Contraception guide

Natural family planning (fertility awareness)

A woman can get pregnant if a man’s sperm reaches one of her eggs (ova). Contraception tries to stop this happening by keeping the egg and sperm apart or by stopping egg production. One method of contraception is natural family planning.

Natural family planning is a method that teaches you at what time during the month you can have sex without contraception and with a reduced risk of pregnancy.

It works by plotting the times of the month when you’re fertile and when you’re not. You learn how to record fertility signals, such as your body temperature and cervical secretions (fluids, or mucus), to identify when it’s safer to have sex. Natural family planning is more effective when more than one fertility signal is monitored.

You can't learn natural family planning from a book. It has to be learned from a specialist teacher.

At a glance: facts about natural family planning

  • If the instructions are properly followed, natural family planning methods can be up to 99% effective, depending on what methods are used. This means that one woman in 100 who use natural family planning will get pregnant in one year.
  • It will be less effective if it's not used according to the instructions – estimates suggest that it may only be around 75% effective because of mistakes.
  • There are no physical side effects, and you can use it to plan when you get pregnant. 
  • You have to keep a daily record of your fertility signals, such as your temperature and the fluids coming from your cervix – it takes three to six menstrual (monthly) cycles to learn the method.
  • Your fertility signals can be affected by factors such as illness, stress and travel.
  • If you want to have sex during the time when you might get pregnant you need to use a condom, diaphragm or cap.
  • By using condoms as well as natural family planning, you'll help to protect yourself against sexually transmitted infections (STIs).

How natural family planning works

How it prevents pregnancy

Your menstrual cycle 

The temperature method

Cervical secretion monitoring method

Combining fertility awareness methods

How effective natural family planning is

How it prevents pregnancy

The aim of natural family planning is to prevent pregnancy by avoiding sex, or using barrier methods of contraception, during the woman's fertile time. Natural family planning involves using your body's signs and symptoms to assess if you're currently fertile and likely to get pregnant if you have sex.

It is important that you are taught natural family planning by a suitably qualified teacher. You can check the availability of instructors in your local area by visiting the Fertility UK website.

The information in this section is designed to serve as an overview only. It is not a substitute for proper instruction and training.

There are three different methods you can use in combination to increase the effectiveness of natural family planning. These are:

  • calculating where you are in your menstrual cycle 
  • taking daily readings of your body temperature
  • monitoring changes to your cervix, specifically the secretions of mucus from your cervix 

Each method is discussed in more detail below.

Your menstrual cycle

Your menstrual cycle lasts from the first day of your period until the day before your next period starts. The length of a woman’s menstrual cycle can vary. Anything from 24 to 35 days is common, although it could be longer or shorter than this. The average length of the menstrual cycle is 28 days. 

Ovulation

During your menstrual cycle:

  • hormones are released to stimulate your ovaries
  • a tiny egg stored in one of your ovaries begins to grow and mature
  • when the egg is mature, it’s released from your ovary (a process called ovulation) and travels down the fallopian tube

Occasionally a second egg is released, within 24 hours of the first egg.

Ovulation occurs roughly halfway through your menstrual cycle, usually around 10 to 16 days before the start of your next period. Ovulation could happen earlier or later than this, depending on the length of your cycle.

When calculating your fertile time, you need to take into account the uncertainty over exactly when you ovulate.

For pregnancy to happen, a sperm needs to meet the egg to fertilise it. Sperm can live in a woman's body for up to seven days after sex.

As the length of a menstrual cycle can vary over time, to make sure your calculations are as precise as possible you will need to measure your menstrual cycle over the course of six months. One way of doing this is known as the calendar method.

This involves the following steps:

  • record the length of your menstrual cycle every month for six months
  • take the length of your shortest cycle and the length of your longest cycle 
  • subtract 18 days from the length of your shortest cycle – this is the first day of your fertile period 
  • subtract 11 days from your longest cycle – this is the last day of your fertile period 
  • do not have sex from the first day to the last day of your fertile period, or use a condom or diaphragm if you do have sex

For example, if your shortest cycle was 25 days and your longest cycle was 33 days:

  • you would take away 18 from 25 to give 7
  • you would take away 11 from 33 to give 22 
  • so you should avoid having sex from day 7 to day 22 of your menstrual cycle

The temperature method

The temperature method is based on the fact that there is a small rise in body temperature after ovulation takes place.

You will need to use either a digital thermometer or a thermometer specifically designed to be used for natural family planning. These are available from pharmacies. Ear or forehead thermometers are not accurate enough to be used in this way.

The temperature method involves:

  • Taking your temperature every morning before you get out of bed. This should be done before eating or drinking anything, before smoking and ideally at the same time every morning. 
  • Look out for three days in a row when your temperature is higher than all of the previous six days. The increase in temperature is very small, usually around 0.2°C (0.4°F). It is likely that you are no longer fertile at this time.

Cervical secretion monitoring method

There is a change in the amount and consistency of the mucus, secreted from your cervix during different times in your menstrual cycle.

You can check this by gently placing your middle finger into your vagina and pushing it up to around your middle knuckle. For the first few days after your period you will probably find that your vagina is dry and you cannot feel any mucus.

As the levels of hormones rise to prepare your body for ovulation, you will probably find that your cervix is now producing mucus that is:

  • moist and sticky
  • white and creamy

This is the start of the fertile period of your menstrual cycle. Immediately before ovulation the mucus will get:

  • wetter
  • clearer
  • slippery, a bit like raw egg white

This is when you are at your most fertile.

The mucus should then soon return to being thicker and sticky and after three days you should no longer be fertile.

Combining fertility awareness methods

It is best to combine all three methods to give you a more accurate picture of when you are likely to be most fertile.

You can use fertility charts to record information from all three methods, which you can then track over the course of each menstrual cycle. You can download fertility charts from the Fertility Education and Training site, with information on how to use them.

There are also apps you can download for smartphones or software for your computer that allow you to track this information.

How effective natural family planning is

If natural family planning methods are used according to instructions, they can be up to 99% effective. This means that one out of 100 women using natural family planning correctly will get pregnant. It takes commitment and practice to use natural family planning this effectively.

Taking into account the fact that people can make mistakes, forget instructions or that other problems can occur, some estimates suggest that, in reality, natural family planning can be around 75% effective. This means that 25 out of 100 women using natural family planning may get pregnant.

If you decide to use natural family planning you can reduce your risk of accidental pregnancy by making sure you are taught natural family planning by a suitably qualified teacher, and then making sure you follow their instructions and advice.

Who can use natural family planning

Most women are able to use natural family planning. However, there are some circumstances where it is not recommended as a form of contraception, or as your only form of contraception. You might want to consider a different method if:  

  • You have a medical condition that makes becoming pregnant dangerous – such as poorly controlled high blood pressure or heart disease.
  • There could potentially be a health risk to the baby if you got pregnant, for example if you are dependent on drugs or alcohol, or taking medications known to cause birth defects.  
  • You are having irregular periods so predicting your fertile time may be hard or impossible. Irregular periods can have a wide range of causes, such as age, stress, rapid weight gain or weight loss, excessive exercise and having an overactive thyroid gland.
  • You have a temporary condition that is disrupting the normal signs of fertility, such as pelvic inflammatory disease (PID), a sexually transmitted infection (STI) or bacterial vaginosis. You would have to wait until the infection passed before using natural family planning.
  • You have a long-term condition (or other underlying factors) that is disrupting the normal signs of fertility, such as liver disease, an over or underactive thyroid gland, cervical cancer or polycystic ovary syndrome (PCOS). Find out more about things that affect your fertility signs
  • You are taking a medication known to disrupt the normal production of cervical mucus making fertility awareness methods difficult to use – this can include lithium (used to treat a number of serious mental health conditions, such as bipolar disorder) and some older types of antidepressants. 
  • You have an increased risk of catching an STI – for example you have multiple sexual partners.

Things that affect your fertility signs

Some factors can disrupt normal fertility signs, for example if you: 

  • have irregular periods 
  • have recently stopped taking hormonal contraception 
  • have recently had a miscarriage or an abortion 
  • have recently given birth and are breastfeeding 
  • regularly travel through different time zones 
  • have an infection in your vagina such as thrush or a sexually transmitted infection

Other factors that affect your body's natural signs include:

  • altering how and when you take your temperature
  • drinking alcohol 
  • taking certain medication 
  • illness
  • some long-term conditions

Advantages and disadvantages of natural family planning

Advantages

  • it does not cause any side effects 
  • natural family planning is acceptable to all faiths and cultures
  • most women can use natural family planning, providing they are properly trained by a teacher in fertility awareness, and keep accurate records 
  • once you have learned the techniques there should be no further need for input from health professionals 
  • natural family planning can be used to avoid pregnancy or to become pregnant, according to your wishes 
  • it does not involve chemicals or physical products 
  • it can help you recognise normal and abnormal vaginal secretions, so you can be aware of possible infection
  • it involves your partner in the process, which can help increase feelings of closeness and trust 

Disadvantages

  • Natural family planning does not protect against sexually transmitted infections (STIs) such as chlamydia or HIV.
  • You will need to avoid sex, or use contraception such as condoms, during the time you might get pregnant, which some couples can find difficult. 
  • If you do decide to abstain there can sometimes be up to 16 days during which you cannot have sex, depending on your cycle.
  • It can be much less effective than other methods of contraception. Depending on how accurately it is used, as many as one in four women using natural family planning may get pregnant.
  • It will not work without the continuing commitment and co-operation of both you and your partner.
  • It can take several menstrual cycles before you become confident in identifying your fertile time. This can be two or three cycles for measuring body temperature and monitoring your cervix, and up to six cycles for using the calendar method. During this time you will have to use barrier contraception, such as condoms.
  • You will need to keep a daily record of your fertility signs.
  • It is not suitable if you have persistent irregular periods.
  • Factors such as stress, illness, travel, lifestyle and use of hormonal treatments can disrupt your fertility signs. This includes oral emergency contraception. If you use the emergency contraceptive pill you will need to wait for two complete cycles before relying on natural family planning again.

Lactational amenorrhoea method (LAM)

Women don't have periods while they're breastfeeding (this is known as lactational amenorrhoea), so breastfeeding can be used as a form of contraception. This is known as the lactational amenorrhoea method (LAM).

The fertility signals used in natural family planning methods are not reliable in women who are breastfeeding.

Women who are fully (or nearly fully) breastfeeding can use the lactational amenorrhoea method for the first six months after their baby is born, as long as: 

  • the woman has complete amenorrhoea (no periods at all)
  • she's fully or very nearly fully breastfeeding (this means that the baby is having breastmilk only, and very little or no formula)
  • the baby is less than six months old

When used correctly and consistently, one in 200 women who use LAM will get pregnant in the first six months. However, take care to use the method correctly. Don't feed your baby other foods because this may reduce your lactation.

LAM becomes unreliable when: 

  • other foods or liquids are substituted for breastmilk 
  • your baby reaches six months old

After having a baby, it is possible to get pregnant before your periods start again. This is because you ovulate around two weeks before your period. For more information on breastfeeding, LAM and other reliable methods of contraception, talk to your health visitor, midwife or doctor. You can also read about breastfeeding in the pregnancy and baby guide

Where to get contraception

Most types of contraception are available free in the UK. Contraception is free to all women and men through the NHS. Places where you can get contraception include:

  • most GP surgeries – talk to your GP or practice nurse
  • community contraception clinics
  • some genitourinary medicine (GUM) clinics
  • sexual health clinics – they also offer contraceptive and STI testing services
  • some young people's services (call 0300 123 7123 for more information)

Contraception services are free and confidential, including for people under the age of 16.

If you're under 16 and want contraception, the doctor, nurse or pharmacists won't tell your parents or carer as long as they believe you fully understand the information you're given, and your decisions. Doctors and nurses work under strict guidelines when dealing with people under 16.

They'll encourage you to consider telling your parents, but they won't make you. The only time that a professional might want to tell someone else is if they believe you're at risk of harm, such as abuse. The risk would need to be serious, and they would usually discuss this with you first.

Page last reviewed: 10/01/2013

Next review due: 10/01/2015

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Comments

The 3 comments posted are personal views. Any information they give has not been checked and may not be accurate.

KashaUK2000 said on 15 February 2014

I used FAM for many years - it is a great form of birth control without risk of side-effects or interrupting sex, but also great at improving body-literacy to the point of not only knowing your cycle but also being able to associate how you feel or certain health issues to your cycles.

Unfortunately many doctors remain ignorant of FAM, my old GP verbally abused me (referred to me as 'a silly little girl who's going to get herself pregnant') and refused treatment - I was shocked, FAM requires a great deal of knowledge of ones body and as well as effective birth control it is an invaluable tool in helping you identify any issues with your cycle/reproduction or hormonal effects on your health issues. This wasn't the only occasion I was faced with ignorance from medical staff, so in the end I felt I had no choice but to get a IUD.

I highly recommend FAM...and changing doctor if yours doesn't understand how FAM works or it's benefits.

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Sarah Panzetta said on 23 July 2013

The information about the Lactational Amenorrhoea Method (LAM) could be better. e.g. this:

Breastfeeding alone does not work as reliable contraception, but breastfeeding and following the LAM (Lactational Amenorrhoea Method) rules is over 98% effective (better than condoms).

All three of the (pretty strict) LAM rules must be followed:
1. Your periods haven't returned; and
2. You are fully breastfeeding. Your baby gets no
formula milk or other food and is still getting night
feeds; and
3. Your baby is less than 6 months old.

You also need to avoid dummies and soothers, and feeding your baby anything from a bottle, even expressed milk or water. Expressing milk reduces the effectiveness of LAM to about 95% (the same as the diaphragm).

Breastfeeding has to be going well for this method to work. For support, contact the National Breastfeeding Helpline 0300 100 0212.

If you want to move from LAM to another fertility awareness based method, consult a specialist teacher.

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Warded_Lock said on 21 April 2013

We switched to this method 5 years ago and feel very close. It also avoids me having to go for intimate examinations and appointments to GP or Chemist. It feels very natural.

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