It seems like literally anything can be done with an app these days, including monitoring our health and wellness. Yet while more and more women are turning to apps to help track their cycles and, in turn, using that information as a means of birth control, there are some things every woman should know before relying on technology for something so important. To help better understand, BRIDES spoke with Dr. Colleen Denny, Clinical Assistant Professor, Department of Obstetrics and Gynecology at NYU School of Medicine.
Cycles Can Vary
While you might already know that cycles can vary greatly from woman to woman, they can also vary month to month for each individual, too. Dr. Denny explains, “Many women generally have cycles monthly (anywhere from every three weeks to every five weeks counts as a 'regular' period). But some women may have an occasional irregular cycle, especially in times of stress, weight change, transitioning off hormonal birth control, or for no particular identifiable reason at all. Other women never really have predictable cycles, especially women with PCOS (polycystic ovarian syndrome).” Thus, irregular cycles can make it difficult to identify your ovulation window, regardless of the apps algorithm or tracking process.
Typically, though, ovulation generally occurs around the middle of a cycle, near the halfway point between periods. However, Dr. Denny says this can also be different from woman to woman. "For some women," she explains, "the pre-ovulation phase may last two weeks or more, but in other women it can be several days shorter.”
There are different signs and signals that your body sends while nearing or reaching ovulation, but those can be tricky to spot, and are not the most reliable ways of tracking your cycle. Of these, many women turn to basal body temperature, cervical mucus, and cervical position to try to understand where they are at in their cycle, along with the specific algorithm or formula the desired app uses.
Using an app to track your temperatures is fairly common, and involves the use of a highly sensitive thermometer to take your temperature as soon as you wake up in the morning, as the temp will rise about a day or two after ovulation. “But it's a really small rise—half a degree, on average," says Dr. Denny. "You need a good thermometer. Furthermore, the rise happens after ovulation, so it only helps you know in retrospect, not to plan ahead to avoid pregnancy that cycle.”
More along the lines of “natural family planning,” women tend to monitor cervical mucus, which is the varying discharge your cervix produces at different times in your cycle. It tends to increase around ovulation and is stretchy and clear, like egg whites. "But again, it's subtle," says Dr. Denny. "This means paying attention to your vaginal fluid all month so you can note your particular changes."
Some fertility apps, like the popilar Ovia, also provide a space to track whether your cervix appears to be high, medium or low, soft, medium or hard, and open, medium, or closed. Yet, Dr. Denny contends that this method isn't completely backed up by research. “OB/GYNs, for example, never note the position of a cervix during a routine exam and think, 'Ah, she's ovulating,'” she says, adding that it’s also not an easy task for some women to touch their own cervix. “It's not wrong to try to do it, but it's probably less useful than the other more proven methods,” she says.
More reliable, medical ways of monitoring and identifying ovulation include blood work and ultrasounds, while at-home urine LH kits are also available. Denny explains that LH, the hormone that causes ovulation, shows up in the urine about a day before actual ovulation happens. These kits and test strips are available at most pharmacies over the counter for even more insight in to what your body is doing.
It’s imperative to note, however, that all these signs are easy to use as identifiers to help you get pregnant if you want to get pregnant. But if you’re planning on using these methods as a means to prevent pregnancy, it’s a bit harder. Why? “Sperm can live inside a female partner for up to five days," says Dr. Denny. "Even if you successfully use the signs above to figure out that you're ovulating, you can't take back the sex you had five days ago!”
Using Apps For Natural Family Planning
For women or couples using apps to prevent pregnancy, things can get a bit more murky and difficult. Also known as natural family planning, or fertility awareness, Dr. Denny says this method works best for women who meet the following criteria: have regular, predictable menstrual cycles, are dedicated to tracking their temperature and cervical mucous, and keep careful count of their cycle days from month to month, and have a partner who is equally dedicated to this method. In these situations, Denny says, “When couples use fertility awareness perfectly, pregnancy rates are low: less than 5% a year.”
Yet for the average, imperfect couple using the fertility awareness method (aka relying only an app for birth control), pregnancy rates are much higher. Dr. Denny says, “Out of 100 women using fertility awareness as their only method of birth control, 12 to 24 of them are pregnant within a year."
Denny points out another potential pitfall of relying on apps while practicing perfect fertility awareness: You just might spend a significant portion of the month—perhaps even half of it—not having sex. This might be less than ideal for many couples.
Why? “If you're totally sure of the exact day you're ovulating, you have to avoid unprotected sex for about a week—five days before, to avoid sperm being present, and then one additional day after ovulation, for the egg to leave the body,” says Dr. Denny. If you can only narrow it down to a few days, and not the definitive day that ovulation is most likely occurring, you’ll have to expand the abstinence window even more. “Many fertility awareness guides recommend not having unprotected sex between days 8 and 19 of your cycle,” explains Dr. Denny. Combine this with other times of the month when you feel like avoiding sex (like during your period, even though Denny says it’s safe) you might end up abstinent for half the month.
If preventing pregnancy is your goal, it’s true that the only 100% effective birth control method is abstinence. But, Dr. Denny says, “There are many non-permanent birth control methods that are better than 99% effective, even for the average user. IUDs are probably the best known of these—they come either entirely hormone-free, like the copper Paragard, or with a small amount of progesterone, like the Mirena and its spin-offs. The Nexplanon implant, which sits under the skin of the arm, is also very effective at preventing pregnancy. Other methods like the Depo shot, oral contraceptive pills, the Patch, or the Ring, aren't quite as good for the average user but still better than just condoms alone.”
While Dr. Denny personally doesn’t believe she has seen unintentionally pregnant patients who relied specifically on a fertility awareness app for birth control, she has seen accidental pregnancies in patients who just relied on fertility awareness in general.
It’s imperative to find the best, most reliable method of birth control for you. If you have any questions or concerns, you should schedule a time to see your gynecologist for their best recommendations based on your unique medical history and needs.