Search "fertility awareness" or "natural birth control" on TikTok and you'll find an endless scroll of videos — oftentimes with sparkle and flower emoji for emphasis.
Fertility awareness methods (FAM), also known as fertility-awareness-based (FAB) family planning, is the use of physiological changes in someone's body to determine whether they're fertile. This non-hormonal method is sweeping TikTok months after the Supreme Court overturned Roe v. Wade. The reversal of the right to privacy upheld by Roe not only eliminated the constitutional right to an abortion, but also threw other rights — like that of contraception — into question.
While not sound medical advice, these FAM TikToks speak to genuine frustrations and fears people have about hormonal birth control. But what are we really talking about when we're talking about FAM, and do these methods work? We asked experts to find out.
FAM depends on natural and physiological changes in someone's body to determine when ovulation is happening, OBGYN Michael Tahery explained to Mashable. Changes in vaginal discharge and mucus, temperature, and emotions can occur during ovulation, which is when an egg is released from the ovaries. Back pain can happen when someone's ovulating, as well.
Ovulation occurs around 14 days into one's menstrual cycle (the first day being the start of their period). The fertile window — when pregnancy is most likely to occur — is five days before ovulation, the day of ovulation, and the day after, according to Johns Hopkins Medicine.
The rhythm method, also called the calendar method, relies on menstrual cycles as well. You track your period and determine when you're ovulating based on past cycles. The difference between the rhythm method and other FAM is that relies more on the calendar than bodily changes. As writer Rachel Mans McKenny summed up in the New York Times, "The rhythm method pretends women run like clocks, while fertility awareness means paying attention to the sometimes unpredictable signs and symptoms that come along with hormonal changes."
FAM seeks to prevent pregnancy by monitoring these physiologic changes in order to predict an individual's fertile window, assistant professor of obstetrics and gynecology at UT Southwestern Medical Center Jessica Shields, D.O. told Mashable.
There's more than one such method, the most common being the Standard Days Method and the TwoDay Method, Shields continued. For the former, using the start of your period as day one of your cycle, you don't have unprotected sex days eight through 19 each cycle. For the latter, you check your vaginal secretions once your period stops. If you haven't had any secretions two days in a row — and only then — pregnancy is unlikely, though not impossible, with unprotected sex.
There are many reasons why someone may want to try FAM as their birth control method, senior director of medical services at Planned Parenthood, June Gupta, NP, told Mashable. There's usually little to no cost; no side effects; and you learn more about your body and fertility.
FAM can be highly effective when used correctly, according to Shields, but that requires more day-to-day involvement and awareness than other contraceptive options.
In order to use FAM effectively, one needs to be very knowledgable of their menstrual cycle, when they're ovulating, and when they're fertile, said Gupta. Shields reiterated this point, and stated that "monitoring the beginning and end of the period, along with vaginal secretions are key to accurately predicting ovulation and thus, fertile days."
This takes not only time but precision and discipline to monitor your fertility signs daily. Another requirement is both partners' support and willingness to learn how FAM is used, and both have to be OK with using condoms (or other contraception) or avoiding vaginal sex on fertile days. Regardless of contraceptive choice, Shields always recommends condoms to reduce the risk of STIs and improve efficacy of one's contraceptive method. FAM, like hormonal birth control, doesn't protect against STIs.
"Like all contraceptive methods that rely on the individual (such as birth control patches, birth control pills, and condoms), efficacy is dependent on the person’s adherence to the method," said Shields.
Because FAM requires this amount of accuracy and adherence, it can be inconvenient or difficult to use correctly. Thus, they're less effective in preventing pregnancy than other types of birth control like IUDs or the implant.
Because FAM requires this amount of accuracy and adherence, it can be inconvenient or difficult to use correctly.
Using an app that tracks your cycle could help, but Shields cautioned that one shouldn't rely on an app alone; these algorithms likely haven't been scientifically reviewed. Further, data privacy experts are worried about these apps post-Roe, and if they can potentially be used as evidence against someone getting an abortion. Social media messages have already been used as evidence in a case against a Nebraska teenager, for example. The period tracking app Stardust, however, provides end-to-end encryption so your data can't be seen by anyone except the recipient.
It makes sense that birth control is top of mind right now, considering the Roe reversal. According to Gupta, birth control appointments scheduled at Planned Parenthood spiked more than 150 percent on June 24, the day the decision came down. Roo, Planned Parenthood's sexual health advice chatbot, saw twice the number of questions about birth control as usual on that day.
TikTok had been home to much FAM content prior to the Supreme Court decision, but has since taken on a new connotation. TikTokkers — who may have no medical training but call themselves cycle awareness coaches or cycle sync nutritionists — hail these methods as "natural" birth control, thus superior to hormone options.
When talking about these TikToks — and about FAM in general — the conversation immediately focuses on effectiveness, said University of Oregon sociology professor Krystale E. Littlejohn, who wrote Just Get on the Pill about societal conversations and pressure around hormonal birth control. Many people assigned female at birth are told a similar sentiment to treat severe gynecological conditions like endometriosis.
By zeroing in on how FAM doesn't work as well as hormone-based methods, we sidestep concerns that are leading people to these FAM TikToks in the first place, Littlejohn told Mashable. FAM critics may seek to protect people's bodily autonomy, but by focusing solely on what FAM means for pregnancy, they sidestep users' bodily autonomy and choice.
"There are people that are genuinely feeling fearful and it doesn't help them to simply say, 'These methods are not effective, you should not use them,'" she said. "That does not help them. If a person is feeling like they are too afraid to use hormonal birth control, they might say, 'I don't care if this method is less effective.'"
Outside observers may focus on pregnancy, but Littlejohn found that it's only one of many concerns people have when it comes to sex and birth control. Fears she has encountered in her research are that of synthetic hormones; of losing control and bodily autonomy if a person chooses a method they can't immediately get rid of (like IUDs); and of access. It's a mistake to dismiss these concerns, Littlejohn said.
By not discussing these other concerns, we're not meeting people where they are — but these TikToks do. Platforms like TikTok are geared towards showing the audience what they want to see, so if a content creator is expressing the same concerns that the user is feeling, they're going to want to see more.
Content creators capitalize on people's fears that aren't being recognized elsewhere, creating communities of people who feel seen, said Littlejohn. The challenge, she continued, is sussing out when this validation acknowledges what people are going through, versus when it pushes misinformation. There's certainly misinformation on TikTok, but to lump all FAM content together as "misinfo" invalidates concerns.
Efficacy should be part of the conversation, Littlejohn believes, but it shouldn't be the first thing people jump to. The solution isn't, she said, getting every single person on a highly-effective form of birth control. That disregards people's needs, desires, and rights to reproductive and bodily autonomy. Instead of jumping to effectiveness, she encourages us to ask: Why is someone afraid of hormonal birth control? How can we address those concerns? How can we then provide accurate information about all their options?
What's often left out in the conversation around birth control, hormonal or not, is the use of condoms. This is because, usually, the responsibility of pregnancy is hoisted upon the person who can get pregnant instead of both partners. In Just Get on the Pill, Littlejohn named the phenomenon "gender compulsory birth control" to refer to when women (and people socialized as women) are compelled to use birth control to prevent pregnancy.
Focusing on FAM's (in)effectiveness plays into gender compulsory birth control. We assume that women are the only ones responsible, that it's their duty to not make "bad" or "risky" decisions lest they get pregnant. "The conversation ends up…chastising young women and people who can get pregnant for considering methods that people think are less effective," she said.
Not only does this type of messaging blur the partner's responsibility for preventing pregnancy, Littlejohn said, but it reinforces the message that women can't make appropriate decisions about their bodies.
"It behooves us as members of society, to make sure that we uphold the responsibility of partners to use condoms, especially strongly and explicitly in this context," Littlejohn said, "because it comes too easy to fall back on this narrative that says it is the woman's responsibility to prevent pregnancy."
Men certainly should take responsibility for their role in pregnancy, Tahery agreed, but noted that condoms — like the pill and FAM — are user dependent, meaning if you don't use them as directed (i.e., the condom isn't the right size and falls off) their efficacy declines.
Birth control methods aren't one-size-fits-all, said Gupta. What might work for someone else may not be the best for you. If you can't take the pill for health reasons — like if it'll interfere with your medication, as it can for people with epilepsy — then you may be better suited for FAM.
Shields said these methods are best used in highly motivated individuals with predictable menstrual cycles. "While the rhythm method is often used to prevent pregnancy, it is also informative for people trying to achieve pregnancy and therefore may be the choice of those interested in pregnancy in the very near future," she explained.
FAM can be great for someone who doesn't care if they get pregnant or not, said Tahery. This is because of how difficult it is to be precise. If you want to be mindful about getting pregnant, but you'd welcome a pregnancy anyway, FAM may be for you.
FAM doesn't work as well for people with irregular menstrual cycles, people who can't track fertility signs every day, and people with certain medical conditions like thyroid disorders that impact your period, said Gupta. It's also not recommended for people who don't use condoms and don't abstain from unprotected sex on fertile days.
Other reasons why FAM may not work for you is if you're breastfeeding (as breastfeeding impacts ovulation), have an unsupportive partner, or medical conditions where an unintended pregnancy would be life-threatening, said Shields.
Tahery advises to use the birth control method that best fits your goals. If you'd welcome a pregnancy, FAM may be for you. If you want to get pregnant in six to 12 months, but not beforehand, the pill may be your best option (and once off them, you can immediately get pregnant). If you don't want to be pregnant for years, consider an IUD.
Before you begin any birth control method, consult your options with your physician.
TikTok may introduce you to new topics, but Tahery warns users to be cautious; what you see on social media isn't tailored medical advice. "All sparkle is not gold," he said.
It's normal, however, to experiment with different methods to see what works best for you. But please — don't trust TikTok on everything.