Get With the Flow: All About FAM
The Big Picture
Like we talked about in On the Rag, your menstrual cycle doesn't just happen when you menstruate. Your period is one part of a complex ebb and flow of hormonal, physiological and emotional patterns called the reproductive or menstrual cycle. One way to see the big picture is with a method called Fertility Awareness.
The Fertility Awareness Method (FAM) is basically a means of observing the three primary fertility signals: cervical fluid, waking body temperature and cervix changes. Day-by-day a woman records her changing fluid, temperature and cervix on a FAM chart or basic calendar like the one provided here, further down this page. The ebb and flow of these fertility signals indicates when a woman is fertile (able to become pregnant) and infertile (not able to become pregnant). Unlike men, whose sperm is capable of fertilizing an egg anytime, a woman’s egg is usually only capable of being fertilized by sperm for about a third of her menstrual cycle.
Fertility Awareness can be fascinating for the sheer science of observing your body. Your observations can provide information about your overall and reproductive health, help you determine if you might have a yeast infection, how cramps were this month versus six months ago and how dietary and lifestyle choices, like exercise, white sugar and fresh vegetables, affect your body.
FAM is sometimes confused with the Rhythm Method, an unreliable means of guessing when a woman is infertile based upon previous cycles. FAM determines a woman’s fertility based upon her present fertility signals and no guess-work is involved.
Round and Round We Go
First, a refresher on the reproductive cycle. Each cycle begins with a menstrual period. A few days after menstruation ends, but sometimes before, eggs begin to ripen inside the ovaries. The ovaries are housed inside sacs called follicles. Follicles release a hormone called estrogen which prepares the body for ovulation, or the release of a ripe egg.
Estrogen stimulates the production of cervical fluid, lowers a woman’s waking body temperature and raises and softens her cervix, or neck of the uterus. Women using FAM chart all these fertility signals.
Estrogen levels increase until they are so high, the cervix so soft and open, cervical fluid so clear and ideal for sperm to survive that a ripe egg bursts from one of the ovaries. Some cycles, some women feel a sharp pain, called mittelshmertz, when ovulation occurs.
The ripe and fertile egg runs to the fallopian tubes and waits for its phone to ring. If sperm doesn’t call within 24 hours, the egg dies and is reabsorbed into the body. At this point, for most women, pregnancy is no longer possible during this menstrual cycle. Women only release one or two eggs per cycle within 24 hours of each other. Once those eggs are dead and gone there is nothing that can be fertilized that cycle and therefore no potential for pregnancy.
Immediately following ovulation, the follicle that formerly held the egg releases the hormone progesterone. Progesterone prepares the reproductive system in case a pregnancy does occur, (think “pro-gestation”), creating an ideal environment for a fertilized egg to implant in the uterus and develop into a fetus. Progesterone dries up cervical fluid, warms a woman’s waking body temperature and lowers and closes the cervix (all dutifully charted to confirm ovulation). Progesterone also causes the uterine lining to become spongy and thick. If pregnancy does not occur progesterone works for about 12-16 days before calling it quits. At that point, the follicle dissolves, progesterone levels drop (as does the waking body temperature), and all that pro-gestation material is sloughed away, via menstruation, and the cycle begins again.
Being the Scientist
In the same way that a scientist has controls for her lab experiment, your FAM observations need to be made every day, at about the same time of day, and in a consistent manner in order for your conclusions to be valid. That said, it’s possible to observe your fertility signals in a casual way and still learn about your body. Some cycles you might feel really curious and on top of the whole charting thing, while others, like when exams are approaching or you’re busy with a project, you might forget to observe and record your signals. If you’re not using the method for sole birth control, it’s all good.
One of the coolest ways to really grasp all this stuff is to get a speculum, lie down on some pillows with a flashlight and a mirror and check it out! Insert the speculum into your vaginal canal, the hole just below the urinary opening, where menstrual blood flows out. Most gynecologists and Planned Parenthoods keep plastic speculums on hand and would be happy to pass them on.
Get With the Flow
Charting can help you make nurturing choices. At the bottom of your FAM chart there is space to record anything you want, like when you eat sugar, exercise, have a headache or how intense your cramps were during your period. In time, you’ll have months, then years, of data to discern the effects of diet, lifestyle, stress and medicine on your health.
Here's a sample chart to see one way you might chart on a basic calendar, so you can get an idea of how someone might note their daily temps and cervical mucus. There's a copy of this calendar you can photocopy in S.E.X., or you can see a larger image of the blank calendar online here and download one on us to print out at home for yourself. Of course, you can also use a regular calendar, or you can chart on graph paper instead to get a more visual idea of the ups and downs of your temperatures.
Cervical fluid (CF) is amazing stuff. Most of us are first introduced to it on dark underwear. It can be sticky and gloppy like old glue, creamy and thick or super stretchy and clear like egg-white, or nowhere to be seen depending on your body and where you are in your reproductive cycle.
To observe your CF, you first need to get a handle on it. You might feel squeamish at first but looking at your CF is pretty cool. It can alert you immediately if something’s up, like a yeast infection or some STI’s. Cervical fluid can also keep sperm alive for up to five days. Because of CF, a woman could have sex on Monday and not conceive until Friday, when the ripe egg was released! When a woman is pregnant, CF forms a cap over the cervix, protecting the uterus and fetus from infection.
Different women observe their fluid in different ways. Some women wipe a piece of toilet paper across their vagina and look at it that way. Other women reach two fingers into their vaginal canal and grab a bit. Still others reach up their canal all the way to their cervix and swipe from there. All three styles are fine so long as you are consistent and choose only one to use for yourself. Observing from toilet paper one day and the cervix another could give you very different readings.
No matter how you do it, use these guidelines:
- Wash your hands first.
- Sample your cervical fluid before going pee so as not to obscure the fluid.
- Check your fluid three times a day because it can change through the day.
- Check for Feel, Color, Quantity and Stretch:
• How does it feel? It might feel dry, sticky, thick, or slippery.
• What color is it? It might be white, clear or yellow.
• How much is there? It might be scant or abundant, or somewhere in between.
• Is it stretchy? Is it super eggwhite stretchy?
- On your FAM chart, write down the wettest, most abundant sample of the day.
Typically after menstruation cervical fluid progresses in the following order through the whole of a cycle:
Dry • Absent-Sticky • Tacky-Creamy-Slippery • Egg white • Dry/Sticky
All cervical fluid is potentially fertile but the slippery stretchy egg-white type is definitely, no doubt about it, bonafide fertile fluid. When you see this fluid followed by a day of dry or sticky fluid, you are probably ovulating.
If you ever observe yellow or unusually strong smelling fluid you might have an infection and should talk with a healthcare provider ASAP.
If you are having a hard time discerning a consistent dry-wet-dry pattern in your cervical fluid you might be having split peaks, when the body prepares to ovulate again and again but can’t quite get there due to low estrogen levels. Check out Garden of Fertility by Katie Singer for more info on split peaks and what might be causing them.
Cold and Hot
From menstruation to ovulation, estrogen keeps the waking body temperature low. After ovulation progesterone causes the waking body temperature to increase and stay high. A clear and sustained temperature shift from low to high temps indicates that ovulation has taken place.
To use your waking temperature to gauge ovulation:
- Take your temperature first thing in the morning at about the same time each day with the same digital thermometer for your entire reproductive cycle.
- Take your temperature after at least three hours of sleep.
- Take your temperature before eating or drinking, going to the bathroom or otherwise getting out of bed (keep the thermometer close by).
- Record your waking body temperature and time taken on the FAM chart.
In a typical cycle, a woman’s waking body temperature has a clear pattern of a cluster of low temperatures (at least six) followed by a cluster of high temperatures. The high temps must be at least one-tenth of a degree higher than the lows temps. The day this sustained shift from low to high temps occurs is the day you ovulated.
Sometimes a woman has a random high temperature, perhaps due to being sick, waking at a different time or drinking alcohol. If you observe one high temperature that is followed by more low temperatures, disregard that temp and keep charting.
You can circle the day that your temperature jumped above and stayed at least one-tenth of a degree above the previous six temps (the day you ovulated). Because the average length from ovulation to menstruation is 12-16 days, (called the post-ovulatory phase), you can figure when to expect your period. If over time you notice that your post-ovulatory phase tends to be eleven days long or less, adjust accordingly. This prediction can help you organize a bit to support your menstrual time.
Often on the day of your period or the day before your waking body temperature will drop suddenly due to the fall in progesterone levels. When you observe this temperature drop you can fully prepare to be on the rag.
Some women do not have clear temperature differentiations for health reasons. If you think this might apply to you, Garden of Fertility addresses potential causes of different waking body temperatures.
The Great Shrinking Cervix
The cervix is the neck of the uterus and it reaches into the vaginal canal. It looks like a round, glossy bulb with a small indent. You can see some pictures of cervixes online here. A speculum and mirror, like I mentioned earlier, are a great way to see the cervix.
Estrogen raises and softens the cervix while progesterone lowers and hardens it. The small indent or opening of the cervix is called the os (sounds like “toss”) and as you approach ovulation, the os opens to allow sperm to enter the cervix. After ovulation it closes again. If you ever have a child, the os will open unbelievably wide for birth!
If you’d like, you can feel the raising, softening and lowering, hardening of your cervix, as well as the opening and closing of your os. Wash your hands and squat or stand with one foot up on something, like the toilet. Reach one or two fingers into your vaginal canal–this should not be painful at all. At the top of your canal you’ll feel the cervix, smooth and round with a small indent in its surface: people tend to describe it as feeling like a nose or a cleft chin. Depending on where you are in your cycle your cervix will feel hard, like your chin, or soft, like your tongue, and be low or high in the canal. The os will feel closed or open. You might also feel some bumps on the cervix, which are normal.
Check your cervical position once a day, in the same position, over the course of your cycle. Record what you observe on your chart. Over time you may recognize the cervix raising and lowering and the os opening and closing in relation to the increase and decrease in your cervical fluid and the shifts in your waking body temperature.
Some women, with a thorough understanding of the method’s rules (which are far too involved for this piece: that's why there are whole books on FAM), very regular menstrual cycles and a disciplined practice of observing and recording their fertility signals, use FAM as a sole method of birth control. For couples who use FAM to-the-letter and practice abstinence when the woman is fertile, the method can be as effective as the Pill in preventing pregnancy.
Abstinence, even temporary abstinence, can sound unappealing, but in practice having ten or twelve days when lovemaking won’t automatically progress to intercourse can be refreshing. We get to experiment with other activities, learn what else turns us on and talk about our sexual desires and needs.
Because young women tend to have more irregular periods, hormonal shifts and rapidly changing lives than older women, FAM isn’t usually a reliable form of birth control for teenagers. FAM does not protect against STI’s (sexually transmitted infections) and couples that use the method should be up-to-date on their STI tests, monogamous and in a long-term partnership, for several years or more. But that doesn’t mean fertility charting can’t be useful for teens.
Over time you might take a class or read a book on FAM and develop a strong grasp of the method and your fertility signals. FAM could then be used to supplement other methods of birth control such as condoms. You might abstain from intercourse when you think that you are fertile and use condoms the rest of the time, charting your fertility signals throughout. If your cycles become very regular and you are in a long-term relationship you might then consider using the method later on with abstinence as your only form of birth control, in which case it’d be great to be a pro at charting in advance. Too, if you’re using another non-hormonal method of birth control, but still dealing with pregnancy scares, FAM can be a helpful tool to soothe your fears, since you can have a good idea of what times you really did – and really did not – need to worry about big pregnancy risks.
If you are using a hormonal method of birth control charting is not applicable since you do not have a natural fertility cycle to chart: hormonal methods work by changing your natural cycle.
If you want to use FAM in an in-depth way, definitely take a class and/or read one of the books on FAM suggested below. Under no circumstances is this short article intended to prepare anyone to use FAM as birth control.
It might feel challenging to chart regularly. There’s a lot to remember! Just take it one day at a time and allow your interest and dedication to wax and wane. You might develop into a regular charter or you might learn that FAM just isn’t for you. Either way, you got to know a bit more about yourself.
FAM rocks because it illuminates the dance of hormonal and physiological changes culminating in the release of a fertile egg and then your period. What can seem mysterious is actually the most normal and observable thing in the world. Nearly every woman on the planet ovulates and menstruates, connecting you with your mom, grandmothers, friends, teachers, ancestors and even the stranger on the street.
It can be tricky to find adults with personal experience with FAM but I promise you, they’re out there. The resources below are a good place to start. Happy Charting!