Fertility Awareness Method as Birth Control - Mediatrix Womens Wellness

“The 4 All Important Rules” of the Fertility Awareness Method as Birth Control

In this post we will cover:

  • How to use the fertility awareness method as birth control
  • “The 4 All Important Rules.”
  • How to combine barrier methods with the fertility awareness method (i.e. condoms, diaphragm etc.)
  • How to use withdrawal with the fertility awareness method safely

How to use the fertility awareness method as birth control

To use FAM effectively for birth control, you need to be able to confidently (and accurately) identify each day whether you are fertile or not. This is done when you tune in and chart your cervical mucus, basal body temperature and – optionally – cervix position to confirm that you have ovulated.

When you identify your fertile window, you simply avoid unprotected sex on those days. No sperm during fertile window = no baby. It is that simple. However, there are some ESSENTIAL (not-negotiable!!) rules that you must follow for the method to be effective. There are also subtleties and considerations that apply individually to women.

The 4 Rules for Birth Control

Learning to use FAM is like learning to ride a bike. It takes some time to get used to it and become confident by practising, but once you have it, you have this skill for life.

There are four simple rules for using this method to avoid pregnancy.

1. Avoid having unprotected sex on days of heavy bleeding during your period. And if you do have sex, use a barrier method.

Bleeding can obscure the presence fertile mucus.

2. You can have unprotected sex on alternate evenings during your dry days before ovulation.

The reason the evening is essential is that it ensures that you are in an infertile phase. If there is fertile mucus, it can take a day of being upright and moving around to flow down from the cervix to the vulva. Another reason for this is that semen and vaginal mucus from arousal will create a moist sensation and can last 24 hours which could mask the beginning of fertile mucus.

3. When there is any change from dryness, treat it as fertile.

This change can include spotting, bleeding, moistness or wetness. If this change then returns to dryness, count three days of consecutive dryness to confirm you are in an infertile phase. This time is required to ensure the mucus plug has reformed. These changes may not progress to ovulation, but they must be treated as so.

4. You are free to have unprotected sex after the 4th day of your Peak day until your period begins.

This phase indicates that you have already ovulated. This rule works because when cervical mucus is present, it changes the pH of your vagina and can keep sperm alive and active for up to 5 days.

Once your cervical mucus dries, it takes a few days for the mucus plug to form in the cervix and the vagina to return to the normal, acidic pH. The three-day rule allows for enough time for your vagina to return to a sperm-killing machine!

Printable moon map and fertility chart by Clara Bitcon Bailey Naturopath

Can I start using the fertility awareness method straight away for birth control?

Yes and no.

Yes in that you can start charting your cycles and becoming familiar with your unique pattern.

No, in that you cannot rely on it for birth control straight away. You need to become confident first. This typically takes about three cycles or more.

How to combine barrier methods with FAM (i.e. condoms, diaphragm etc.)

Your mucus signs (and temperature to confirm) will indicate when a barrier method is necessary. When you are three days past your Peak symptom (on the fourth morning), you can then quite safely have sex without condoms or a diaphragm.

How to use withdrawal with FAM safely

You may be interested to know that withdrawal as a birth control method CAN be quite effective. The problem is, in practice, it usually isn’t.

One well-respected study found that perfect use of withdrawal is estimated to be 97% effective yet typical use is 73% (Trussel, 2004). This gap can be explained by not properly understanding the finer details of how it needs to be done. As one of my teachers said, withdrawal is “entirely user dependent”. So if you’re thinking about using FAM and withdrawal as your birth control strategy, make sure you and your partner take careful note of the following:

When ‘withdrawal’ is most effective:

  • When your guy has not ejaculated in the past 24 hours
  • Withdrawal occurs before orgasm and ejaculation (he needs to have excellent control over his orgasm and ejaculation)
  • Sex is not repeated on the same occasion (otherwise thorough cleaning and a condom should be used)
  • Neither one of you should be under the influence of drugs or alcohol
  • Your partner needs to have a genuine belief that this is his responsibility and cares about your wellbeing.

Withdrawal will fail if:

  • None of the above is factored in
  • either of you believes that having a shower or urinating is enough to render you safe between lovemaking sessions
  • withdrawal is used directly around the Peak day – as the cervical fluid will take excellent care of the small amount of sperm that possibly will make it through. I always recommend a barrier method around this time.


Why pre-cum is considered a possible risk for pregnancy.

A large proportion of men leak active sperm in their pre-ejaculatory fluid (pre-cum). If sexual intercourse is repeated in a short space of time (estimated to be less than 24 hours) the pre-ejaculate may be primarily made up of sperm. Due to male anatomy, apart of the tubes connecting the testicles to the urethra are not in contact with urine (check out the diagram). Thus urination does not affect these higher tubes that contain motile sperm (Killick et al., 2010). Eeck!!!


  • Billings, E., & Westmore, A. (2011).* The Billings Method: Usings the body’s natural signal of fertility to achieve or avoid pregnancy*. Penguin Books.
  • Killick, S., Leary, C., Trussell, J., & Gutherie, K. A. (2011). Sperm content of pre-ejaculatory fluid. Human Fertility (Cambridge, England), 14(1), 48–52. https://doi.org/10.3109/14647273.2010.520798
  • Trussell, J. (2004). Contraceptive failure in the United States. Contraception, 70(2), 89–96. https://doi.org/10.1016/j.contraception.2004.03.009
  • Weschler, T. (2015). Taking Charge of Your Fertility : The Definitive Guide to Natural Birth Control, Pregnancy Achievement, and Reproductive Health. William Morrow & Company.

“The 4 All Important Rules" of the Fertility Awareness Method as Birth Control

Women's Health Issues & Conditions

December 9, 2017

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