Problems With Use

• Problems with fertility awareness methods affect women’s satisfaction and use of the method. They deserve the provider’s attention. If the client reports any problems, listen to her concerns and give her advice and support. Make sure she understands the advice and agrees.
• Offer to help the client choose another method—now, if she wishes, or if problems cannot be overcome.

Inability to abstain from sex during the fertile time

• Discuss the problem openly with the couple and help them feel at ease, not embarrassed.
• Discuss possible use of condoms, diaphragm, withdrawal, or spermicides or sexual contact without vaginal sex during the fertile time.
• If she has had unprotected sex in the past 5 days, she can consider ECPs (see (Chapter 3 – Emergency Contraceptive Pills)

Calendar-Based Methods

Cycles are outside the 26–32 day range for Standard Days Method

• If she has 2 or more cycles outside the 26–32 day range within any 12 months, suggest she use the calendar rhythm method or a symptoms-based method instead.

Very irregular menstrual cycles among users of calendar-based methods

• Suggest use of a symptoms-based method instead.

Symptoms-Based Methods

Difficulty recognizing different types of secretions for the ovulation method

• Counsel the client and help her learn how to interpret cervical secretions.
• Suggest she use the TwoDay Method, which does not require the user to tell the difference among types of secretions.

Difficulty recognizing the presence of secretions for the ovulation method or the TwoDay Method

• Provide additional guidance on how to recognize secretions.
• Suggest she use a calendar-based method instead.