Would You Trust an App for Your Contraception?

While the promise of non-hormonal birth control can be alluring, are app-based contraceptives trustworthy?

From the pill, to condoms, to the rod, there are no shortage of contraceptives on the market.

But often, they come with hormonal side effects, such as weight gain, mood swings, and breakouts, that can leave many feeling less than amazing.

A new option has arisen that could solve these issues, and it’s all to do with tracking menstrual cycles and the body’s temperature naturally. Whilst this method has been used for centuries, technology is making it far more accurate.

The process involves logging the body’s data into apps that then determine when the body is most fertile. The app then tells users to abstain from sex during these periods or use another form of protection, such as condoms.

Apps such as NaturalCycles and Dot are a form of non-hormonal contraception, but with recent studies arising that suggest the app-method isn’t as effective as traditional protection, would you trust your fertility, and the risk of becoming pregnant, with an app? 

How does it work?

Swedish app NaturalCycles, which first came on the market in 2013, uses an algorithm-based system to determine when users are most fertile. Daily, users take their basal body temperature with a thermometer and plug it into the app.

This then reveals when to avoid having sex, so as to limit the chances of falling pregnant.

On the other hand, Dot , doesn’t use temperatures, but instead uses information provided by the user about their menstrual cycles, such as when their period starts and ends. 

This app then uses an algorithm that relies on these “Bayesian statistics” provided by the women, which results in providing the user with a window of about 11 to 13 days where they will be most fertile. During this period, they are encouraged to use other forms of protection.

Other apps require users to check their “cervical mucus” every day and then log this information into the app.

 “Cervical mucus” is found by swabbing the vagina with toilet paper when first waking up in the morning. Looking and feeling the mucus (discharge) that comes out, and then recording it every day for at least a month. By examining the changes in the mucus, fertility can be tracked.

How effective is it?

According to NaturalCycles VP of Science and Communication, Anita Kraker, the app is 93% effective if used correctly. Additionally, this statistic, and other research, was enough for the US Food and Drug Administration (FDA) to approve the marketing of NaturalCycles as a legitimate form of contraception in August 2018.

But a peer-reviewed study found that there’s an approximate 7 in 100 chance that an unplanned pregnancy will result even if all instructions are followed right. The study of 4000 women between the ages of 18 to 45 found that the “typical use” failure rate of the app was 7 per cent. Approximately 143 pregnancies occurred, and ten of these were due to the application falsely suggesting a ‘safe day’ within the fertile window to have sex.

“Typical use” of the app accounts for mistakes, such as having unprotected sex on a day when the app suggests otherwise or taking the temperature at a different time.

If a woman has a “perfect use” of the app every time, NaturalCycles says there is a 5 out of 1000 chance of falling pregnant, and if they use condoms on “red days” when the app advices unprotected sex is not safe, a 98% perfect use effectiveness is reported. But “perfect use” is hard to achieve, and a UK based Advertising Standards Authority (ASA) found that only 9.6% of inputted cycles into the app would meet this classification. This resulted in a Facebook ad for the app being banned in the UK, on the grounds that it was falsely promoting its accuracy.

A new 2019 study conducted by the Georgetown University Medical Centre found that the fertility app Dot, on the other hand, is just as effective as other forms of contraception.

Although the study was smaller than the one conducted on NaturalCycles, with only 718 participants, the results found that in the course of one year, the typical-use failure rate was 5 per cent, and the perfect-use failure rate was 1 per cent.

 24 pregnancies occurred throughout the study, with most of them resulting from incorrect use of the app, such as having unprotected sex on days of high fertility. Only one pregnancy was as a result of the app producing incorrect information, compared to the 11 that were found in the NaturalCycles study.

While the 93 per cent accuracy rate of NaturalCycles seems high, it’s clearly not as effective as using other traditional birth control, and the results from Dot have to be considered under the guise of the smaller study.

In contrast, the birth control pill is 98 per cent effective with perfect use, while the IUD is 99.95 per cent. Click here to read the full “perfect use” and “typical use” rate for all methods of birth control.

What is the cost?

NaturalCycles is priced at approximately $99AUD per year, and it comes with a free thermometer. A monthly plan is available for approx. $13 AUD.

Dot is free, however the app offers an in-app purchase option for ‘Dot Pro’ for $4.99, which supports the apps studies while also unlocking additional features, such as being able to sync the calendar to the phone.

Should you use it?

Fertility tracking apps such as NaturalCycles and Dot can be effective if used perfectly, however they require the user to be completely diligent when tracking their cycles and logging their information.

For example, the body temperature must be inputted at exactly the same time every day – yet other factors can also cause this to change, such as travelling.

For many, simple swallowing a pill each day, or having the rod inserted and then not thinking about birth control, is a much easier way of ensuring protection against pregnancy.

However, these options are hormonal, and some people can have adverse side effects to these. Fertility planning apps are natural, with no hormones, which also could be an attractive option to many.

It’s completely a personal choice, but it’s definitely worth consulting a health care professional before changing to method of birth control such as this.

Family doctor and author of How to avoid the Superwoman Complex, Dr Nicole Swiner, makes a good point in saying, “smartphones aren’t perfect, people don’t always plug in the right date or data for things, and this is not the best way to prevent pregnancy.”