Assessment of a woman who is planning to use a fertility awareness–based contraceptive method should include answers to the following questions:

• Does she have a medical condition that would make pregnancy especially dangerous?
• If she does have such a condition, she may want to choose a more effective contraceptive method.
• If she does not want to use another method, stress that the fertility awareness–based method must be used carefully.
• Is her menstrual cycle sufficiently regular to reliably estimate the fertile time?
• Ask:
• Does she have irregular menstrual cycles, vaginal bleeding between periods, or heavy or long monthly bleeding?
• For younger women: are her periods just starting?
• For older women: have her periods become irregular, or have they stopped?
• If her menstrual cycle is irregular, predicting her fertile time with only the calendar method may be hard or impossible. She can use basal body temperature, cervical mucus, or urine hormones. Or she may prefer another type of contraceptive method.
• Does she have a chronic condition that could affect fertility signs, making fertility awareness–based methods hard to use?
• Ask:
• Did she recently give birth or have an abortion?
• Is she breastfeeding?
• Does she have any other condition that affects the ovaries or menstrual bleeding, such as stroke, serious liver disease, hyperthyroid, hypothyroid, or cervical cancer?
• These conditions do not restrict use of fertility awareness–based methods, but they make these methods difficult to use. The woman or couple may therefore prefer a different type of contraceptive method. If not, they probably need more counselling and follow-up to be able to use the fertility awareness–based method effectively.
• Does she have a temporary condition that could affect fertility signs, making fertility awareness–based methods hard to use?
• Ask:
• Has she had any infections (in particular, sexually transmitted infection or pelvic inflammatory disease) in the last 3 months, or vaginal infection?
• These conditions may affect fertility signs, making fertility awareness–based methods hard to use. Once an infection is treated and reinfection is avoided, however, a woman can use fertility awareness–based methods more easily.
• Does she take any drug that affects cervical mucus, making fertility awareness–based methods hard to use?
• Ask if she is taking:
• A mood-altering drug.
• Lithium.
• A tricyclic antidepressant.
• Anti-anxiety therapy.
• Predicting her fertile time correctly may be difficult or impossible if she uses only the cervical mucus method. She can use basal body temperature, and/or the calendar method, and/or urine hormone levels. Or she may prefer another type of contraceptive method.
• Is she at increased risk for sexually transmitted infection?
• Assess the risk and, when appropriate, advise testing, promote safer sex, and/or refer for counselling.
• If the woman is at risk for sexually transmitted infection or HIV (including during pregnancy and postpartum), recommend correct and consistent use of condoms, either alone or with another contraceptive method.

• Physical examination and laboratory tests are not usually necessary when assessing a woman who is planning to use a fertility awareness–based contraceptive method.

• These recommendations are based on guidelines published by the Faculty of Sexual and Reproductive Healthcare (FSRH), (formerly the Faculty of Family Planning and Reproductive Healthcare [FFPRHC]), and the World Health Organization [Hatcher et al, 1997a; FFPRHC, 2006a].