Fertility awareness methods (also sometimes called FAMs, “natural family planning,” or “the rhythm method”) are all about tracking your body’s signs and symptoms to determine which days of the month you can get pregnant, also known as your fertile days.

Effectiveness

Pretty effective the way most people use them (but they’re not the easiest to use).

Perfect use: 95 to over 99% effective

Typical use: 77 to 98% effective

Ongoing effort

Using a fertility awareness method requires a lot of effort including monitoring, tracking, and planning–plus you’ll need to use another method on fertile days.

To find out when your fertile days are, you’ll need to pay very close attention to your body and its patterns, and you’ll also need to keep careful track of what’s happening. There are several different signs and symptoms of fertility that you can track, and there are multiple ways to monitor them.

The diaphragm is a small, flexible cup made of silicone that you insert into your vagina, along with spermicide, before penis-in-vagina sex. The diaphragm covers your cervix, preventing sperm from entering your uterus and fertilizing an egg. The spermicide you use with it makes sperm less able to move. 

The diaphragm is reusable for up to two years, no matter how many times you use it during those two years. There are two kinds of diaphragms, a one-size-fits-most version, called Caya, and a type with multiple sizes available that has to be fitted by a provider, called Milex. 

Effectiveness

The diaphragm (used with spermicide) is pretty effective the way most people use it.

Perfect use: 84% effective

Typical use: 83% effective

Ongoing effort

You have to put it in place every time you’re going to have penis-in-vagina sex and leave it in for six hours after. You can leave it in for up to 24 hours, but you have to apply a new dose of spermicide before having sex each time.

Withdrawal, also called the “pull-out method,” is one of the oldest forms of birth control on the planet. Withdrawal is when, during penis-in-vagina sex, the person with the penis pulls their penis out of their partner’s vagina before they ejaculate (cum). They can then ejaculate outside of the vagina if they like, but it’s important not to ejaculate on the vulva (the parts on the outside, which include the labia and the clitoris), as that can also lead to pregnancy.

Effectiveness

Pretty effective the way most people use it (but it’s hard to pull out on time every time).

Perfect use: 96% effective

Typical use: 80% effective

Ongoing effort

You have to make an effort every time you have sex.

Spermicide contains chemicals that prevent pregnancy in two ways. The first way spermicide works is by stopping sperm from moving normally. The second way is by keeping sperm from getting through your cervix and into your uterus. (Think of your cervix like a doorway between your vagina and your uterus.) In order for spermicide to work correctly, you have to insert it deep into your vagina, so that it actually covers your cervix.

Phexxi is a birth control gel that is similar to over-the-counter spermicide but is more effective. Phexxi is only available by prescription.

Effectiveness

Spermicide on its own, without a barrier method like a diaphragm or condom, is pretty effective the way most people use it. Prescription-only vaginal gel is more effective than over-the-counter spermicide.

Perfect use: 84% to 93% effective

Typical use: 79% to 86% effective

Ongoing effort

You have to apply a dose of spermicide before each time you have penis-in-vagina sex.