Behavioral Methods continued...

For maximum effectiveness, FAM users follow 4 rules:

1. Intercourse is allowed in the first 5 days of the menstrual cycle (beginning with the first day of your period) if you had an obvious temperature shift 12-16 days before.
   
   
2. Before ovulation, intercourse is allowed the evening of every dry cervical fluid day.
   
   
3. Intercourse can resume the evening of the third consecutive day your temperature rises to post-ovulatory levels.
   
   
4. Intercourse can resume the evening of the fourth consecutive day after your peak cervical fluid day.

Intercourse is not considered "safe" for avoiding pregnancy unless all of these rules are met. It is recommended that 2 full cycles be charted before relying on this method.

FAM has advantages and disadvantages.

• How effective: If a couple takes chances and has intercourse without backup protection during the fertile period, their odds of pregnancy increase dramatically. In August, 2002, the FDA reported a failure rate of 20 pregnancies per 100 women per year for periodic abstinence. This figure did not differentiate for particular types of periodic abstinence. ACOG lists a higher failure rate for periodic abstinence of 25%. Again, this figure did not differentiate for method of periodic abstinence. 
  
  
• Advantages: No harmful effects from hormone use occur. FAM methods can also be used to achieve pregnancy. 
  
  
• Disadvantages: Complete abstinence is necessary during the fertile period. This method requires discipline and systematic charting. The method is not effective with improper use. For maximal effectiveness, a woman or couple should be trained by a medical professional or qualified counselor. A relatively high failure rate has been reported. This method does not protect against STDs.

Other methods of periodic abstinence 

Several other methods of periodic abstinence exist.

• Rhythm method: Couples who practice the rhythm method, also called the calendar method, decide when to abstain from intercourse based on calendar calculations of the past 6 menstrual cycles. However, allowances are not made for the normal variations in the menstrual cycle that many women experience. This method is not as reliable as the sympto-thermal method of NFP or FAM.
  
  
• Cervical mucus method: Also called the ovulation method, the cervical mucus method involves monitoring cervical mucus only, without also recording basal body temperature or menstrual history. The safe period is considered to be any dry mucus days just after menstruation and the 10 or 11 days at the end of the cycle. Days of menstrual bleeding are deemed infertile; however, pregnancy can occur during menstruation. Vaginal infections, sexual excitement, lubricants, and certain medications can significantly affect the accuracy of cervical mucus assessment.
  
  
• Basal body temperature method: This method involves monitoring basal body temperature only, without also recording cervical mucus or other signs. Sex is avoided from the end of the menstrual period until 3 days after the increase in temperature.