Medically reviewed by Sophia Yen, MD, MPH – Written by Pandia Health Editorial Team

What Is Natural Family Planning or Fertility Awareness Method?

The average American woman only wants to have two children in her lifetime. Children are a significant time, money, and emotional investment. Despite the massive strides women have made to obtain equality, they still provide the majority of childcare. Also, only women can get pregnant, give birth, and nurse an infant. To have a baby, women have to make a huge, upfront investment and sacrifice to bring a tiny person into the world. For women who want two children or fewer, they will spend almost thirty years of their lives trying to prevent an unwanted pregnancy.

Natural Family Planning

Fortunately, there are many different types of highly effective birth control methods women can use to protect themselves from an unintended pregnancy. There are barrier methods, hormonal, and nonhormonal methods. There are even natural methods that are low-cost or even free that women can use. While natural family planning contraceptive methods are not as effective as hormonal contraceptives, they can work when used correctly.

Natural family planning (NFP) is also known as the “rhythm” method or the fertility awareness method (FAM). For this method to work, a woman needs to be aware of her body’s natural signs that indicate fertility and apply her knowledge to prevent fertilization. On the flipside, Fertility Awareness skills/knowledge can also be used to conceive.

With typical use, natural family planning is 76% effective at preventing pregnancy. For context, male condoms are 82% effective and the birth control pill, patch, and ring are 91% effective with regular use.

What are 3 most popular NFP or FAMs?

  • Basal Body Temperature Method – the person with the uterus has to check her temperature every morning as soon as she wakes up, before getting out of bed.
  • Cervical Mucus Method – the person with the uterus checks her cervical mucus every time she wipes herself after using the toilet.
  • Calendar Method – chart your menstrual cycle on a calendar and use that to predict the next ovulation.
    • The Standard Days Method – is a variant of the Calendar Method. Track your cycle for several months. Figure out if your cycle is always between 26-32 days long. If it is longer or shorter, you canNOT use this method. On days 8-19 of your cycle (when you are fertile), either abstain from sex or use condoms.

It’s most effective to use all 3 methods together and that’s called the symptothermal method.

What are the benefits of using NFP to prevent pregnancy?

  • It does not require the use of hormones or prescriptions.
  • It is safe to use and 100% natural.
  • It is relatively inexpensive to use.
  • NFP can also help a couple conceive when they want to have a baby.
  • Women gain a greater awareness of their bodies.

What are the most significant downsides to using NFP?

  • It has a higher failure rate than other methods
  • NFP requires a lot of human effort to be effective.
  • It is not as effective as hormonal contraceptives or the copper IUD at preventing pregnancy.
  • NFP requires discipline and awareness on the part of the couple to abstain from sex during fertile days. (10 days out every month)
  • Some studies have found that up to 24 out of 100 women who use NFP will become unintentionally pregnant within a year of using the method.
  • NFP will not protect against Sexually Transmitted Infections.
  • NFP can be impossible to use accurately if a woman has an irregular cycle.

How does NFP work?

At its core, NFP is a way of tracking the female reproductive cycle to determine which days of the month a woman is fertile. To prevent pregnancy, couples who use NFP must abstain from sex during the fertility window.

According to NFP, the female reproductive system operates in three phases. Phase one starts on the first day of menstrual bleeding. According to NFP, a woman is not fertile during her period, and she is also infertile for at least a few days after menstruation. The second phase of the cycle includes 5  days before ovulation and 5 days after ovulation. For women who are healthy and have predictable cycles, this fertile window can last for up to 12 days. The third phase occurs after ovulation has passed, and typically includes the last week of a woman’s menstrual cycle, and before her period starts.

Four hormones influence the different phases of the female reproductive cycle, and those hormones can give off signals that NFP teaches followers to observe. The hormones are progesterone, estrogen, FSH, and luteinizing hormone. NFP includes tracking the cycle with a calendar and also following the hormonal signs of fertility, which include:

  • Changes in cervical mucus.
  • Basal body temperature.
  • Changes to the cervix.

NFP followers often make use of apps or calendars to track these changes and the different days of the menstrual cycle and fertility window.

Why would NFP not work for a couple?

Not all women have predictable menstrual cycles. A normal menstrual cycle for an adult woman can have a wide range, between 21 and 35 days. Also, most women will not get their period on the same day of every month like clockwork. So many things can interfere with the timing of menstruation and fertility. Stress, illness, medications, and perimenopause can significantly interfere with a woman’s menstrual cycle. Some women may also have hormonal imbalances that can prevent the usual signs of fertility from appearing.

In most NFP cases, couples will have to abstain from sex for 10 days each month to avoid the fertility window completely. This can be difficult or impractical, and it’s also possible for a couple to easily forget precisely where they are in the fertility window. Couples who have a high need for pregnancy avoidance may also error too far on the side of caution and practice more abstinence than is necessary. This may not meet their relationship needs.

For couples who are leery of using hormonal birth control methods, using condoms on fertile days can be highly effective for preventing unintended pregnancy. There are also non-hormonal IUDs that are 99% effective at preventing pregnancy. IUDs also do not require as much intervention, charting, and tracking that NFP requires.

One of the other benefits of using NFP is that it can help a woman realize if she has a hormonal imbalance. Wildly unpredictable menstrual cycles or skipping periods when a woman isn’t pregnant can indicate a serious issue. These hormonal imbalances can be corrected with birth control pills or treated with a hormonal implant or a hormonal IUD.

Are you interested in learning more about how birth control pills can help balance hormones or alleviate other gynecological issues? Pandia Health has helped hundreds of women with PCOS, and minor hormonal imbalances find relief with low-cost or “free”(no copay, no deductible with insurance) birth control pills, patches, and rings. Please contact Pandia Health today to learn more about how birth control can help you prevent pregnancy and alleviate certain health conditions.