How Effective Are Fertility Awareness-Based Methods? | FAMM Research Series (Episode 536)

Full Transcript: Episode 536

Lisa Hendrickson-Jack:

This is the Fertility Friday podcast, episode number 536.

Today I’m sharing a brand new research series episode, a brand new FAM research series episode. And in today’s episode, we are going to talk about efficacy — efficacy of fertility awareness-based methods. And I’m going to talk about an interesting study, and the study doesn’t necessarily paint a favorable view of fertility awareness-based methods, and we’re going to talk about why that is. But we’re going to talk about the data, because even if they’re not necessarily painting it in a favorable light, in many cases the data speaks for itself. So, without further ado, let’s go ahead and jump right in.

All right, so the title of the paper that we are going to be covering today is Fertility Awareness-Based Methods for Pregnancy Prevention. This paper came out in 2019, it was published in the BMJ. And essentially, it really presents as information for clinicians for how to move forward, given that fertility awareness-based methods are becoming more popular, more people are using them. So they actually start with a stat: fertility awareness-based methods of contraception are increasingly being used for pregnancy prevention. In the U.S., the portion of contraceptive users who choose such methods has grown from 1% in 2008 to approximately 3% in 2014. So here we are in 2024. So it would be interesting to know what that stat is to date. But I would imagine that it has grown quite a bit.

And this is relevant because such a dramatic change — I mean, that’s a tripling within less than a 10-year period — and that would mean that the increasing number of women who are using fertility awareness-based methods — I mean, doctors are starting to notice, more people are starting to come into the doctor’s office asking about these methods. And many of these clinicians have not necessarily been trained in fertility awareness-based methods beyond being told that they’re ineffective. So I think that the tide is turning, and it will be interesting to see what papers continue to come out, what research is continuing to be done.

Because I think at one point, even when I’ve interviewed doctors who’ve gone through medical school, they’re often conveying that in medical school they’re getting very little if any education about fertility awareness-based methods beyond basically lumping them in with calendar calculation methods, rhythm-based methods, and being told that they’re essentially not effective, and then kind of shuttling them toward the, quote, “more effective” options, which would be the hormonal methods, specifically the long-acting methods. So there is this kind of preference for the hormonal IUD or the implant. Anything that reduces the possibility of user error, therefore theoretically increasing the overall effectiveness, is considered to be the best option.

And I think if all you’re looking at is effectiveness, then that would make sense. But when you’re looking at actual women who are looking for what’s best for them, they’re looking at effectiveness, but they’re also looking at side effect profile. They’re looking at the transition phase following coming off contraceptives, they’re looking at the impact it may have on their hormones, on their fertility, on a variety of different factors. So to just look at effectiveness only and recommend those methods kind of to the exclusion of other methods, I think, is starting to fall out of favor because many women are voicing their dissatisfaction with many of these hormonal methods.

So anyways, that was a bit of a preamble just to get a sense, because I think it’s interesting that this paper is kind of coming up because it’s like, oh no, we need to address this because all these women are coming into our offices talking about these methods. And I would say that that’s one of the reasons why, as we’ll talk about, this paper doesn’t necessarily paint fertility awareness in the most favorable light.

So basically, there’s a couple of things that I want to talk a little bit about today. I think the key thing, the most important thing I want to talk about is efficacy. But I do want to touch on the different types of fertility awareness-based methods. So for example, our Fertility Awareness Mastery Mentorship Practitioners — one of the first units that we cover in the program is fertility awareness-based methods, so that we can all learn a bit about the different types of fertility awareness-based methods. Some of the feedback that we get in the program is many of our practitioners — they didn’t even know about this kind of history of fertility awareness and the fact that there’s so many different methods.

And so in this paper, they acknowledge that there’s different fertility awareness-based methods and they divide them into a few categories. So in this paper, they talk about the calendar-based method. So that would be what you would think of as the rhythm method, where we are not necessarily looking at your biomarkers in real time, but we’re looking at your past cycles and calculating an average of when ovulation was estimated to occur and the total length of your cycle, and then use those calculations to determine when your fertile window is going to be. So there are modern day rhythm methods, calendar-based methods. The standard days method is an example of that, or the two-day method is an example of that.

So interestingly, those methods do have research behind them and they’re still used, and there are certain populations that find them to be incredibly useful. So it is interesting also just to expand your mind to learn what’s out there. And what we’ll do is we’ll link a very old episode where I actually interviewed one of the practitioners of the standard days method — again, a modern day kind of calendar rhythm method. And it was a fascinating interview to kind of shed some of those beliefs about the fact that there are still women who use calendar-based methods. Although it’s not necessarily a method that I would recommend for most of the women, if not all the women that I work with personally, it’s still interesting to learn about them.

So anyways, calendar-based methods, mucus-based methods. So it is interesting to learn that there are methods that use mucus only or suggest to use mucus only — so not necessarily including temperature or actively dissuading women from using temperature. So that’s interesting as well to note. So for example, some of the mucus-based methods include the Billings method, and also the Creighton method has two examples. So, basal body temperature-based methods. So there are methods that are to be used at temperature only, essentially. So, kind of bypassing mucus altogether.

Now I think the most common category of fertility awareness-based methods, or at least the method that I teach, that we teach in FAM, is the — you know, one of the versions of these symptothermal methods. So symptothermal methods — it’s a category — and methods that fall under that umbrella rely on multiple biomarkers. So they rely on cervical mucus typically, basal body temperature, sometimes incorporating cervical position, and sometimes incorporating a last pre-ovulatory infertile day calculation. So we’ll talk a little bit more about the differences between symptothermal methods. And then there’s also symptothermal hormonal methods — in this paper they refer to them as urinary hormone-based methods. So there are methods that incorporate different biomarkers, such as cervical fluid, in addition to tracking specific urinary metabolites — so typically luteinizing hormone, or some methods employ the devices that track estrogen metabolites, as well as progesterone, which can also be used.

So that kind of gives a summary of it. So even just that information is helpful, I think, for people to kind of get their head around that there are a variety of ways to track. So all fertility awareness-based methods, I would say, what they have in common is that they’re trying to identify that fertile window — either for achieving pregnancy or preventing pregnancy. And there’s different ways to do that. And so one of the ways to do that is literally to look at the hormones themselves. And another way to do that is to look at the effects of the hormones. So when you’re tracking your cervical fluid, when you’re tracking your basal body temperature, you’re actually looking at the impact of the hormones. So you’re kind of indirectly looking at those hormones. And of course, there are also the calendar-based methods. And then the symptothermal method — kind of those methods incorporate a lot of these signs together.

So that’s kind of their starting point. What I do appreciate about this paper is that it is factual, but like I said, there are instances where they’re painting fertility awareness-based methods in maybe not the best light. But when we’re talking about fertility awareness-based methods, as I read this paper, it does make me think and remind me of how I conduct the birth control training part of my program. So whether I’m working directly with clients or whether I’m working with women’s health practitioners, we always have to talk about how to manage that fertile window and the reality of why it is that some women do experience unplanned pregnancies.

So it is really helpful, I think, to discuss the difference between a method failure and a user failure. One of the things that I talk about quite a bit is that fertility awareness-based methods are very different to the birth control pill, or the IUD, or the implant, or you know, insert some of these hormonal methods. So I have been known to talk about hormonal methods as — hormonal methods are intended to change your body. So the way that I talk about it is that they make your body resistant to sperm. When you take a pill, or when you get the shot, or when you get an implant, or when you get an IUD, what’s happening is it’s changing the way that your body is responding to sperm.

So the primary mode of action for many of these hormonal methods is to suppress ovulation. Secondary method is to prevent your body from producing fertile-quality cervical fluid. So your cervix instead fills with the thick mucus plug that blocks sperm from being able to access your cervical canal and your reproductive tract. So essentially blocking out the sperm so it can’t get anywhere. And then since it’s suppressing ovulation, there’s no egg anyways. And then a third mode of action is typically to ensure that that uterine lining is very thin and flat, so not receptive to a fertilized egg.

So there’s typically these three primary modes of action happening in the use of most of these contraceptive methods. And for example, the IUD doesn’t always fully suppress ovulation. You know, sometimes ovulation continues, sometimes it continues partially. And so having that cervical plug in place, having that thin endometrial lining that is not receptive to a fertilized egg, serves as then a kind of secondary measure if ovulation does happen.

And so in the use of those methods, you’re quite literally changing your body, and I would say you’re making your body resistant to sperm. So in those cases, you can have unprotected sex with a partner, yet it doesn’t result in pregnancy. Now, when you’re using a fertility awareness-based method, by definition, you are not using hormonal methods. And so you’re not actually changing your body, you’re not making your body resistant to sperm. You still have a fertile window, pregnancy is still possible for you. The only difference is that you’re changing your behavior. So instead of changing your body, you’re identifying that window and then you’re abstaining from unprotected sex during that fertile window.

So with fertility awareness-based methods, they are entirely user-dependent methods, and so the effectiveness of the method is highly dependent on the user. If you can correctly identify your fertile window and you actually take action and you avoid unprotected sex on those days — no unprotected sex whatsoever on your fertile days during that window — and you’re only engaging in unprotected sex outside of that window, on the days where pregnancy is impossible, then the method is highly effective. But if you as the user are using a method that is not as effective at identifying that fertile window — so if you have sex on days that are actually fertile days, you make the mistake as a user and you’re not correctly identifying those days — then the effectiveness rate is not going to be very effective, it’s not going to work as well.

And so this is one of the challenges. So when you’re reading studies like the one I’m talking about here today, or when you’re speaking with medical professionals who haven’t necessarily been trained in fertility awareness-based methods, typically what they’re telling you is, well, it’s really difficult, people are not perfect, and the average person is just going to mess it up. And so therefore these methods aren’t effective because it’s just too complicated. So these women can’t get their pretty little heads around this fertile days thing, and so it can’t be effective.

So it can feel very discouraging when you’re having these conversations with sometimes medical professionals or others who have kind of heard about the rhythm method, they don’t really think fertility awareness-based methods could be effective, they have kind of a bias, they don’t think it’s too difficult. There is certainly that aspect of the conversation. And the way that I talk about it, really — because I’m often asked this when I’m doing interviews and things like that — is that fertility awareness methods are not a method that anyone is forcing anybody to do. What I find is that the women who I’ve worked with over the years, they are self-selecting. Women come to fertility awareness-based methods for a variety of reasons.

One of the top reasons why many of my clients came to me to teach fertility awareness for birth control was because they were dissatisfied with their experience on hormonal contraceptives. Many women do have a negative experience — doesn’t mean all women have a negative experience, but many women do have a negative experience on hormonal contraceptives where the side effects are unbearable for them. And many women have had the experience where they’re going from contraceptive to contraceptive method, trying all these different methods because they’re not satisfied — maybe they’re having panic attacks, maybe they’re experiencing depression, maybe their libido is gone, maybe they are one day feeling happy and the next day they’re crying and they don’t understand what’s going on. Maybe two years in, after not really having a lot of side effects, they start having panic attacks, and then in a desperate Google session they realized that even though they didn’t have those panic attacks at the beginning when they first started the pill, it could be contributing to that now.

So there’s a lot of women who’ve had really negative experiences on hormonal contraceptives, and so they’re looking for other alternatives. And of course other women didn’t necessarily have a negative experience on the pill but they’re just looking to gain that insight into what’s happening in their bodies. Many women are wanting to prepare for pregnancy and they want to give their body a break from hormones while they’re still able to prepare — while they’re still able to prevent pregnancy successfully — and they want to be able to do those things at the same time instead of using a hormonal method that suppresses their cycle so that they can’t really prepare for pregnancy at the same time as avoiding.

So there’s a lot of different reasons why women self-select this method. And with that said, I would argue that fertility awareness-based methods aren’t for everybody. And I would also say that we shouldn’t ever lump in women who are not really using a specific method of charting — who are kind of maybe using an app and kind of just having protected sex whenever they want but saying that they’re kind of using it — we shouldn’t lump women who are not really using a method in particular with women who are actually following a specific method. We shouldn’t really lump those in together.

And so I think the researchers kind of got to that in one of the sections here. So one of the sections, they’re asking well how effective are these methods. So they’re talking about some of the challenges with research, and there’s different types of methods. And so they narrowed it down to a few different studies — again they’re looking at these different categories of fertility awareness-based methods. They define typical and perfect use, which is really an important concept to get your head around. So perfect use is what it sounds like — if you are using a specific method and you take the time to learn those rules and you’re actually following those rules correctly, then that would be perfect use. And that applies not just to fertility awareness-based methods but it applies to condoms, it applies to the birth control pill. I mean, if you think about it, if you’re taking a pill that you’re supposed to take around the same time every day but you don’t take it every third day or something like that, then that’s not perfect use. Similarly, if you’re using condoms but you don’t put it on — that’s not perfect use.

So if you’re using a fertility awareness-based method, that kind of perfect-use stat would imply that you actually know what you’re doing and you’re following the instructions correctly. And of course typical use refers to what typically happens. And so it is important to know the difference between the typical-use stats and the perfect-use stats for any birth control method — not just fertility awareness methods, just to put them on blast, but for all methods. Because whenever we look at the data, the typical-use stats are going to be lower than the perfect-use stats.

I would argue that perfect use is possible for women who are highly motivated and who take the time to learn a specific method from an instructor. So I’m a proponent of — for any woman who’s wanting to use fertility awareness-based methods and use it for birth control as their primary method of birth control — I think that it is important and helpful for women to really consider working with an instructor, even a few sessions. And I feel like there’s some debate on this in the fertility awareness community. I know there are many women who will say that they are self-taught and it’s great, and I think that there is some validity to that. But arguably, even those women who are self-taught still find communities of other women who use the method and they still compare notes and support each other. So I would say that the women who typically are most successful are the ones who did not do it completely alone and who are highly self-motivated. But I would say the highest efficacy for someone who’s looking to use the method would be among women who actually did take the time to work with an instructor.

So when they’re looking at effectiveness, they kind of did call it out, which I think is useful. They said in the United States there’s a grouping of all users together kind of under the umbrella of calendar methods, and people who are saying that they use apps and things like that, and they were saying that the rate of unintended pregnancies was 15 pregnancies per 100 women-years.

Then they looked at — so I’ll read what they say — in moderate quality prospective studies, among users of most fertility awareness-based methods, typical-use estimates for unintended pregnancy ranged across different methods from 10 to 34 pregnancies per 100 women-years. So they’re looking at data in a very broad, general sense, and there are studies that basically group everything together — so they group together users of symptothermal methods, users of apps, users of mucus-only methods, and just calendar methods, and basically anyone who says that they’re charting in any respect. They’ll kind of put it all together and you’ll end up with this really, really low efficacy rate. And that can certainly make it seem like fertility awareness-based methods are all the same and none of them work.

The thing about it though is that when we look at the data on fertility awareness-based methods, there is some really good data on — especially double-check fertility awareness-based methods. So the Sensiplan method is an example of that. And in that method, they are using two distinct parameters to open the fertile window. So they’re looking at cervical mucus as well as the last infertile day pre-ovulatory calculation. So they do incorporate a calculation as one of the two ways to open the fertile window. So essentially as you start a new cycle, it’s the earliest of either when you start to see mucus or a specific date that you’ve calculated based on your history and also based on the specific rules of the method. And then in order to confirm ovulation, we are then confirming — we’re looking at your cervical mucus and your basal body temperature and looking at kind of the latest of the two within those rule systems. So this is what we would call a double-check method, where we are using two distinct signs to open the window and we’re using two distinct signs to close the window.

Now as I described that, it’s no surprise that methods that employ this double-check method have the highest efficacy. And so when you’ve heard that stat used by many fertility awareness educators — where we talk about the effectiveness of fertility awareness being up to 99.4% — it actually comes from a study that is using these double-check strategies. So I believe sometimes that stat is being used incorrectly for methods that don’t actually use that double-check approach. So they’re not actually using two signs to open the window and to close the window — maybe they’re just using mucus to open the window — but they’re still using the stat. So it is actually really helpful to look at the research and to know, especially if you’re wanting to use fertility awareness or if you’re wanting to teach fertility awareness, to know which methods do show consistently the highest efficacy.

So in this research study, they kind of talk about some of these studies that lump together all these different methods. But then they also have to say that the methods like the Sensiplan method — like I said, that uses the double-check approach — and the Marquette method, they say they may be the most effective fertility awareness-based methods in typical use, with moderate-quality studies generating typical-use effectiveness estimates of 1.8 to 6.8 pregnancies per 100 new users in the first year of use. So they’re saying that there is a range of effectiveness with fertility awareness-based methods, with some methods showing effectiveness that is comparable to the condom, sponges, and diaphragms during the first year of use, and they’re saying other methods have a higher efficacy similar to the efficacy of the combined progestin-only pill, patch. So those methods have a 7% failure rate during the first year of use. And they’re saying the condoms, sponges, and diaphragms have a failure rate of somewhere between 13 to 21% during the first year of use.

And so they’re saying in typical use we’re seeing these types of ranges — we’re seeing a failure rate of 2%, in some cases 1.8%, failure rate to a 6.8% failure rate in the most effective methods, and then we’re seeing a higher percentage in some of the other methods that are kind of lumped together — 10 to 34% failure rate. And then when they’re looking at perfect-use statistics, the highest efficacy again goes to the double-check symptothermal method.

So within our FAM program, our Fertility Awareness Mastery Mentorship Program, we do teach our practitioners the highest efficacy methods with the pre-ovulatory double-check strategy as well as the post-ovulatory cross-check, so that we are always opening and closing the window using two specific markers in line with the research that shows the highest efficacy.

So in the study, for the perfect-use statistics, they’re basically saying that there are studies that show that with these specific methods the efficacy is comparable to condoms. And I think that that’s useful information. It’s almost like they’re a bit reluctant to admit it, but there is research showing that when we do use and follow the most effective methods, they are on par to some of our most effective methods. They didn’t go ahead and say that the 99.4% efficacy perfect-use puts the double-check symptothermal methods in line with hormonal contraceptives — they didn’t go that far in the study — but they did concede that there are methods that are extremely effective.

So a few things just to point out in the study then. The reason that I said that they don’t necessarily paint it in a favorable light is because they do also talk about some of the challenges, which I think is important — it is important to talk about the challenges — but sometimes I feel like they talk about the challenges with fertility awareness-based methods in a way that would make it seem like it’s just so impossible. You know, how could anybody use these methods successfully? It’s just so hard and you have to have a perfect cycle.

So they do list a few special considerations. I’ll go through what they talk about as some of the special considerations — or people who shouldn’t use the method, air quotes — and then we can talk about it. So they do point out that people who are unable to negotiate the timing of intercourse with their partner would be unable to use the method. So I think that that is a fair point. Like I said, fertility awareness-based methods are not for everybody. And if you have someone in a situation where their partner is just going to have sex with you whenever he wants to, then no, the method isn’t going to work. Because you do have to have your partner’s cooperation in order for fertility awareness-based methods to work.

They say women with long or irregular cycles should generally not rely on calendar-based methods, though methods that rely on tracking changes in mucus and temperature or urinary hormones may still be appropriate — which I also agree with. I mean, I would argue that calendar-based methods are just not that optimal for kind of our modern woman in our modern world. And the reason I would say that is because there are so many different factors affecting our hormones from our diet to our lifestyle to our stress level to just the light exposure to chemical exposure — there’s so many different things that can affect our hormones — that I feel that most of the women I see, even when their cycles are fairly consistent, there’s always going to be fluctuation.

And then they do say that when a person has strong personal or medical reasons to avoid pregnancy, that they would encourage hormonal methods. And so I think for me, the way I would say it is that because I believe that women self-select into fertility awareness-based methods, I wouldn’t say that if a person has a strong reason to avoid pregnancy that they can’t use fertility awareness-based methods. I think it would depend on the person, because I have seen women successfully use this method when you are really serious about it — you learn from an instructor, you follow the rules — and then it is possible to be successful.

So they talk about frequent reproductive tract infections, which I’m assuming they’re saying that if you have frequent reproductive tract infections, that it’s going to have a negative impact on the mucus and make that more difficult. I would argue that if you have frequent reproductive tract infections, we should probably look at that and solve that, instead of just saying no, you can’t use the method. I think that once you resolve the kind of consistent infection, then that would be fine.

They also note a few different situations. They say people who have medications that may affect cervical mucus tracking — so they say antihistamines or vaginal creams. So again, when I think of these things, if a person is using antihistamines for example, that can dry up cervical fluid and that can make it a bit obviously challenging for a person to chart particularly in that cycle. But I wouldn’t go so far to say that a person who uses antihistamines from time to time couldn’t chart their cycles. And then they also say those who have an irregular sleep, work, or travel schedule. Again, I would say that these there’s a lot of women who chart their cycles who experience temporary challenges — whether that’s they have a yeast infection one cycle, whether it’s allergy season and they’re using antihistamines for a couple of weeks, or whether they travel and they have some sleep irregularities, or if they have a varied work schedule. But these are all things that you can — these are not deal breakers.

So the majority of the things that they’re listing in the study, I just want to say, are not deal breakers. And I would say that this is one of the reasons that you want to work with an experienced instructor, to help to guide you through some of these things. Because what I always say is that if your life has to be perfect in order for charting to happen — if you can never have any type of sleep disruption or disturbance, if you can never have an illness where your temperature could be varied, if you could never get a yeast infection — like if all of these things have to just always be perfectly in line, like you can never go anywhere, there can never be any time zone changes — it’s just not going to work.

So one of the perspectives that I suppose I bring to the table, having been in this field for as long as I have and charting myself through a variety of different circumstances and supporting my clients to chart through pretty much any circumstance you could think about — I’ve had a client who’s charted through it — I can say that it is, easy is not the right word, but you can chart through these different challenges. It’s not that big of a deal. And if you’re looking at charting for the long term, then it adds to your experience overall.

There are times when you may have to extend your days of fertility in a particular cycle when you’re unsure. But what I would say is that that is one of the foundational pieces of understanding how to use the method for birth control, because whenever you do feel unsure you do have to consider yourself fertile. So I would say that many of the situations that they’ve pointed out in the study are not deal-breakers forever, but typically phases that you go through.

Overall I think that the study was at least somewhat fair in terms of how it presented the data, but I do feel that there was a little bit of bias — which is understandable — against fertility awareness-based methods. Because I think that there is bias in the medical community against fertility awareness-based methods. I feel that there’s this general assumption that it’s just so complicated, it’s so hard, women aren’t going to be able to do it, and we should be so cautious in how we talk about it. But again, I think it comes from this place of it’s going to be too hard for our clients to do.

I do think there’s room for a conversation on both ends. I feel like I could have a conversation with clinicians who would say, look, I’m working with the general public and there’s a lot of women who wouldn’t really be up for this. And I would say, yes, you are correct. But those women typically are not wanting to do it. The women who are really genuinely wanting to do it — asking about it, buying the books, reading about it, charting — those are the women who typically are quite motivated.

And then I could also see myself having a conversation with someone that says, well, what about those studies where you have such a high failure rate? And I would say, well, if we’re going to lump in everybody who has ever downloaded an app, who has never been trained correctly, and look at their failure rates, then of course you’re going to have a high failure rate. But that doesn’t really reflect the effectiveness of specific fertility awareness-based methods.

So I would say this is inherently one of the challenges with incorporating tech. Today I had a really fun and interesting interview, and one of the questions that I was asked was about the tech — you know, how do you feel about these different devices and things like that? And what I would say — what I said in the interview and what I usually say — is that I really like tech, I like the different devices, I think that it’s really a great way to introduce women into fertility awareness-based methods, many women who potentially wouldn’t have learned about it otherwise. But in my perfect world, I would want women to have the knowledge and understanding of their bodies to be able to chart their cycles and understand what they’re seeing in their charts, and then be able to use the data and information presented in the app as an additional kind of supportive piece of information to bring the picture together.

But what typically happens is women don’t have the knowledge and information about their cycles. They are first exposed to the apps and the different devices and all the things. And so a lot of women might — if the app tells you that you can have sex, if it gives you the green light — you might be doing that. But if you don’t have the knowledge of your body, you don’t understand the role of cervical mucus, temperature, you’re not tracking those things independently, then you’re setting yourself up for an increased risk of failure.

So what I’ve seen is that the majority of failures related to fertility awareness-based methods are user failures — where somebody is taking risks when they shouldn’t be, someone is having sex before they’ve got a sufficient number of cycles under their belt, when they’re not working with an instructor, when they’re really excited about the method but they just don’t really have the information yet, they’re not clear on how to interpret their mucus, they’re not clear on the information. And so ultimately, that’s one of the things that I’m really passionate about — to try to really educate my clients, educate our practitioners, so that we’re really showing women the correct way to use the method. And we’re also relying on the data and the science so that we know which methods and strategies are the most effective, so we can really rely on those strategies over and above our feelings. Let’s rely on the methods and strategies that show the highest possible efficacy so we can set our clients and ourselves up for success.

So with that said, I feel like that’s a great place to wrap today. So I suppose in conclusion, there are a variety of different fertility awareness-based methods, and there’s all of these different biomarkers, there’s different ways we can be tracking it. Fertility awareness-based methods are becoming more common. And when I see studies like this, I’m encouraged because it’s like, well, we can’t stop them. All these women are coming to our offices talking about these methods, so we need to have more data on it.

What I liked about the study is that even though I do feel that they didn’t necessarily paint fertility awareness-based methods in the most perfect light, because there’s so much data on them, they still had to concede that we do have data showing that double-check symptothermal methods show the highest efficacy rate and they are on par with some of the methods of contraception that have the highest efficacy. So even despite all the word salad around the different challenges and all the things, they still have to concede that there is a high efficacy when these methods are used correctly. And so I think that that is extremely, extremely encouraging.

We did talk about some of the special considerations, which I do think it’s fair and important to talk about some of the challenges that can arise when women are using fertility awareness-based methods. But as I mentioned, I feel that the majority of the considerations that they brought up from my perspective are not deal breakers when you’re actually working with an experienced practitioner who can help to guide you through. And many of their special considerations that they listed would represent a temporary phase. When you’re looking at charting as a long-term strategy for pregnancy prevention that you may be using over many, many years, I feel that it’s just one of those things that you learn to adapt to. The different changes that you might go through — users can still be successful as long as they have a backup method of birth control for any periods of time where they are unsure of their observations as they’re going through some of those temporary phases.

So I hope that you enjoyed today’s episode. I took it in a lot of different directions. Ultimately, I wanted to talk about the efficacy, I wanted to talk about some of the challenges. And what I really want you to take out of it, though, is to feel encouraged that fertility awareness-based methods — I feel like they’re real, they’re effective when used correctly, and when the methods with the highest efficacy are used — and they’re here to stay.

And also, a note for practitioners: as these methods become more popular, you’re going to end up with more and more women in your office wanting information about these methods and wanting a place to learn how to chart their own cycles and to learn how to be really effective with their use so that they can feel confident in using this method for birth control. And so I highly, highly recommend that anybody who is wanting to shift into that to really take the time to receive adequate training. I always say that if someone comes to you for birth control and they pay for fertility awareness — let’s say to use as birth control or conception — it may be the only time in their lives that they’re actually paying somebody to teach them. It could be that one opportunity when they reached out to do that. So we really want to ensure that our clients have the best possible experience and that they leave understanding the strategies that leave them with the highest possible efficacy when they’re wanting to use this method as birth control.

So definitely food for thought. You’ll find the show notes page over at fertilityfriday.com/536. And you can also head over there — we will make sure to link the study that we went through today. And if you’re enjoying the FAM research series and you’re wanting to listen to other episodes in the series, you can head over to fertilityfriday.com/research. So with that said, I hope you have a wonderful weekend whenever you’re tuning into the show. And of course, as always, until next time, be well and happy charting.