Fertility Awareness Methods 101
Most of us grew up terrified of getting pregnant. We turned to pills, patches and IUDs contraception to save us. What if there was a safe, effective option all along?
Lily is a certified FAM teacher, herbalist and public health professional. The big idea behind this Substack is we deserve to know ALL the options when it comes to our reproductive health choices. Here we aim to fill in the gaps.
What is FAM?
FAM stands for Fertility Awareness Method. Sometimes, you’ll also see it written as FABM, Fertility Awareness Based Methods. While FAMs include a variety of methods with different protocols, the core concept is this: identifying your fertile window.
Knowing your fertile window is key because once you know it, you can:
Naturally avoid conception
Proactively plan for and time conception (when you’re ready!)
Assess your health in real-time, and take action accordingly
How does FAM work?
I practice and teach sympto-thermal FAM based on the work of Toni Weschler, combined with my certification from Fertility Education and Medical Management (FEMM), and my training as an herbalist, which included many hours of anatomy.
The key biomarkers I track and suggest my clients track are:
Basal Body Temperature (BBT): BBT is your temperature upon waking, prior to getting out of bed or otherwise moving. It’s your lowest waking temperature.
Why it matters: after you ovulate progesterone rises and increases metabolism and thus BBT. Observing a slight increase in temperature (usually .4-1 degree), is a sign you ovulated. When using FAM to avoid pregnancy, confirming you ovulate allows you to determine when your fertile window ends. Ovulation means releasing an egg(s). An egg only survives up to 24 hours. Once you’re past the window of possible egg survival, there is no longer a risk of pregnancy for that cycle.
Cervical Fluid: Cervical fluid is secretion produced from the cervical crypts, which line the lower walls of the cervix.
Cervical mucus plays several key roles throughout the cycle including protecting the uterus, filtering out poor quality sperm, and facilitating the survival and movement of healthy sperm during the fertile window.
It is THE most essential FAM sign (and the only tracked in some methods) because unlike BBT, which only alerts us after ovulation occurs, cervical fluid tells us when our fertile window begins. The point of change is when we first identify fertile fluid. From there, the fluid continues to gain more of what we call ‘estrogenic’ properties leading up to ovulation.
As we get closer to ovulation, cervical mucus becomes clear, stretchy, and slippery. After ovulation, cervical mucus thickens and decreases.
Other biomarkers: Personally, I feel great about using the two above. They are simple, low maintenance, and highly accurate. That said, there are two other options that can be helpful.
Cervical position: The cervix is low, closed and firm early in the cycle. As ovulation approaches it opens, moves higher, and becomes softer. Learning to track the cervical position takes more practice than the other signs, but is a good option for anyone wanting more clarity, or having trouble with discerning cervical fluid.
LH strips: Luteinizing Hormone rises 24-36 hours before ovulation. LH strips are inexpensive to buy in bulk (in the US–not everywhere), and I’ve found, especially useful when learning to track because they validate your own observations, increasing your confidence. If you’re tracking cervical fluid you’ll typically see a positive LH test as the fluid becomes more estrogenic (slippery, clear, stretchy). Likewise, you’ll typically see the rise in BBT ~ 2 days after your first positive LH strip.
Image: University of California San Francisco Center for Reproductive Health
Pulling it together: Why do this?
As you can see, FAM is about tuning into your body on the daily.
Since you know when you’re fertile, you can make choices that align with your desires and risk tolerance. If you’re not trying to conceive (TTC), you can use barrier methods on fertile days (e.g. condom), withdrawal, or abstain from intercourse completely. You’ll also know when there’s no chance of pregnancy and can fully enjoy that too.
You’ll also have new information every month that gives you insight into your overall health. The amount of and color of your blood, the days of fertile mucus, when and if you ovulated, and the length of your luteal phase all provide real-time intel on your wellbeing.
Plus, when you know what phase you’re in, and understand the hormones at play, you are better able to lean into the gifts present while also handling the shadows. I’ll write about this more soon, but for now, here’s a brief note I wrote explaining:
Tips and FYIs:
⭐When learning, it’s helpful to track very consistently –overtrack even. Like driving, you have to follow detailed directions when you’re learning a new route. Then, over time, you may be able to look up, see the familiar landmarks and know exactly where you are. Once you fully understand your own rhythms, depending on your goals and scenario, there may be opportunity to implement shortcuts.
⭐Research has found FAM to be over 98% effective(1) –in these studies participants are always taught by a qualified instructor. You can learn FAM by yourself, but you’ll likely be able to implement it more quickly and confidently with a coach.
⭐I’ve reviewed the basics of the FAM biomarkers, depending on your goals, there are different protocols to follow. There are also different methods of FAM for contraception. The methods will tell you exactly how to track the biomarkers, options for recording them, and guidelines to follow to prevent conception (if that is your goal).
⭐FAM is not just about tracking your cycle biomarkers, it’s about interpreting them. When you track, you’ll know if the amount of blood you have is normal, if your period phases indicate healthy follicular development, get insight into your monthly hormone levels, and be able to track changes over time. This is prevention! This is agency! This is power!
⭐Cycle Tracking Apps like Clue and Flow are great for keeping track of when you bleed and recording other signs and symptoms, however they are NOT the same as symptothermal FAM. These apps are predicting your fertile window based on an algorithm–not the real-time data from your body. Natural Cycles is a FDA approved cycle tracking app/system that works best with regular cycles. It uses temperature to predict your fertile window. It is 93% effective with typical use, and 98% when used perfectly. While those are still decent odds, the control piece is what gets me–you are putting your trust in an algorithm! When you use a symptothermal FAM method, you are using real-time info from your body.
What do YOU think?
Was this information new, or familiar to you?
Have you tried FAM? If not, would you? Why or not?
What are your questions?
About this newsletter:
I believe we deserve to know ALL the options about our cycles, contraception, and fertility. I write from my perspective as a FAM coach, herbalist, and woman on my own journey. You can read more the newsletter and why I write it here.
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References:
Steward K, Raja A. Physiology, Ovulation And Basal Body Temperature. [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546686/
U.S. Food and Drug Administration. (2018, August 10). FDA permits marketing of first direct-to-consumer app for contraception to prevent pregnancy. https://www.fda.gov/news-events/press-announcements/fda-allows-marketing-first-direct-consumer-app-contraceptive-use-prevent-pregnancy
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. doi:10.1093/humrep/dem003