An app for birth control? Some experts urge caution despite regulatory approval

Some women are trading in birth control pills for contraceptive apps, but some health experts question the reliability of this tech-driven approach.

One of these contraceptive apps, called Natural Cycles, received Health Canada approval on Jan. 9 for its use as a medical device for birth control.

Previously sold in Canada as a fertility tracker, Natural Cycle is the first app to be cleared as a contraceptive in Canada, according to the company. It’s also approved for use as a form of birth control in the United States and Europe.

The app is a form of natural and hormone-free contraception that allows users to track their fertility to know when it’s safe for them to have unprotected sex and not get pregnant.

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While some people are hailing it as a hormone-free alternative to birth control pills, others, such as Diane Francoeur, CEO of the Society of Obstetricians and Gynecologists of Canada (SOGC), say relying on a smartphone app to deter pregnancy is “playing with fire.”

“We’re always happy when we have a new contraceptive method. But you really have to know if it is applicable to you,” Francoeur warned. “And the first question is: do you do you want to take a chance to be pregnant or not? If the answer is no, this is not for you.”

This is because many people’s period cycle can fluctuate due to a number of factors such as hormones, stress, travel or sickness, she said. The Natural Cycles app relies on tracking a woman’s menstrual cycle to predict fertile days accurately, with better accuracy achieved when the cycle is regular or consistent.

“Unfortunately, we’re not robots. And if you have a robot who has a perfect 28-day cycle, then okay, but most women will have a cycle that’s going to move around in a couple of days,” she said.

The Natural Cycles app works by monitoring a user’s body temperature and menstrual cycle to identify their fertile window, during which conception is more likely. This is because our hormones cause body temperature to rise around ovulation.

Users of the app are asked to measure their temperature either overnight or in the morning, which they then log into the application. The app  uses an algorithm to analyze this data, informing users of their fertility status: green days indicate non-fertile periods where protection is unnecessary, while red days signify fertile phases, recommending the use of protection.

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In an email to Global News on Wednesday, a spokesperson for Natural Cycles said it differs from a regular fertility app “by analyzing biometric markers, such as temperature, to detect ovulation when many apps rely on calendar dates, and hence, guess when ovulation happens.”

If users prefer not to use an oral basal thermometer to monitor their temperature, the company suggests alternative options such as an Oura Ring (a smart ring designed to track sleep and physical activity) or an Apple Watch equipped with temperature sensors.

Last year, 23-year-old Shae-Lynn Graham, from North Bay, Ont., decided she wanted to take her fertility into her own hands.

Tired of grappling with health issues stemming from birth control methods like the intrauterine device (IUD), she sought guidance from a naturopath to address her health concerns head-on.

She decided to try out the Natural Cycles app after a few friends had recommended its effectiveness in fertility tracking.

“I started just wanting to gain more knowledge about my cycle,” she told Global News. “The app is user-friendly, and allowed my naturopath to gain some insight about my personal health.”

She also now uses it as a form of sexual contraceptive. However, she emphasized that she still uses condoms with her partner for additional protection.

Initially, she felt hesitant about the app due to the extensive personal data required. That’s why she began using it primarily as a fertility tracker. However, as she became more attuned to her cycle, she recognized its potential as a form of birth control as well.

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Graham also pairs it with her Oura ring, which measures body temperature directly, so she doesn’t have to take her temperature every day.

“Another reason why maybe some people are hesitant is because a lot of the onus does fall on the user,” she explained. “So if you are not someone who has a regular sleep schedule, maybe you work shift work or maybe you are not consistent with imputing the data… the data that really does fall on the user to make it accurate.”

Natural Cycles acknowledged this as well but said the app’s algorithm can work around it.

A company spokesperson told Global News the app’s effectiveness of birth control is not affected by stress, travelling, gaining weight or irregular periods.

“If a user logs fewer temperatures because they’re travelling or if they have irregular cycles, they may experience more Red Days when protection is needed. Again, the algorithm always errs on the side of caution,” the spokespersons said.

Natural Cycles’ medical director, Dr. Kerry Krauss, an OB-GYN, noted the app can be easily confused with less effective fertility awareness methods and period-tracking apps. However, she believes Natural Cycles’ effectiveness is comparable to birth control pills when used correctly.

“While no method of birth control is 100 per cent effective, I believe that Natural Cycles provides a reliable alternative to hormonal birth control for those who desire this option and is more effective than many other non-hormonal methods, such as condoms alone, including for women with irregular cycles,” she said in an email.

On the Natural Cycles user manual, the company warns that it “does not guarantee that you cannot get pregnant, it only informs you whether and when you can become pregnant based on the information that you enter into the application.”

Even when used perfectly, the company clarified that like other forms of birth control, there remains a risk of unintended pregnancy.

The company also warned that Natural Cycles me be “less suitable” for users that have irregular menstrual cycles (cycles with lengths less than 21 days or greater than 35 days)

“Natural Cycles is 93 per cent effective under typical use, which means that seven women out of 100 get pregnant during one year of use. With using the app perfectly, i.e. if you never have unprotected intercourse on red days, Natural Cycles is 98 per cent effective, which means that two women out of 100 get pregnant during one year of use,” the company said.

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In an email sent on Wednesday, a Health Canada spokesperson said: “Most birth control methods vary in their effectiveness based on their typical use. The device’s instructions for use explain how to use the device for maximum effectiveness. This includes information on when and how to measure temperature, how to navigate the app, and how certain conditions (e.g. Polycystic ovary syndrome (PCOS)) may impact the device’s effectiveness.”

The health regulator added that “patients should discuss the benefits and risks of birth control options with their healthcare practitioners.”

As an OB-GYN, Francoeur said she is hesitant about people using the app as a form of birth control and was “surprised” Health Canada approved it for this use.

She explained that common experiences such as increased sleep, illness, or stress can disrupt both body temperature and menstrual cycle, posing challenges to the app’s effectiveness.

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“If you don’t want to get pregnant, it’s not a reliable method,” she said, adding that she still believes hormonal birth control is the most effective way to protect against pregnancy.

While Graham acknowledges that hormonal birth control may be a better option for some individuals, she personally found it to be a very negative experience. She said she’s had such a great experience with the Natural Cycles app, and plans to continue using it.

“Overall, it’s been really positive and it’s a great way for people who are looking to prevent pregnancy and pregnancy or just learn a little bit more about their bodies,” she said.