FAM (Sympto-Thermal Method), is one of nearly twenty different types of methods defined as “natural.” Not all natural methods are equal. FAM is an evidence-based system of fertility management that involves the daily observation of three primary fertility signs or biomarkers, in addition to secondary fertility signs. When charting these biomarkers, one can easily identify their fertile and infertile days.
The ‘rhythm’ or “calendar” method is an unreliable method because it is based on a calculation that uses the length of previous menstrual cycles for the purpose of predicting current cycles and fertile days.
Calculation methods (often found in fertility apps and devices) are not accurate enough to rely on because menstrual cycles do not behave with swiss-clock precision. Ovulation and hormonal regularity can be affected by common occurrences such as drinking alcohol, travel, illness, stress, poor sleep, medications and more. Statistically, the rhythm method is considered 75% effective while FAM can reach 95% efficacy when learned and used correctly.
FAM is the only method of contraception that divides the menstrual cycle into three separate phases of infertile and fertile days. Pregnancy is only possible during a 3-5 day window. On average, contraceptive protection is only necessary for up to a week out of a typical four week cycle. FAM does not require abstinence. FAM does require the use of two, simultaneous back-up methods during the fertile days, e.g. a combination of spermicides and barrier methods like condoms and diaphragms. This is a couple’s choice to make. FAM reduces dependence on these other methods, as they are only necessary to use on the fertile days.
Any person can learn to recognize and decipher their fertility signs.
To learn and implement it effectively, you will need:
- 7-10 hours of learning (privately or in a group workshop)
- A trial learning period of 2-3 natural cycles for tracking and charting your fertility signs
- Commitment and motivation
- Less than two minutes per day for observation and documentation.
After the initial learning period, when your personal patterns have been identified and your confidence has increased, there are shortcuts that allow for less daily charting and more days of sexual freedom. It makes a huge difference when the person teaching you is an experienced, qualified teacher, who can provide professional follow-up and support.
Anyone who desires a new, refreshing and intimate connection with her body, fertility, sexuality and health and who wants to learn how to trust her body’s innate wisdom and intelligence, once and for all.
- Those who can not or do not want to use hormonal methods, intrauterine devices, or other artificial methods of contraception.
- Anyone who is having difficulty conceiving.
- Niddah-observant women looking for alternatives that don’t interfere with their way of life.
- Those in special situations, e.g. transitioning from hormonal methods, irregular cycles, perimenopause, postpartum and breastfeeding, or trying to conceive using alternative medicine.
- Couples who want to share mutual responsibility for managing their fertility needs.
Effectiveness for nearly all methods can vary greatly; it can be high or low. Your own personal statistic for efficacy is not guaranteed in a book or by a physician. Personal effectiveness depends on your ability to use FAM correctly and consistently, as taught..
The highest effectiveness rates for FAM will be among users/couples who learned the method with a certified teacher, including proper follow-up, and who are serious in their goal to prevent or postpone pregnancy.
As with other methods, ultimate effectiveness depends on many personal/behavioral factors: adherence to the rules, using two additional methods during fertile days, avoiding risks, having a stable enough lifestyle, motivation to succeed and partner support.
FAM can be very “unforgiving” among couples who are not careful. In the first year of use, FAM has a typical efficacy rate of 80-90%. Efficacy is expected to increase over time and with accumulated experience, confidence and satisfaction with the method.
- A completely natural, safe and effective method with no side effects.
- Does not require medical intervention or suppressing one’s natural hormones.
- FAM can save a ton of time for couples who want to get pregnant and/or significantly shorten the time to diagnosis if there is an underlying health/hormonal/fertility problem.
- Increases awareness about the importance of the menstrual cycle and its connection to overall health, not just fertility and reproduction.
- It gives users a powerful sense of control, peace of mind, and confidence.
- As a tool for personal empowerment and fertility management, it allows women to trust themselves and their bodies.
- Encourages mutual responsibility and cooperation between couples and it can improve sexual communication.
- Requires about 2 minutes a day during the learning period.
- It requires 7-10 hours of learning during 2-3 months or cycles.
- It can be “unforgiving” when implemented incorrectly or when couples take risks.
- It requires a serious commitment by the couple using it.
- The method does not protect against sexually transmitted diseases or infections.
Most medical schools don’t teach about fertility awareness-based methods and most physicians confuse FAM with the ineffective ‘rhythm’ method.
Some physicians believe that FAM is “primitive” and “low-tech” and that women are not smart or trustworthy enough to learn it or use it with high efficacy.
FAM can free women from a dependency on hormonal medications and IUD’s. FAM also frees people from a dependency on doctors.
An unhealthy alliance exists between the health care system and the pharmaceutical companies. It is no coincidence that the methods which reap huge profit for big pharma companies are those that doctors recommend. Natural methods do not serve the economic interests of pharmaceutical companies who work tirelessly to convince both health professionals and the lay public that hormonal drugs and IUD’s are the only worthwhile and effective options.
Because these are the only methods they know and trust. As a result, this can create bias and negative attitudes about other options. Gynecologists cannot recommend methods with which they have little clinical experience, so they often end up underestimating and trivializing the side effects that are caused by hormonal methods or IUDs. This in turn leads to patients losing faith and trust in their practitioners.
In an ideal world, gynecologists would be trained as counselors and they would have extensive knowledge and experience about all methods. Medical students would be better trained in communication and counselling skills.
A counselling model involves an exchange of information and a discussion about all methods, the patient’s individual situation, her lifestyle, her sexual needs and her sexual relationship/s. The goal of counseling is to empower the client/patient to make their own informed decisions. This is a model we need to advocate for so our reproductive health needs are adequately addressed
It is time that patients/consumers understand that they are part of a two-way conversation. It is time for gynecologists to acknowledge they don’t have all the information and answers, that there is no “one size fits all,” and that all methods have a price tag.
Choosing the right method goes way beyond the technical act of writing a prescription. There is no perfect method, as all methods have their advantages and disadvantages.
Research shows that patients want a partnership with their practitioners. They expect transparent communication, at eye level, with their doctors. When it comes to decision-making, physicians need to ask more questions. They need to listen and respect their patients’ needs, preferences, values and autonomy. If they don’t have time or are not inclined to do so, they can refer their patients to other reliable sources of information or NGOs that provide this service.
Anyone can learn the theory behind FAM from a book or a friend, but when it comes to actually applying it on your body, and tracking your individual fertility signs, the process can be challenging.
While a minority of people are able to learn and implement the method on their own, reaching a strong level of self-confidence and effectiveness will be higher if learned with a certified instructor. Although there are excellent books and online resources about FAM, they are no substitute for professional guidance and individual follow-up.
This is all the more relevant when taking into account the fact that many new learners are in hormonal transition (coming off the pill, post-partum and breastfeeding), or they have a history of irregular cycles, metabolic reproductive syndrome (polycystic ovaries) or underlying health and gynecological issues like endometriosis, sexual pain, and nutritional deficiencies. These situations often require treatment/intervention before learning FAM, but they are best managed when a certified instructor can walk you through the process and provide essential long-term follow-up.
Anyone who experiences irregular cycles or bleeding will want to verify a teacher’s certification and experience before making a commitment to work with them.
Fertility charts can reveal an array of problems: hormonal imbalances, miscarriage, annovulation (cycles without ovulation), abnormal bleeding, nutritional deficiencies and more. Blood and hormone tests can usually confirm these problems.
A woman trying to conceive learns to monitor her fertility signs or bio-markers for at least 2-3 cycles, using a special chart where you document your basal body temperature, cervical secretion changes and more.
The charts reveal if the cycle is hormonally balanced and when pregnancy is most likely to occur. If the charts look normal and have sex on your fertile days, but still can’t get pregnant for over three months, you should refer to testing.
While there are more than 100 period-tracking and fertility monitoring apps on the market, very few can be relied on as a contraceptive method per say. It is important to remember that an app is not a “method” in itself, they are merely tools for collecting and saving personal data.
Understanding and interpreting the data requires you to learn and implement the method rules. After learning FAM from a certified instructor, a person gains experience and learns to understand her unique fertility patterns.
After the learning period, it is possible to switch to one of a small number of apps and use it as a convenient “short-cut.” If a FAM student doesn’t want to use a paper chart, she can choose a number of online charts which work very well. Online charts are not exactly apps but they are user friendly and can usually be managed from a mobile phone or computer.
FAM in specific circumstances
- Join the club! Droves of pill users around the world are ditching hormonal birth control (HBC) in search of better, natural alternatives. FAM can be an ideal method for the right person who not only wants a natural method but is ready to take on the serious responsibility of managing their fertility without meds and devices. If you are considering going off the Pill (or removing an IUD), you can learn and practice FAM while still using those other methods. In that way, you are protected and stress-free as there is no deadline for making the change. While learning to chart your cycle, you will not see signs of ovulation (because the hormones in the Pill suppress it), but you can still learn a lot about your body and cycle, how FAM works, and whether it will be a good fit for you. You decide if/when the timing is right for making the switch. Just take into account that your body may need time to “re-set,” hormonally-speaking, before your cycles become regular again and you can implement the method. The transition can take a month or two and sometimes longer (see link below)
- Many people like the idea of using a “natural” method but FAM only works, ultimately, when the user is choosing it for the right reasons. There’s a huge difference in choosing FAM as the “default” (because all other methods are worse) and between choosing it because it’s the best fit- meaning it suits your lifestyle, relationship/s, and health and it also syncs with your values. Choosing FAM after hormonal methods involves a shift, adopting new priorities, skills and values. FAM may not be as easy, convenient and hassle-free as the Pill or an IUD, but if it works for you, the benefits and joy will be enormous. There is no perfect method; there are only personal values, needs and priorities to consider. The best method for you is the method you are going to use -correctly and consistently. There is a “price to pay” for every method and only you can know whether the price is “right” or not. Learning and using FAM requires a conscious and mature choice. FAM is an amazing gift, for life, but it requires responsibility, a high level of motivation and a commitment to the values that go with it.
- If you are in a relationship, it is important to prepare with your partner for the new reality- going from a state of complete freedom and sexual spontaneity 24/7 to a state where you begin to listen to and honor your own hormonal rhythms. You need time to learn and gain confidence. If you want to go off HBC, then you both need to get comfortable and experienced with other methods- for the interim and for the fertile days in the future when you may want to be spontaneous. Stopping the Pills unilaterally can cause relationship stress, uncertainty and risk. So if you are not 100% sure that FAM will work for you, there is no obligation to make the shift until you are ready. You can learn and practice FAM, have control and peace of mind- even if you are taking hormonal contraception. More information on transitioning from hormonal contraception to FAM.
It depends on your expectations and needs. To apply the method successfully, both partners are involved because they have a joint commitment to a common goal. Sexual partners also need trust, certainty, confidence, and peace of mind. The more your partner is aware of your fertility, the more likely he is to be attentive and supportive. The more your partner understands how your body and the method works, the higher the chances of success and efficacy.
Your partner doesn’t have to learn the method with you but it is important that you take the time to explain the method and how it works in real-time. Partners can take an active role if you want them to. For example, if a couple lives together, he can be in charge of taking and recording your temperature.
When the goal is preventing or postponing pregnancy, FAM will allow you to identify exactly when you are fertile so at this time you need to determine together what to do: avoid penetrative sex, find other ways to pleasure, and/or use two, simultaneous other methods on your fertile days. Openness, sharing and transparency can lead to higher satisfaction. The degree of success will depend on the nature of the relationship. A steady partner should be able to take a more active role than say a casual partner. It really depends on you, on what you want and need.
Some couples actually choose FAM because they prioritize taking joint responsibility for their fertility and sexuality.
- This depends on your expectations and your needs around safe sex. We know from studies and surveys that there is a positive correlation between stable, long-term relationships (which include mutual trust, communication, and shared values) and success, efficacy, and satisfaction with FAM.
- In casual relationships, the situation is different. If a partner doesn’t know you or FAM well enough – can they be expected to trust it? This can theoretically interfere with intimacy and even sexual pleasure. If you enjoy sex with more than one partner, then you need to take precautions in terms of preventing sexually transmitted diseases and infections. This means using a condom every time, regardless of FAM. Furthermore, using a condom by itself during your fertile days can be risky. If it breaks or malfunctions, there is a potential for surprise pregnancy. Never say, “Oh, that won’t happen to me/us.” Every person who has ever experienced this scare learns the hard way that condoms can be “imperfect.”
- Getting to know your body and learning FAM can be an ideal opportunity when you are single and not sexually active. You can practice the method at your own pace, learn about your body, hormones, and fertility at your own pace, stress-free, while gaining experience and confidence. When the time comes, you will have a safe and effective method to share with your next partner.
A natural and regular menstrual cycle is an essential vital sign of health and not just a sign of fertility. Like blood pressure, respiratory rate, heart rate, and body temperature, your cycle, when seen through a fertility chart, can give you valuable information about whether your hormones are balanced and healthy. If you want to go off hormonal methods, and you have a history of irregular cycles, then you need to be prepared for the following:
- A waiting time to see what happens to the body and the cycle after stopping hormones
- Motivation and desire to make changes in your lifestyle, e.g. diet, exercise, stress reduction as these changes can help your body “re-set.” Furthermore, you may need to consult with a natural medicine practitioner, like a naturopath of a nutritionist, to help you reach your goal.
- Willingness to conduct diagnostic tests (approximately three months after stopping the pills) to verify your hormonal status. You can start learning FAM while taking the Pill or after coming off the Pill. You just need to prepare for the possibility that you may not get your period for a few months. See this article on the transition from pills to a natural cycle.
Theoretically yes. Hormones and IUDs are certainly not the only methods that can provide high levels of effectiveness. The question is whether a natural approach is right for you in terms of personal values, your lifestyle and sexual relationship/s. Are you interested in learning about your body and fertility? Are you ready to take full responsibility for your sexual health? Can you trust your body and yourself? Have you examined all other possible options and weighed their advantages and disadvantages? Do you need more information before making a choice? These are very subjective questions that only you can answer.
There is a fundamental difference between pharmacological and natural contraception. There is a difference between choosing a method because everything else “sucks,” and between choosing a method because it is the best fit for you. FAM should not be the “default.” FAM works when used correctly and consistently. FAM works when the couple using it are mature, organized, and responsible. It requires an initial investment of time, money, and patience to learn and master. Even though learning to chart and interpret your fertility signs only takes about two minutes a day, it is still a big commitment. It is also important to remember that FAM is not a “stand-alone” method. During the fertile days of the cycle, two methods, used simultaneously, are necessary if you want spontaneity and also high efficacy. Click here for a list of contraceptive methods that can be combined with FAM.
Breastfeeding by itself is not an effective method of contraception. If you have the curiosity, desire , and commitment to manage your fertility naturally, then FAM can teach you a lot about your natural secretion pattern, which is directly related to your fertility status and to the frequency of breastfeeding. With FAM, you can know every day if and when you are fertile. You can know in advance when your body is trying to ovulate and when fertility is returning. When you learn FAM with a certified teacher, which includes personal follow-up, you will know how to identify potentially fertile days- even before your first, post-partum period occurs. I suggest you speak with a FAM instructor, who can help you reach the right decision.
FAM can be an ideal contraceptive for women in general and for religious women in particular. If taking hormones is causing unpleasant side effects such as bleeding or staining, then know there is a safe and effective alternative. FAM is not for everyone. For religious couples who have a heter (permission) to postpone pregnancy, FAM offers a great deal of freedom and very high effectiveness when used correctly and consistently. Most rabbis permit contraception for up to two years post-partum and many rabbis and halachic counselors (yoatzot) are familiar with FAM. If you wish to consult with a certified Halacha counselor, you can call the Nishmat Hotline. Nishmat institute
A woman trying to conceive while learning FAM will chart her fertility signs for up to three months or cycles. The charts will reflect a basic picture of her fertility status. If everything looks fine and sexual relations occurred on the right days, but no pregnancy resulted, then a couple can be referred for tests. If the fertility charts show irregularities, we can get an idea of what the problem might be, how to reach a diagnosis and what the options for treatment are. Personal follow-up with a FAM teacher is one of the great benefits you receive when learning the method in an organized and professional way.
If you experience chronic yeast infections, the situation could be aggravated by the way synthetic hormones interact with and “off-set” your natural hormones. Hormonal birth control is not considered a cause of yeast infections but it can increase the risk of getting them. But so can a lot of lifestyle factors- like overuse of antibiotics, poor nutrition (consuming too many sugars and simple carbohydrates), high and persistent stress, lack of sleep, nutritional deficiencies, and even an unhealthy sexual relationship.
Before you start learning FAM, it is best to do a vaginal swab/culture test to clarify your situation. You may not have an infection after all. But when you start learning to chart your fertility signs, you may experience difficulty in identifying the pattern of your natural secretions because candida can produce its own secretions which mask the natural ones. If a vaginal culture confirms candida, you can choose pharmaceutical remedies or natural remedies. If you’ve suffered for a long time and have not received a proper diagnosis or found the right treatment, you are not alone. Going off hormonal birth control may improve your situation, in addition to consulting with an experienced naturopath, nutritionist, Chinese practitioner, or other practitioner because you might need to make dietary and lifestyle changes that will help you recover, forever. If you are struggling emotionally or sexually in a relationship, the infection could be your body’s way of communicating that something deeper is screaming for attention. A FAM instructor can refer you to a practitioner who specializes in body-mind and sexual healing.
In terms of FAM it is best to join a workshop after you are treated and your secretions return to normal.
If you see unfamiliar secretions and are having difficulty getting pregnant, it is possible that a fungal or bacterial infection is affecting the process. In this case, too, it is best to diagnose and treat the problem before planning a pregnancy.
That depends on a number of things. First, it is not enough for a doctor to tell you that you have PCO/S. You need to be tested to meet the diagnostic criteria: blood and hormone tests, an ultrasound exam and a thorough medical intake including your family history and symptoms, such as long, irregular cycles. One random ultrasound is not a definitive diagnosis.
There are different types of PCO and most doctors are not fully informed about them, nor are they fully informed about the ways it can be treated naturally. Physicians usually recommend hormonal birth control because it causes a monthly bleed but it is really just a “fake period”. If and when you want to get pregnant, the doctors will offer you other medications and hormones. Unfortunately, hormonal medications cannot cure or fix the problem; they only mask and hide it. PCO/S is related to hormonal imbalance, insulin resistance, and infertility. Many cases can be treated naturally with dietary changes, nutritional supplements, herbs, and regular exercise. A qualified FAM teacher can lead you in the right direction and you are encouraged to read and collect information from reliable sources, such as Lara Briden’s blog -available on the internet.
If your cycles are skipping, this doesn’t mean you are less fertile; it just means you are in transition and your cycles are less predictable. There can be various reasons for skipped cycles and you will want to collect more information. Ultrasound, blood and hormone tests can help clarify your situation. Consider yourself fertile even if you have begun the peri-menopause, which is defined as the 2-10 years when your body is going through hormonal and other changes that eventually lead up to menopause (defined as reaching one year without a menstrual bleed). Even if your hormones are shifting, pregnancy is still possible during these years so it is important to have effective birth control.
It is also important to listen to your body and take charge of your health. Learning and using FAM can give you tremendous personal knowledge, control and peace of mind because you know every day and every cycle what your body is actually telling you, and whether or not you are fertile or ovulating. One sign of perimenopause is skipping cycles. As our fertility potential decreases, ovulation tends to be less regular and its frequency varies because of shifts in estrogen and progesterone. Monitoring changes in natural secretions in particular is a fantastic tool for knowing what your body is doing. Vaginal dryness, less lubrication, changes in bleeding patterns are common during this transition.
FAM is a choice; it can be used as an effective birth control method (even if cycles are erratic) and it can be helpful for monitoring your fertility and hormones. But beyond that, FAM promotes body awareness and it can be a great catalyzer for becoming more pro-active about your overall health care and enable you to seek out treatment modalities that will strengthen your health and your quality of life. For information on the FAM workshop for women before or after the age of 40.
First, it’s great that you’re interested in the method and willing to take part in it. Through your partner, you will hopefully learn more about her cycles and fertility patterns. Based on my 35-years of working with women and couples, I can share the following insights:
- The method can enrich your relationship. If you are curious and supportive, this can help your partner reach a higher level of confidence and satisfaction with the method. It can improve communication in general and sexual communication in particular. You can enjoy unprotected sex for many days of the cycle when you know that she is infertile! This is a definite win-win situation.
- There is a different learning curve for each person and couple who learns FAM.
- To effectively prevent pregnancy during the fertile days, joint responsibility means choosing one of two options: engage in other kinds of sex/pleasure without penetration or ejaculation in the vagina, or have full intercourse while using two contraceptives simultaneously (e.g. a condom and a spermicide). The choice is yours to make.
Info about FAM workshops for couples (yes, there is such a thing!)
Some couples take interest in fertility awareness because they want to increase their chances of conceiving a boy or a girl. FAM is one tool that can be used for this purpose because it can help to identify the fertile window and the most probable time of ovulation (aided by ovulation kits/urine sticks that identify the LH hormone). To benefit, it is recommended to chart at least three cycles so that individual fertility patterns can be learned. There is literature, based on in vitro fertilization, that claims that the timing of intercourse (either at the beginning or the end of the fertile window) can increase the chances of having a boy or a girl by 10-15%. This is only slightly higher than the 50-50% that mother nature gives us. The original “recipe” was published in a book back in the 1980s. You can get more information about this from a FAM instructor or from the internet.
It is highly recommended to be examined by a pelvic floor physiotherapist in order to reach a proper diagnosis. She can explain if and how the prolapse and the symptoms resulting from it can be treated. In a FAM workshop you learn to monitor two or three signs of fertility, one of which involves feeling with your middle finger changes in the cervical os near the top of the vagina. If there is prolapse and checking the os is problematic, there are still two other fertility signs which can be monitored- basal body temperature (BBT) and cervical secretions.
Congratulations on your upcoming wedding. There is in fact a better way for brides to reach the wedding date and the sheva brachot without having to take birth control pills, which can cause staining, mood swings, and other annoying side effects. The secret is in the timing. Many brides and their gynecologists try to calculate and predict the fertile days based on past cycle lengths. This is an unreliable method! Furthermore, cycles can become irregular before a wedding, with all the positive and negative stress that comes from planning a wedding. Some doctors think it is easier to prescribe continuous hormonal birth control a few months before the wedding. Others prescribe a progesterone-only pill called primulut-nor, taken around the time of ovulation if the next period is close to the wedding date. This pill does not suppress your cycle hormones because it does not contain estrogen, which means no unpleasant side effects (e.g. vaginal dryness, low libido, mood swings, depression, migraines). When taken at the right time, the pill will push off the next period, until after the wedding (or sheva brachot) when you stop taking it. Theoretically, this method works. Unfortunately, it often fails because one can never accurately predict the time of ovulation based on cycle length alone.
If you sign up for a FAM workshop at least 2- 3 months before the wedding, you can learn to identify your fertile days, which always occur 10-14 days before your next period. You cannot accurately calculate these days in advance. If you know exactly when you are in your fertile window, this gives you nearly two weeks’ advance notice to take primulut-nor at the right time. You will only need to take it once, for up to 3 weeks (including the sheva brachot). You can relax and enjoy the wedding time while being in full control and avoiding accidental staining or bleeding. When you stop taking it, your natural period will come within a few days.
Learning about your body, cycles, hormones, and fertility will contribute greatly to your health, self-image, sexuality, and relationship as you begin your new life chapter in marriage. FAM is a great gift and a skill for life for every new bride. For more information on preventing Chupat Nida on your wedding day.