Would You Rely On An App To Prevent Pregnancy? Natural Cycles, A New (Controversial) Digital Contraceptive Tool

When I was fourteen I experienced one of the most mortifying moments of my life. During our weekly PHSE lesson, my 64 year old maths teacher handed out a supply of bananas followed by a flurry of little square metallic packets that could have contained elements of plague for all we wanted to touch them. Even though I attended an all girl's school and didn't have to attend with idiotic remarks from rather embarrassed boys, it was not an experience I would ever want to repeat. Sex education was brief, top-line and mostly consisted of the potential list of infections and diseases you could contract if you didn't do it properly; there was no choice provided about contraceptive methods, no information on relationships in general and certainly no advice on what to do when it all goes a bit tits up (i.e. when you've had six jeagerbombs and wake up somewhere unfamiliar.)

It may be twenty years later, but I don't think sex-ed has improved much in this country: we're still struggling with an increase in STIs (figures published by Public Health England state cases of syphilis had jumped by 76% between 2012 and 2015 while cases of gonorrhoea rose by 53%,) even if teenage pregnancy is at its lowest since records began in the 1960's. The majority of us still don't really understand our bodies or how contraception works, and are generally ill-informed about sexual health. I'm a firm believer in giving young men and women as much information as possible, encouraging them to practice safe sex and look after their health as a priority - mainly because I feel like I've been scrimped along the way and haven't been given the support I would've liked during the most important years of my life.

Contraception is such a important issue, but the method you choose is all about personal choice. Whether you opt for the pill, the coil, the implant, the injection or stick to trusty old condoms, every one of us will prefer their own combination to keep them safe from sexually transmitted nasties and unwanted pregnancies. Rather interestingly, a new form of 'contraception' has emerged in 2017 that has created quite the stir and debate, particularly after a lot of influencer endorsement: Natural Cycles. This innovative approach to pregnancy prevention is described as: "...an effective method of contraception. And so much more. It's the app that gives you the knowledge to get to know your body and truly understand how your cycle works. It's protection with more sexual freedom - minus the side effects." 

In a nutshell, Natural Cycles involves an app and a thermometer which is used to measure your body temperature every morning before you get out of bed; it's placed under the tongue and you enter your temperature into the app, where you'll be given a notification of either a green (safe to have sex) or red day (possibility of getting pregnant.) Although it obviously doesn't provide any protection against STIs, it is a fascinating alternative for those that either don't want to ingest additional hormones or don't get on with other forms of contraception. You know I'm all about the science, so I've done a lot of research into this method and reliance on body temperature as a form of birth control in general - as have Natural Cycles themselves. (In fact, there's a whole science section on their website here.)

In order to prove the validity of the method, a retrospective study was commissioned by the brand and performed on 1501 cycles of 317 women aged 18 to 39; only 0.05% of non-fertile days were falsely attributed and found within the fertile window. (It's worth nothing, however, that retrospective studies are flawed in that the data collected was not intended for the purpose in which it's being used and may not always give an accurate representation.) Additionally, the app's efficiency as a contraceptive method was examined on data from 4054 women who used it for a total of 2085 woman-years. (Side note: what the hell is a 'woman year'? I can only assume this is a year's worth of average cycles..!) The number of identified unplanned pregnancies was 143, which works out at around 3.5% of the women involved; ten of the pregnancies were due to the application falsely attributing a safe day within the fertile window (that 0.05% I mentioned earlier,) and the rest presumably being due to incorrect use of the app. The overall cumulative pregnancy probability results in a pregnancy rate of 7.5% per year: that's about comparable with the contraceptive pill and actually better than condoms.

So in a nutshell, the science does prove that this can be a rather effective way of preventing pregnancy - if you use it correctly. However (and that's a big however,) there are obvious drawbacks to this method. The first and most important is that it doesn't provide any form of protection from sexually transmitted infections, so unless you're with a long-term or trusted partner who you're sure is tip top and healthy it's a no-go without additional protection. It also doesn't cover anyone who may experience things like PCOS, Endometriosis or thyroid problems (all of which can interrupt your cycle and also have an impact on body temperature, which the app relies on to be effective,) or even things like stress and sleep which can also have an impact on the way our bodies work. And the elephant in the room: there's still a 7.5% chance you'll get pregnant anyway.

Natural Cycles was approved as a class IIb medical device by Tüv Süd, which means it can be marketed as a hormone-free, non-invasive contraceptive option in Europe - however, there has been much industry-wide concern expressed as to the effectiveness and reliability of such a new method. The sexual health charity FPA, the Faculty of Sexual and Reproductive Health of the Royal College of Obstetricians and Gynaecologists (FSRH) and Dr Cecilia Pyper of the University of Oxford and FertilityUK have all said that apps such as Natural Cycles often have complicated instructions that need to be strictly followed if they are to be effective; they've also stated that being classed as a medical device doesn't guarantee the app will effectively prevent pregnancy. It's also worth noting that the research was conducted by a company that is essentially funded by the app developers, so there may be some kind of conflict there; it can't be ignored that they may want to interpret the data to meet their marketing (and shareholder) needs.

In my opinion this kind of method could work well for those of you with a clean bill of health, a regular cycle, no problems with stress or sleep, the ability to commit to the daily temperature readings - and more importantly, the ability to either abstain from sex or use alternative methods during your red days. It's a good alternative for those of you that don't get on with the pill (it can cause weight gain, mood swings and lack of energy among other things) or don't like the idea of injections or foreign objects being inserted into your body; it's also a great method for those that can't use alternative forms of contraception for religious or medical reasons. However, if you don't fit this profile (and I would imagine it's pretty slim pickings) then it's not necessarily the solution you're looking for.

What concerns me about this brand is that their research could potentially be flawed, so their claims aren't necessarily completely accurate. A red flag was also raised for me when I'd seen they'd been paying for influencer endorsements and not effectively managing the communications that are out there (of all the pieces I've seen, only one mentions the fact Natural Cycles doesn't protect against STIs) or ensuring their message is conveyed in a responsible manner. In the interests of transparency, I was approached to try the device and actively encouraged to "stop using your current form of contraception" without any mention of consulting with a doctor or protecting against STIs; that is simply irresponsible. Having been part of many medical campaigns over the years, I know how many governing bodies and approval processes there are before content can be made live, but in this instance there seems to be no hoops that Natural Cycles have to leap through in order to market their product - especially to so many young women who hang off every word and recommendation from their favourite influencer. It makes me feel uneasy.

I feel really strongly about informed choices and responsible marketing, so I felt strongly inclined to write up my own thoughts and research on a device I would have otherwise left lingering at the back of my office cupboard. Personally I don't feel this is right for me, and as I'm not in a position to deal with an unplanned pregnancy right now it's not a chance I want to take. However, I do see its potential value to those that have exhausted all other options and want a hormone-free contraceptive method. It's all about finding what's right for you and doing as much research as you can in order to be fully informed; when it comes to your sexual health, don't treat is as flippantly as buying the latest foundation launch - because the consequences of a bad choice hang around for a lot longer.

IMPORTANT NOTES TO READ:
1. If you're with a new partner or aren't 100% sure your partner is free from any infections, always use a condom. It's the only way to prevent the transmission of STIs.
2. Before stopping any medication or opting for Natural Cycles as your only form of contraception, always speak with your doctor and discuss your options.
3. If you are considering relying on an app as your birth control method, then ensure you read the instructions fully and follow them to the letter on a daily basis.
4. The research conducted into Natural Cycles could potentially be flawed, biased or inaccurate, so don't believe everything you read or hear without questioning it and adding a sprinkling of common sense.

DISCLAIMER: I was not paid or asked in any way to write this post. I wasn't actually planning on covering the concept until I saw a huge amount of discussion (much without any fact based opinion) on social media; I personally feel like it's always important to have a balanced view point and all the information on the table to make a decision that's right for you. That's what I've tried to achieve here.

You can find out more about Natural Cycles here: www.naturalcycles.com
The service is priced at £39.99 for a year long subscription, alongside the thermometer.

Read up more about what the NHS says about the service, and its drawbacks, here. 

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