on September 09, 2026
For decades, hormonal contraception has been the default conversation in reproductive health. But more women are asking a different question: what if there's another way? Whether driven by concerns about side effects, a desire to understand their bodies, or simply a preference for hormone-free living, a growing number of women are exploring natural family planning (NFP) or fertility awareness methods (FAM) as a genuine alternative.
This article doesn't advocate for one approach over the other. Instead, it lays out what the research actually shows, so you can make an informed decision for your own body.
How hormonal contraception works
Hormonal contraceptives, including the pill, patch, hormonal IUD, implant, and injection, through different combinations of mechanisms, chiefly suppressing ovulation and/or thickening cervical mucus to impede sperm, or thinning the uterine lining. They are effective, widely available, and for many women, a practical and positive choice.
However, they do introduce synthetic hormones into the body, and research increasingly shows that this can have effects beyond contraception.
How natural family planning works
Fertility awareness methods are methods that use the body's own fertility signals to identify fertile and infertile days. The main approaches include:
- The sympto-thermal method (STM): tracking basal body temperature (BBT) each morning alongside cervical mucus observations to identify the fertile window
- Fertility monitors: devices like Daysy and Lady-Comp that measure BBT daily and use algorithms to calculate fertility status, removing much of the manual interpretation
- The Billings Ovulation Method: based on cervical mucus observation alone
The science behind these methods is well established. Ovulation causes a measurable rise in basal body temperature, and by tracking this consistently, it's possible to confirm whether ovulation has occurred and identify the fertile window with high accuracy.
What the research actually says
On effectiveness
Effectiveness in contraception is typically measured using the Pearl Index, which expresses the number of pregnancies per 100 women over one year of use.
- Combined oral contraceptive pill: Pearl Index of 0.3 (perfect use) to 9 (typical use)
- Sympto-thermal method: Pearl Index of 0.4 (perfect use) to 1.8 (typical use), based on the Frank-Herrmann et al. study published in the European Journal of Obstetrics and Gynecology
- Daysy and Lady-comp fertility monitor: 99.4% efficacy rate based on clinical validation data
The gap between perfect use and typical use is significant for all methods. For NFP/FAM, effectiveness depends heavily on consistent daily practice and proper training. Fertility monitors like Daysy reduce this variability by removing the need for manual interpretation.
On hormonal contraception and quality of life
Research into the broader effects of hormonal contraception has grown substantially in recent years:
- A large-scale Danish cohort study found associations between hormonal contraceptive use and increased risk of depression, particularly in adolescents
- Studies have documented effects on libido, with some women reporting reduced sexual desire while using hormonal contraceptives
- Research has explored links between synthetic hormones and nutrient depletion, including B vitamins and magnesium
It is important to note that many women use hormonal contraception without experiencing these effects, and for some, the pill improves quality of life by managing conditions such as endometriosis or heavy periods.
On fertility awareness and body literacy
Beyond contraception, research supports fertility awareness as a tool for understanding reproductive health. Women who track their cycles are more likely to identify irregularities early, including anovulation, short luteal phases, and signs consistent with PMOS. This data can be clinically useful when shared with a healthcare provider.
Who is each approach suited for?
There is no single right answer. The best contraceptive method is the one a woman will use consistently and correctly, and that aligns with her health, values, and lifestyle.
Hormonal contraception may suit women who prefer a low-maintenance method, are managing a hormone-related condition, or find cycle tracking difficult to sustain consistently.
NFP/FAM may suit women who prefer to avoid synthetic hormones, are planning a pregnancy in the near future and want to understand their fertility, have experienced side effects from hormonal methods, or are interested in deeper body literacy as part of their broader health practice.
Fertility monitors like Daysy and Lady-Comp are particularly well suited to women who want the accuracy of a science-backed method without the manual complexity of traditional charting.
What women say
"I stopped taking the pill after 13 years and the Daysy was the BEST thing to help me learn how to tune into the natural rhythm of my cycle. I wanted something that was really accurate for taking my temperature, especially because I wasn't ready to have a baby yet. I love that it's easy to use, it syncs to my phone and I just have to follow the light code on the device. I wish more doctors would offer the Daysy an alternative for women who are looking to avoid hormonal contraception. I wouldn't have been confident to do the Fertility Awareness Method on my own without the Daysy."
K, Daysy user
Where to start if you're curious
If you're considering fertility tracking, either as a contraceptive method or simply to understand your cycle better, a fertility monitor takes the guesswork out of the process. Daysy and Lady-Comp both measure your basal body temperature each morning and give you a clear fertility status for the day, backed by clinical research.
This article is for informational purposes only and does not constitute medical advice. Please consult your healthcare provider before making changes to your contraception.
References
1. Cipelli R et al. An Overview of Current Contraceptive Modalities and Historical Perspectives: A Review. GREM: Gynecological and Reproductive Endocrinology & Metabolism. 2024;(01). Available at: https://gremjournal.com/journal/01-2024/an-overview-of-current-contraceptive-modalities-and-historical-perspectives-a-review/
