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Billings ovulation method

Billings Ovulation Method
Birth control type Behavioral
First use developed in 1950's
Failure rates (first year)
Perfect use 0-2.9%
Typical use 1-25%
Reversibility immediate
User reminders Accurate teaching and daily charting are essential.
Clinic review None
Advantages and disadvantages
STD protection No
Period advantages Prediction
Weight gain No
Benefits Low cost, no prerequisites for use, no side effects, can aid pregnancy achievement

The Billings Ovulation Method (BOM) is a method which women use to monitor their fertility, by identifying when they are fertile and when they are infertile during each ovarian/menstrual cycle. Users pay attention to the sensation at their vulva, and the appearance of any vaginal discharge. The Billings Ovulation Method does not rely on the presence of ovulation, rather it identifies patterns of potential fertility and obvious infertility within the cycle, whatever its length. This information can be used to achieve or avoid pregnancy during regular or irregular cycles throughout all stages of reproductive life, including breastfeeding, and peri-menopause. Described by the World Organisation of the Ovulation Method Billings (WOOMB) as "Natural Fertility Regulation", this method may be used as a form of fertility awareness or natural family planning, as well as a way to monitor gynecological health.

In trials, method related pregnancy rates have ranged between 0% to 2.9%.[1] In a major trial in China 992 couples using the Billings Ovulation Method were compared to 662 couples using the IUD. The method-related pregnancy rate amongst Billings users was zero and the total pregnancy rate was 0.5%.[2] In studies up to the 1980s teaching related pregnancies ranged between 0% to 6%.[1] Total pregnancy rates vary between 1 and 25%.[3] Reasons for a higher total pregnancy rate include misunderstanding the method, risk taking, ambivalence toward pregnancy, and deciding to become pregnant.

The lead scientist of the Chinese trials, Professor Shao-Zhen Qian of the Shanghai Institute of Materia Medica, speaking there at the Chinese Academy of Sciences in 2005 said: "The method is highly efficient only when a series of precautions and regulations are strictly followed. Inappropriate use would result in failure rates, as in the preliminary trials in China in 1989 and some other places. Drawing a lesson from the earlier work, we always stick to the authenticated Billings teaching materials. In China only these materials, with Chinese translations approved by WOOMB are used and nobody is permitted to rewrite, revise or modify them. .... We pay much attention to the teacher-training courses .... as well as an adequate guidance system with regular follow-up visits with the couples."

Over the years there has been emphasis on raising the standards of teaching and ensuring that only authentic materials are used when teaching the Billings Ovulation Method which, together with ongoing scientific research that has increased understanding of particularly the ovarian and pituitary hormones and the function of the cervix, has meant that the method is now used successfully by millions of couples worldwide.[citation needed]

In more recent times, approved teaching curricula have been updated and requirements for accreditation have been made consistent for Billings Ovulation Method teachers. Use of authentic teaching materials has also been required in teaching couples.

Dr John J Billings developed the method as a form of natural family planning in response initially to local needs, and as an expression of his and Dr Evelyn Billings' deep commitment to relief of suffering, and later to the expansion of availability of this knowledge "that every woman should have". Dr Evelyn Billings who joined in this work from 1963, solved what were perceived as technical problems, advance teaching methods, etc. The Drs Billings worked for the rest of their lives as a unit, and many of the recognitions received were joint awards. He was recognized with a Papal knighthood and many academic and civic honours in life, and world-wide condolences on his death. The Drs Billings strove to raise awareness of the significance of cervical mucus to fertility to all people, regardless of their religion, race, education, etc.

The Billings Ovulation Method or The Billings Method as it became known, became well-known globally with the publication of the book written by Dr Evelyn Billings and Dr Ann Westmore, first published in 1980. This book has undergone numerous revisions and reprints with the latest new edition published in 2011. Over one million copies have been sold in 22 languages.

A range of variants have appeared, some self-referencing the “Billings” or “Ovulation” method, some adding back temperature or calendar calculations. The Billings Ovulation Method has consistently distanced itself from these.


The first recorded observations of the relationship between cervical mucus and survival of spermatozoa come from the mid-19th century.[4] The topic was not systematically studied, however, for almost another century. In 1948, Erik Odeblad was studying mycoplasms in the female genital tract. During the course of his studies, he noticed that cervical mucus changed in a predictable pattern through the course of a woman's cycle. He continued his study of the cervix.[5]

Independently in 1953, Dr. John Billings (1918–2007) discovered the relationship between cervical mucus and fertility while assisting the marriage consultant for the Melbourne Catholic Family Welfare Bureau. Some of the couples he worked with had serious reasons to postpone pregnancy, and followed the Catholic Church's teachings of only using natural methods of pregnancy avoidance. While Dr. Billings was familiar with the Calendar and Basal Body Temperature methods, he felt there was a need for something more flexible and more reliable. He embarked on a study of medical literature, and found the mid-19th- and early-20th-century references to cervical mucus and sperm survival. He instructed women using the Rhythm method to avoid intercourse also on all days, and for a few days after, they noticed vaginal discharge. This resulted in a dramatic decrease in unintended pregnancies among these couples.[4]

In the early 1960s, Dr. James Brown took a position at the Royal Women's Hospital in Melbourne, Australia. Dr. Brown had earlier developed the first tests to measure oestrogen and progesterone, and he used these tests to assist Dr. Billings in further study of the relationship between cervical mucus and fertility. Dr. Evelyn Billings joined the research team in 1965. By the late 1960s, the rules for identifying fertile days had been established and teaching centers began to be set up around the world. The method was called the Ovulation Method, to emphasize that the central feature of a woman's fertility cycle was ovulation, rather than menstruation. In the 1970s, a committee of the World Health Organization renamed it the Billings Ovulation Method.[4]

Scientific verification of the Billings Method is ongoing. Dr. James Brown continued to study ovarian activity until his retirement in 1985.[6] Dr. Erik Odeblad was acquainted with the Billings Ovulation Method in 1977, and reported that his research into the activity of the cervix confirmed all the conclusions made by Dr. Billings.[4] Dr. Odeblad's research into the cervix and cervical mucus also continued for many decades.[7]


  • A woman ovulates at only one time during her cycle, and an ovum can survive for only 12–24 hours.[citation needed]
  • Cervical mucus enabling healthy sperm cells to navigate the genital tract is necessary for fertility
  • Most commonly, spermatozoa live only one to three days in the presence of fertile mucus, with survival up to five days being rare. The possibility of pregnancy from sperm survival longer than five days has been compared to "the chances of winning a huge lottery."[8]
  • Menstruation will occur about 2 weeks after ovulation.
  • A ten-year study of 45,280 subfertile couples in China found that 32.1% of women were able to achieve pregnancy and live birth through the use of Billings.[9]


In the days leading up to ovulation the cervix responds to oestrogen by producing mucus capable of sustaining sperm survival. This mucus leaves the vagina as the woman is in an upright position. The mucus is observed through the sensation at the vulva and by looking at any cervical secretions. Daily charting of these observations will reveal either an unchanging pattern indicating infertility or a changing pattern of sensation and discharge indicating fertility. Both of these patterns follow the hormonal patterns which control sperm survival and conception.[10]

Billings Method teaches women how to recognize and understand their signs of fertility. This can help in the early diagnosis and treatment of gynaecological disorders, and can contribute to a woman's reproductive health.[11]

The World Organisation of the Ovulation Method Billings

The World Organisation of the Ovulation Method Billings, generally known as WOOMB International, is the sole international body for ensuring authenticity of materials and training of the Billings Ovulation Method. It was founded by Dr. John Billings and his wife, Dr. Evelyn Billings. It is based in Victoria, Australia. WOOMB International is affiliated to the following organisations worldwide:- Asociacion CAF Nieves Senderos De La Naturaleza,Ovulation Method Research and Reference Centre of Australia Ltd (OMR&RCA),Confederação Nacional de PlanejamentoNatural da Familia – CENPLAFAM Av: Bernardino de Campos, 110 ap 12‐ Paraíso‐ CEP 04004‐040 ‐ São Paulo SP Brasil, WOOMB Canada Inc, Pontifica Universidad Catolica de Chile, Learning Centre of Billings Ovulation Method - Taiyuan, Instituto para el Martimonia y la Familia - Universidad Pontificia Bolivariana - Medellin, WOOMB Costa Rica, Centar Za Prirodno Planiranje Obitelji, Pro-Vida Cuba, BIOEC Fundacion Ecuatoriana de Salud & Bioetica, Saint Joseph Institiute for the Family, NFP (OMB) Bioethics & Pro Vita - Cairo, The BOM Trust,Ethiopian Catholic Secretariat - Gender and Development Unit, WOOMB France Billings LIFE, Caritas Family Service, Caritas Hong Kong, Indonesian Information Centre Of The Billings Ovulation Method ( Pusimob Indonesia), NAOMI- Billings Ireland, Centro Studi e Ricerche Regolazione Naturale della Fertilita - ISI, Universita Cattolica del Sacro Cuore, Family Life Counselling Association of Kenya, Billings Ovulation Method - USA (BOMA-USA), Medicina Educativa - Switzerland, Fertility Care Scotland, Society of Responsible Parenthood in Katowice - Poland (Towarzystwo Odpowiedzialnego Rodziecielstwa - Oddziat w Katowicach), WOOMB Espana, Tanzania Family Strengthening Association UFATA.


  1. ^ a b Trials of the Billings Ovulation Method The Billings Method, Dr. Evelyn Billings & Ann Westmore, 2000, p. 215.
  2. ^ Evaluation of the Effectiveness of a Natural Fertility Regulation Programme in China: Shao-Zhen Qian, et al. Reproduction and Contraception (English edition), in press 2000.
  3. ^ Hatcher, RA; Trussel J; Stewart F et al. (2000). Contraceptive Technology (18th Edition ed.). New York: Ardent Media. ISBN 0-9664902-6-6. 
  4. ^ a b c d THE QUEST - leading to the discovery of the Billings Ovulation Method, Billings, J., Bulletin of Ovulation Method Research and Reference Centre of Australia, Vol 29 No.1 March 2002, pp18-28.
  5. ^ The Discovery of Different Types of Cervical Mucus, Erik Odeblad, Bulletin of the Ovulation Method Research and Reference Centre of Australia, Volume 21 No.3 September 1994, pp3-35.
  6. ^ Ovarian Activity and Fertility and the Billings Ovulation Method: Dr. James B. Brown, 2000.
  7. ^ Cervical Mucus and their functions, Erik Odeblad, Journal of the Irish Colleges of Physicians and Surgeons, Vol. 26 No.1 January 1997.
  8. ^ Kippley, John; Sheila Kippley (1996). The Art of Natural Family Planning (4th Edition ed.). Cincinnati, OH: The Couple to Couple League. p. 88. ISBN 0-926412-13-2. 
  9. ^ China Successfully Launching Billings Method: Dr. Shao-Zhen Qian
  10. ^ Teaching the Billings Ovulation Method, Dr E. L. Billings AM, MB BS, DCH (London), 2001.
  11. ^ Part. 2 Variations of the Cycle and Reproductive Health, Evelyn L. Billings and John J Billings.

12. Smith A., Smith J. 2014 billingsMentor: Adapting natural family planning to information technology and relieving the user of unnecessary tasks. Linacre Quarterly 2014 81: 219-238. DOI:

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