Amanda: Hey, this is Amanda, women’s health dietitian.
Emily: And I’m Emily, nutritional therapy practitioner.
Amanda: And this is the Are You Menstrual? podcast where we help you navigate the confusing world of women’s hormones and teach you how to have healthy periods.
Emily: Each week we will be diving into a different topic on women’s health and sharing our perspective using nutrition, female physiology, and metabolic health.
Amanda: Our goal is to help you wade through conflicting health information and empower you on your healing journey.
Emily: We hope you enjoy it.
Amanda: In this episode, we are focusing on my favorite method of birth control, the Fertility Awareness Method or FAM, and we’re actually talking to my friend Nina Boyce. She’s a certified Fertility Awareness coach and Reiki practitioner based in Columbus, Ohio. Her program or programs focused on FAM for optimized conception and/or non-hormonal birth control, and she passionately believes all women deserve to understand how their body functions. Nina takes a holistic approach focusing on nutrition and mineral testing, cycle charting, and lifestyle modifications to help her clients achieve their desired fertility goals. She’s also the host of the Healing Hormones podcast, which I’ve been on quite a few times. And she interviews the leading women in the world of menstrual health. So I’m really excited to have you here, Nina, chatting with us about all things FAM.
Nina: Me too. I’m excited because the roles are switched, like, you’ve been on my podcast three times. So now I feel like I’m in the hot seat and I’m loving it.
Amanda: Yeah, I get to ask you all the hard questions now. So fertility awareness…and if anyone’s like, what about regular birth control? We talked about that in the last episode, all the hormonal methods, how they impact the body, all that kind of stuff. So definitely listen to the previous episode for that if you’re someone that’s currently taking it, has taken it, or wants to learn more. Today we’re focusing on FAM, and of course I feel like people know FAM for birth control and for fertility, you know, trying to conceive it can definitely be helpful. But I also think it’s so much more than that. You know, I mean, especially, it’s funny, because you’re, it’s like that’s what you do is you teach people how to use it. But it’s really to look at their hormones and their overall health.
Nina: Yeah, I mean, learning FAM not only helps you achieve whatever fertility goal it is, like to not get pregnant or to get pregnant, but you learn so much about what is happening at the hormonal level, like what, where my hormones are fluctuating in the cycle, how my body is responding to that, how do I feel during each of the phases? Like there’s so much that goes into it.
Amanda: Yeah, I feel like it’s an essential tool on your healing journey. And then it’s really nice as you transition to different phases like postpartum, very helpful when you’re like, when am I going to get my period back? What do my hormones look like? Are things regulating? And then of course, like perimenopause, I think it’s essential for that. So that, you know, am I in this stage or not? And then of course, defining menopause because you have to obviously be tracking your cycle to know if you’ve fully gone into that. Can you give us a little bit of background on how you got into Fertility Awareness Method and just hormone health in general?
Nina: Yeah, well, I got into all this work, just because I was like a huge ball of stress myself, like, this was probably five-ish years ago when I was a teacher. I was teaching middle school choir, like running my body to the brink. After a while, like, I just, I started to really struggle with like hormonal acne, period pain was a huge one for me, lots of spotting throughout my cycle. I was like, experiencing so much anxiety, that was like another real big thing for me that I just was like, I can’t deal with this anymore. So of course, you know, I did the normal go to my doctor’s and I just didn’t really get the answers I was looking for. I just was handed prescriptions. And so finally, I just started doing my own research. And that’s when I got the health coaching certificate. But then that led me even deeper into wanting to study women’s hormones, and what’s going on with my period and how to start to get to the root of that. So through doing my own work, I started like coaching clients more on hormones and periods. And then slowly but surely, I like decided, you know what, this is exactly what I want to focus on within this space. And then when I was trying to get pregnant myself, I, and well, actually back up. I was trying not to get pregnant. I wasn’t on birth control. So I started to look into Fertility Awareness Method, and I realized wow, I’m even in this space of health and hormones and there is still so much I don’t know about how the body works. And I decided to get my certification in FAM and that’s where I ended up now. So now I like highly focus on that specific area. And then of course, you know, I’ve collaborated with you in like multiple different ways and using your tools as well to help my, my clients with just general hormone balance stuff.
Amanda: So how would you describe Fertility Awareness Method? It’s a, it’s an aggressive name. I feel like it’s kind of like what does that mean? How would you describe like this whole practice to someone?
Nina: Really, at its core, it’s knowing when you’re fertile and when you’re not fertile. Like if you really simplify it down. And it’s just learning need different biomarkers to determine when those times of the, your cycle are. So in the end, like the way that I practice is the simple thermal method. So we use basal body temperature, we use cervical mucus, and I also include LH testing. And then if clients want to I even include progesterone tests, like after they’ve ovulated, to confirm ovulation to confirm healthy progesterone levels. So those are the main biomarkers that I use. And that really is i—you’re tracking according to what your body is showing you every day, as opposed to like the calendar, the rhythm method, which is more of just like an estimate of like, my period should come on this day, and I should ovulate on this day. It’s like very specific to the day what my body is doing.
Amanda: And so with some of those markers, what are people, what are you really looking for to identify that fertile window?
Nina: The main thing is cervical mucus. It’s like the, the word I never thought I would say so many times in my life, but I say like over and over and over, that really is the deciding factor. For example, you know, you’re on your period for what, let’s say like three to seven days, there’s like a range. And then after your period ends, most women experience dry days, and that’s because estrogen levels are low. And then as estrogen levels begin to rise, you get into what we call the fertile window or your point of change. So you start to see these different types of cervical mucus, non-peak and peak, and that’s when you obviously can determine like, alright, ovulation is just around the corner. And then after that, after ovulation happens, we can go into more details if you want to, but you dry up again. And so that is another signal that you obviously have ovulated in your, in your, in fertile phase. So those are the main ones. And then temperature is just I think is like an extra clue. Right? It’s like an extra confirmation that ovulation has happened. And also, you know, you can use it just for your health, too.
Amanda: Yeah, I feel like a lot of people know I talk about basal body temperature in relation to metabolism and how we want to have healthy temperature both in our follicular and luteal phase. But it does increase during that luteal phase. So that’s kind of the confirmation that we’re getting to say, hey, you did ovulate. So when are you fertile?
Nina: You’re fertile whenever you see cervical mucus. There, I mean, there’s obviously some fluctuation in that because, you know, say you see cervical mucus after you’ve confirmed you’ve ovulated. Like you’ve had a temp rise of three high temps, that’s what you go by, you know, three high times you can confirm, but you see like non-peak, or you see some cervical mucus, you’re not fertile, you’ve already ovulated, that egg is gone, it’s dissolved after 24 hours. And there is no physiological way that you can get pregnant until your next fertile window rolls around. So you have to kind of keep that in mind. But after you get that period, and you’re like waiting for ovulation to happen, you really have to consider any of those days…and we call it the pre-ovulatory phase, or you know, your menstrual follicular phase…you have to consider any of those days that you see cervical mucus a possible fertile day. There are you know, some calculation rules after you’ve been charting for like a year or whatever, are more detailed than that. But at the core, that’s pretty much what, what we go with.
Amanda: Yeah, and I think that’s, you know, cervical mucus is something that we don’t really talk about. And some women are probably, like, embarrassed by it. And so I feel like that’s why it can be the most confusing, but once you start paying attention to it, it’s easier than taking your temperature, you know, to just pay attention throughout the day.
Nina: Yeah, I mean, you go to the bathroom every day. So you’re going to naturally look down at your underwear, which honestly, isn’t even the best way to observe, it’s like, look at your toilet paper, or feel what it feels like when you wipe or when you’re walking. Like once you learn how to observe it, you’re like, oh, this takes me seconds. And it happens all day, throughout the day—it just becomes second nature.
Amanda: So who do you think that fertility awareness method is best for?
Nina: I won’t personally, I wouldn’t want to say it’s for everybody, like Fertility Awareness Method is for everybody, but you have to be willing to make assessments on a daily basis. But like I said, once you get into the habit of it, it takes seconds, like every time you go to the bathroom. But you also have to be willing to mark it, whether that’s like on a paper chart or in an app, you know, you have to have that dedication to mark down what you’ve seen. But as long as you are able to stick to checking your biomarkers every day, I think it’s for you. You also do have to have a partner that would be willing to believe in Fertility Awareness Method. Or if you’re not, you know, with one specific person, you have to also have that in mind too like, hey, that person needs to know, I’m not on hormonal birth control. I’m in my fertile window, we need a barrier method. So I feel like that’s something to keep in mind is what’s your sex life? And also like, who’s your partner or who’s not your partner? And how would you navigate those questions when they come up?
Amanda: Yeah, I feel like there definitely needs to be a lot of communication there even because like your partner has to learn about it just as intently as you doI feel like just so that you’re both on the same page.
Nina: Mmhmm. Oh, it’s funny. My husband will say, oh, you’re ovulating right now aren’t you? Or like, wait, you just got your period. That like, he like knows where I’m at in my cycle, which is awesome. But yeah, they have to be open. I mean, the clients, I just had a client right before this call, and we were talking about how her partner is like, totally onboard now. But he still is like, wait a minute, so you’ve ovulated so like, there’s no way you can get pregnant. You know, they just need educated too and then they’ll, they’ll be onboard.
Amanda: It was like the same thing. I feel like it took so long for my husband to grasp that. And I’m like, no, and I know, I’m like, I know, it’s scary, because what’s drilled into our heads is that we can get pregnant every day. But I’m like you’re fertile every day. I’m not. So what are some of the biggest mistakes that you see women make when it comes to using Fertility Awareness Method?
Nina: I think that a lot of us are used to that calendar method where we just assume we ovulate every day on day 14. So even if they’re using Fertility Awareness Method, that’s kind of still in the back of their head. And so I wonder if really, if there are any mistakes made with it, it’s that they truly aren’t observing their cervical mucus every day, and they’re still in the back of their mind think they’re not going to ovulate for like so many days. So that kind of seems to be the common like mistake or misconception that I’ll see.
And then the next common mistake I see is people think when their temp rises, that means they’re currently ovulating. And that drives me insane. I see influencers like that promote Natural Cycles, I don’t know if you’ve seen that out there, and every time I watch their promotions or their ads, it’s like, and then when you’re temp rises you’re fertile. I’m like, no, you’re not fertile. It’s the opposite. Yeah. So like, if you’re trying to get pregnant, and you wait until your temp rises, you’ve already passed ovulation. So that’s a really big mistake that people are like, well, I’m tracking my temperature. Temperature only confirms after ovulation has happened.
Amanda: I feel like that’s the most common one I see is only tracking their temperature and not looking at cervical mucus. Because I’m like, you can’t predict ovulation with your temperature. You can only confirm it.
Nina: Right. Yeah, people don’t realize that’s truly the biggest clue. I mean, if you think about OPKs, like I’m thinking the clear blue with a smiley face. Nobody even knows like what that’s looking for. They’re just looking for like the blinking smiley face or the non-blinking smiley face to tell them that they’re ovulating. But really like what that’s doing, it’s just tracking your estrogen levels and it’s tracking your LH surge. And you can do that without the device, you can just look at what your body is doing, and if you’re producing fertile CM, and that is going to be more valuable and more accurate, whether you want to get pregnant or not get pregnant.
Amanda: Yeah, I think one of the biggest mistakes I see people make is not working with a coach, whether that’s through like a specific guided program or even if you just, like a lot of people, it’s like you can learn about this whether it’s an online course, there’s great book resources, and you just need to implement. But I think going through your charts with a Fertility Awareness coach, even if it’s like one or two sessions, you know, I feel like that’s like, if you’re, if you don’t feel like you’re grasping it and you don’t feel confident of using that as a birth control method, then I would say try to work with someone.
Nina: If you are using it for birth control, and you are very, very adamant about not getting pregnant, I highly recommend booking some sessions with a Fertility Awareness educator. And I, like I mentioned previously, when you’re like, how’d you get into this, I read all the books and I even did like a specific like hormone course through IIN, like, and I had been doing a lot of work with other coaches in the hormone space. And it wasn’t until I got my certification that I truly feel like I grasped the intricacies of FAM. And that was after reading, you know, “Taking Charge of Your Fertility,” “The Fifth Vital Sign”…like all the big hitters out there. It’s a lot of information, like it’s information overload, and sometimes you just need someone to sit down and like look at your chart, zoom out, and help explain it to you.
Amanda: Yeah, I would say like, if someone’s looking at their basal body temperature and as like a health marker as well, when they feel like they have a lot of low temperatures, I think they don’t hold the thermometer in their mouth long enough. That’s like the other biggest mistake I see. And like just hold it in there for a little bit longer if it looks low or if you’re not seeing a change. It could be because it’s not, it’s not heated up enough before you’re taking that measurement.
Nina: People get frustrated with that sometimes because you just have to sit there with a thermometer in your mouth, but it’s really not that long. You know, you’re just waking up so you just have to let it warm up under your tongue. Oh, you do not have to take your temperature vaginally, I get that question a lot. People say like, oh, you can? It’s oral? It’s like yes, I mean, you can take vaginally if you want but you don’t have to, which is oddly a mistake, but not mistake but just like a question people ask.
Amanda: That’s funny. So let’s go through some of the myths, because I think that people do get it confused with the rhythm method. It’s not the rhythm method, but kind of how about you like debunk that myth? Like what is FAM versus the rhythm method?
Nina: So the rhythm method is like what we mentioned before, you’re just assuming you’re on, your body is literally like clockwork, and that you get your period on the same day all the time, you ovulate on the same day, every cycle, and then you just go with that. And you’re like, okay, here’s, you know what my app is telling me because I put my first day of my cycle in blah, blah, blah. But with Fertility Awareness Method, again, you’re looking at every single day before you ovulate as possibly fertile. Because ovulation, our bodies are so sensitive. So it could be, be sped up, or it could be delayed according to whatever’s going on in your life. So you could be traveling, you could be changing up your diet or exercise routine, you could be sick. I mean, something could happen that stresses the body out and ovulation decides, hey, estrogen levels rise a little bit quickly, and we’re coming early. Or you know, as we are stressed in our bodies, gonna delay ovulation. So that’s the biggest difference is like we don’t assume when we’re gonna ovulate or one more fertile, we literally check on the day.
Amanda: And it’s interesting because I feel like people don’t realize that their apps are basically the rhythm method. And they think because it’s an app, and it has like algorithms that it’s better at predicting. I’m like, it’s the same exact thing. That’s why it’s like your app can’t predict when you’re going to ovulate only you can when you’re tracking those different signs.
Nina: Exactly. I think it’s cool that, I mean, you can totally use it in addition to checking your daily temps. Like I’ve had clients that they’ll say, oh, my app says that I’m in my fertile window, but guess what I also saw non-peak cervical mucus. So it’s right, you know, like they almost use, you use your body to confirm what the app is saying. And that’s fine. You know, of course, I have my favorite apps that I like in general and dislike certain apps, but…
Amanda: Which ones do you like?
Nina: My favorite is Read Your Body. It’s, but, but I feel like you do, you have to know about fertility awareness in order to use it or be working with an instructor to kind of walk you through it. So that’s definitely my favorite. I mean, even like the Tempdrop app, I guess, like none of the other ones are my favorite. People like Kindara. Kindara is okay, you still need to know what’s going on with your body. So I guess I would vote Kindara. But other ones like the Flow app….I don’t like Daisy anymore, unfortunately. Those are just all, they’re you know, they’re using algorithm, algorithms and things and they’re not always accurate. So yeah.
Amanda: But I like the idea of cross checking. What about the effectiveness of FAM? A lot of people don’t think it’s as effective as hormonal birth control.
Nina: It is, it’s 99, I want, I just looked up this metric, I think it’s 99.8% effective, with perfect use. So that’s, you know, work or 99 might be 99.9%. Effective with perfect use from within instructor or whatever, really knowing what you’re doing. And then I think it’s like 9…I’m not gonna know that one… with imperfect use, it’s still high.
Amanda: The typical use?
Nina: The typical use, which is the same as like a condom or birth control. If you think about it, like how many people…you have to take your birth control every single day, they say, at the same time every day. Yeah. So it’s like, that’s perfect use of the birth control pill. Well, most people use imperfect use of the birth control pill too. So it is just as effective as any other method or barrier method that you’re going to use.
Amanda: What about, I hear this a lot, that women feel like if they have irregular cycles, like if they have PCOS that they can’t use FAM.
Nina: It does make it trickier in the sense that you may not have a pattern like somebody that doesn’t have PCOS. After a few cycles, they also can use their pattern as another biomarker, like for the past few cycles, I have ovulated on day 15. So that’s a tool that I’m going to use with all the other tools. But it actually is fantastic for people with PCOS in a way, because you’re saying alright, I’m still looking at my body’s clues to when I’m ovulating. I know people with PCOS, they can see a lot of cervical mucus throughout the cycle. So in that sense there are a lot of days where ovulation may not be around the corner, but your body is telling you that you’re fertile. So from a birth control standpoint, I see that that can be confusing, but it’s still incredibly empowering to understand like what your body is doing on a daily basis and makes you feel in control of something that’s almost feels out of your control.
Amanda: And to know are you ovulating? That’s why I have my clients with PCOS use it because I’m like, I want to know if you’re ovulating. A lot of times they will use LH strips just to see, like what’s going on to see if they, if they have a much longer cycle. But I feel like it’s so helpful.
Nina: Well, and that actually reminded me… I’ve had two or three PCOS clients, diagnosed PCOS, told that they weren’t ovulating, and within the three months we worked together, they’ve, their chart was showing me that they were ovulating. And I was like, what? That just blew my mind. And who knows maybe it was a combination of changes they were making or not. But the fact that they had this idea in their head that they weren’t able to get pregnant because they weren’t ovulating and then they actually were, it just maybe wasn’t around the time that they thought it was gonna happen. I mean, it’s just so empowering to know what’s going on.
Amanda: Yeah. So if you’re someone listening and you have longer cycles…don’t feel like you can’t use it, you definitely can, especially, and it, maybe it’s not your first choice for birth control, but it’s something that you can use to better understand, like, are you ovulating? Are you not? What’s going on with your hormones? One of the other things like that I hear about FAM and using it is people think like, it kind of puts a little damper on your sex life, because it’s like, wait, are you fertile? Are you not? You know, like, and so it’s kind of like, you know, are you going to have a less spontaneous sex life if you’re using FAM?
Nina: I don’t think so, personally, from personal use. I mean, this is the conversation for us, is, hey, you have to grab a condom, or… I don’t know how frank I can be on here… Like, hey, you have to pull out today. Like, you know, like, certain things like that. By the way, if you’re really, really, really trying not to get pregnant, there is a small percentage of men that have semen like, or have sperm in their precum, so or pre-ejaculation, however you wanna say it. So be careful—the pullout method is not like, totally effective all the time. But really, like, that’s the thing when it comes to your partner, you just have to have that open communication of like, here’s where we’re at, here’s where we’re not at. And you have to be willing to do another option, or choose another way to go about it if you are in that fertile window.
Amanda: Yeah, and I, I mean, for me, I feel like if anything it improves your sex life, especially after you’re ovulated, you’re like, you’re in the clear, you know, like, I feel like it’s more fun. And you don’t have to worry if you are trying to use it for birth control and avoid getting pregnant. And I do think that communicating more about where you’re at in your cycle, and having your partner know that, again, is really good for your sex life, and just getting to know you and your needs, because it is going to change depending on where you’re at. So, but I do get that like, oh, like, that’s got to be really hard on the partner. I’m like, it’s not it’s, it’s really not, you guys just have to, like, get used to it and have good communication, which hopefully, you know, is only going to benefit the relationship.
Nina: Honestly I feel like it is a benefit to the relationship, because then, you know, we know our body even emotionally changes and our physical interests change during different phases of the cycle. So when they’re aware of that, that just increases your connection together. And what can be wrong with that?
Amanda: Exactly. But that’s one that I know that people tend to like be wary of, especially if you’re not in a serious relationship.
Nina: I was gonna say, if you’re not in a serious relationship, I get it that you might have to say like, hey. But also like, in my mind, we’re giving the power to the other person. Whereas like, hey, let’s bring the power back to ourselves. Like, maybe you feel better when you’re off of hormonal birth control, maybe you love to understand what’s going on with your body. So is it worth having a quick, hey, this is what I need right now for this like interaction to happen. I think that’s totally worth it.
Amanda: Yeah. I mean, I just, we did the hormonal birth control episode before this one. And you know, one of the most common things is a low libido when you take the pill, and it’s like, what is the point of taking it if your libido is then going to be low, so…
Nina: And it can be low after you get off of it for a while. So what’s the, that’s no fun.
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Amanda: So what are some things that women can expect to learn when they start charting and using FAM?
Nina: You, oh, so many things. First of all, like even, like starting at the beginning, you’ll get a really good sense of what your period means about your health. So when we’re tracking, I’m usually having clients tell me like, okay, how many tampons, pads, or menstrual cups did you go through? How many days was your period? How many spotting days did you have? Was it medium, heavy, or light? And that in itself, like gives us so much information about hormone levels. And then just knowing like, you know, when you start that fertile window like, does your estrogen rise slowly. How do you feel as your estrogen is rising? And how long is that follicular phase? That’s like really good, valuable information. And then you know, post ovulation in general. It’s really cool to see like, wow, my body does dry up after I ovulate. That’s because of progesterone. Wow, look at how my temps are increasing now. Or like noticing, we draw something called a cover line. So that helps us to determine the difference between the first phase of your cycle and the second. And it’s fun for clients to say like, oh my gosh, my post-ovulatory temps used to be really close to the cover line. Now they’re so much higher, my progesterone must be increasing, my hormones must be balancing out. My luteal phase is longer. You know, you just get to learn so much about what your body produces, but also like how you feel and how your hormone levels are throughout each phase.
Amanda: Yeah, I feel like it’s priceless for looking at that. And then you know, when you make nutrition, supplement, lifestyle changes, or if you have like a major stressor going on, you’ll be able to see how that those things are impacting you in your chart.
Nina: Yeah, so I ended up getting my second shot and my temp that next morning skyrocketed, like insane. And then the day after it came right back down. But I was like, wow, it’s just the little things that your body I mean, in a 24-hour period, like my basal body temperature was so much different, and we call those outliers. So even outside of something so extreme, it’s like if you drink a lot the night before, what did your temp do? Did you not get a lot of sleep, what’d your temp do? Those can also be clues I guess like according to stress on your body and health. So it is fascin