Natural Family Planning is one of the most simple, powerful and overlooked aspects of preconception preparation. The beauty of it is you can use it as a mode of birth control before trying to conceive and then return to it throughout your entire childbearing years. It’s often overlooked by mainstream medicine, and it’s a skill that every woman has the right to know. The way we use our knowledge of our fertility allows us to choose when we’d like to conceive, and when we don’t.
Before we jump in, I’d love to note a little caveat. If you’ve spoken to your doctor about natural family planning, you may likely have been met with “it’s not a reliable method”.
Unfortunately, all fertility awareness-based methods are often judged by the lowest common denominator: the Rhythm Method. This method is indeed is very unreliable and not to be trusted in either the context of avoiding pregnancy or trying to conceive.
The Symptothermal Method is the method that I teach women in my clinical practice. It is a Natural Family Planning Method backed by rigorous science (Billings, 2011; Frank-Herrmann et al., 2007).
What’s the difference between the methods?
SymptoThermal Method (Which includes Natural Family Planning & Fertility Awareness Methods):
The symptothermal method is the type I’m teaching you here. This method uses a combination of cervical mucus observation and temperature to identify fertile times.
When in the fertile window, if trying to get pregnant, this is the optimal time to have sex. If you’re using Natural Family Planning for birth control, sex must be protected (i.e. condoms, diaphragm etc.) or abstained.
User beware, the rhythm method is what gives Natural Family Planning a bad name! Please note, this is NOT a reliable form of birth control.
It was introduced in the 1930s following the discovery of the timing of ovulation in the menstrual cycle, usually around day 10 – 14 based on a 28-day cycle. In other words, this method would be useful for a textbook. Or a Barbie doll. Not a menstruating human.
It does not give you real-time information about your unique cycle. Ovulation can occur at completely different times for different women. Even though the rhythm method has been outdated for around five decades, many couples still rely upon it, and this is the method many apps are based upon.
Why I’m an Advocate of Natural Family Planning
Natural Family Planning, at its essence, is knowledge of your body that empowers you as a woman with the choice of when you’d like to have kids (if at all).
It’s useful as a birth control method. The Symptothermal Method, when learned from a trained educator, is 99.6% effective with perfect use when used to avoid pregnancy (Frank-Herrmann et al., 2007)
It costs very little: the initial investment is taking a class or private sessions with an educator plus a thermometer. Once you have this knowledge and awareness, you have it for life. There are no upkeep costs. It is a device-free and hormone-free method of fertility management; therefore, you don’t have the side effects or dangers associated with other methods.
Women, in general, overestimate their knowledge of their cycle and fertility.
In one notable study that looked at women’s confidence in knowing when they’re fertile vs. when they’re not, found that 68.2% of the women interviewed felt they knew when they were fertile. When the researchers enquired into what they were basing this off, only 13% were accurately identifying this. That’s a huge gap! It’s also interesting to note that this study took place in an inpatient unit in an IVF clinic in Melbourne. In other words, 87% of women undergoing a high level of fertility intervention could not identify their fertility (Hampton, Mazza, & Newton, 2013).
Natural Family Planning and Preconception
Fertility Awareness gives you real-time insight into your fertility. It also allows you to identify any underlying health issues and develop an action plan to improve fertility naturally. You cycle contains a tremendous amount of information about your fertility and health.
For example, your chart can reveal:
- the health of your thyroid
- patterns of ovulation and anovulation
- if your luteal phase and progesterone levels are -healthy and thus able to support conception and -pregnancy
- effects of stress on your body
- and most importantly for preconception, your fertile window!
If there are health challenges present, you will be able to pick these up and treat them before trying to conceive. The benefits of this: a healthier, more prepared body AND not having to go through the heartache and stress of conception challenges.
The current medical model uses the term “infertility” when a couple has not conceived within 12 months of unprotected sex. If a couple is not getting their timing right or there are health factors at play, 12 months is too long to have to find that out.
Your Menstrual Cycle is as Unique as You Are
There is no such thing as a perfect cycle. The aim is not to have a 28-day cycle where you ovulate on day 14. You can conceive and have a very healthy pregnancy, even if you have an irregular cycle or have a cycle that doesn’t fit this textbook definition.
Each cycle there are 3 days where you have the best chance of conceiving and natural family planning allows you to learn when that is.
*It’s very important to work with a professionally trained educator who has qualifications in natural fertility/natural family planning. *
Conception & Probability
Before we dive into the basics of how you can start charting your fertility, I must share some important statistics with you.
Even if you time sex correctly with your fertile window and the day of ovulation, you still have a 20% chance of pregnancy each cycle. Even if an egg is fertilised, it does not guarantee this will progress to a pregnancy. In other words, within 12 months, 80-83% of couples who are trying to conceive and getting their timings right will become pregnant. 93% will within 2 years (Crosignani, 2000; te Velde, Eijkemans, & Habbema, 2000).
Having a mindset of faith in nature’s design and patience is very helpful as you embark upon this process.
So! How do you know when your fertile window opens?
Natural Family Planning 101
One common misunderstanding that you may have been led to believe as a teenager is that you’re fertile every single day.
Perhaps the school nurse thought it was easier to give us the hard word on being careful with boys rather than explain mucus to a group of giggling teenagers. A more likely tale is because she wasn’t taught it in her nursing training.
WE’RE ONLY ABLE TO GET PREGNANT FOR ABOUT 5-7 DAYS EACH CYCLE.
Not what you were taught right?
Natural Family Planning is based on observing the changes in your cervical mucus and your temperature. Mucus is going to take on a whole new meaning for you. It’s the gatekeeper of ALL fertility. Here’s why:
Cervical mucus can keep sperm alive for up to 5 days (6-7 days in some instances). Without mucus, the sperm will die within 2 hours.
Have a look at the diagram below. The cervix is the neck of the uterus that leads down to the vagina. Within the cervix are a series of glands that are mucus-producing machines. When no egg is present, a thick mucus is formed that creates a plug that closes off the vagina to the uterus. For 3/4 of our cycle, the sperm has no access and are killed.
Ovulation & Fertile Mucus – the cervix is open, and the sperm has free passage up into the uterus. This is your fertile window – the time you can get pregnant.
Infertile phase – there’s a mucus plug formed at the cervix which is impenetrable to sperm. The sperm have no access and will die within 2 hours. This is the time that you cannot get pregnant.
As ovulation approaches, cervical mucus is produced.
Ovulation only occurs once in each cycle, and if the egg is not fertilised, it dies within 12 – 24 hours. It’s impossible to ovulate twice in a cycle. More than one egg can be released – in the instance of fraternal twins – but this will happen in the same 12 – 24 hour period.
Take away point – You can not get pregnant unless you have unprotected sex during your fertile window.
Natural Family Planning Charting
The most important take-home message of Natural Family Planning is:
Natural Family Planning is based on what you see and feel today.
Not last month.
Not from a fertility predictor app… what you see and feel today.
This is THE KEY to using this method effectively.
Learning to observe your fertility signs: cervical mucus and basal body temperature.
Using Natural Family Planning involves learning to interpret your two main fertility signs: cervical mucus and basal body temperature. There’s an optional third: cervical position.
Cervical mucus is the gateway to your fertility.
A fascinating phenomenon is that the cervix makes many different kinds of mucus. Each type of mucus has unique properties.
The wet, slippery mucus produced in the fertile window contains channels that create speedways for the sperm to travel. And while sperm does swim, those channels use a negative pressure system to PULL THEM UP into the womb. They get a chauffeur service up into the fallopian tubes. During the fertile window, from the time of ejaculation to the sperm hanging out in the fallopian tubes awaiting your egg is 20 minutes. It’s a very efficient system!
The thicker mucus doesn’t have this property. There are no channels. It contains proteins that create a mesh that traps the sperm, and then immune cells engulf them. RIP sperm.
What is the best way to check my mucus?
The vulva is a sensitive area of a woman’s body, and walking enables even the smallest quantity of fertile mucus to be sensed. Only sometimes, there is enough fertile mucus produced in the fertile phase of the menstrual cycle for it to be observed as well as sense. This is why sensing fertile mucus at the vulva can more accurately identify the fertile phase than seeing fertile mucus. When you’re walking around throughout the day ask yourself, “What do I feel down there? Is it wet? Moist? Or do I feel nothing at all?”
Observing cervical mucus:
When you go to the bathroom, use a piece of toilet paper and wipe from front to back. What do you notice? Is the sensation dry, smooth or slippery? Look at the paper. Is there any cervical mucus present?
NOTE: There’s no need to insert your fingers into your vagina. Sensing at the vulva is more accurate.
Basal Body Temperature
When you track your temperature every day, you’ll notice a pattern. It’s different for every woman, but will generally be divided into low temperatures in the first half of the cycle, and high temperatures in the second half. (Image)
Basal body temperature is also referred to as ‘waking temperature’ and is a measure of your resting metabolic rate. It’s the lowest normal body temperature taken after 4-6 hours of complete rest (i.e. sleep) and before any activity.
Before ovulation, your basal body temperature ranges from around 36.2 – 36.6 degrees Celsius. After ovulation, BBT will shift 0.2-0.5 degrees Celsius and will usually remain elevated until menstruation.
The rise is due to the increased levels of progesterone produced by a little gland in the ovary (the corpus luteum) that is ONLY produced if ovulation has occurred. Progesterone is a hormone that increases our basal metabolic rate that is measurable by temperature.
When charting, you’ll see two distinct groups of temperatures on your chart. Low temperatures and high temperature, and this is the way you can confirm if you’ve ovulated, and when it happened. The cover line is the line you can use to split the two groups of temperatures apart when using a graphing temperature chart.
Setting the temperature myth straight.
A common myth about basal body temperature is that it can help you to predict when you’ll ovulate. You’ve probably seen it on TV when the woman takes her temperature and exclaims she’s ovulating and that male lead should make a beeline for the bedroom. * Sigh *. Television playing havoc with our understanding.
Basal body temperature has no predictive value. Because the temperature rises after ovulation have occurred, it’s a retrospective sign of ovulation. For this reason, temperature alone isn’t a valid method of contraception.
But when combined with the mucus method, it can confirm ovulation by cross-checking the temperature shift with mucus signs. This is why it’s a useful tool in confirming ovulation.
Taking Accurate Basal Body Temperature
You’ll need a basal body thermometer. Check your temperature as soon as you wake up in the morning before you get out of bed or move around (before you have a shower, get a drink of water or brush your teeth).
Try to check your temperature around a similar time each day. If you get less than 4 hours of sleep, your temperature isn’t considered accurate – make a note of it.
Factors That Affect Basal Body Temperature
Make a note of any of these on your chart:
- Having a fever
- Getting less than four consecutive hours of sleep -(particularly crucial for breastfeeding mums).
- Using an electric blanket or heater in the bedroom
- Drinking alcohol the night before
- Certain medications may lower BBT (such as aspirin or paracetamol)
This is an optional sign to check for. Some women love to check, as it provides that extra set of data to corroborate with the cervical mucus and basal body temperature to pinpoint precisely when the fertile window is. But it isn’t necessary for the method to be effective.
Around ovulation, the cervix rises and becomes soft and open. This is to allow sperm-entry into the womb and fallopian tubes. An easy way to remember how the cervix should feel around your fertile window is SHOW. Below image adapted from “Taking Charge of Your Fertility” by Toni Weschler (Weschler, 2015)
S – soft.
H – high.
O – open.
W – wet.
The softness is like the softness of your lower lip. When you’re in a non-fertile phase, the cervix sits lower; it’s firm (like the end of your nose), closed and not wet (dry).
How to check your cervix?
After you’ve observed your cervical mucus, wash your hands, and slip two fingers up into your vagina and feel for your cervix. If it’s very high, you may not be able to feel it. Other days you’ll feel it immediately.
NOTE: It’s essential to record your cervical mucus BEFORE checking your cervix. Manually checking your cervix is enough to stimulate “arousal” fluid (even if you’re not aroused, it’s the body response to any stimulation to these parts) and can obscure your cervical mucus sign.
What is the Peak Day?
The Peak Day refers to the day of ovulation. The signs that’ll help you identify your Peak day are:
- Cervical mucus: it’s the last day of the mucus being wet and slippery before returning to dry.
- Basal body temperature: when you experience the rise in temperature of 2/10ths of a degree (and is confirmed by your temperature remaining high).
- Cervix position: when the cervix is SHOW – soft, high, open and wet.
How To Determine The Best Time To Get Pregnant
The Two Principles For Knowing The Best Time To Get Pregnant With Natural Family Planning
Following these principles not only ensures correct timing, but they also help to preserve the quality of the sperm being produced.
#1 Have sex (if you want to) on alternate days of your infertile phase leading up to your fertile window
There are two reasons for this. The first is to allow for precise identification of when the fertile window does begin. Arousal fluid and semen can mask the presence of fertile mucus for about 12 hours, so having sex every other day allows you to know when your fertility window begins.
The second reason is that it helps to preserve the quality of the sperm.
#2 Have sex every day of your high fertility window and for two days after.
When your cervical mucus begins to become wetter, wait and see for a day (to ensure that this is indeed your fertile window beginning), then as the mucus becomes slippery and wet this is the sign that you’re at your highest level of fertility, ovulation is about to occur, and it’s the best time to get pregnant.
Have unprotected sex over the next few days and two days after your Peak day (your wettest cervical mucus day and your basal body temperature going up two-tenths (0.2) of a degree Celsius).
The reason for continuing to have sex for an extra two days is that ovulation can be delayed for as long as 48 hours after the Peak day. Once released, an egg can only survive for up to 24 hours.
If your partner’s sperm count or quality is compromised, change this strategy by having sex on every second day during the high fertility window and a day after (Billings, 2011; Weschler, 2015).
Some women may only get the wet sensation for one day, or even part of a day. In some cases, this is enough for conception. If you don’t see any mucus, focus on the vulva sensation changes of dry to wet to slippery. This can be a subtle experience. For women with subfertility who’ve been trying to conceive for some time, being tuned into this sensation can make all the difference in knowing the best time to get pregnant.
If you’ve recently stopped taking the pill or another hormonal birth control method, don’t be disappointed or discouraged if you don’t conceive straight away. It can take some time for the body to adjust to its own hormones and rhythms again.
Why Knowing The Best Time To Get Pregnant Is Empowering Knowledge
The beautiful thing about charting your cycle and knowing when you ovulate is that you’ll be able to more accurately determine the date of your Bub arriving in the world.
Conventional medicine currently calculates week 1 from the end of the last period. Which can be inaccurate for some women who ovulate on day 21 (or beyond). The expected delivery date is actually 266 days, plus or minus 6 days from your Peak day.
TIP – It’s useful to know when you ovulated to give yourself the best chance of going full term (and not being induced early when in fact you are in week 38, not 41).
You don’t need a perfect cycle to get pregnant!
I hope this article will help you begin to see the value of understanding your fertility in advance of trying to conceive. This skill gives you:
- Brilliant insight into your own body
- Flags potential barriers to conception in advance
- Allows you to transition off hormonal based medications, devices and injections and use a natural mode of birth control while you do your preconception prep.
- Gives you the sovereignty to choose when you want to conceive and improve your chances of getting pregnant when you do begin trying
It’s simple once you’ve learned the method and have had an instructor mentor you through your understanding.
Natural family planning is a lifelong skill that every woman and couple should have the right to learn.
I dream of a healthcare system that one day offers lessons and sessions to all menstruators.
Please let me know in the comments below if you have any questions!
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References & Resources
Billings, E. (2011). Billings Method: Controlling Fertility without Drugs or Devices(New Edition) by Evelyn Billings (Illustrated, 10 Jun 2011) Paperback (16th Revised edition edition). Gracewing.
Crosignani, R. (2000). Optimal use of infertility diagnostic tests and treatments. Human Reproduction, 15(3), 723–732. https://doi.org/10.1093/humrep/15.3.723
Frank-Herrmann, P., Heil, J., Gnoth, C., Toledo, E., Baur, S., Pyper, C., … Freundl, G. (2007). The effectiveness of a fertility awareness based method to avoid pregnancy in relation to a couple’s sexual behaviour during the fertile time: A prospective longitudinal study. Human Reproduction, 22(5), 1310–1319. https://doi.org/10.1093/humrep/dem003
Hampton, K. D., Mazza, D., & Newton, J. M. (2013). Fertility-awareness knowledge, attitudes, and practices of women seeking fertility assistance. Journal of Advanced Nursing, 69(5), 1076–1084. https://doi.org/10.1111/j.1365-2648.2012.06095.x
te Velde, E. R., Eijkemans, R., & Habbema, H. D. (2000). Variation in couple fecundity and time to pregnancy, an essential concept in human reproduction. Lancet (London, England), 355(9219), 1928–1929. https://doi.org/10.1016/s0140-6736(00)02320-5
Weschler, T. (2015). Taking Charge of Your Fertility, 20th Anniversary Edition: The Definitive Guide to Natural Birth Control, Pregnancy Achievement, and Reproductive Health (Revised, Updated edition). New York: William Morrow Paperbacks.