Fertility Awareness-Based

Methods and
Lactational Amenorrhea Method
FERTILITY AWARENESS-BASED
METHODS
are family planning methods that focus on the
awareness of the beginning and end of the
fertile time of a woman’s menstrual cycle.
These methods involve:
• Determination of the fertile and infertile
periods of a woman within the menstrual
cycle.
• Observation of the signs and symptoms of
infertility and fertility during the menstrual
cycle.

EFFECTIVENESS: All FAB Methods are

above 95% effective.
 SIGNS OF FERTILITY
fertility signs that a woman can observe to
determine when she can or cannot become
pregnant. These are:
1.Changes in the cervical mucus: Cervical mucus can
be used to determine the beginning
and end of the fertile days.
2. Changes in the basal body temperature: Basal
body temperature can be used to
determine when ovulation has passed and the
fertile days have ended.
3. The first day of menstruation is the sign for
keeping track of a woman’s menstrual cycle.
THE FAB METHODS
 CERVICAL MUCUS/BILLINGS
OVULATION METHOD (CMM/BOM)
is based on the daily observation of what a woman sees and feels at
the vaginal area throughout the day. Cervical mucus changes
indicate whether days are fertile or infertile and can be practiced by
couples to avoid or achieve pregnancy. On the 4th day after the last
day of wetness, all dry days are absolutely infertile days. On dry
days following menstruation, couples can engage in sexual
intercourse on alternate nights only. With perfect (correct) use, this
method is 97% effective. However, with typical use, it is 80%
effective. Alternatively, the Two Day Mucus-Based Method Rule
states that two dry days (no secretions for two consecutive days)
signify that intercourse will not result in pregnancy
BASAL BODY TEMPERATURE (BBT)
• is based on a woman’s resting body temperature
(i.e., body temperature after three hours of
continuous sleep) which is lower before ovulation
until it rises to a higher level beginning around
the time of ovulation. Her infertile days begin
from the fourth day of the high temperature
reading to the last day of the cycle. All days from
the start of the menstrual cycle up to the third
high temperature reading are considered fertile
days. With perfect use, this method is 99%
effective. With typical use, its effectiveness is
80%.
 SYMPTO-THERMAL METHOD (STM)
• is based on the combined technology of the Basal
Body Temperature (e.g. the resting body
temperature) and the Cervical Mucus/Billings
Ovulation Method(e.g. observations of mucus
changes at the vaginal area throughout the day)
together with other signs (i.e., breast
engorgement, unilateral lower abdominal pain)
which indicate that the woman is fertile or
infertile. This method is 98% effective as correctly
used.
 STANDARD DAYS METHOD (SDM)
• is based on a calculated fertile and infertile
period for menstrual cycle lengths that are 26 to
32 days. Women who are qualified (e.g. with 26
to 32 days menstrual cycles) to use this method
are counseled to abstain from sexual intercourse
on days 8-19 to avoid pregnancy. Couples on this
method use a device, the color-coded “Cycle
Beads”, to mark the fertile and infertile days of
the menstrual cycle. SDM is 95.25% effective with
correct use and 88%
 How to use the CycleBeads
• Assess the length of the menstrual cycle if it falls within
the range of 26–32 days by considering the following
information:
• The last menstrual period
• The previous/past menstrual period
• When she expects her next menses
• If the cycle length is less than 26 days or more than 32
days, the client cannot use the method.
• If the cycle meets the criteria, provide an SDM card and
cycle beads, which can be used in marking the days of
the cycle
Show the woman the CycleBeads and
instruct her on how to use it:
Pre-ovulation Day 1
(infertile)
Post-ovulation
(infertile)

Fertile days
(D8-D19)
 Women with Special Conditions
• Contraceptive shifters may also use SDM
provided that the following criteria are met:
 • Shifting from pills
• – Menstrual cycles were within 26-32 days
before taking the pill
• – Expects current cycle to be within 26-32
days
 • Shifting from injectables
– At least three months have passed since the
last injection
– Menses have returned
– Menstrual cycles were within 26-32 days
before using injectables
– Last menstrual cycles were within 26-32 days
 Recently used IUD
• – IUD has been removed
• – Menstrual cycles while using the IUD were
within 26 to 32 days
• – Last menstrual cycle was within 26-32 days
 Postpartum and/or Breastfeeding
– Menstruation has returned
– Has had at least four normal menstrual
periods
– Expects current cycle to be within 26 to 32
days
 Advantages of FAB methods:
• • Effective when used correctly and consistently.
• • No physical side effects.
• • No prescription required.
• • Inexpensive; no medication involved.
• • No follow-up medical appointments required.
• • Better understanding of the couple about their sexual
physiology and reproductive functions.
• • Shared responsibility for family planning.
• • Foster better communication between partners.
• • All FAB methods can be used for spacing, limiting,
and achieving pregnancy
 Disadvantages of FAB methods:
• May inhibit sexual spontaneity.
• Except for SDM, need extensive training - it takes about two to three
cycles to accurately identify the fertile period and how to effectively
use it.
• • Require consistent and accurate record keeping and close
attention to body changes.
• • Require periods of abstinence from sexual intercourse, which may
be difficult for some couples.
• • Require rigid adherence to daily routine of awaking at a fixed
time, without any disturbance
• before taking the temperature (specific for BBT and STM).
• • Can be used only by women whose cycles are within 26-32 days
(specific for SDM).
• • Offer no protection against STI, HIV/AIDS.
 Key Points on the FAB Methods:
• Fertility awareness-based methods require cooperation of
both partners.
• A woman or couple using FAB methods must be aware of
body changes or keep track
• of fertile and infertile days according to the rules of the
specific FAB method being practiced.
• To avoid pregnancy, the couple should abstain from sexual
intercourse during the fertile phase. To achieve pregnancy,
the couple can time sexual intercourse during the fertile
phase.
• FAB methods have no side effects or health risks.
• SDM can be used by women with 26-32 days menstrual
cycles.
 LACTATIONAL AMENORRHEA
METHOD
• is a contraceptive method that relies on the
condition of infertility that results from
specific breastfeeding patterns. LAM is the use
of breastfeeding as a temporary family
planning method. “Lactational”- means
related to breastfeeding. “Amenorrhea”means
not having menstrual bleeding.
There are three criteria that must be
met to be able to qualify for the use
of LAM:
1. The woman exclusively breastfeeds infant
• Exclusively breastfeeding may be interpreted as:
a. Exclusive means no supplements of any sort are
given. Infant receives no other liquid or food, not even
water in addition to breast milk.
b. Very small amount (one or two swallows) of water,
vitamins or antibiotics as medically prescribed.
c. Simply put, the woman should use both breasts to
breastfeed her baby on demand with no more than a
four-hour interval between any two daytime feeds and
no more than a six-hour interval between any two
night time feeds.
• 2. Amenorrhea
Mother’s monthly bleeding has not returned. In
the first weeks postpartum (e.g.in the first 56
days postpartum), there is often continued
spotting. This is not considered to be a
menstrual period if the woman is fully
lactating
• 3. Infant is less than six months old.
If she is fully breastfeeding and her menses have
not returned, the effectiveness of LAM
diminishes over time. Ovulation resumes in
20% to 50% of women near the end of the six-
month postpartum.

If any of the criteria is not met, it is no

longer LAM.
• Mothers should initiate breastfeeding as soon
as possible after birth, and avoid separation
from the baby as much as possible. Breastfeed
the infant on demand day and night, with no
more than a four hour interval between any
two daytime feeds, and no more than a 6-
hour interval between any two night time
feeds.
 ADVANTAGES OF LAM
1. It can be started immediately after delivery.
2. It is economical and easily available.
3. It does not require a prescription.
4. No action is required at the time of intercourse.
5. There are no side effects or precautions to its use.
6. No commodities or supplies are required for clients or
for the family planning program.
7. Fosters mother-child bonding.
8. It serves as a bridge to using other methods since LAM
is used for a limited time only.
9. It is consistent with religious and cultural practices.
 DISADVANTAGES OF LAM
• 1. Full or nearly full breastfeeding pattern may be difficult
for some women to maintain.
• 2. The duration of the method's effectiveness is limited to a
brief six-month postpartum period. If a
• mother and child are separated for extended periods of
time (because the mother works outside
• the home), the breastfeeding practice required for LAM
cannot be followed.
• 3. There is no protection against sexually transmitted
infections, including HIV.
• 4. In addition, it may be difficult to convince some
providers who are unfamiliar with the method
• that LAM is a reliable contraceptive.
NOTE: If returning to a clinic will be
difficult for the client, provide a
complementary family
planning method for use, when
needed. Use condoms with LAM if
there is a risk of
STI/HIV infection.
CHOOSING AN FP METHOD FOR
POSTPARTUM BREASTFEEDING
WOMEN