Choosing the right birth control often means that most women try to pick the best option between the proverbial “rock” and “hard place.” While hormonal birth control – in the form of birth control pills, patches, and devices – offers a greater protection against an unwanted pregnancy, they also come with their unwanted risks and side effects. Some of these risks can become exceptionally dangerous, especially if the woman is older, smokes, or has history of heart disease or blood clots.
I’ve often thought of a woman’s hormones similar to that of an orchestra. Even if just one instrument is out of tune, it could have a detrimental affect on the entire conduction. Likewise, a woman’s physiological and hormonal systems operate in the same fashion. While synthetic hormones prevent pregnancy, the majority of them do this in a way by “tricking” the body into thinking it is already pregnant. A woman often feels “off” or “just not herself” when starting hormones until her body can adapt to its new state – and even then, side effects may still pursue.
Most women find themselves in a difficult situation. Truth be told, it is not only difficult to understand the drugs, devices, and all the side effects associated with birth control; it is equally cumbersome to understand a woman’s body and her cycle. The rise and fall of hormones, cycle lengths, fertile windows, etc. can all be very confusing to first learn and then apply to your own body. Most women are relatively unaware that there are only a few days each month in which pregnancy can occur. To understand how birth control works – or conversely, fertility – a woman needs at least a rough understanding of what’s happening on the inside.
For the vast majority of women, low-dose synthetic hormones for birth control are relatively safe. However, I always advocate using the lowest effect dose and for the shortest amount of time possible. For long term protection against an unwanted pregnancy, I sometimes recommend an intrauterine device (IUD), either hormonal or non-hormonal. Hormonal IUDs have a “local” effect – which means they secrete hormones just in the ovaries to prevent pregnancy. In theory, these options should be safer, however risks still prevail.
These days, I find myself recommending smartphone apps – either alone or in conjunction with other pregnancy prevention methods – to almost all women, and especially those who are in monogamous relationships and don’t have to worry about sexually transmitted infections. Smartphone apps that track ovulation and help women understand their cycle are at the cornerstone of today’s healthcare, in which technology and active patient participation help guide many decisions for treatment and care. Today’s modern woman has information at her fingertips, is aware of risks and side effects, and wants to play an active role in all aspects of her health. Apps such as these put the woman in the driver’s seat of her health and help her to understand what’s going on with her body during any given day of the month. They also help take the guessing game and confusion out of cycle calculations – by inputting all of the pertinent information, technology then takes the reigns and allows you to see your cycle laid out before your eyes.
The FDA just recently approved marketing of the first smartphone app intended to prevent pregnancy by using an algorithm to calculate the most fertile days of a woman’s cycle by tracking body temperature and using other information from her menstrual cycle. The app is called Natural Cycles and requires women to take their body temperature using a basal thermometer immediately upon waking. The temperature is then entered into the app, which also tracts menstrual cycles.
Your body basal temperature (BBT) is your body temperature when you are at complete rest. During ovulation, a hormone called progesterone will cause your body temperature to rise by about 0.5 to 1 degree. Your temperature will stay higher until your period, when progesterone levels fall and body temperature returns to normal.
While taking your BBT seems easy enough, there are some important caveats to remember. Your BBT is measured at complete rest, so you must have had at least 3 or 4 hours of sleep upon rising and absolutely no activity (even going to the bathroom) before it is taken. It is best to keep your thermometer right on your nightstand for quick access in the morning. Your BBT should also be taken around the same time each morning (or at least within a half hour). Sometimes, the logistics of such an accurate activity can be difficult and annoying. Taking an accurate BBT every single day also may be difficult for women who do shift work or have a varied schedule.
The Natural Cycles app underwent clinical studies to prove its effectiveness. One study evaluated close to 16,000 women over the course of 8 months. Overall, the app had a “perfect use” failure rate of 1.8 percent – this means if the app is used close to perfectly, 1.8 out of 100 women will become pregnant after a year. A “perfect use” rate puts more fault on the app itself, since human error is negligible if the app was utilized perfectly. The app also showed a “typical use” rate of 6.5 percent, which means 6.5 out of 100 women will become pregnant after a year of typical, imperfect use. This statistic is probably more realistic; as mentioned previously, it can be somewhat rigorous to take an accurate BBT every day and use the app perfectly.
The majority of apps don’t require women to take a BBT every day. Many apps just have you input your days of menstruation and the duration, and they are able to “map out” your cycle. Because the Natural Cycles app will be marketed for pregnancy prevention without using any other means, the addition of taking a BBT helps to make the technology much more accurate.
While many ovulation apps are intended for pregnancy prevention, they can also be a great way to know when you are most fertile for conception. I also recommend these apps for women who are having trouble conceiving, along with some other lifestyle modifications such as moderate physical activity, stress reduction, less alcohol, prenatal vitamins, and the addition of more unprocessed, organic foods.
Whether you favor these apps or not, one thing is clear: the use of these apps inherently forces women to know, understand, and better predict their bodies. Because a woman’s overall health is closely linked to her hormones and female cycle, using an app can be almost an investigative way to help identify underlying problems that may be associated with constant rise and fall of hormones. Many issues like premenstrual syndrome (PMS), polycystic ovarian syndrome (PCOS), and even just the nuances of everyday health – such as days when you feel “off” or mentally fatigued or even certain foods you’re craving – can be better understood by tracking your cycle and understanding which hormones are coming into play.
Remember, while ovulation apps are incredibly helpful, most of their accuracy depends on near perfect user input. If you feel like you are having trouble keeping on top of your app as well as you should, a back-up method for pregnancy prevention should always be used, no matter which day of your cycle. Even in these cases, apps still can provide a rough guide.
Ovulation apps are just another way in which technology is playing a role in today’s ever-evolving healthcare. They take the guessing game out of cycle mapping and allow women to be more in tune with their bodies, which – at the end of the day – is always beneficial.
References:
- FDA allows marketing of first direct-to-consumer app for contraceptive use to prevent pregnancy [news release]. Silver Spring, MD; August 10, 2018: FDA website. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm616511.htm. Accessed August 14, 2018.
- About Natural Cycles. Natural Cycles press kit. https://www.naturalcycles.com. Accessed August 10, 2018.
