FERTILITY AWARENESS
DEFINITION
Methods that identify the days in a woman’s cycle when she is at risk for pregnancy. This information may be used to avoid or achieve pregnancy. Many couples prefer these methods because they wish to use periodic abstinence (abstain from intercourse during the fertile period are using natural family planning) or use a barrier method during at-risk fertile days (fertility awareness). Traditional methods for identifying those days have included the ‘rhythm” method, the Billings technique, basal body temperature measurement and the symptom-thermal method. Today those methods have largely been replaced by two streamlined methods that are rapidly implementable by the couple: the Standard Days (CycleBeads) method and the TwoDay Method. Fertility Awareness Based methods used to prevent pregnancy are 75%-98% effective. Selected Practice Recommendations (SPR) indicate a 24% failure rate.
Standard Days (CycleBeads) Method (described below)
SUBJECTIVE
Must include:
1. Menstrual cycles lasting 26-32 days.
2. Patient and her partner plan to abstain during the identified at-risk days (up to 12 consecutive days of the cycle--days 8-19) or are willing to use another method during those days.
3. Patient able to follow instructions on use of 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. Provide CycleBeads
2. Instruct patient to start CycleBeads on first day of menses.
3. Tell her to move (advance) the rubber band over the red bead that day and advance the band one bead a day. She may mark on the small calendar included with the beads each day when she moves the band. Day 1-7 red beads=okay for sexual activity
4. During the white (glow-in-the-dark) bead days, she and her partner should abstain from intercourse or use another method with every act of intercourse. Day 8-19 white beads=Abstain or use barrier method to prevent pregnancy
5. Intercourse is allowed without protection on days when the rubber band crosses a brown bead. Day 20-through end of cycle.
6. The rubber band should be advanced to the red bead to start the next cycle on the first day of her menses each cycle.
7. 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.
8. 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.
9. 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.
a. NOTE: tell her that having sex even with protection will cause secretions to be present the subsequent day.
4. 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. April 25, 2014, Vol. 63, No.
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-
http://www.cdc.gov/zika/index.html
Reviewed/Revised 2017
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