Timing is everything Fertility awareness based methods for contraception © 2019 BMJ Publishing Group Ltd. Interactive Calendarmethods Type of method Biomarkers used Method Mucus onlymethods Basal bodytemperatureplus methods Symptothermalmethods Urinary hormonebased orsymptohormonalmethods 0% 20% 40% * Implants, copper IUDs, and hormonal IUDs Combined pill Male condom Tubal (female) sterilization P Vasectomy (male sterilization) P Long acting reversible contraception* P Withdrawal Other methods This graphic presents data on selected methods. At present, the best available failure rate estimates come from a small number of moderate quality studies, and should be interpreted with caution. People using these methods should know that they may prove less effective if and when assessed in higher quality studies or diverse populations. Presented for comparison. Evidence for these methods is generally more extensive and robust Basal body temperature Basal body temperature Cervical mucus Cervical mucus Urinary hormones Menstrual cycle length Menstrual cycle length Cervical Position Cervical Mucus Menstrual cycle length Menstrual cycle length Optional markers Urinary hormones Standard days method Two Day Method Billings Ovulation Method Natural Cycles Bioself French single check Thyma double check Sensiplan® double check Persona® contraception monitor Marquette monitor based methods Failure rate Data sources Terms of use The percentage of women with unintended pregnancy in first year of use With perfect use With typical use A range of values is reported Select methods for more information Peragallo Urrutia R, Polis CB, Jensen ET, Greene ME, Kennedy E, Stanford JB. Effectiveness of Fertility Awareness-Based Methods for Pregnancy Prevention: A Systematic Review. Obstetrics and Gynecology 2018;132(3):591-604. FABM estimates Hatcher RA, Nelson AL, Trussell J, Cwiak C, Cason P, Policar MS, Edelman A, Aiken ARA, Marrazzo J, Kowal D, eds. Contraceptive technology. 21st ed. New York, NY: Ayer Company Publishers, Inc., 2018 Other methods estimates This infographic is not a validated clinical decision aid. This information is provided without any representations, conditions, or warranties that it is accurate or up to date. BMJ and its licensors assume no responsibility for any aspect of treatment administered with the aid of this information. Any reliance placed on this information is strictly at the user's own risk. For the full disclaimer wording see BMJ's terms and conditions: http://www.bmj.com/company/legal-information/ Disclaimer Sensiplan® double check symptothermal Languages available: Requirements to permit use Cycle length 26-32 days Fertile Time Rules Fertile window begins according to a calendar calculation or appearance of cervical mucus (whichever comes last). It ends after cervical mucus quality decreases or basal body temperature shifts (whichever comes last) woombinternational.org Estimated failure rate 0.1% Perfect use 11-14% Typical use Features App available App available Certified TeacherRequired Certified TeacherRequired Gives instructions towomen trying to conceive Gives instructions towomen trying to conceive May include religiouscomponents May include religiouscomponents Biomarkers used Menstrual cycle Menstrual cycle Menstrual cycle Cervical mucus Cervical mucus Cervical mucus Basal Body Temperature Basal Body Temperature Basal Body Temperature Cervical Position Cervical Position Cervical Position Urinary Hormones Urinary Hormones Urinary Hormones Prediction made by User User Algorithm Algorithm No high quality effectiveness data available Thyma double check symptothermal method Method no longer available or taught There are a variety of apps available that can be used in conjunction with some individual methods, particularly symptothermal methods. Apps that are not implementing one of the methods specified in this graphic have not been tested for effectiveness so should only be used as an aid to recording signs and symptoms and not relied upon for their predictions of the fertile days The percentage of women with unintended pregnancy in first year of use