Are Birth Control Applications an Effective Form of Contraception

Are Birth Control Applications an Effective Form of Contraception?

The Food and Drug Administration approved the Natural Cycles program in August as a "legitimate contraceptive method to prevent pregnancy" - the first application-based fertility tracker to obtain the agency's seal of approval. The smartphone app helps people track their menstrual cycle and uses daily body temperature and tracking readings to predict the days they can ovulate so the information can be used for pregnancy planning or contraception.

But although this algorithm-based and hormone-free method of birth control may seem ideal, you should know a great deal about fertility monitoring and how the application (and others similar) works before you decide whether it is right for you.

Fertility monitoring, that is, knowing when you ovulate, so you can determine which days are most likely to get pregnant, has been around for a lot longer than the applications available for download at Natural Cycles. There are three main methods by which a woman can trace her own fertility, explained Samantha Schon, a physician in the departments of obstetrics and gynecology and reproductive endocrinology of Michigan Medicine.

The first method analyzes the duration of your cycle. "The cycle is divided into two parts, the follicular phase, and the luteal phase," Schon said. "The luteal phase occurs after ovulation and is relatively constant in most women - around 14 days. Thus, in a 28-day cycle, ovulation occurs around the 14th. In a 30-day cycle, it would occur around the 16th. "This method works best if you are reasonably regular (you know you have a period of every 28 days, 32 days, etc.).

The second way to track fertility involves looking at the cervical mucus. "As estrogen rises toward ovulation, there are changes in the appearance of cervical mucus," said Schon, who is the mucus that comes out of his vagina like discharge and looks thin and elastic - more like an "egg white."

You can track your mucus daily to determine safe days and unsafe days to have sex or use a simpler "two-day" method, according to Planned Parenthood. This method involves asking yourself two questions: "Do I have cervical mucus today?" And "Did I have cervical mucus yesterday?" If the answer is "no" to both, it is safe to have sex and probably not get pregnant. Note: This leads to only 12 "safe" days per cycle, however.

The other method of fertility screening involves basal body temperature (TBB), which is the process used by Natural Cycles technology. Typically, a woman's body temperature shortly before ovulation is between 97 and 97.5 degrees Fahrenheit but will increase slightly (less than one degree) as her body releases an egg. Thus, temperature tracking allows you to know when it is most fertile.

Natural Cycles lets users track the BBT to two decimal places with a super-sensitive thermometer (which you can buy on your own). Then the application lets you know directly on the screen whether you should "use protection" (written in a red circle) or "not fertile" (in green). For best results, you should track your BBT at least five days a week and allow about three cycles for the algorithm to get the hang of your personal cycle. If you have irregular cycles, the algorithm will have a harder time to predict when you are fertile and will end up with more red days.

Normally, screening fertility on your own as a form of birth control is risky, said Alan Copperman, director of the Division of Reproductive Endocrinology and Infertility at the Department of Obstetrics, Gynecology and Reproductive Science at Mount Sinai in New York.

"Fertility awareness methods, or the timing method, are ineffective at approximately 20 to 25 percent of the time in pregnancy prevention," he said, meaning that one in four people will become pregnant using the method for one year. "Birth control pills, IUDs, implants, surgical procedures and, of course, condoms are much more effective in preventing unwanted pregnancy."

The orientation of Natural Cycles is better than the old-fashioned methods of fertility control, according to the FDA. The agency cites Natural Cycles' "perfect use" failure rate at 1.8%, which means that 1.8% of women who use the application exactly as they should for a year become pregnant. The typical failure rate of use, which covers potential user errors, is 6.5%, which is not terrifying when compared to the rate of effectiveness of other forms of birth control.

Since you must safely track your BBT daily - or check the mucus, or know how much your periods are regular - and follow instructions very carefully for the best results, many doctors are suspicious of screening as their only method of birth control.

"It really depends on the patient," Schon said. "Some patients have really regular cycles or are very in touch with their bodies, so it may be reasonable as long as you're fine in case you get pregnant."

If you absolutely do not want to get pregnant, you may want to consider duplicating a tracking application with another form of birth control. It is worth noting that there has been a setback for some women who use Natural Cycles, including those who have had unwanted pregnancies.

If you are looking for a hormone-free option, you can also consider a copper IUD - which has a 99.9% success rate and very little chance of user error.

"Long-acting reversible contraception such as IUDs will still be more effective," Schon said, but noted that the reported efficacy of applications such as Natural Cycles and Dot is "similar to birth control pills."

"I think [apps are] a reasonable option in a motivated patient with regular menstruation who wants to avoid other forms of birth control," continued Schon. "If patients do not want to be restricted when they can have sex or not, that would not be a good option."

If you are interested in using an application as a contraceptive method, the FDA warns that Natural Cycles is not for "women who have a medical condition where pregnancy would be associated with a significant risk to the mother or fetus" or women who currently are "using birth control or hormone treatments that inhibit ovulation." Before making this choice, talk to your doctor about which options are best for your needs.

All told, Copperman thinks that Natural Cycles and other applications that try to mix technology with fertility screening "empower women with knowledge about their own reproductive biology," which, of course, is always beneficial.

"Some women follow their menstrual periods to determine fertile windows, others to track times when conception is less likely, and still others simply want to be informed about their reproductive cycle," he explained.

The more you know, the safer you feel in your reproductive choices, right?