Sympto-Hormonal Methods (SHMs) teach married couples how to observe, chart, and interpret multiple signs of fertility.

Central to SHMs is the fact that when fertile, a woman’s urinary metabolites carry trace elements of her reproductive hormones (estradiol and luteinizing hormone). SHMs make use of fertility devices to help married couples pinpoint the woman’s time of fertility. Depending upon the SHM, the device can be a fertility monitor or test strips.

SHMs also provide education about the presence of cervical mucus as a support to the hormonal readings. In some cases, the Basel Body Temperature may also be taught.

Like all NFP methods, to appreciate SHMs it is important to understand basic facts about human fertility. With SHMs, it is especially important to understand the role of a woman's reproductive hormones in the menstrual cycle. This detail can be found in An Introduction to NFP. Below, only a brief discussion is provided.


In the United States, researchers at the Institute for Natural Family Planning at Marquette University (Milwaukee, WI), were the first to develop a SHM. Called the “Marquette Method” (MM), this SHM makes use of an electronic hand-held hormonal fertility monitor and cervical mucus observation. The fertility monitor detects two reproductive hormones in the woman’s urine and provides information on three levels of fertility (i.e., low, high, and peak). The observation and charting of cervical mucus is used as a double check to the monitor’s readings.

  • When used correctly, the MM has an effectiveness rates of 98-99% for avoiding pregnancy.
  • When not used correctly, the method is 87-90% effective for avoiding pregnancy.
  • When married couples attempt conception following the guidelines of the MM, they will be twice as likely to achieve pregnancy than couples who do not use a fertility monitor (one study of the fertility monitor used in the MM, showed couples achieving pregnancy within two menstrual cycles; see Robinson, et al., "Increased pregnancy rate with use of the ClearBlue Easy Fertility Monitor,” Fertility and Sterility 87 (2005): 329–334).

Learn SHM

 Please note, in the USA Marquette University College of Nursing's Institute for NFP (MUCN-INFP) is the leading SHM. The MUCN-INFP's leaders conduct and publish peer review research on the method and related subjects.


SHM NFP Provider

Marquette University College of Nursing Institute for NFP (MUCN-INFP)
(414) 288-3854

Select Articles

(See the NFP Bibliography fora list of foundational and current research.)

Please be advised that the content below represents the research of the authors. Links to external websites are provided solely for the user's convenience. Reference to these sites do not imply USCCB official endorsement.

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Thomas Bouchard, Richard Fehring, Mary Schneider. “Achieving Pregnancy Using Primary Care Interventions to Identify the Fertile Window.” Frontiers in Medicine 4: 250 (January 9, 2018).

Richard J. Fehring, Mary Schneider, Kathleen Raviele, Mary Lee Barron. “Efficacy of cervical mucus observations plus electronic hormonal fertility monitoring as a method of natural family planning.” Journal of Obstetric, Gynecological, and Neonatal Nursing 36 (2007): 152–160.

Richard J. Fehring, Mary Schneider, Mary Lee Barron. “Efficacy of the Marquette method of natural family planning.” MCN, American Journal of Maternal Child Nursing 33 (2008): 348–354.

Richard J. Fehring, Mary Schneider, Kathleen Raviele, Dana Rodriguez. “Randomized Comparison of Two Internet-Supported Fertility Awareness Based Methods of Family Planning.” Contraception 88 (2013): 24–30.


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