Fertility Awareness Method (an intro by Beth Moonstone)

Fertility awareness method is a natural safe form of birth control. It is based on developing a deep understanding of how our bodies natural cycles work. There are three main indicators of fertility that are charted in fertility awareness method: basal body temperature, cervical changes and cervical mucus. By observing these three signs you can determine when you are fertile. This method can be used to avoid or achieve a pregnancy. It takes only a few minutes each day to take and record these changes. It is important to chart every day! This method of birth control is highly effective when done properly. The success of fertility awareness to avoid pregnancy is directly affected by the dedication of the individual. It is important not to get lax in charting. Fertility awareness allows women to have the choice of postponing vagina-to-penis contact or using a barrier method during the fertile period. With fertility awareness method women can identify the two thirds of the cycle when they are infertile. Some women report no problems combining barrier method with fertility observation especially if using a condom. Be aware that jelly or foam in the vagina can mask signs of fertility. Fertility awareness is most effective as a birth control method when women refrain from vagina-to-penis contact while fertile. Books are an excellent resource but it can be helpful to learn from and consult with other women directly. Learning fertility awareness directly from other women allows for personal feedback, support and a sharing of experience not available in any book. You can get listings of fertility awareness classes and resources from the Fertility Awareness Network (FAN) P.O. BOX 1190, New York, NY 10009.

Body Basics
The menstrual cycle refers to the time from the beginning of one menstrual period to the last day before your next menstrual period. This cycle lasts an average of 28 days. For some women this is a 26 days cycle and for others 34 days. No matter how long the cycle happens to be once ovulation occurs the start of the next period is always between 12 and 16 days. The menstrual cycle begins with the first day of menstrual bleeding. For most women this will last four to six days. When menstrual bleeding begins the pituitary gland sends out a hormone called FSH, follicle stimulating hormone. The release of FSH signals the ovaries to begin to get eggs ready for release. The ovaries mature a few eggs and push them toward the outer surface of the ovary. Eggs develop inside a follicle on the ovary surface. The hormone estrogen begins to be produced and released by the developing follicles. Estrogens job is to help a woman prepare to become pregnant. As the eggs develop estrogen steadily increases. Estrogen also signals glands in the cervix to produce a fluid called cervical mucus. The cervical mucus helps sperm survive and travel. Endocervical mucus cells consist predominantly of water and under the influence of rising estrogen levels the amount and consistency of mucus changes. To be hospitable for sperm cervical mucus must be thin, clear, watery, profuse, alkaline, and acellular. It is one of the signs of fertility that we chart with fertility awareness. Cervical mucus elasticity also called spinnbarkheit, increases. This gives the cervical mucus a stretchy quality. Cervical mucus also increases ferning capacity as ovulation approaches. The cervical mucus ferns or crystallizes due to decreased levels of salt and water interacting with glycoproteins on the mucus. Ferning is an indirect indication of estrogen production. There are specially made devices that allow women to test for ferning at home. These devices usually costs under $40. Laboratory testing for ferning is done with glass laboratory slides and a microscope. This can be a very useful tool in addition to charting. The increasing levels of estrogen also signal cervical changes. There is a change in the position and feel of the cervix. These changes in the cervix are our second fertility indicator. The height, texture and opening of the cervical os change. When fertile the cervix becomes higher and softer and the os (opening) widens. When the cervix become dry again it will be lower, firmer and less open. Estrogen also causes the endometrium inside the uterus to thicken in preparation for pregnancy. When the egg is ready for release estrogen is at its highest point. The pituitary gland responds by releasing LH, lutenizing hormone. LH signals the ovary to release the egg into the fallopian tubes. If there are sperm in the tube within 24 hours pregnancy can occur. Once the egg is released from its follicle on the ovary the follicle begins to release progesterone. The follicle is now called the corpus luteum. The release of progesterone prepares the lining of the uterus for the egg and prevents the release of additional eggs. Once progesterone I released there is a rise in body temperature that occurs. This temperature will stay higher until the start of the next menstrual period. This is called the basal body temperature and is our third indicator of fertility. Temperature elevation does not predict the day of ovulation rather about a day after ovulation basal temperature provides some verification that ovulation has occurred.

Basal Temperature Charting
The basal temperature must be taken with a special kind of thermometer which measures temperatures between 35.6 C (96 F) and 37.8 C (100 F) and is calibrated by tenths of a degree. This allows for the detection of slight temperature changes. Basal temperature should be taken in the morning before getting out of bed and after at least three hours of sleep. A tympanic thermometer may also work and takes less than 2 seconds to get a reading (Wolf & Baker 1993).

Charting Cervical Mucus
You should begin charting cervical mucus changes on day four of each cycle. If there is still a significant amount of menstrual blood you can wait until it lightens. Observe your cervical mucus throughout the day as you use the bathroom. Before urinating use some clean white tissue paper and wipe front to back for mucus. You can just get in the habit of wiping for mucus before you go to the bathroom. The first thing to check for is wiping sensation. The four types are dry, moist, wet and slippery. Dry would mean that wiping is uncomfortable and/or chafing. The tissue seems to drag. Moist is sometimes described as a sensation of nothingness. The uncomfortable feeling of dry is gone but it does not yet feel wet and lubricated. Wet I when you definitely feel the presence of fluid at the vulva. The tissue will slide easily. On a slippery day there is not necessarily more lubrication but the tissue swooshes across the vulva. If mucus is present than the next thing is to determine color. This is usually easy. The mucus may be white, yellowish, brownish or even pinkish in color. Then determine the texture or consistency of the mucus. To do this you lift the mucus off the tissue. It may be pasty, lotiony, gummy, or like raw egg white. Pasty will feel like toothpaste and doe not stretch much. Lotiony has the feel and look of hand lotion and may have some stretch. Gummy feels like partially dried glue. It may stretch a lot but the strands are thick and gluey. If it is also yellow tinged this can be indicative of an infection. Raw egg white feels like raw egg white do and will easily stretch an inch or more. If your mucus doesn't seem to fit one of these categories you can make your own label for it. Just be sure to keep track of what you are describing. The last mucus observation you need to determine is stretch. Just take some mucus between your thumb and fingers and see how much it will stretch. Mucus can change throughout the day. You should wait to record your findings until the end of the day. Record the most fertile sign you saw at any point that day. Mucus can also be influenced by outside factors. These include douching, the constant wearing of mini-pads, contraceptive jelly or foam, and megadoses of certain vitamins. Some medications can alter mucus symptoms. Consult your doctor or a fertility awareness counselor if you suspect you mucus symptoms have been disturbed and have questions.

Charting Cervical Changes
Start observing and charting the cervix on about day 4 of each cycle, depending on how heavy your period is. The cervix will feel like a cylinder about one inch in diameter. It is smooth and will have a dimple or small slash at its bottom center point. Check your cervix at night before bed. You can make it part of your bedtime routine. This examination can be done sitting on the toilet, squatting or standing with one leg up on the tub or toilet. Try each and see what feels comfortable for you. Use the same method throughout your whole cycle. If you decide you want to switch start the new position at the beginning of your next cycle.

References

For Natural Birth Control - Body Awareness - Conception - Understanding - Women's Health