Users iffy about Natural Cycles
CONTRACEPTION? Yes, there’s an app for that.
And a Food and Drug Administration-approved app at that. Last week, Natural Cycles became the first app to be approved by the government to prevent pregnancy.
The app, developed by Swedenbased company Natural Cycles, had been cleared in Europe in 2017, and is an emerging product within the “Femtech” industry – a catchall name for “female health technology”, which has reaped about $1 billion (R14bn) of investment worldwide in the past three years.
This app is marketed as “a natural method of contraception that is powered by a smart algorithm”.
It sells the idea of “empowering women”.
Not all are convinced that the app represents the future of contraception, or should even be used now.
Women might be drawn to having a sense of control over their reproductive lives. And as with so much else in modern daily life, their data is at their fingertips.
But gynaecologists and women who have used the app caution that it requires a level of diligence: The app is only as good as the information women enter. And they point to incidents of unexpected pregnancies by those who have relied on it.
Natural Cycles works by calculating which days of the month a woman is likely to be fertile based on information she enters about her menstrual cycle and basal body temperature. The method, often referred to as the fertility awareness-based method, identifies the days per menstrual cycle in which a woman is fertile.
Women using the app must take their temperatures immediately after waking up each morning using a basal body thermometer.
Basal body thermometers are more sensitive than others.
The thermometer comes with the app, which costs $79.99 annually.
Clinical studies to screen Natural Cycles’ effectiveness for use as a contraception included more than 15 500 women who used the app for an average of eight months.
Of those who used the app perfectly as directed, 1.8% became pregnant (what is known as the “failure rate”), according to the FDA.
The app had a “typical use” failure rate of 6.5%, that accounted for women who sometimes didn’t use the app as directed and had unprotected sex on fertile days.
For comparison, the US Centres for Disease Control and Prevention’s estimated failure rate of birth control pills is about 9%. Hormonal intrauterine devices have failure rates of less than 1%, and condoms about 18%. And in fact, the only foolproof way to avoid pregnancy is not to have sex.
Juan Acuna, an obstetrics and gynaecology specialist at Florida International University and an adviser to Natural Cycles, said there had been a long-standing view that natural contraception – like the rhythm method, for example – could not safely prevent pregnancy in women who were fertile and having sex without other forms of contraception. Natural contraception required women be educated about their cycles and willing to map out when they were fertile.
A program like Natural Cycles ran those calculations, he said.
Still, like most other forms of birth control, Acuna said women shouldn’t rely solely on the app during their first few cycles of using it.
“It helps fill a vacuum in the world of natural contraception,” he said. Before its approval in the US, the app came under fire when a Swedish hospital reported that more than 36 women who had used Natural Cycles as their sole form of birth control sought abortions there between September and December 2017. The company said the number of pregnancies, in proportion to the registered number of Swedish users, was “in line with our expectations”, The Guardian reported.
Laura MacIsaac, associate professor of obstetrics, gynaecology and reproductive science at the Icahn School of Medicine at Mount Sinai, said Natural Cycles was “a little more exciting” in that it tracked both menstrual calendars and basal body temperature.
But she cautioned against forms of contraception that required such intense maintenance and attention, especially for women seeking longterm pregnancy protection. Even women who obsessively complied with the program would be fertile for a stretch of every month, MacIsaac said. She said contraception methods that were highly labour intensive were also the hardest to stick with.
“High-maintenance methods are the ones that have the highest failure rates, not because they don’t work biologically but because they don’t work in normal people’s lives,” MacIsaac said. That could include women who travelled or had unpredictable schedules, or women who could not ritualistically take their temperatures before doing anything else in the morning.
“Whoever could do that; I don’t know those women,” she said.
Last month, a woman detailed her own experience of becoming pregnant while using Natural Cycles and subsequently having an abortion.
Olivia Sudjic described the shame she believed led other women not to report their unplanned pregnancies. She said she was drawn in by the promise of a hormone-free, non-invasive contraceptive, only to wind up feeling “colossally naive”.
Another woman quoted in the article, who fell pregnant and had an abortion, said she felt ashamed.
“I felt like I’d acted alone in the decision to use the app and had been overly trusting.
“But I was also angry that I’d been treated like a consumer, not a patient,” the woman told Sudjic.
For her part, MacIsaac said she wouldn’t recommend Natural Cycles to her patients.
“I think the way technology can make women more healthy and happy,” she said, “(is to have) better sleep and healthier sex lives: get your phone out of your bedroom.”