Can I Really Ditch My Birth Control For An App?

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As mbg’s associate health editor, Gretchen has become the go-to person for any (and every) health question in our office. Her strategy is simple: Approach modern health conundrums using a combination of ancient wisdom and current research. In Modern Medicine, Gretchen will deconstruct the latest wellness trends by evaluating research and consulting leading integrative health experts to tell you what’s brilliant—and what’s bogus. 

There's a new kind of birth control on the scene, and it's not an IUD, patch, or pill. It comes—like so many great inventions these days—in the form of an app. And even though cycle monitoring has been practiced for years, these natural family planning (NFP) applications are everywhere right now, growing in popularity and gaining major respect in both the wellness and medical communities.

But are these apps really a reliable birth control option? Could they possibly protect us from pregnancy like the pill or an IUD? The world is buzzing over the possibility of a low-cost, zero side effect, and totally natural birth control option, but we have a lot of questions before we head to the app store—and we know you probably do too. We consulted leading experts in women's health, birth control, and even a few of the scientists working to develop this new type of health technology to answer your most urgent questions.

How do these apps really work?

These apps use a form of NFP called the rhythm method, which works by predicting ovulation, the time of the month when an egg is available to be fertilized. So essentially, the app tracks your menstrual cycle, predicts your ovulation (usually day 14 of a woman's cycle), and alerts you on the days that you are most likely to conceive so that you can use a backup method of birth control or abstain from sex. This seems simple at first—you might wonder why you need an app at all—but many women have irregular cycles, which makes it more difficult to predict ovulation. To further complicate the matter, sperm can live for up to 72 hours, so if you were to have sex a day or two before ovulation, the sperm could hang around and you could still get pregnant. Therefore, these apps work by predicting your window of fertility, which extends a few days on either side of ovulation.

So how do these apps accurately predict this window and actually keep you from getting pregnant? They all work slightly differently, but most of them use a complex algorithm that takes information about your cycle (i.e., basal body temperature [BBT] readings, cycle length, and period start and stop days) and uses math to predict your fertility each day.

Is it possible at all, assuming your cycle is regular, to get pregnant during any other time?

For some of us, it's a surprise to learn that we can only get pregnant a few days out of each month. After all, we're pretty sure they didn't divulge that in our tenth grade health classes. But according to Dr. Anna Cabeca, a board-certified gynecologist and mbg women's health expert, this is true; research shows that our fertility window is only about six days long. For many women, this newfound knowledge about their fertility may be one of the most important benefits of this new technology. So many of us just started taking a pill or got the IUD and stopped thinking about fertility altogether, which is amazingly convenient, but doesn't make us very proactive or in touch with our bodies. Leslie Heyer, the founder of Cycle Technologies and creator of Dot—a family planning and birth control app—says they often hear from women who are upset that they'd always been told they can get pregnant at any time of the month. So if you didn't know this until now—you're definitely not alone.

Will my doctor be on board with this newfangled tech?

NFP has a decidedly alternative feel. Will your OB/GYN be behind it? Dr. Sherry Ross, a gynecologist to the stars and Author of she-ology: The Definitive Guide to Women’s Intimate Health. Period., explained that fertility planning apps are a great way to both prevent a pregnancy and plan for one. Dr. Cabeca also says she's excited about this new methodology for two reasons: "First, non-hormonal contraception is always my preferred choice whenever possible. And second, this will provide women with an insight into their own bodies' natural rhythm and will help match the body's signals and symptoms with their cycle in a very intelligent way."

What does the science say about these apps? Can I really trust them?

Many associate natural family planning with already-moms in a committed relationship for whom an accidental pregnancy might not be a huge deal. But these apps are for everyone. How reliable are they? Well, it definitely depends on the specific app, but many of the scientists and doctors behind these new technologies are investing in some serious research. Dr. Raoul Scherwitzl, the co-founder of Natural Cycles—the first app certified as a contraceptive with an effectiveness comparable to the pill—says they decided to conduct clinical research studies very early on in order to prove themselves to the medical world and industry authorities. And they are definitely succeeding as they currently have over 200,000 users in 161 countries worldwide.

Dot is working toward a similar goal. "In developing Dot, we first did extensive computer modeling and determined that the theoretical efficacy would be at least 97 percent. But you can’t really talk about effectiveness of contraception until you have done a full contraceptive efficacy study," explains Heyer. This full study is being performed at Georgetown University's Institute for Reproductive Health right now and will allow the effectiveness of the app to be officially compared to the pill, condoms, IUDs, and other forms of contraception.

According to Dr. Cabeca, the research on these apps has a bias (since they are generally being conducted by the app's developers) but the calculations and analysis of the results seems objective. Based on the research and her clinical experience she thinks that those who adhere to this method can expect very good results with very low risk. So while the research is still developing, it does exist—and it's looking pretty promising.

I'm not so sure about my cycle; is this still an option for me?

If you're thinking about trying one of these apps out, it's important to talk to your doctor, and if your period seems to come and go as it pleases, it's even more important that you be cautious and ask the right questions to determine whether you're a good candidate. The consensus seems to be that only women with regular menstrual cycles should use them—so if you have highly irregular or extremely long cycles, you'll definitely want to sit down with your doctor to discuss. For example, Dot is designed for women with cycles ranging from 20 to 40 days who have less than 10 days of variation in their cycle lengths in a given year. The good news is that most of these apps will alert you if you're falling outside the range for pregnancy prevention. Plus, the longer you use the app, the more data it will have on your cycle and the better it will work.

Dr. Cabeca advises getting comfortable with this method for at least two to three cycles before relying on it as your only form of birth control, "especially if you have irregular cycles such as those with PCOS, hormone imbalance, high stress levels, and athletes triad as well as anyone with a history of failed birth control and impulse control." She is also reluctant for perimenopausal women (40 and above) to rely on an app—since the studies have not targeted this age group—and would recommend the non-hormonal IUD instead.

Will this teach me anything about my hormones?

The answer to this is (most likely) yes. If you go off a form of hormone birth control to opt for this method, you could experience your natural hormone production for the first time in many years. It's likely you'll experience a host of different symptoms ranging from subtle to not-so-subtle. These apps can help draw your attention to your hormonal fluctuations throughout the month and after a while you may even be able to tell when you're ovulating or when your period is coming just based on how you feel, which can make you feel crazy in-tune with your body. But it's also more than that. If you're one of the many women unsatisfied with the birth control options on the market right now, finding a method that is effective, hormone-free, noninvasive, and completely natural could finally make you feel empowered in your body, hormone health, sex life, and decision to have children when you want, and only if you want.

What should I be looking for in a fertility app?

If you've gotten this far and are thinking about trying this out, make sure you do your research because not all birth control apps are created equal. First, it's important to know that there's a difference between a period tracker, fertility app, and birth control app. Some apps, like Clue, chart your cycle and give you insight into your personal health and hormones. Other apps, like Glow, pinpoint a woman's most fertile days to help them conceive. And while these can both provide super-interesting and helpful data about your cycle, if you're looking to prevent pregnancy, we think it makes sense to focus on the apps that were designed for that specific purpose.

When it comes to choosing an app, it’s just a matter of weighing your options because the specifics vary quite a bit. Some apps require you to take your temperature every day while others just have you track your period or enter other data. Some apps tell you whether or not you need to use backup birth control options, and others simply give you a high, medium, or low fertility score. It's important to commit to the one you choose and enter the data consistently, so pick one your know you'll be able to keep up with. It’s really just a matter of knowing yourself: Should you go for the least energy- and time-consuming option or will it make you feel more comfortable to enter data each day? Dr. Cabeca would tell a patient interested in one of these apps that "user preference is key here, and most apps seem to offer free trials so that's the way to go! Find out which one you prefer." Still needing some more direction? A great option is to have your doctor recommend one or find a company that is investing their time, money, and energy in good research to establish their credibility.

Is one of these apps the right choice for me?

Despite the research and doctor recommendations, many women are still nervous about this type of birth control. It feels a bit risky—and we totally get it. Contraception is such a personal choice, and we'd never tell you what to do. But for women who despise the pill because of its side effects, have rejected the IUD, or just want a totally natural option—this is a pretty exciting new field of options. Many of these apps have been proven to be clinically effective methods of contraception. And they've also been put through rigorous testing (not so different from other forms of birth control) in order to gain authority in the medical community. If they're used correctly, doctors, researchers, and industry regulators seem to think this is a legit option for a lot of women.

So is this the future of birth control? Are we all destined to ditch the pill for our iPhones? We can't say for sure, but the minds behind these apps can agree on one thing: The future of birth control is all about more innovation and more optionsespecially ones that really meet women's needs and make them feel confident, protected, and safe. And that's a message we can definitely get behind.


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