The past month has seen the widely used contraceptive app Natural Cycles become the first of its kind to receive approval for marketing in America by the Food and Drug Administration (FDA). This follows it receiving CE certification as a medical device in the European Union. Despite its current criticism, Natural Cycles, along with many similar apps, claims to be an effective form of both contraception and an aid to conception.
How does it work?
Natural Cycles uses a unique algorithm that predicts an individual’s fertility window. This is calculated using basal body temperature (BBT), which naturally fluctuates throughout the menstrual cycle, along with other factors such as sperm survival and cycle length.
The user must take their temperature, using the thermometer provided with a £39.99 annual subscription, at approximately the same time each morning. The strict instructions for the app state measurements must be taken before commencing any basic activities, such as standing, urinating or eating. Any of these activities can cause changes in BBT that interfere with the accuracy of the reading, and subsequent reliability of the app. After entering the thermometer reading into the app, users are shown their daily fertility status. A green symbol indicates that the user is not fertile, and can have sex without protection, while red indicates fertility, with a warning to use protection.
The app estimates progesterone levels through changes in BBT. The concentration of progesterone in the body steadily increases after ovulation, causing an increase of 0.2-0.45% in BBT. Natural Cycles also recommends Luteinising Hormone (LH) tests to increase accuracy. At around day 14 in the menstrual cycle, LH levels spike, triggering ovulation. Users are informed that an increase in LH can be identified up to 48 hours before ovulation occurs. However, performing this test is optional, and tests are not provided with the subscription.
After entering data for 1-3 cycles, the app provides a more accurate prediction of an individual’s fertility window, the period where conception is possible. The window lasts 6 days and consists of the 5 days prior to ovulation, accounting for the length of time that sperm are able to survive within the female reproductive tract, as well as the 24-hour life span of the egg following ovulation.
The non-intrusive nature of Natural Cycles is ideal for those unable to use hormonal or more intrusive methods of contraception due to religious beliefs, health concerns, or other personal reasons. However, as with all contraceptives apart from condoms, the app does not offer protection against sexually transmitted infections.
In the digital age, it’s no surprise contraceptive and fertility tracking apps have seen widespread use, with Natural Cycles alone claiming more than 900,000 users. With the app allowing women to track their fertility, avoid the intrusiveness of other contraceptives, and ultimately assume control of their own body, why hasn’t its popularity grown even faster?
An investigation was launched by the Swedish Medical Products Agency following the report of a number of unwanted pregnancies while using Natural Cycles. Of the 668 women that sought an abortion at Södersjukhuset hospital in Stockholm between September and December 2017, 37 had become pregnant while using the app. Although Natural Cycles responded by saying these statistics are ‘in line with what was expected’ of the app, this number does not include other pregnancy outcomes besides abortion.
Natural Cycles are open about their effectiveness rates and claim that when accommodating for human error, the app falls from 99% effectiveness to 93%. In comparison, the pill is 91% effective, and the male condom 82% effective with typical use. However, when using the app, human error is much harder to identify compared with other methods. Many of those who experienced unwanted pregnancies while using the app state that they were unable to pinpoint what went awry. With other contraceptives, such as the pill, it’s much easier to know if something has gone wrong.Some unsatisfied users have said that they feel they don’t fit the demographic of the ‘ideal user’ of Natural Cycles. Looking around the FAQ section of their website, you can piece together what Natural Cycles deems their target audience. They state accurate measurements can only be taken by someone who has a regular sleeping pattern, doesn’t get sick, doesn’t regularly travel and doesn’t suffer extreme levels of stress or use medication that affects body temperature. Moreover, one adviser to Natural Cycles, Professor Kristina Gemzell Danielsson, states ‘it’s not a good option for women who absolutely want to avoid a pregnancy’. This goes against the core idea of contraception, which aims to prevent pregnancy.
Furthermore, Natural Cycles is readily promoted by influencers as an attractive choice of contraception across a range of social media platforms, such as YouTube and Instagram. This leaves their impressionable audiences with possibly little awareness of the vital information needed to use the app as intended. While the company may say that it’s up to the potential users to research the contraception before using it, such promotion may make it seem far easier to use than it is in reality.
The truth is that Natural Cycles is not designed for the majority of the population. Although the app boasts a high rate of effectiveness, it’s perhaps poorly marketed, and their ideal user doesn’t match their actual consumer base. However, while they may fall short in providing this information in advertising, it’s important for individuals to consult their doctor and carry out thorough research before choosing any contraceptive method.