Method Comparisons
Do you ever wish you could have a side-by-side comparison of methods to pick the best one for you?
When looking for the right method of fertility awareness, it is important to consider things like personality, budget, health and family planning needs, mental health, etc. It would be nice to know that there’s one method that is the perfect fit for women who are postpartum, women trying to conceive or women seriously trying to avoid. But if there’s one thing we’ve learned, method choice is just not that simple.
We love the uniqueness and flexibility of having different methods, and we know that can make the process of choosing the best method for you messy and complicated.
But here at FAbM Base, our mission is to minimize the challenges and barriers to choosing and practicing the best method of fertility awareness - for you!
Here you can find...
…a comprehensive list of the different reproductive category needs and symptoms you are most likely to encounter during your fertile years and connected with our pro instructor friends from 6 of the most popular options – Billings, FEMM, Marquette, Boston Crosscheck, Creighton, and SymptoPro – to learn what charting these needs actually looks like.
This page makes it possible for you to…
Click each option above to navigate directly to that part of the page.
*Reproductive category describes the stage of life, types of cycles, or situation you are dealing with in relation to fertility, reproduction and health.
May the *best method fit for you in this stage of life* win.
Happy hunting!
Reproductive Category Comparisons.
1
Click below to compare how each method handles the different reproductive categories.
Post hormonal birth control
Creighton
Charting can begin immediately after stopping the pill or removing the IUD. There are various things the client should expect when stopping the pill. It may take several weeks or months for the first menses to appear and episodes of unusual bleeding are more common. The woman may be temporarily anovulatory and have variable pre/post peak phase lengths. The first ovulation may be painful. It can take up to 6 cycles for the system to recover and it is recommended to wait 3-6 cycles before trying to achieve pregnancy as the body heals. This education is built into the follow up form.
Because post-pill is a pre-peak time (meaning the woman is waiting to ovulate), the couple will remain on end of day intercourse instructions on days of infertility to avoid pregnancy until the woman is back in normal cycles. In my experience, the woman coming off of the pill charts very easily with Creighton, especially since it’s usually a time of dryness until ovulation returns.
Creighton offers a huge benefit to women coming off the pill. Many women are placed on the pill for medical reasons and were not given true diagnoses or treatment. Women coming off the pill experiencing symptoms/issues can benefit from NaPro evaluation and treatment. I have had multiple clients coming off the pill be diagnosed with hormone imbalances or endometriosis. The charting was always the first indicator and red flag that something was not right.
Both myself and a colleague have also taught women to chart while using hormonal birth control and an IUD because they wanted to be confident in charting before getting off of it and/or to avoid a potential unsuccessful implantation due to a breakthrough ovulation when sexually active.
Marquette
Charting begins as soon as possible after any type of contraception. Fertility may return immediately so if a couple is avoiding pregnancy, the protocol is to abstain from intercourse until the end of fertility is identified. Realistically, this may be two weeks or it could be several months. Every woman’s body responds differently to coming off hormones, particularly if it’s combined hormonal contraception. Those who use an IUD, implant, patch, or ring, can expect the same. A woman would test her urinary hormones every day until she identifies peak/ovulation and the fertile window would end a certain number of days after that. If the return of fertility seems to be extremely prolonged, an instructor may refer to a Restorative Reproductive Medicine provider to assist in inducing a cycle.
Boston Cross Check
For all of the situations below, I have to offer the caveat that I can’t give all of the protocol details! Many of these are situation- or goal-specific to the client, though general recommendations can be followed.
For any client coming off of hormonal birth control, BCC will have modifications to our standard protocol in the event that cycles take a while to “regulate” again! So clients will receive the standard instruction for temps, fluid, and monitor, but we’ll recommend abstaining from the cessation of birth control until we verify a first ovulation. And then we may offer a modified algorithm for the start of fertility for subsequent cycles, depending on how quickly a woman’s body gets back into typical cycle presentations. Unfortunately, many women are put on the pill in order to relieve symptoms of an underlying issue, so in those cases we may work very closely together to monitor how that issue is manifesting anew, and make specific recommendations based on what we see with this new cycle data.
SymptoPro
When a woman is post hormonal birth control, charting can begin immediately. Abstinence is required until a temperature rise is confirmed or for 28 days, whichever comes first. In the case of a temperature rise, that means that cycling has begun again and typical instructions and rules can be applied while keeping a close eye on the mucus sign. This can be confusing for several cycles postpartum. The use of the temperature sign can be very helpful post hormonal birth control because it is so objective.
If cycling does not return within the first 28 days of charting, the woman would begin using a mucus only rule which requires diligent charting of the mucus sign. The mucus only rule requires setting a peak day and counting days after that mucus peak. This rule can be difficult to apply right away because a woman may not feel comfortable charting the mucus sign right away. This would be the case for any method that requires charting the mucus sign.
FEMM
For post-pill charting, we could start following with that client immediately to teach the method, but wouldn’t necessarily expect resumption of normal cycles for 3-6 months. So, the process of referring to Medical Management would be slower in that sense since it will take time for normal cycles to resume. However, if a woman has a history of hormonal issues prior to pill use, then we would likely recommend that she be referred to Medical Management more quickly.
Billings
Billings has the same four rules for every charting scenario. Someone post-pill would have to establish a basic infertile pattern and then do alternate evenings of the basic infertile pattern until ovulation occurs.
PMS
Creighton
PMS is a legitimate medical condition that can be treated through NaProTECHNOLOGY™, which is the medical extension of the Creighton Model Charting System. Conventional gynecology and culture would have women believe that PMS is normal. While some mild degree of PMS symptoms can be normal 1-2 days before menses, severe symptoms impacting quality of life and/or symptoms lasting 5-7+ days before menses is not normal.
PMS is frequently associated with low progesterone and biomarkers that indicate this potential can be seen within Creighton charting. These include tail end brown bleeding and premenstrual spotting. Most women will not report PMS symptoms due to accepting it as a normal part of life. A PMS questionnaire is built into the Creighton follow up form to make sure it gets evaluated and reassessed. Neither an instructor or the chart can diagnose, but we are trained to identify risk factors and refer to a NaPro provider who can address and treat PMS through bio-identical progesterone supplementation and full medical evaluation to assess for other contributing factors.
Marquette
PMS may be associated with imbalanced hormones which may or may not be evident in Marquette charting. If a client is reporting debilitating PMS, an instructor may refer to a Restorative Reproductive Medicine provider to assess hormones.
Boston Cross Check
We are not a method which offers diagnostic or direct medical support. Clients who present with PMS symptoms can be instructed to note those on the chart, in conjunction with fertility biomarkers, in order to aid diagnostics with a provider. We can also offer general guidelines on cycle-balancing supplements, or look at the rest of the chart to see if she has biomarkers which might tell us about the cause of the PMS (e.g., low progesterone) to help guide her conversation with a provider.
SymptoPro
While instructors of SymptoPro are trained to notice cycle red flags, they are not medical providers. In any case of cycle irregularities or red flags like PMS, premenstrual spotting, irregular cycle pain, or any other situation, SymptoPro instructors are prepared to refer you to a medical provider.
FEMM
In our initial Health intake form that you bring to your first session, there is a list of PMS systems that we ask about, how long they persist, if they require the client to take medication etc. We know the guidelines as to what is considered normal within these symptoms (very little) and open a conversation from there if we expect PMS to be present. We cannot, as instructors, officially diagnose, but we can identify patterns and refer to our Medical Management branch for in depth hormone paneling and support. The whole method is based on this. We can certainly suggest and offer the research indicating how much lifestyle (i.e. sleep, diet, exercise, etc.) impacts our hormonal and overall health, and while I would not suggest some specific protocol for a client as that is outside of my scope, I could certainly have the conversation and offer simple things that I’ve seen work for people if they want to try that before medical management.
Billings
Billings does not offer support for PMS.
Pelvic pain (i.e. menstrual cramps, endometriosis, etc.)
Creighton
Creighton practitioners are trained to identify risk factors for endometriosis. Some of those risk factors can be seen in charting (limited mucus, clotting during menses, signs of hormone disturbance), but many times those risk factors are identified through the general intake form when health and menstrual history are reviewed. Pelvic pain that is interfering with daily life and not controlled by over the counter pain medications is a major red flag. When I have a woman tell me that her period is so painful that she has to leave work/school, or she vomits or faints, I am very concerned. When a woman tells me intercourse is painful consistently or that she cannot use a tampon due to pain, I am concerned. Creighton practitioners also ask about middle of the night urination and bowel habits. This is important because many endometriosis patients have bowel and bladder symptoms. While the Creighton practitioner cannot diagnose, these red flags prompt the practitioner to refer the client to the proper NaPro provider for evaluation and treatment (including NaPro surgery if needed). This is important because early diagnosis for endometriosis is imperative.
Marquette
Debilitating menstrual cramps may be a sign of imbalanced hormones or a structural condition.
Assessing menses and pelvic pain is part of a chart review and signs of abnormalities would be referred to a RRM provider.
Boston Cross Check
Pain can be charted in conjunction with other biomarkers to look for patterns of presentation. Instructors can guide clients on possible causes of this pain and encourage them to use their charts to aid a provider with diagnosis or further investigation.
SymptoPro
While instructors of SymptoPro are trained to notice cycle red flags, they are not medical providers. In any case of cycle irregularities or red flags like PMS, premenstrual spotting, irregular cycle pain, or any other situation, SymptoPro instructors are prepared to refer you to a medical provider.
FEMM
Pelvic pain is not normal and so we would refer for medical management immediately while continuing to accompany the woman in her charting to identify patterns or abnormalities that could indicate the root cause of these issues. We are also trained to ask further questions with any abnormality to rule out the possibility of infection etc.
Billings
Billings teachers may refer to FEMM or Billings doctors for cycle issues. Of course, this is a very limited service because doctors who are trained to understand charting are few and far between.
Continuous mucus
Creighton
Creighton practitioners receive extensive training in the advanced management of continuous mucus. When a client is experiencing this, Creighton practitioners have a protocol to follow to assist the client in identifying a base infertile pattern (time of infertility) and a point of change (time of fertility). The client is taught to ask the “essential sameness question” and to pay attention to the behavior of mucus from day to day. In being attentive to this behavior, the client tries to identify a significant/obvious change in the mucus due to an estrogen rise towards ovulation. Even in the case of seeing mucus every day, the appearance/quality of the mucus will have a distinctive change with the estrogen rise. Once the client has charted the essential sameness for two cycles and has confident identification of point of change, yellow stamps can be used to mark days of “infertile” mucus.
It is important to note that continuous mucus is often associated with PCOS, cervical erosion or eversion, and/or estrogen dominance. For this reason, all women experiencing continuous mucus, especially in the presence of long cycles, should be considered for NaPro evaluation. Clients with continuous mucus should expect to have more frequent follow ups or greater than the standard 8 follow ups in 1 year.
Marquette
Marquette is an excellent option for clients who have difficulty identifying their fertility status with mucus or who don’t feel confident in interpreting their mucus signs. The subjectivity of the mucus biomarker may cause a hesitation or confusion with identifying fertility and may result in unnecessary abstinence, so using the objective monitor readings and protocol may be more compatible for clients with this issue. The monitor only protocol allows women to ignore mucus signs and has actually been proven to be the most effective approach (98% in typical use) for avoiding pregnancy with Marquette. When couples are doing the monitor only they rely on the results of the Clearblue monitor as well as the method protocol to identify fertility. The monitor will detect estrogen rise and the LH surge to identify the beginning and end of the fertile window.
Boston Cross Check
If a woman has particularly long cycles, continuous mucus may present a challenge for getting “usable days” at the beginning of a chart when trying to avoid pregnancy. Generally, however, continuous mucus (or, as we prefer to say: fluid) is not an issue for standard BCC charting if the woman is able to distinguish between peak-type fluid and the rest of her flow. Because BCC has many options for biomarkers, women who struggle with continuous fluid signs may also be able to confidently opt out of charting that sign, in favor of a temps + hormone monitor approach.
SymptoPro
For situations of continuous mucus, the SymptoPro method has a protocol for identifying what is called a basic infertile pattern and working with that information to establish the fertile window. In any case of continuous mucus regardless of method, diligent charting of the mucus sign is necessary. Because the SymptoPro SymptoThermal method uses both visible mucus on the tissue and sensation felt at the vulva for the mucus sign, many times one of those two will help to identify a more clear pattern of fertility. There is also an option to use mucus at the cervix, as well as cervical positioning, to identify the fertile window in these cases which can be very clear and objective for women who choose to chart the internal cervix changes.
FEMM
The goal in the initial 3 months of charting with FEMM is to learn and establish that particular woman’s Basic Infertile Pattern (BIP). We recognize that some women do simply have continuous mucus and approach this by helping her to recognize her Point of Change and the difference between the continuous mucus and her fertile mucus. This is after, or at least simultaneous with, ruling out that continuous mucus is not a result of infection or an underlying health issue.
Billings
In my opinion, besides a sympto-hormonal method that could ignore mucus, Billings is the strongest method for continuous mucus. Billings has no predetermined “peak” and “non-peak” mucus and any type of mucus may become part of a basic infertile pattern if it meets the criteria. As long as someone has an overall unchanging pattern of mucus (including rotating days of different types of mucus that are overall the same over 14 days), they can establish a basic infertile pattern in mucus. I’d recommend that anyone curious about this work with an educator for more information. I’ve had clients with extremely complex basic infertile patterns because Billings can add to them over time.
Long / irregular cycles / PCOS
Creighton
Some degree of mild variability from cycle to cycle is normal as long as the post peak (luteal) phase length remains stable. The issue with irregular cycles is if the post peak phase is unstable (varying more than 3 days) or if the client is in long cycles (>38 days).
Long, irregular cycles are a biomarker risk factor for PCOS. Women charting with Creighton who have unmanaged PCOS can expect to see long cycles (>38 days) and continuous mucus. This is not the case for every woman and often varies by the degree to which the PCOS has been well managed.
PCOS can be especially challenging for the woman wanting to learn fertility awareness. Some methods require ovulation to occur to be usable. With PCOS, the woman is frequently anovulatory. With Creighton, the method works whether you are ovulating or not. Creighton is an excellent method for women experiencing long cycles or PCOS because it also gives them access to NaProTECHNOLOGY™. I have seen such amazing improvements not only in chart biomarkers but in the quality of life of the woman once she receives NaPro evaluation and treatment.
Marquette
Some say that Marquette is not a good option for women with these conditions. On the contrary, it can be a very effective and objective approach, but it’s important for clients to work directly with a teacher. The menstrual cycle is a vital sign of a woman’s health and a woman with irregular cycles is showing signs of imbalance and needs to work with an RRM provider to get to the root cause. Cycle tracking and charting can identify when a treatment is working effectively for a woman and urinary hormone testing can objectively identify ovulation and end the fertile window. An experienced instructor can give specific guidance for couples navigating Marquette in these situations.
It’s likely that clients with irregular cycles and/or PCOS will be recommended to utilize multiple biomarkers, which may include additional devices or expenses, such as temperature or additional urinary hormone tests. As with regular cycles, the first 6 cycles may include more abstinence as couples gather a baseline of data prior to approaching the protocol more liberally. Couples who fall in this category may benefit from using the Mira monitor instead of the Clearblue monitor-I’d recommend consulting an instructor prior to making a purchase to know which one might fit their needs.
Boston Cross Check
Guidance in these situations would be incredibly specific to the woman! PCOS does not always present with long or irregular cycles, so we are careful to inquire about a woman’s particular cycle presentation and symptoms with that diagnosis. In general, long cycles can be a challenge (see some of my comments above), so we’d work with the client to establish alternative testing recommendations with the monitor and/or LH. I also tend to recommend that all clients with long cycles make sure they have a progesterone confirmation sign, which would be temps or Proov (PdG) strips, because they can have multiple occurrences of fluid patches and sometimes misleading monitor or LH peaks.
SymptoPro
For long cycles, because the SymptoThermal method uses real time biomarkers to chart the signs of fertility, there is no issue with longer cycles. During the learning period, there would be more abstinence for a woman with a longer cycle, but once confident in charting the mucus sign, a woman with a longer cycle would simply have a longer early cycle infertile period of time than a woman with cycles that are shorter in length.
While instructors of SymptoPro are trained to notice cycle red flags, they are not medical providers. In any case of cycle irregularities or red flags like PMS, premenstrual spotting, irregular cycle pain, PCOS or any other situation, SymptoPro instructors are prepared to refer you to a medical provider.
FEMM
We are trained in all normal parameters for a “regular” cycle and anything outside of that we will refer to medical management if it presents itself for 2 consecutive cycles or 3 cycles in a 6 month period. We can not diagnose PCOS, but can certainly identify warning signs of it and can, with clarity, say when cycles are long or irregular and advise/refer the client to our Medical Management team for further guidance and solutions.
Billings
For the reasons mentioned under the continuous mucus tab, Billings can be great for irregular cycles!
From the tab: In my opinion, besides a sympto-hormonal method that could ignore mucus, Billings is the strongest method for continuous mucus. Billings has no predetermined “peak” and “non-peak” mucus and any type of mucus may become part of a basic infertile pattern if it meets the criteria. As long as someone has an overall unchanging pattern of mucus (including rotating days of different types of mucus that are overall the same over 14 days), they can establish a basic infertile pattern in mucus. I’d recommend that anyone curious about this work with an educator for more information. I’ve had clients with extremely complex basic infertile patterns because Billings can add to them over time.
Postpartum
Creighton
The postpartum time can either be the easiest time to chart or one of the most difficult. It is definitely the time a woman should be working very closely with her instructor. Within Creighton, the woman is considered infertile for the first 56 days postpartum if totally breastfeeding. The woman will resume observations when the lochia bleeding flow slows down. Once she has two weeks of charting, she should make an appointment to see her Creighton practitioner.
*There is a different follow up schedule during the postpartum period. The client/practitioner will meet every 2 weeks initially, then move to meeting every 6 weeks once she is confident of the charting pattern postpartum. Ovulation is naturally suppressed during the time of breastfeeding. This means the woman can expect for this to be a time mainly of dryness with occasional mucus patches. As weaning begins, the woman can expect fertility to return soon. The woman will begin to see a variable return of peak type mucus which indicates fertility is returning. If postpartum depression occurs, there is treatment through NaPro with progesterone supplementation.
During breastfeeding, some women experience continuous mucus. This can be challenging as the postpartum period is often a time filled with adjusting to parenthood and sleep deprivation. Advanced management can be done through yellow stamps and essential sameness as described previously.
Marquette
A woman who has just had a baby but is not nursing would begin testing and abstain until cycles resume and the fertile window is passed.
For a woman who is postpartum and breastfeeding, whether fully or partially, Marquette is a highly reliable method to use. Marquette has 3 efficacy studies on the method during the return of fertility while breastfeeding, see above for rates of efficacy in typical and perfect use.
Most breastfeeding women will ovulate prior to her first postpartum period, so if a couple wants to avoid pregnancy prior to knowing their fertility has returned, it’s important to start charting fertility before cycles resume.
A breastfeeding woman who meets the criteria for Lactational Amenorrhea Method (LAM) is encouraged to utilize this highly effective, low cost and simple method. Once a woman no longer meets LAM criteria she should begin tracking with a method of family planning prior to resuming intimacy. A woman could also begin the Marquette cycle 0 protocols immediately even if they meet LAM criteria. Only 2 tested days are required before utilizing the infertile days in cycle 0.
The Marquette Method also implements a special return of fertility protocol in the first 4 cycles if breastfeeding as these are transitional cycles. The certified Marquette instructor will help the couple implement LAM or the Marquette method protocols during the different stages of return of fertility and weaning.
With the use of the fertility monitor, women don’t need to rely on mucus, which may only match underlying hormones 1/3 of the time. The objectivity of the monitor readings can give a lot of comfort and confidence in NFP. During this time, a woman should expect to test with the monitor every day until her fertility returns, which often takes months or even more than a year for some.
Boston Cross Check
By this I will assume we’re talking about postpartum breastfeeding. If you are not breastfeeding, the general instruction will be to wait to resume intercourse until you can verify your first ovulation. Modified start of fertility protocols will be applied until cycles regulate. That’s fairly straightforward. But postpartum breastfeeding is not!
If you are breastfeeding, BCC offers standard guidance on LAM as an option for all clients who meet the criteria (we make sure you understand that really well!) As soon as LAM criteria are no longer met *or* the client just wants to start charting, we offer a few protocol variations for the postpartum transition.
Almost every client will be instructed on how to use the Clearblue monitor for postpartum support with BCC. Whether they use that in conjunction with fluid is a matter of preference, and we can guide clients on the pros/cons of that combination. Clients can use temperatures throughout, but are reminded that temps will not provide meaningful data until after ovulation has happened, so that could be a long time!
Postpartum breastfeeding is a totally separate class from our standard materials. This means that clients can choose to learn *just* postpartum protocols if they prefer to use a different method when they are back in regular cycles. The course includes multiple instructional sessions at various stages through the return of fertility, and covers unlimited charting support from birth until the postpartum transition is considered “complete” after six cycles.
SymptoPro
Postpartum with a SymptoThermal method looks very similar to a mucus only method. A simple mucus only rule is used. For women who have continuous mucus, a basic infertile pattern is established and the same mucus only rule is used. Some women have a difficult time charting mucus postpartum and do not prefer any method that uses mucus as its main sign during the postpartum period of time. Some women do not have any trouble charting mucus and relying on that sign until fertility returns. The temperature sign does not predict ovulation, so while it is still charted postpartum, it is not used until a temperature rise is confirmed, and with that, ovulation and the return of fertility and cycling.
For the first 12 weeks, SymptoPro considers a woman infertile if she meets very specific breastfeeding guidelines that an instructor would work with you on. These requirements are called “full breastfeeding” and require little to no pump and bottle use as well as regular feeding throughout the night. These are things you would need to work one on one with an instructor to see if you fit the requirements for full breastfeeding. If a woman did not fulfill the requirements, she would begin using the mucus only rule immediately.
FEMM
We offer different instructions for charting depending on if/ how frequently the woman is breastfeeding as this has the largest impact on cycle return. This ranges from beginning to chart as early as 2 weeks postpartum and varying times thereafter depending on breastfeeding. We accompany women throughout this often challenging time of charting to reestablish her Basic Infertile Pattern with her changing body and hormones.
Billings
For the reasons mentioned above, Billings can be great for postpartum! Billings is also one of the few methods with postpartum studies.
Reasons mentioned above were: In my opinion, besides a sympto-hormonal method that could ignore mucus, Billings is the strongest method for continuous mucus. Billings has no predetermined “peak” and “non-peak” mucus and any type of mucus may become part of a basic infertile pattern if it meets the criteria. As long as someone has an overall unchanging pattern of mucus (including rotating days of different types of mucus that are overall the same over 14 days), they can establish a basic infertile pattern in mucus. I’d recommend that anyone curious about this work with an educator for more information. I’ve had clients with extremely complex basic infertile patterns because Billings can add to them over time.
Miscarriage
Creighton
The woman can begin charting immediately following a miscarriage. The woman will be considered to be in a pre-peak (pre-ovulatory) phase until ovulation occurs. Therefore, end of day intercourse instructions will apply on days of infertility through the first normal menstrual cycle. Ovulation can occur in as little as 2 weeks and postpartum depression may occur.
Miscarriages can happen for various reasons (low progesterone, genetic/chromosome abnormalities, clotting disorders, etc). NaPro (the medical extension of the Creighton Model System) can evaluate and treat women who have experienced one or multiple miscarriages. Miscarriage is often a red flag for low progesterone. NaPro providers utilize the evidence-based progesterone supplementation protocols. Progesterone levels are assessed post-peak (post-ovulatory/luteal phase) and supplementation of bio-identical progesterone is done in the post peak phase if labs reveal that progesterone is low. Subsequent lab draws in future cycles will be done to ensure progesterone is in optimal range.
If a client has a history of miscarriage, the Creighton practitioner may recommend the couple avoid pregnancy until a NaPro evaluation can be done, especially if there are biomarkers in the chart indicating risk for miscarriage. Some particular red flags would be a short post peak phase, limited mucus, and any of the low progesterone red flags. Within NaPro, progesterone is supplemented and optimized ahead of pregnancy to create an optimal environment for implantation. Supplementation will continue during pregnancy under the direction of the NaPro provider as needed.
Marquette
Charting post miscarriage starts after bleeding has stopped or after a woman has had a D&C. The approach to this situation is very individualized and will vary based on whether a couple is TTC or TTA and how conservative of an approach they want to take. While there are numerous possibilities for which route to pursue, the most conservative approach for avoiding pregnancy would be to abstain until the first ovulation is identified, which may happen within a week or may take a month or more.
Boston Cross Check
General miscarriage instructions are offered as part of our standard course, but I always let clients know that if they experience miscarriage, they are very welcome to reach out to me for direct support as soon as they are ready. Miscarriage is a term that spans a LOT of different situations, and support should be tailored to the situation and the current goals of the couple. We always defer to the recommendations of healthcare professionals, and understand there are mixed evidence-based guidelines out there!
But our approach, as instructors who know that our clients understand their cycles much better than the general population, is to suggest that couples wait to try to conceive again until regular cycle parameters have re-established after a miscarriage. For us, the resumption of a “normal” cycle is the best indicator that a woman’s body has healed and is ready for another pregnancy.
We instruct clients that repeat miscarriage always merits a conversation with a medical provider, and are happy to review charts for any obvious indication of luteal phase deficiency or other issue which might contribute to a higher likelihood of miscarriage. That way, clients can ask specific questions of their providers.
SymptoPro
SymptoPro instructors are not trained in specific education materials for women who experience miscarriage. If a miscarriage occurs, SymptoPro instructors rely on the doctor’s advice on how long to abstain and help the woman to utilize either regular cycle rules or the postpartum mucus only rules.
FEMM
Once again, as a teacher, we hope to be on top of cycle patterns that could be indicative of health issues and refer the woman to medical management ideally before a miscarriage, but especially if there has been a miscarriage already. (Of course not all causes of miscarriage are known or avoidable through charting but it does give us helpful insight).
A miscarriage in itself, even if there are not obvious cycle pattern irregularities, would be a reason to refer to medical management right away. More concretely, women often resume cycles in 4-6 weeks, though irregularity can last several months. We recommend that they begin charting as soon as their miscarriage bleeding ceases (if they are up to it). I would treat this situation with the utmost reverence and compassion.
Billings
The same four rules apply regardless of life stage. Billings educators can refer to FEMM or Billings doctors.
Infertility
Creighton
There is so much hope to be found for the woman experiencing infertility when she uses Creighton. Research shows that when you combine Creighton with the medical treatment of NaProTechnology, it is up to 80% effective! It is one of the only methods that has a medical component with surgical specialists. NaPro medical consultants are certified medical providers that can provide medical/hormonal evaluation and treatment with the Creighton chart as the foundation. NaPro surgeons spend a year in surgical fellowship at the St. Pope Paul VI Institute learning how to identify/treat endometriosis, severe PCOS, and various other abnormalities, as well as prevent/decrease scar adhesions.
The NaPro approach is to identify and treat the root cause of infertility. The woman can expect a complete evaluation from the NaPro provider, including hormonal labs timed to the Creighton chart, in as early as two cycles charted. This is essential. Most conventional OB/GYNs will draw hormones based on ovulation occurring on day 14, which only happens in 10% of women. Within NaPro, hormone labs are drawn specific to the woman and her chart so that they are drawn at the correct time that the body makes these hormones.
Frequent diagnoses found in infertility work ups: PCOS, thyroid disorder, hormone imbalance, estrogen dominance or low estrogen, low progesterone, and/or endometriosis. Women experiencing endometriosis should choose a highly trained endometriosis surgeon. Within a NaPro surgery, the woman can expect not only excision of endometriosis but a focus on anti-adhesion techniques, cultures of the endometrium, and testing of pressures within the fallopian tubes (selective HSG).
Marquette
If a couple is experiencing subfertility/infertility, it’s recommended that they work closely with an instructor who can help them navigate the different aspects of charting to make sure they are gathering all the data necessary as well as correctly identifying the fertile window. All Marquette instructors are health professionals and specially trained to identify aspects of the fertility chart that might point towards issues that might be preventing conception. Certain instructors who have taken the Marquette medical management course may also be able to provide guidance or recommendations on non-invasive approaches that may assist in conceiving. These instructors are all those who have advanced health professional degrees, such as being a doctor, physician’s assistant, or nurse practitioner. Instructors have also been trained to identify at what point the couple should be referred to a provider for evaluation, which is typically after 6 months of fertility focused intercourse. Marquette instructors would prefer to refer clients to providers who practice Restorative Reproductive Medicine or NFP friendly providers.
Boston Cross Check
BCC instructors will typically offer a consultation chart review after couples have been trying to conceive for 6 cycles, just to check for any obvious markers that might indicate a cause of decreased fertility; however, we are not able to diagnose or treat any conditions related or contributing to infertility. Our standard course includes guidelines on Catholic-approved reproductive technologies and provides conversation guides/relationship tips for couples who may be struggling with infertility.
SymptoPro
In cases of infertility, SymptoPro instructors are prepared to assist a woman in identifying the days of highest potential fertility. If a woman has not conceived within 6 months of dedicated charting and utilizing the days of highest potential for fertility, an instructor would refer to a fertility specialist.
FEMM
Infertility is defined as being unable to conceive after 1 year of trying. Thus, through consistent charting and discussion of family planning goals, we would certainly be able to identify infertility and refer to medical management. Cycle patterns from consistent charting will hopefully have alerted us to certain irregularities where I could then suggest that what I’m seeing might be cause for concern and then refer to Medical Management for further insights and interventions long prior to reaching that official 1 year mark.
Billings
Billings has instructions designed to enhance chances of conception. In one China study, there were 14,524 among 45,280 couples who were infertile and had a conception success rate of 32.1% after learning Billings. Citation: Shao-Zhen, Q. (2003). China Successfully Launching Billings Ovulation Method. Bulletin of the Ovulation Method Research and Reference Centre of Australia Ltd Vol, 30(2), 13-15.
Difficulty avoiding pregnancy (“hyperfertility”)
Creighton
“Hyperfertility” can be very difficult. As a quality control measure, it is expected for Creighton practitioners to do a pregnancy evaluation on all women who become pregnant in the method. The practitioner and the woman/couple meet and go through a structured evaluation of the conception. If the conception cannot be explained, a second pregnancy evaluation by a different Creighton practitioner is required. If it is determined to have been a “method pregnancy” (woman got pregnant and followed all rules to avoid it), special instructions like “subtle change” rules can be applied moving forward in using the method should the couple continue. This woman would have special instructions where certain observations normally considered to be infertile would be considered fertile for her.
If a woman is charting with Creighton and is very worried about avoiding pregnancy, the instructor should make sure she understands that the method is most effective when she is making 100% observations (which can be harder for some women). Women who, despite their best intentions, struggle to be consistent with that may find a different method, in addition to or in place of Creighton, to be most successful for her. With any method, the couple can choose to maintain post-ovulatory intercourse only because there is more flexibility and confidence post-peak, as long as the couple is confident that ovulation has passed.
Marquette
Many couples who have experienced back to back unintended pregnancies have found Marquette to be a breath of fresh air. The process of identifying the fertile window is very straightforward and with a certified instructor’s assistance, a couple can navigate any stage of fertility with confidence so that they can feel comfortable knowing which days are fertile and which are not. The easy part is identifying the fertile window. Marquette itself is not “easy.” It’s often straightforward and simple to understand, but it is still NFP. There will still be abstinence, sometimes prolonged, and sacrifice. This is often not easy for couples who are avoiding pregnancy. However, the objectivity of the method usually makes the abstinence more manageable.
Boston Cross Check
We don’t tend to use the term “hyperfertility,” as that has specific connotations in the medical field and also implies that robust fertility is somehow now the norm we should expect from healthy couples! But it is true that some couples feel that standard protocols in NFP methods are not quite “conservative” enough for them. And those are people BCC is built to accommodate well! As stated earlier, we tend to have a slightly longer fertile window than some other methods, so this offers an extra degree of comfort to couples who may have experienced unexpected method-related pregnancies with another charting system. If clients choose to forego intercourse in the preovulatory phase, they can certainly do so! But most of our clients will opt to use both pre-ovulatory (what we call “relatively infertile”) and post-ovulatory (“infertile”) days, knowing that we have a little bit of an extra buffer built in.
SymptoPro
In the case of hyperfertility, a charter would want to work closely with their instructor to confirm that they understand the rules of avoiding pregnancy and are correctly charting and interpreting their signs. SymptoPro has many more conservative options if a couple had a strong reason to avoid pregnancy, like the case of hyperfertility or concern of miscarriage. An instructor would work with the couple to establish rules that best fit their circumstances.
FEMM
In the case of someone finding it difficult to avoid pregnancy, we would want to rule out infection or hormonal imbalance through teaching her to chart, identifying any red flags– referring to Medical Management if there are any. However, for a woman that has hormonally healthy ovulatory cycles, we would give her support to identify her Basic Infertile Pattern.
Billings
Post confirmed peak only intimacy would be recommended.
Perimenopause
Creighton
The instructions for Creighton remain the same for a woman entering into perimenopause because observations and charting occur every day for any situation. Creighton considers every woman to have entered premenopause at 40 years old. At that time, a section opens up on our follow up form to help us educate the woman on what she can expect – her cycle may be anovulatory and mucus pattern may be irregular, unusual bleeding and PMS becomes more common, and importantly, that her pre-peak phase might be shorter, so the woman should watch for early ovulation and mucus during the light and very light days of bleeding at the end of the period. Again, this is always the instruction for women charting with Creighton, but it is very helpful to prepare the woman for this specifically so she can make sure to pay attention and follow instructions according to her intentions.
I think Creighton continues to add unique value for health maintenance during this reproductive category because of the questions asked during follow up, potential risk factors identified on the chart (which can change with age), and the connection to NaProTechnology physicians who can assess and treat PMS symptoms if needed. Any woman can ask their doctor to supplement with bioidentical hormone replacement therapy. This can reduce hot flashes, improve painful intercourse, and more, as menopause approaches and arrives.
Marquette
Once a woman is over the age of 40, the Marquette Instructors will utilize the STRAW staging criteria to determine where on the perimenopause continuum a woman is to give personalized guidance through the perimenopause transition. The Marquette instructor will educate women over the age of 40 on decreasing fertility, the stages of perimenopause and family planning considerations in determining a personalized approach to NFP during this time.
When cycles reach >60 days in length she may need to transition from the Clear Blue Fertility Monitor (CBFM) to mucus only or could consider use of the Mira monitor with experimental protocols recommended by the Marquette research team. Alternatively, in consultation with her provider, she may decide that she no longer needs to chart due to very low statistical chances of conceiving combining lab work, clinical charting data and age and discernment with spouse. It’s imperative to work with a certified instructor during this phase of fertility if avoiding pregnancy due to the unpredictability of fertility patterns women often experience. Marquette instructors are equipped to help charters navigate their cycles on an individualized basis using urinary hormones, mucus patterns, and basal body temperatures as needed.
Boston Cross Check
BCC has a course with specialized protocols for women going through the perimenopause transition. We utilize the STRAW+10 staging criteria to assess and provide customized support through the Late Reproductive, Early Perimenopause, and Late Perimenopause stages. Once a client reaches late perimenopause, our protocols strongly recommend utilizing temperatures to assess the possibility of failed ovulation attempts. Guidance is also offered on incorporating LH tests and/or PdG testing if desired.
SymptoPro
SymptoPro continues to utilize the same primary biomarkers of cervical mucus and basal body temperature through perimenopause. This can be a more challenging time to chart, but an instructor will be able to walk with women through this season of life. It is always recommended that women chart both cervical mucus signs (sensation at the vulva and visible mucus on tissue) but it becomes necessary in this season as the cervical mucus sign can change from what a woman was typically observing. Basal body temperature is extremely helpful in this season to be able to confirm ovulation, especially on cycles with more limited cervical mucus. SymptoPro users also have the option of adding cervical checks as a secondary biomarker. These internal checks can be very helpful in determining fertility during perimenopause or when cervical mucus is scant. The early cycle infertility rules are modified from the recommendations for typically cycling women in order to account for early or late ovulations that are common in perimenopause. Guidance from a qualified instructor will help a woman to navigate any changes to charting practices or fertile window rules.
FEMM
FEMM emphasizes walking with women through the beginning, all the way through the end of the reproductive stage, ie, puberty through menopause and thus we do receive training and have follow up forums and case studies involving women of all reproductive ages and stages. The initial protocol would not change in perimenopause as we would want to assess what her chart is telling us and offer support through referral to medical management if adverse symptoms are being experienced as a result of perimenopause.
We learn the parameters of what is normal during the perimenopause stage and have access to our network of instructors and healthcare professionals to ask questions about what a “normal” chart would look like in this stage and thus are able to accompany clients through the changes they may be noticing and have peace of mind through this transition. As a FEMM instructor, my primary role is in helping the woman feel confident in charting what she sees and noticing changes that are out of the ordinary and connecting her with the proper care team for her needs.
Billings
Pregnancy evaluations & determining due dates
Creighton
As a quality control measure, it is expected for Creighton practitioners to do a pregnancy evaluation on all women who become pregnant in the method. The practitioner and the woman/couple meet and go through a structured evaluation of the conception. During a pregnancy evaluation, the practitioner will classify the pregnancy. This allows the practitioner to evaluate whether or not the method was taught correctly, used correctly, or understood, etc. It also is a time where the estimated time of conception range can be established as well as the estimated time of arrival. The estimated time of arrival is shown to be highly accurate and often correlates closely with the due date given at the first ultrasound since it is based on estimated time of conception and not the last menstrual period.
Marquette
A pregnancy evaluation is recommended for all pregnancies and expected for any pregnancies when a couple is intending to avoid pregnancy. If a couple has an accurately filled out chart, they can identify what the most likely day of ovulation/conception is. A pregnancy evaluation for unintended pregnancies will classify the pregnancy as method related, user related or instruction related pregnancy and provides an opportunity to discuss future use of NFP for family planning. All method related pregnancies are expected to be written up as a case study and sent to the researchers at the Institute for NFP at Marquette University.
Boston Cross Check
Clients are welcome to reach out to their instructors for a pregnancy chart review to determine the most likely time of ovulation and assess which act of intercourse might have led to the pregnancy. This can be done if couples were trying to conceive, or if they were trying to postpone and would like help determining whether the unexpected pregnancy was user- or method-related.
SymptoPro
Pregnancy evaluations are done by taking the peak day, adding 9 months, and subtracting one week. This would be the estimated due date. When a woman has 18-20 high temperatures, she can be 97% sure of a pregnancy.
FEMM
NA – we could certainly do a chart review and try to pinpoint the day of conception, but we do not receive formal training in pregnancy evaluations.
Billings
We have a pregnancy evaluation form and give a 12 day estimated due date range.
*Fertility monitors like Mira and Inito are not included in this because these are not methods of fertility awareness. They are designed to help couples achieve pregnancy. In order for them to be effective at avoiding pregnancy, they must be used in conjunction with protocols supported by research. Mira research is currently ongoing through the Marquette Method.
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Handy details about each method.
Click below to understand what is required to learn a method, how much they cost, general strengths and weaknesses and more.
Why did you choose the method you teach and what do you love about it?
Creighton
In 2016, my husband and I chose to learn Creighton due to the extensive documented research associated with the method. In learning the method, I discovered NaProTECHNOLOGY™ (NaPro). I had a friend at the time who had been going through infertility for 7 years. She had “done it all” through conventional medicine including IUI and she had no answers and no baby. I told her about Creighton charting and its unique medical extension of NaPro, which she pursued, and ended up receiving actual diagnoses and treatment. She ultimately had her hormones balanced, had NaPro surgery for endometriosis, and became pregnant a few months later. I was in complete awe that this type of medical care existed and I had never heard of it as a nurse. I knew that women deserved better and I was on a mission to spread this knowledge to women struggling with infertility and other women’s health issues.
What I love about Creighton is that it gives the woman so much knowledge of her body from unusual bleeding to mucus cycle scores (helpful in identifying risks for subfertility, miscarriage, and ectopic pregnancy) to luteal phase tracking, and more. It is a noninvasive way to monitor a woman’s health. But what I love most about Creighton is NaProTECHNOLOGY™. It leads the woman to authentic answers and medical treatment.
Marquette
I teach the Marquette Method, which is a SymptoHormonal method of NFP. It primarily utilizes a fertility monitor which detects urinary metabolites of the hormones responsible for ovulation, estrogen and LH, to identify the fertile window. I started using Marquette when I was postpartum with my first child. At the time I felt that Marquette wasn’t as widely known and I felt a little jipped that I wasn’t exposed to it before marriage. I decided to become an instructor because I wanted to be part of the movement to make this method more accessible for couples and I was also already a nurse, which qualified me for going through the training.
As much as one can “love” NFP, I really appreciated the objectivity and simplicity of this method. Unlike the first method I used, I felt very confident in knowing our fertile days and our infertile days. There was no question or uncertainty and this lifted a lot of weight off my shoulders, particularly during the strenuous months of being postpartum. Marquette isn’t “easy” because it’s still NFP and requires sacrifice and self denial but it is simple, objective, straight forward, and manageable, which is all any couple could ask for in a method. I’ve seen Marquette be incredibly beneficial for marriages and it’s an honor to be a part of that.
Boston Cross Check
I teach Boston Cross Check, partly because it was the in-house method with the Archdiocese of Boston for many years, and therefore it’s the method I had access to when I moved here! But I’ve stuck with BCC because of the versatility: I’ve used pretty much every combination of biomarkers possible over the years, and enjoy the confidence of knowing I can switch things up whenever I need to!
SymptoPro
The SymptoThermal method uses two main biomarkers to track: cervical mucus and basal body temperature. I love the cross check of information with the temperature and cervical mucus to close the fertile window. I feel that having the temperature rise coupled with the drying up of cervical mucus gives me high confidence that ovulation has occurred and that I am in the completely infertile time. I also find great simplicity in the simple mucus categories and objective temperature data. Once you learn the SymptoThermal method and get comfortable with identifying the opening and closing of the fertile window (about 4-10 charts), it becomes second nature. I also love that the SymptoPro method has many alternate rules that can be used for times when either temperature or mucus is not readable. For example, during a yeast infection or if a charter missed a few mucus observations, there is still a clear way to establish the end of the fertile window. And on the other side, if a few temperature days are missing or disturbed, there are many alternate rules that can be used to still be able to avoid pregnancy with high efficacy.
FEMM
FEMM stands for Fertility Education and Medical Management. I love this method for its partnership with the Reproductive Health Research Institute (RHRI) and global team of OBGYNs that you can connect with via telehealth for in depth hormone paneling should issues arise, but also the peace of mind that the whole method is thoroughly backed by science and research.
Billings
I teach the Billings Ovulation Method. I chose to certify in Billings after certifying in the Natural Family Planning Teachers International SymptoThermal method. The Sympto-Thermal method can be extremely limited for women with irregular cycles like with PCOS or postpartum. I found that it didn’t offer many safe days for couples, and Billings seemed like a better alternative for unusual charting situations. What I love about Billings is that it offers the same four rules for every life stage a woman may experience in her menstrual cycle (regular cycles, irregular cycles, perimenopause, post HBC, postpartum, PCOS, and more)!
Describe the charter who loves your method. What does she enjoy?
Creighton
The charter who loves Creighton is the woman who wants a full picture of what is going on with her body/health and fertility, and in particular, women who struggle with infertility. While it requires observations throughout the entire day, the woman is not limited to a specific time window for urine or temperature testing. This creates freedom for those working swing or night shifts and those who travel or drink alcohol. There are also no algorithms used within Creighton. Fertility is decided in real time based on what is observed that day. Women who enjoy fully knowing what is going on throughout the cycle and how that impacts each day will enjoy Creighton as Creighton provides such a foundational knowledge base of the menstrual cycle.
Women interested in having access to comprehensive medical care to treat any woman’s health condition (PCOS, hormonal imbalance, PMS, infertility, miscarriage, endometriosis/painful cramps, etc.) will also love this method. It is important to not only have information but to be able to do something with it. Creighton gives unique access to NaPro trained providers and surgeons who can easily read a Creighton chart, time testing and treatment appropriately, and use protocols based on research using the Creighton chart.
Women who enjoy having a personal relationship with their instructor, or enjoy frequent one on one access, will love Creighton. The client and practitioner will meet 8 times in the first year of learning with the first 4 follow ups occurring in the first 2 months of learning. This leads to forming a trusting relationship and gaining confidence in the method. The follow up form helps to make sure that no important information is missed, assesses how well the information is being integrated by the user over time, and provides a place for ongoing documentation. All Responsible Practitioners are required to maintain 10 hours of continuing education each year.
Marquette
Users of the Marquette Method of NFP appreciate the scientific basis of the method. The Marquette Method was founded to provide strong research in NFP and the research team is continuously conducting research to improve NFP for women and couples. The Marquette users work with a healthcare professional (RN, MD etc..) who can custom fit the method to the couple’s needs using evidenced based research.
The charter who loves Marquette is someone who desires simplicity or who doesn’t want to have to continuously monitor mucus signs throughout the day or take her temperature every morning. She knows her fertility status at the start of the day every day and appreciates that identifying fertility and charting takes only 5 minutes. She doesn’t feel the burden of being the gatekeeper to her fertility because the monitor and protocols are responsible for identifying her fertility status. She is able to include her partner/spouse in the process through the use of technology with the monitor and charting process.
The couple trying to avoid pregnancy will be able to identify the infertile phase and resume intimacy in the first cycle after the fertile window closes when a peak is identified and within 2 days if breastfeeding in cycle 0.
While the method has proven high levels of efficacy for TTA in peer reviewed research studies utilizing simply the Clearblue Fertility Monitor and a simple calendar calculation, users of the Marquette Method can incorporate cervical mucus, BBT and other urinary hormone tests to identify the fertile window.
Marquette users can work with certified instructors in the method who are required to maintain continuing education competencies with the Marquette Method Professional Association (MMPA) proving they are staying up to date with current research and are connected to a network of Marquette scientists and instructors for support in their practice of teaching the Marquette Method of NFP.
Boston Cross Check
I believe BCC caters well to a client who loves information, whether that means tracking all of the options of biomarkers to get the MOST information, or sifting through the various options to find which information is most helpful and makes her feel the most confident with her cycles. BCC also tends to be a slightly more conservative method, so it might mean a little more abstinence per cycle compared to other methods, but I have found that this is a very comforting and liberating facet of the method for women and couples who have anxiety around charting.
SymptoPro
The charter who loves this method likes having both the objective data of temperature alongside the cervical mucus sign. Having both data points gives a charter more confidence in establishing the fertile window than they might if they were only charting one sign. This charter appreciates the additional info gained from charting more than one sign and does not mind having an additional data point to track each day.
The charter who loves this method easily notices her mucus sign throughout the cycle when wiping. She also either has a similar sleep/wake schedule throughout the week or is interested in using a Tempdrop wearable thermometer in order to get accurate temperature readings.
The greatest strength of the Sympto-thermal method is identifying the post ovulatory infertile time. Because this method cross checks the drying up of the mucus sign alongside the rising of the temperature pattern, users of this method can be extremely confident that ovulation has passed and pregnancy is impossible for the remainder of the cycle.
Women who use the SymptoThermal method also appreciate the ability to rely on just one sign if needed. Sometimes thermometers break or mucus observations are impossible or missed. In these cases, there are specific protocols available to use the data available and still avoid pregnancy with high efficacy.
Many women who succeed with Sympto-thermal methods have typical cycles, but the Sympto-thermal method is not limited to typical cycles and can be adapted for longer and shorter cycles easily. There are also specific protocols for postpartum and premenopause.
FEMM
The biggest FEMM charting fan would be a woman who cares about being an active participant in her health journey, believes in informed consent, and wants to partner with providers that will work with her body to get to the root of any issues. She loves the ease of having her chart in her phone with immediate feedback and helpful insights given from the research and person backed app. She also can feel confident in reaching out to her instructor for help along the way in between sessions and know that a whole reproductive institute and team of health care providers are behind her instructor should even the slightest irregularity arise.
Billings
The charter who loves this method wants a simple method that requires no outside technology or tools. They are okay with having intimacy on alternate evenings when pre-ovulatory and any time of day post-ovulatory. They have the ability to tune into sensation throughout the day and chart what they see in the bathroom. The strength of the Billings method is in the simplicity.
Describe the weaknesses of your method. Where do you see your clients struggle?
Creighton
There is no doubt that I see clients struggle the most with continuous mucus. Women can experience continuous mucus for various reasons (PCOS, estrogen dominance, stress, cervical erosions/eversions, etc.). With this, it is very important for the client to work with an instructor experienced with advanced management. The client must be taught how to identify the behavior of mucus to determine the base infertile pattern of mucus versus where the mucus changes due to the estrogen rise preceding ovulation. This can feel subjective and especially be stressful if trying to avoid pregnancy. It can sometimes lead to prolonged abstinence until days of fertility vs infertility are defined.
It’s not an issue for most clients, but it does take more time and effort. Having a good practitioner fit helps. For some clients, it may be difficult to identify the “point of change.” This can especially be seen with unmanaged PCOS and when the woman is not ovulating. I will often refer this type of woman to Marquette for family planning while she continues to chart with Creighton for medical management through NaPro. Many times, continuous mucus is a sign that something may be going on in the body which is worth investigating through NaPro. Although it is not always the case, I have seen this resolve through NaPro treatment.
I have also noticed that some women struggle with or are initially intimidated by the frequency of observations made throughout each day. This is a tough one because this is one factor that makes the method so valuable in giving such a comprehensive and in-depth look into the woman’s body. At the same time, it (understandably) feels like too much for some women’s personality or state in life. It is not a problem for others.
Marquette
The biggest concern that clients have with this method is that there is an initial and ongoing cost requirement. While Marquette does have a mucus only protocol, which would not have any ongoing costs, the majority of users utilize the fertility monitor and accompanying urinary hormone test sticks. The monitor is about $125 and then the monthly cost for test sticks can be anywhere from $10-$45/month, which may be a barrier for some users. An additional weakness for new users- as with most methods, is that Marquette approaches the first 6 cycles of charting fairly conservatively so couples should anticipate additional days of abstinence when getting started.
Couples who have long cycles due to PCOS, postpartum or perimenopause may experience more days of abstinence than a day-to-day mucus-only NFP method due to the calendar rules to start the fertile window, However, hormone testing gives a clearly identified peak day that gives the couple an objective end to the fertile window and the calendar rules assure the couple that they have enough days of fertility ahead of peak identified if mucus signs are not present.
Boston Cross Check
If clients present with very long and unpredictable cycles, our algorithmic calculation for start-of-fertility can be rather prohibitive during the first 12 cycles of use. It’s often the case that those clients may receive specialized instructions depending on the issue, but we simply don’t have the research to back up the efficacy of modified protocols for cases like this (e.g., PCOS), so that’s a trade-off. BCC is also very much a “Catholic” method, since we were developed by the Archdiocese for marriage prep: this doesn’t mean you have to be Catholic to use the method, but means that our instructors are typically Catholic and you will have religious teaching materials in your course packet, even if you opt out of receiving that education directly from the instructor.
SymptoPro
This method is difficult to use if a woman has a hard time noticing and charting the mucus sign. I have found in my work with clients that some women do not notice very much mucus or have a hard time charting it down. If this is the case, these women often rely very heavily on the temperature sign and often use temperature only rules to establish the close of the fertile window. While this is still an effective way to avoid pregnancy, it does result in a much longer fertile window and more abstinence if avoiding pregnancy.
During the learning phase (4-6 cycles), if a woman has longer cycles (30+ days), the period of abstinence can be longer (2+ weeks) because the SymptoPro SymptoThermal method is a double check method which requires 4-6 cycles of data to allow for the highest efficacy when applying early cycle infertility rules. With proper instruction and diligent charting, this window can be significantly reduced to a typical window of 9-15 days.
The final area of struggle that I see with clients is understanding the “sensation” sign. This is an overall awareness throughout the day of the sensation at the vulva. Many other methods utilize this sign as well. Because women are not typically aware of the sensation at the vulva, it can be difficult to begin to learn this sign and categorize it properly. I often find this sign takes about 6 cycles for women to feel confident in charting the sensation sign.
FEMM
I think, like most methods, there is a learning curve to gain confidence in knowing and interpreting your biomarkers. I see clients struggle most with confidence in the beginning – even if they are actually charting very well. I do love this method for the addition of LH strips which I think really aids clients in gaining that confidence that they are correctly identifying the approximate time of ovulation. The way we teach is very much a process complete with accompaniment and progressive learning/understanding with practice exercises to reinforce the concepts being taught.
Billings
The main weakness of Billings is that intimacy is restrained to alternate evenings in the preovulatory time of the cycle. Someone who is postpartum or who has PCOS may only be able to have evening intimacy for months or years. This can be an issue for those who have weak mucus build-ups that do not meet Billings strict peak rules as well.
What symptoms (biomarkers) does your method track? What is the frequency of observations made throughout each day?
Creighton
While various biomarkers are evaluated within Creighton for health, the main biomarker for monitoring fertility is cervical mucus. Observing becomes part of the woman’s habit when going to the restroom. Using flat layers of tissue, the woman will wipe and determine sensation. Next, she observes the tissue and finger tests anything seen for length and color. The woman makes this observation every time before and after urination and before and after a bowel movement. Other times of observations occur around bathing and at bedtime. These observations take less than 30 seconds and the majority of women report it as part of their normal routine once it becomes a habit. Because it is possible to only see fertile mucus once in the whole day, 100% observations throughout the day are essential for method effectiveness.
Marquette
The primary biomarker that Marquette users observe is urinary metabolites. The Clearblue fertility monitor, LH tests/ovulation predictor kits, and Proov/Progesterone tests are the primary ways of identifying hormone changes with urinary tests. In cycling women, testing the urine is required once a day starting on day 6-9 of the cycle until peak is identified. For some women this may require as few as 5 days of testing. For women who are postpartum and not yet cycling, they will be required to test every day. This process takes just 5 minutes each morning. The Marquette method also has a mucus protocol and a temperature protocol which some couples choose to incorporate. If a woman is tracking mucus, she will need to make observations every time she uses the restroom and then will chart that biomarker at the end of the day, which is similar to other mucus methods. What I love about Marquette is how flexible it can be. If a couple wants to be as simple as possible, then they have the flexibility to use the monitor only. If they want to know all the things, they can use the monitor, mucus, and temps.
Boston Cross Check
In our standard protocols (what we call the “Method Instructional Program”), we teach all clients how to observe cervical fluid, basal body temperatures, and hormones with the Clearblue fertility monitor. They do not actually have to chart with all those options! But we want them to learn how to do so, in case they need that flexibility down the road. Temps can be taken either orally or with Tempdrop. That is once a day. Hormone readings with the monitor are also just once a day, from the start of testing (around Cycle Day 6) until first peak reading. Fluid observations take place throughout the day, with an emphasis especially on first morning and end-of-day signs. After confirming ovulation, clients can choose to do what is called “short cut charting” which means they would no longer need to observe fluid, or oral temps (Tempdrop would require ongoing use!).
Beyond these, we also offer optional tracking of cervical positioning, use of LH tests, and Proov (PdG) tests.
SymptoPro
SymptoThermal uses cervical mucus and basal body temperature as its main biomarkers. The cervical mucus is tracked through both visible mucus seen on toilet paper as well as sensation felt at the vulva. SymptoPro has the additional option of tracking cervical mucus internally at the cervix. Cervical positioning is also an optional sign that can be tracked for additional information. Temperature can be taken orally, vaginally, rectally, or by using a wearable thermometer.
Temperature observation is made once per day at the beginning of the day, mucus on the tissue is checked whenever the woman goes to the bathroom, and sensation is charted at the end of the day looking back and deciding what sensation she felt throughout the day.
FEMM
Cervical mucus and LH surge through LH test strips (ovulation predictor kits). FEMM works best when you are making observations with each trip to the restroom throughout the day.
Billings
Sensation at the vulva (also known as walking sensation), very obvious wiping sensation (slippery wipes), and any visible cervical mucus seen throughout the day (as a normal part of the routine; no wiping before using the restroom or at other times that someone wouldn’t normally wipe).
What are the upfront & ongoing costs of your methods?
Creighton
- Initial Intro Session (60-90 min): $50-75+
- Initial Materials (chart, stamp pack, intro book): $25 + postage (if necessary)
- Picture dictionary required for long distance: $25
- Standard 60 min follow up (8 in a year): $50-70+ per session
- Extended follow ups (60+min): $65-75+, 90 min ($90)
- Chart reviews (optional): $30-45
- Paper chart (good for 6 months in regular cycles): $5
- Creighton App: $5/month + $10 registration fee
Prices will vary by instructor and location and some will offer discounted rates if you pay for all follow ups at once. Others offer the option to pay as you go. Some offer a sliding scale fee, if needed, with proof of income.
If a Creighton Practitioner sees clients in a doctor’s office, they may be able to accept health insurance. Most FSA and HSA plans will reimburse. Most instructors will respond to questions sent over email in between appointments at no additional charge.
Marquette
While every instructor has different costs, an average rate for an intro session plus support is $150-$300, the Clearblue Fertility Monitor is $125, and test sticks can be anywhere from $10 to $45/month. A woman with shorter, regular cycles will likely pay less than $10, while a postpartum couple can expect to be on the $45 side of the spectrum.
Boston Cross Check
BCC programs actually have standardized instruction costs across all instructors, which I quite like!
Our Method Instructional Program (4 sessions, covers 1 year of service) costs $200. Specialized Postpartum Breastfeeding Program is $300 for instruction and support through 6 transitional cycles (no matter how long that takes!). Our Perimenopause program is $200. Ongoing retainer services can be purchased annually for $75 or on a per-consultation basis for $25 each– these are completely optional!
If you choose to chart with the monitor, that costs about $150 upfront and has monthly recurring costs associated with test sticks. Most clients will use between 10-15 sticks per cycle, altho daily use is required during the postpartum period. Test stick prices can fluctuate, but typically settle around $35-40 for a box of 30 sticks. A basic oral thermometer can cost only $10-15, but Tempdrop would be about a $200 one-time purchase.
All instructors are able to consider financial accommodations for hardship clients, and may do so through tuition reduction, payment plans, parish support programs, or private sponsorship.
SymptoPro
SymptoThermal mostly has upfront costs and little to no ongoing costs. Start up costs include the course of instruction as well as a basal body thermometer. Many instructors include a regular basal thermometer in their course cost. Courses can cost anywhere from $120-$500 depending on instructor and location. Regular basal thermometers cost between $15-$40. Tempdrop thermometers cost about $175-$200
The only ongoing cost that a SymptoThermal user might have is if they want a review session from an instructor. SymptoPro instructors are asked to charge $30 for a half hour session.
FEMM
FEMM classes on average range from $50-75/ session. It is 3 classes initially spaced out throughout 6 weeks (3 months typically). There is often a bundling option if you pay upfront for all 3 classes. Successive sessions for chart review etc usually average $30-50 a session. You also need to purchase LH strips, which average around 30-50 cents/ strip or less. You can buy in bulk for around $20 and that supply should last you at least a year.
Billings
Billings Ovulation Method has a policy to never turn anyone away in need, so those without funds should contact the organization in their country if they do not have the money to pay. In the USA, I’d say instruction is on average $100-$250 for a year of support.
Before our readers dive into the different categories, do you have any thoughts, encouragement or extra tidbits you’d like to share?
Creighton
I think a special population to consider are the single women. This method is for them too! I have numerous single women who chart with Creighton and it has empowered them with knowledge of their bodies. Many go on to get engaged and feel confident to use NFP in their marriage because they have already been observing and charting for quite awhile. I have others who have been experiencing medical symptoms with little to no answers. Unfortunately, as young single women, they are often disregarded by their medical providers, offered birth control, or told they have anxiety. I have had multiple single clients get diagnosed with thyroid disorders, low progesterone, or PMS and get their health back once they began treatment through NaPro. Many have been able to identify and treat conditions affecting their fertility prior to marriage, which places them in the best place they can be to be healthy to conceive once ready to do so. Creighton is for every woman because every woman deserves authentic healthcare.
Marquette
Some extra tidbits I think might be helpful to know:
- Perfect use efficacy is 98% for both regular and postpartum cycles. Typical use efficacy is 98% for regular cycles, and 94% efficacy for postpartum cycles.
- Efficacy of the method of NFP that is implemented is a very important part of choosing a method of NFP for avoiding pregnancy. You want the method you choose to work! Here are the stats and references for these numbers. Looking at the efficacy for your circumstance and continued research of the method you are implementing is informed consent.
Efficacy of the Marquette Method for women in regular cycles using the Clear Blue Fertility Monitor (CBFM) w/ algorithm:
- Perfect use: 0-2 per 100 women over 12 months of use
- Typical use: 2-7 per 100 women over 12 months of use.
Efficacy of the Marquette Method for breastfeeding women using the CBFM w/ return of fertility (ROF) protocols:
- Perfect use: 2-3 per 100 women over 12 cycles or months of use
- Typical use: 4-14 per 100 women over 12 cycles or months of use
All Marquette instructors are trained medical professionals. Most are nurses, doctors, nurse practitioners, or physician’s assistants. All clients can be confident that they are working with a well trained, knowledgeable teacher when they hire a Marquette Method Certified Professional who is a member of the MMPA.
The Marquette Institute for NFP is currently researching new protocols with the Mira fertility monitor. This is another fertility monitor with a higher price point than the Clearblue, but it provides more data, which may be more beneficial for women with PCOS or who are going through Perimenopause.
Boston Cross Check
We are a very small (but growing!) method. A few years ago, the Archdiocese was no longer able to support an NFP office and so the BCC method was effectively “shut down.” Thanks to the determination and generosity of a few key individuals, BCC is now an independent method!
In 2021 we had only 4 active instructors in the whole world. At the close of 2022, we are up to 16 instructors and plan to add more in 2023!
All this is to say: if you’ve never heard of BCC, we don’t blame you! But we’re a very close-knit group and are happy to serve through providing a very robust, flexible option for NFP.
SymptoPro
Not answered
FEMM
I’m constantly blown away by the confidence that comes to women the more they understand the way their bodies’ are designed and empowered to be active participants in their own health. FEMM is all about truly empowering women of all reproductive stages and that makes this work so exciting to me!
Medical Management is available to all women, either via telehealth or in person if we have providers local to you. There is a cost associated with this and whether insurance covers it will vary depending on the insurance provider.
Billings
I have had two clients with zero safe days in the sympto-thermal method (because they did not regularly ovulate and had continuous mucus) who were finally able to have intimacy with Billings because of the different approach to charting cervical mucus.
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Meet Our Guest Instructors
Method instructors undergo rigorous training to teach their methods. They’re also genuinely cool people who are passionate about sharing this knowledge with women. Get to know our contributors below*.
CREIGHTON - Lisa Morvant, RN, BSN, CFCP
I have been practicing as a registered nurse since 2011. My nursing background includes…
I have been practicing as a registered nurse since 2011. My nursing background includes…
My name is Lisa Morvant. I have been practicing as a registered nurse since 2011. My nursing background includes adult and pediatric-OB/GYN ER, nursing education, and PACU. I am a Certified FertilityCare Practitioner in the Creighton Method and have been teaching since 2018. I am located in Louisiana and work with clients at the local, national, and international level through virtual instruction. Find Lisa at lcmorvant@gmail.com & @littleflowerfertilitycare, additional contributions by Mary Bruno, CFCP.
MARQUETTE - Theresa Sullivan, MSN
I am Theresa, a wife, mom to two littles, nurse, nurse practitioner student, and FAM/NFP teacher. I am passionate about…
I am Theresa, a wife, mom to two littles, nurse, nurse practitioner student, and FAM/NFP teacher. I am passionate about…
I am Theresa, a wife, mom to two littles, nurse, nurse practitioner student, and FAM/NFP teacher. I am passionate about holistic approaches to working with women and couple’s fertility, whether that’s avoiding pregnancy naturally, striving for hormonal health, or finding the root cause of issues that might be causing issues with fertility. I have found so much personal empowerment with understanding my cycle and working with my body’s hormonal symphony for both avoiding and achieving pregnancy and love helping others do the same! When I’m not talking about hormones or women’s health, you’ll find me spending time with my family, drinking coffee (or red wine), or being active.Additional contributions made by Sara Flood, BSN, RN, MMCP (www.nfpcoach.com)
BOSTON CROSS CHECK - Christina Valenzuela
Christina Valenzuela is the owner and creative director of Pearl & Thistle, LLC, where she provides resources to help…
Christina Valenzuela is the owner and creative director of Pearl & Thistle, LLC, where she provides resources to help…
Christina Valenzuela is the owner and creative director of Pearl & Thistle, LLC, where she provides resources to help Catholics share lifelong body literacy with their family, friends, and parishes. She has been a certified instructor in the Boston Cross Check™ method of Natural Family Planning since 2013 and her signature first period (menarche) course, Cycle Prep, was a 2021 OSV Innovation Challenge finalist. She holds an undergraduate degree in Philosophy and Theology from the University of Notre Dame as well as a Masters in Theological Studies from Harvard Divinity School. She is a life-professed member of the Lay Fraternities of St. Dominic and resides with her husband and four children outside of Boston. Find Christina’s work at HOME – Pearl and Thistle.
SYMPTOPRO - Ellen Holloway
I teach the SymptoThermal method through SymptoPro because I love this method’s…
I teach the SymptoThermal method through SymptoPro because I love this method’s…
I teach the SymptoThermal method through SymptoPro because I love this method’s simplicity and flexibility. I also love the SymptoPro organization and the flexibility it gives its instructors to charge a fair price for services rendered and teach in group or individual settings. I also chose to teach this method because the training process was flexible and straightforward. The teacher training involves self-paced reading and videos with regular coursework and check-ins from the instructor trainer. I was able to work at my own pace to finish the training program and did not need to be present at specific times for classes. Find Ellen’s work at Vines in Full Bloom.
FEMM - Sarah Jane Schmidt
I chose to become a FEMM teacher because of the abundance of accessibility…
I chose to become a FEMM teacher because of the abundance of accessibility…
I chose to become a FEMM teacher because of the abundance of accessibility this method offers with very little barriers to entry through printable paper charts, a very user friendly and functional app, and most importantly, 1:1 lessons with a certified FEMM teacher. I think it is one of the easiest methods to learn and integrate into everyday life while really teaching you how to properly observe the signs your body gives you.
BILLINGS - Kristin Putnam
I teach the Billings Ovulation Method. I chose to certify in Billings after certifying in…
I teach the Billings Ovulation Method. I chose to certify in Billings after certifying in…
I teach the Billings Ovulation Method. I chose to certify in Billings after certifying in the Natural Family Planning Teachers International Sympto-Thermal method. The sympto-thermal method can be extremely limited for women with irregular cycles like with PCOS or postpartum. I found that it didn’t offer many safe days for couples, and Billings seemed like a better alternative for unusual charting situations. What I love about Billings is that it offers the same four rules for every life stage a woman may experience in her menstrual cycle (regular cycles, irregular cycles, perimenopause, post HBC, postpartum, PCOS, and more)!
*While we do not believe that any one method is the absolute and overall best, we do believe that there is a best-method-fit for most individuals. It’s no different for instructors, so keep this in mind if you notice some bias or a little excitement for what their method has to offer. We think instructors *should* be excited about and teach the method they love the most and is best for them, while also understanding the value of referring out when they identify that a different method might serve other unique needs of the client.
At FAbM Base, we are all about empowering you with the info you need to make the best decisions for you and your family. One of the most important decisions you will make when it comes to fertility awareness is which method will serve you best for this stage in your life, and we are proud to offer you various creative ways to explore your options at fabmbase.org.