programs (2018) Family Planning: A Global Handbook for Providers. Baltimore and Geneva. Retrieved from https://apps.who.int/iris/bitstream/handle/10665/260156/9780999203705-eng.pdf?sequence=1