Choice of Methods
It can feel overwhelming and confusing to be faced with such a choice of methods. Especially if your usual medical practitioner doesn’t know about FAMs. Our FAM co-ordinator is able to have a 1-1 conversation to help you decide and put you in touch with suitable instructors. Get in touch by email: famc.eastanglia@rcdea.org.uk
The effectiveness of FAM to avoid pregnancy is similar to user dependent hormonal contraceptive methods and higher than barrier methods. Learning FAM from an instructor is crucial and is particularly important in special circumstances. Special circumstances include: irregular cycles, breastfeeding, peri-menopause, coming off hormonal contraception.
Here is a summary of the range of Fertility Awareness/NFP Methods that are currently taught in the UK and their effectiveness at avoiding pregnancy, when taught by a certified instructor:
Note: if viewing these tables on a mobile phone, please see all five columns.
|
|
Billings Method |
Creighton Model FertilityCare |
Sympto-Thermal |
Marquette Model |
|
Biomarkers used |
Cervical mucus (simple observations) |
Cervical mucus (detailed observations) |
Cervical mucus, temperature, calendar, +/- cervix |
Urinary hormones + calendar, +/- cervical mucus |
|
Perfect use |
>99% |
99.5% |
99.5% |
98% |
|
Typical use |
78-99.5% |
83-97% |
98% (effectiveness study done on regular cycles) |
93.3% (monitor only) 85.8% (monitor and mucus) |
|
Advantages |
Simple to learn and use |
Can be used in conjunction with NaPro Technology (treating infertility) |
Temperature rise confirms ovulation |
Simple to use, objective readings on monitor, proven effectiveness when breastfeeding |
|
Websites |
|
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|
Cost of learning (if you would struggle with cost, financial assistance is available) |
£50 donation for admin only
|
£50-£80 per lesson, at least 8 lessons
|
NFPTA: donation for admin, thermometer £10 CCL: £100 includes all materials |
Monitor cost £85, test strips £15+/month (email FAM co-ordinator for UK instructor contacts) |
|
Ongoing costs |
Nil |
Up to £50 for annual follow up and charting materials |
Nil |
Test strips £15+/month |
There are also device-based methods which do not require lessons from an instructor. Please note that these methods may not be suitable for you if you have special circumstances. They may also involve more abstinence than other FAMs.
|
|
Natural Cycles |
Lady Comp |
Persona |
|
Biomarkers used |
Temperature, calendar and algorithm |
Temperature, calendar and algorithm |
Urinary hormones |
|
Perfect use |
98% |
99.3% |
94% |
|
Typical use |
93% |
96.2% |
82% |
|
Cost |
£49.99/year |
£385 one off cost of monitor |
£84.99 one off cost of monitor + £12.50/month for test strips |
|
Website |
The motivation of users hugely affects the effectiveness of FAMs for avoiding pregnancy. Those who are not highly motivated will be more likely to miss observations or break the rules on abstaining from intercourse in the fertile window, which then carries a high risk of pregnancy.
Lactational Amenorrhoea Method (LAM)
If you are exclusively breastfeeding*, your baby is less than 6 months old and your periods have not restarted, then you are considered infertile. LAM is 98% effective in avoiding pregnancy and does not require charting or abstaining. However it is recommended that you start charting in preparation to transition to another method once the LAM criteria no longer apply.
(* breastfeeding at least every 4 hours day and night, no supplements with other fluids / formula or food, not expressing milk, baby not using a dummy)
Factors to consider
Choosing which FAM to use depends on many factors:
- Desire for simplicity or complexity: Do you want a method which uses simple observations, with minimal demands on charting? Or would you prefer to record and know as much information as possible about what is going on in your body?
- Lifestyle: do you have a regular routine? If so, temperature readings may be easy. However, if your sleep is regularly disrupted or you are travelling, then temperature readings are more of a challenge (but not impossible with some of the newer technology available).
- Budget: there is generally a basic cost for learning a method (though some instructors teach for free) and then the cost of materials used. The ongoing method costs vary hugely from charts on paper or apps (low cost) to a range of hormone monitoring devices (expensive).
- Do you have fertility or gynaecological problems to address? A method that incorporates medical management protocols may be more suitable for your needs.
- Instructor availability: if you already know an instructor or one has been recommended, then it can be convenient to learn the method they teach.
This quiz might be helpful when deciding on which method to use.
Different methods may suit you at different times in your life- do not be afraid to re-evaluate your options and learn a different method if your circumstances change or you are struggling.
References
Billings:
World Health Organisation, Task Force on Methods for the Determination of the Fertile Period, Special Programme of Research, Development and Research Training in Human Reproduction. “A prospective multicentre trial of the ovulation method of natural family planning. I. The teaching phase.” Fertility and Sterility 36 (1981): 152-158.
Indian Council of Medical Research Task Force on Natural Family Planning. “Field Trail of Billings Ovulation Method of Natural Family Planning.” Contraception. (1996);53(2):69–74
Quian, S. Z. et al “Evaluation of the Effectiveness of a Natural Fertility Regulation Programme in China.” Chinese Medical Journal (1998)
Creighton:
Hilgers T. W., Stanford J. B. “Creighton Model NaProEducation Technology for avoiding pregnancy. Use effectiveness.” Journal of Reproductive Medicine 43 (1998): 495-502.
Howard M. P., Stanford J. B. “Pregnancy probabilities during use of the Creighton Model of FertilityCareTM System.” Archives of Family Medicine 8 (1999): 391-402.
Sympto-Thermal:
Frank-Herrmann P. et al. “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 (2007) 22(5):1310-9
Marquette:
Mu Q, Fering RJ, Bouchard T. “Multisite Effectiveness Study of the Marquette Method of Natural Family Planning Program.” The Linacre Quarterly (2020)
Fehring RJ, Schneider M, Raviele K. “Efficacy of cervical mucus observations plus electronic hormonal fertility monitoring as a method of natural family planning.” Journal of Obstetric Gynecolic Neonatal Nursing. (2007) 36:152–160
Persona monitor:
Bonnar J et al. “Personal hormone monitoring for contraception”. British Journal of Family Planning (1999) 24(4):128-34.