2/28/2020 NC Department of Health and Human Services Fertility Awareness Based Methods of Family Planning (FABMs): What are they and how do they work w ebinar? Rachel Peragallo Urrutia, MD, MA Medical Consultant, Women’s Health Branch, NC Division of Public Health UNC ‐ Chapel Hill February 5, 2020 NCDHHS, Division of Public Health, Women’s Health Branch | FABMS: What are they and how do they work? | February 5, 2020 1 1 My story NCDHHS, Division of Public Health, Women’s Health Branch | FABMS: What are they and how do they work? | February 5, 2020 2 2 Presentation Overview • What are Fertility Awareness Based Methods of family planning (FABMs) • The Female Cycle: What Happens and Why? • Estimating the effectiveness of FABMs • Overview of Effectiveness of specific FABMs NCDHHS, Division of Public Health, Women’s Health Branch | FABMS: What are they and how do they work? | February 5, 2020 3 3 1
2/28/2020 What are Fertility Awareness Based Methods (FABMs)? Methods that allow people to track one or more signs of fertility (biomarkers) to determine the days during each menstrual cycle when the chances of conception would be highest and lowest . FABMs can be used to: Avoid pregnancy Plan pregnancy Monitor health NCDHHS, Division of Public Health, Women’s Health Branch | FABMS: What are they and how do they work? | February 5, 2020 4 4 Who uses FABMs? • Likely underrepresented in national surveys • Growing over the last decade in the US o US National Survey of Family Growth (NSFG) o US Title X (Family Planning) • Currently: 2% ‐ 3% of all contraceptive users globally • 0.31% of LHD family planning clinic users in NC NCDHHS, Division of Public Health, Women’s Health Branch | FABMS: What are they and how do they work? | February 5, 2020 5 5 Observable Fertility Signs Day of menstrual Basal Body cycle Cervical Temperature Fluid Urinary Hormone Cervical Detection Position NCDHHS, Division of Public Health, Women’s Health Branch | FABMS: What are they and how do they work? | February 5, 2020 6 6 2
2/28/2020 Major Categories of FABMs with some examples FABM category Examples of FABM methods Calendar-based Dynamic Optimal Timing, Rhythm Method, (menstrual cycle) Standard Days Method, many “Period trackers” Billings Ovulation Method, Creighton Model Cervical mucus-based Fertility Care System, T wo-Day Method T emperature-based Bioself, Daysy, Marshall, Natural Cycles Symptothermal Couple to Couple League, Justisse, Sensiplan, (multiple indicator Symptopro, Taking Charge of Your Fertility methods) Urinary hormone-based Marquette, Persona NCDHHS, Division of Public Health, Women’s Health Branch | FABMS: What are they and how do they work? | February 5, 2020 7 7 The Female Cycle Brain Signals Ovaries with FSH SOURCE: www.replyobgyn.com NCDHHS, Division of Public Health, Women’s Health Branch | FABMS: What are they and how do they work? | February 5, 2020 8 8 The Female Cycle Follicles Develop and Produce Estrogen SOURCE: www.replyobgyn.com NCDHHS, Division of Public Health, Women’s Health Branch | FABMS: What are they and how do they work? | February 5, 2020 9 9 3
2/28/2020 The Female Cycle Effects of Estrogen SOURCE: www.replyobgyn.com NCDHHS, Division of Public Health, Women’s Health Branch | FABMS: What are they and how do they work? | February 5, 2020 10 10 The Female Cycle Effects of Estrogen SOURCE: www.replyobgyn.com NCDHHS, Division of Public Health, Women’s Health Branch | FABMS: What are they and how do they work? | February 5, 2020 11 11 The Female Cycle Two Types of Cervical Fluid SOURCE: www.replyobgyn.com NCDHHS, Division of Public Health, Women’s Health Branch | FABMS: What are they and how do they work? | February 5, 2020 12 12 4
2/28/2020 The Female Cycle Effects of Estrogen • Brain is triggered to release LH SOURCE: www.replyobgyn.com NCDHHS, Division of Public Health, Women’s Health Branch | FABMS: What are they and how do they work? | February 5, 2020 13 13 The Female Cycle LH Triggers Ovulation SOURCE: www.replyobgyn.com NCDHHS, Division of Public Health, Women’s Health Branch | FABMS: What are they and how do they work? | February 5, 2020 14 14 The Female Cycle Ovulation SOURCE: www.replyobgyn.com NCDHHS, Division of Public Health, Women’s Health Branch | FABMS: What are they and how do they work? | February 5, 2020 15 15 5
2/28/2020 The Female Cycle 12–24 Hour Window SOURCE: www.replyobgyn.com NCDHHS, Division of Public Health, Women’s Health Branch | FABMS: What are they and how do they work? | February 5, 2020 16 16 The Female Cycle Corpus Luteum Produces Progesterone SOURCE: www.replyobgyn.com NCDHHS, Division of Public Health, Women’s Health Branch | FABMS: What are they and how do they work? | February 5, 2020 17 17 The Female Cycle Effects of Progesterone • Uterine Lining is Stabilized SOURCE: www.replyobgyn.com NCDHHS, Division of Public Health, Women’s Health Branch | FABMS: What are they and how do they work? | February 5, 2020 18 18 6
2/28/2020 The Female Cycle Effects of Progesterone • Cervical Fluid Decreases SOURCE: www.replyobgyn.com NCDHHS, Division of Public Health, Women’s Health Branch | FABMS: What are they and how do they work? | February 5, 2020 19 19 The Female Cycle Ending A: Menstruation SOURCE: www.replyobgyn.com NCDHHS, Division of Public Health, Women’s Health Branch | FABMS: What are they and how do they work? | February 5, 2020 20 20 The Female Cycle Corpus Luteum Fades Off SOURCE: www.replyobgyn.com NCDHHS, Division of Public Health, Women’s Health Branch | FABMS: What are they and how do they work? | February 5, 2020 21 21 7
2/28/2020 The Female Cycle Ending A: Menstruation SOURCE: www.replyobgyn.com NCDHHS, Division of Public Health, Women’s Health Branch | FABMS: What are they and how do they work? | February 5, 2020 22 22 The Female Cycle Ending B: Pregnancy SOURCE: www.replyobgyn.com NCDHHS, Division of Public Health, Women’s Health Branch | FABMS: What are they and how do they work? | February 5, 2020 23 23 The Female Cycle What if the Egg has Company? SOURCE: www.replyobgyn.com NCDHHS, Division of Public Health, Women’s Health Branch | FABMS: What are they and how do they work? | February 5, 2020 24 24 8
2/28/2020 The Female Cycle Fertilization SOURCE: www.replyobgyn.com NCDHHS, Division of Public Health, Women’s Health Branch | FABMS: What are they and how do they work? | February 5, 2020 25 25 The Female Cycle Ending B: Pregnancy SOURCE: www.replyobgyn.com NCDHHS, Division of Public Health, Women’s Health Branch | FABMS: What are they and how do they work? | February 5, 2020 26 26 The Fertile Window SOURCE: Lynch, Jackson, & Buck Louis. Paediatr Perinat Epidemiol 2006:20(Suppl 1):3–12 . www.replyobgyn.com NCDHHS, Division of Public Health, Women’s Health Branch | FABMS: What are they and how do they work? | February 5, 2020 27 27 9
2/28/2020 The Female Cycle What is the Typical Female Cycle Length? NCDHHS, Division of Public Health, Women’s Health Branch | FABMS: What are they and how do they work? | February 5, 2020 28 28 The Female Cycle What is the Typical Female Cycle Length? Percentage of Cycles 2309 Cycles 426 Women Cycle Length (Days) Stanford et al, unpublished data NCDHHS, Division of Public Health, Women’s Health Branch | FABMS: What are they and how do they work? | February 5, 2020 29 29 The Female Cycle Why Do Cycle Lengths Vary? NCDHHS, Division of Public Health, Women’s Health Branch | FABMS: What are they and how do they work? | February 5, 2020 30 30 10
2/28/2020 The Female Cycle Pre ‐ Ovulatory Phase Variability NCDHHS, Division of Public Health, Women’s Health Branch | FABMS: What are they and how do they work? | February 5, 2020 31 31 What is “normal” variation? • FIGO: more than 20 days of variation is “irregular” (>95%) • For some FABMs, variation of 7 or more days makes it hard or impossible to use the method • Variable length menses of 7 or more days may need clinical investigation SOURCE: Fraser IS et al. The FIGO Recommendations on Terminologies and Definitions for Normal and Abnormal Uterine Bleeding. Sem Reprod Med 2011; 29(5):383 ‐ 90. Available at : http://www.pharllc.com/wp-content/uploads/2014/03/Fraser-Semin-Reprod-Med-2011.pdf NCDHHS, Division of Public Health, Women’s Health Branch | FABMS: What are they and how do they work? | February 5, 2020 32 32 The Female Cycle What is the Typical Day of Ovulation? NCDHHS, Division of Public Health, Women’s Health Branch | FABMS: What are they and how do they work? | February 5, 2020 33 33 11
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