FERTILITY AWARENESS

DEFINITION

Methodsthatidentifythedaysinawoman’scyclewhensheisatriskforpregnancy. This information may be used to avoid or achieve pregnancy. Manycouples preferthesemethodsbecausetheywishtouseperiodicabstinence(abstain from intercourse during the fertile period are using natural family planning)orusea barrier methodduringat-riskfertile days (fertility awareness).Traditionalmethodsforidentifyingthosedayshave includedthe‘rhythm”method,theBillingstechnique,basalbodytemperaturemeasurementandthe symptom-thermalmethod.Todaythosemethodshavelargelybeenreplacedbytwostreamlined methodsthatarerapidlyimplementablebythecouple:theStandardDays(CycleBeads)methodand theTwoDayMethod. Fertility Awareness Based methods used to prevent pregnancy are 75%-98% effective. Selected Practice Recommendations (SPR) indicates a 24% failure rate.

Standard Days (CycleBeads) Method (described below)

SUBJECTIVE

Mustinclude:

  1. Menstrualcycleslasting26-32days.
  2. Patientandherpartnerplantoabstainduringtheidentifiedat-riskdays (up to 12 consecutive days of the cycle--days 8-19)orarewillingtouse anothermethodduringthosedays.
  3. Patientabletofollowinstructionsonuseof method.
  4. Zika Risk Assessment

a.Travel-self and partner(s)

1)Past travel –last 8 months –where and when

2)Plans for future travel –where and when

OBJECTIVE

None

LABORATORY

Consider Zika screening if indicated by Zika Risk Assessment.

ASSESSMENT

Candidate for Standard Days (CycleBeads) Method for fertility awareness.

PLAN

  1. ProvideCycleBeads
  2. InstructpatienttostartCycleBeadsonfirstdayofmenses.
  3. Tellhertomove(advance)therubberbandovertheredbeadthatdayand advancethebandone beadaday.Shemaymarkonthesmallcalendarincludedwiththebeadseachdaywhenshe movestheband. Day 1-7 red beads=okay for sexual activity
  1. Duringthewhite(glow-in-the-dark)beaddays,sheandherpartnershouldabstainfrom intercourseoruseanothermethodwitheveryactofintercourse. Day 8-19 white beads=Abstain or use barrier method to prevent pregnancy
  2. Intercourseisallowedwithoutprotectionondayswhentherubberbandcrossesabrownbead.Day 20-through end of cycle.
  3. Therubberbandshouldbeadvancedtotheredbeadtostartthenextcycleonthefirstdayofher menseseachcycle.
  4. If her menses starts before the rubber band reaches the dark brown bead on cycle day 26, tell her that her cycles are too short for this method. She should not rely on CycleBeads as her method.
  5. If her menses do not start until after the rubber band reaches the black elongated bead on cycle day 32, tell her that her cycles are too long for this method. She should not rely on CycleBeads as her method.
  6. Provide Emergency Contraception (EC) in advance of need for her to use in case of unprotected intercourse during an at-risk day.

PATIENT EDUCATION

Review the elements in the Plan above.

  1. To prevent pregnancy-unprotected intercourse is permitted on days 1-7 and from days 20 until the end of the cycle.
  2. To become pregnant-unprotected intercourse is suggested every other day between days 8-19 of your cycle.
  3. Zika virus education and prevention strategies

a.Avoid traveling to impacted areas

b.Avoiding mosquito bites if traveling to impacted areas

c.Using condoms to prevent transmission of virus

d.Avoiding pregnancy if infected or partner infected

1)Risk to unborn fetus

REFER TO MD/ER

None

Two-Day Method (described below)

SUBJECTIVE:

Must include:

  1. Woman willing and able to touch her external genital area and to detect any vaginal secretions.
  2. Patient and partner willing to abstain or use another method during at-risk days.
  3. Zika Risk Assessment

a.Travel-self and partner(s)

1)Past travel –last 8 months –where and when

2)Plans for future travel –where and when

OBJECTIVE

Must exclude any condition which alters vaginal secretions, such as vaginal infections or vaginal creams or lubricants.

LABORATORY

Consider Zika screening if indicated by Zika Risk Assessment.

ASSESSMENT

Candidate for Standard Days Two-Day Method for fertility awareness.

PLAN

  1. Instruct patient to touch her introitus each morning upon arising before she urinates to check for any moisture or secretions.
  2. If she has any secretions or moisture, she should not have intercourse that day (or night).
  3. If she determines that her introitus is dry today, she must then remember if she was dry yesterday. Only when she has been dry for 2 consecutive days can she have sex without protection.
  4. NOTE: tell her that having sex even with protection will cause secretions to be present the subsequent day.
  5. Provide Emergency Contraception (EC) in advance of need for her to use in case of unprotected intercourse during an at-risk day.

PATIENT EDUCATION

Review the elements in the Plan above.

  1. To prevent pregnancy avoid unprotected intercourse if you notice any secretions of any type any day
  2. To become pregnant unprotected intercourse is suggested every other day on days of secretions.
  3. Zika virus education and prevention strategies

a.Avoid traveling to impacted areas

b.Avoiding mosquito bites if traveling to impacted areas

c.Using condoms to prevent transmission of virus

d.Avoiding pregnancy if infected or partner infected

1)Risk to unborn fetus

REFER TO MD/ER

None

REFERENCES

  1. CDC. Providing Quality Family Planning Services MMWR.July 29, 2016, Vol. 65, No. 3
  2. Hatcher RA, et al (editors). Contraceptive Technology, 20th Ed. New York: Ardent Media 417-433.
  3. Centers for Disease Control and Prevention (CDC). Zika Virus Homepage-

Reviewed/Revised 2018

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