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Calendar (Rhythm) Method

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The calendar method involves tracking your menstrual cycle to help you predict your next ovulation. This method is most effective if you have a regular 26 to 32-day menstrual cycle and use it in combination with other birth control methods.

We don’t recommend the calendar method if you:

• Have short, long, or irregular cycles
  
• Are breastfeeding
  
• Give your baby formula in addition to breast milk

Risk of pregnancy

The calendar method is a less effective method form of birth control. The risk of pregnancy with the calendar method is 12 percent, when practiced correctly and consistently. This means that 1 in 8 women who use this method will become pregnant each year.

How to use the calendar method

Record the dates of your menstrual periods for 6 to 8 months.

• Mark your calendar on the first day of your menstrual period (Day 1) and each day thereafter (Day 2, 3, 4, etc.) until your next period.
  
• Observe how many days are in your total menstrual cycle. A regular menstrual cycle is between 26 and 32 days. Every woman's cycle is different.
  
• If your cycle is irregular (shorter than 25 days or longer than 33 days), we do not recommend that you use the calendar method.
  
• If your cycle is regular (26 to 32 days), this method will help you predict when you ovulate. You are most likely to ovulate approximately 12 to 16 days before the first day of your next menstrual cycle.

Calculate which days of the month you are fertile (ovulating) using these guidelines. Pregnancy is most likely to occur if you have vaginal intercourse right before or after you ovulate.

• To figure out when you are ovulating, subtract 14 to 16 days from the number of days in your average menstrual cycle.
  
• For example, if your menstrual cycle is usually 28 days, you would subtract 14 to 16 days from 28 to get 12 to 14.
  
• This means that if your cycle is an average of 28 days, your fertile days are approximately from Day 12 through Day 14 of each month.

If you are not planning to get pregnant, do not have intercourse or be sure to use another method of birth control for 1 week before your fertile days, during your fertile days, and 3 days after your fertile days.

• To figure out your unsafe times, subtract 7 days from your fertile days and add 3 to your fertile days.
  
• For example, if your menstrual cycle were 28 days, you would subtract 7 days from Day 12 to Day 14 to get 5 to 7.
  
• You would avoid sex or use another method of birth control from Day 5 (1 week before your fertile days) to Day 17 (3 days after your fertile days).

These guidelines can help you figure out which days you ovulate. Keep in mind that these estimates might not be accurate for everyone, because every woman's cycle is different. Many women find that their cycle varies each month.

You may want to use an online ovulation calculator to help predict your monthly ovulation.

Standard Days Method (SDM)

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The standard days method (SDM) is another way to help you track your menstrual cycle and determine your monthly fertility phase. It works best for women who have regular menstrual cycles (between 26 and 32 days long). 

There are different ways to keep track of your cycle in SDM including using a calendar, a computer program, or a string of beads. Different brands of beads are available to buy.

We do not recommend this method if you:

• Have short menstrual cycles (shorter than 26 days)
  
• Have long menstrual cycles (longer than 32 days)
  
• Use hormonal contraception such as emergency contraception (Plan B) or intrauterine devices (IUD) with hormones
  
• Are breastfeeding
  
• Have had a pregnancy within the last 6 months  
  

Risk of pregnancy

SDM is a less effective method of birth control. The risk of pregnancy with the SDM method is 12 percent. This means that with normal usage, 1 in 8 women will become pregnant each year. The risk of pregnancy may be lower if you practice this method perfectly.

How to use SDM

With this method, certain days of your cycle are considered fertile and certain days are considered infertile. Day 1 is the first day of your period.

• Days 1 to 9 are considered infertile. You can have unprotected intercourse during these days and have a lower risk of pregnancy.

• Days 8 to 19 are considered fertile. If you are trying to get pregnant, this is when you should have intercourse. If you are not trying to get pregnant, don't have vaginal intercourse unless you use another method of birth control like a condom, diaphragm, or cervical cap.

• Days 20 until the end of your menstrual cycle are considered infertile. If you are not planning to get pregnant, you can have unprotected intercourse during these days and still have a lower risk of pregnancy.
  

Temperature Method

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The temperature method involves checking your body temperature every morning for several months to figure out when you ovulate. You will use this information to know when it’s safe to have unprotected sex.

During ovulation, your body temperature will rise by 0.4ºF (0.2ºC). It will stay high for about 3 to 5 days. You will use a special ovulation thermometer, called a basal thermometer, which shows tenths (0.1º) of a degree. Most local drugstores carry these thermometers, and some Kaiser Permanente pharmacies have them as well.

Using your body temperature as a guide, you should avoid unprotected intercourse on the last day of your period and until 3 days after you ovulate. It is safest to avoid unprotected intercourse during the last few days of your period because sperm can remain in the vagina for up to 5 days after intercourse.

The temperature method is most effective if you have a regular menstrual cycle (28 to 32 days). We recommend that you use the temperature method in combination with other birth control methods.

This method will not be effective if you:

• Have short, long, or irregular cycles
  
• Are taking fever-reducing medicines (Aspirin, Tylenol, or Motrin)
  
• Use tobacco
  
• Drink alcohol
  

Risk of pregnancy

The temperature method is a less effective method of birth control. The risk of pregnancy with the temperature method is 13 to 20 percent. This means that 13 to 20 percent of women who use this method will get pregnant each year.

How to use the temperature method

• Take your temperature in the morning, every day, before you get out of bed.
  
• Be sure to take your temperature before you eat, drink, have sex, or do any other activity.
  
• Use the same type of thermometer and location (mouth or rectum) each time.
  
• Leave the thermometer in place for 5 minutes. Do not take it out too soon.
  
• Record your temperature on a chart or graph.
  
• If you're not planning to get pregnant, don't have sex or be sure to use another method of birth control from the last day of your menstrual period until 3 days after ovulation.

Your temperature may be affected by a number of things besides your menstrual cycle. The temperature method may not work well if you:

• Have a fever
  
• Are traveling or experiencing stress
  
• Are having problems sleeping
  

Cervical Mucus Method (Ovulation Method or Billings Method)

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The cervical mucus method involves observing changes in your cervical mucus. It is also called the Ovulation or the Billings Method. This method helps you look for the following changes in your cervical mucus:

• Amount
  
• Texture
  
• Color
  
• Thickness

You may be able to predict when you will ovulate by watching, feeling, and recording this information for several cycles.

We do not recommend the cervical mucus method for women who have short, long, or irregular cycles. This method is most effective for women who have a regular menstrual cycle (28 to 32 days). We recommend that you use the cervical mucus method in combination with other birth control methods. 

The cervical mucus method will not work well if you:

• Are breastfeeding
  
• Use vaginal lubricants
  
• Use douches or other feminine hygiene products
  
• Have recently used hormonal contraceptives, including emergency contraceptive pills (Plan B)
  
• Recently had cervical surgery (cryotherapy or electrocautery)
  
• Use spermicides
  
• Have a sexually transmitted disease (STD)
  
• Have a vaginal infection such as vaginitis
  
• Are nearing menopause
  

Risk of pregnancy

The cervical mucus method is a less effective method of birth control. The risk of pregnancy with the cervical mucus method is 20 to 22 percent This means that 1 in 5 women who use this method will become pregnant each year.

How to use the cervical mucus method

Each day put one clean finger in your vagina to test the stretchiness of your cervical mucus.

• Put a drop of the mucus on your finger and thumb.
  
• Spread your finger and thumb apart to see if the mucus stretches.

Right after your period, you will notice:

• The amount of your cervical mucus has decreased.
  
• The mucus is thick, cloudy, and sticky.

Just before and during ovulation, you will notice:

• The amount of your cervical mucus has increased.
  
• The mucus is thin, clear, and sticky.
  
• The mucus is stretchy: it may stretch about 1 inch (2.5 cm) before breaking.

Mark your calendar every day. If you are not planning to get pregnant, do not have vaginal intercourse or be sure to use another method of birth control during the few days before, during, and after ovulation.

Contacting Me

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You can connect with me in a variety of ways, depending on the situation and what is most convenient for you at the time. I am available online, by telephone, or in person.

• For nonurgent questions or concerns, you can e-mail me using this site. You can also book an appointment online to see me in person.
• If your concerns are immediate, or you simply prefer to use the telephone, please call our Appointment and Advice line, which is available 24 hours a day, 7 days a week. Our advice nurses can give you immediate advice, and our telephone staff can send me a message or book an appointment for you. 

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How We Coordinate Your Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay current on your health status and to collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments as needed. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to a specialist

My specialty colleagues are readily available to assist me if I need additional advice about your condition. In some cases, I may contact them during your visit, so we can discuss your care together. If we decide you need a specialty appointment after that discussion, we can often schedule it the same day or soon thereafter.

If you are due for preventive screenings or tests

As part of our commitment to prevention, additional members of our health care team may contact you to come in for a visit or test. We will contact you if you are overdue for cancer screenings or conditions which may require monitoring.

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Convenient Resources for You

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As your personal physician, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available 24/7 so that you can access and manage your care where and when it is most convenient. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions and schedule appointments.
• View your past visits and test results.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at our medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

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