Intended for healthcare professionals

Practice Clinical Updates

Fertility awareness based methods for pregnancy prevention

BMJ 2019; 366 doi: (Published 11 July 2019) Cite this as: BMJ 2019;366:l4245
  1. Rachel Peragallo Urrutia, assistant professor1 2,
  2. Chelsea B Polis, senior research scientist3 4
  1. 1Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
  2. 2Reply OB/Gyn & Fertility, Cary, NC, USA
  3. 3Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
  4. 4Guttmacher Institute, New York, USA*
  5. Correspondence to R Peragallo Urrutia

What you need to know

  • Best available estimates of the effectiveness of fertility awareness based methods for contraception come from a small number of moderate quality studies, and should be interpreted with caution

  • People using fertility awareness based methods for contraception should know that they may prove less effective if and when assessed in higher quality studies or diverse populations

  • Offering a range of acceptable family planning methods is essential to help people achieve their reproductive goals in a patient centred manner

  • Providing clear information about all contraceptive options requires high quality scientific evidence. Some fertility awareness based methods have (moderate quality) effectiveness data available; others do not

  • Online and in-person educational resources are available to help potential users learn more about fertility awareness based method options and how to use them correctly

Fertility awareness based methods of contraception are increasingly being used for pregnancy prevention.1 In the US, the proportion of contraceptive users who choose such methods has grown from 1% in 2008 to approximately 3% in 2014.12 Relative to other methods of pregnancy prevention, however, substantial misinformation exists around fertility awareness based methods of contraception, particularly about the effectiveness of specific methods and how to use them. Providers who offer family planning counselling can promote correct and consistent use of the chosen method by helping people find a method that best fits their individual lifestyle, preferences, and goals.3 This article aims to help clinicians counsel people about fertility awareness based methods for pregnancy prevention by explaining the different methods, the evidence base for their effectiveness, and practical considerations for use.

What are fertility awareness based methods of contraception?

Fertility awareness based methods are devised on the premise that sexual intercourse can only lead to pregnancy during approximately 6-9 days of the menstrual cycle, commonly referred to as the “fertile window” (or fecund window, box 1).5 …

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