Should You Use Charting Apps for Birth Control? (Episode 505)

Full Transcript: Episode 505

Lisa Hendrickson-Jack:

Today I’m sharing another brand new episode in my FAMM research series, and the topic of the day is: should we use charting apps for birth control? So without further ado, let’s go ahead and jump right in.

The topic of charting apps has been a hot one and very interesting since I first started in the field. And I think I have an interesting perspective to share because I started in this field before charting apps were even a thing. When I first started charting my cycle, I was literally creating spreadsheets on Excel and printing them and binding them into a book — which has now morphed into the Fertility Awareness Mastery Charting Workbook.

With that said, I wanted to share just a little bit of an overview about charting apps and how they have evolved since their inception. I also think it’s helpful to know that there are different kinds of apps. If you personally have used charting apps, you have probably noticed that there are apps that are period trackers — apps that are simply designed to help keep track of when your next period is coming. They don’t necessarily contain detailed information or settings that would allow you to note cervical observations or temperature. And then there are fertility awareness apps. For the bulk of today’s episode, we will be focusing on those fertility awareness apps — the ones more specifically designed for cycle tracking in a more detailed sense, and many of which have the potential to actually predict when you’re going to ovulate, when your fertile window is, or when your period is coming.

I use that term “predict” loosely, and we’ll get into that a little bit more. But I think it’s helpful to know the distinction between period trackers and fertility awareness apps, and then between predictive and non-predictive apps. There are also some apps that boast that they are evidence-based — meaning they’re based on specific rules or a specific algorithm developed to improve the efficacy of their predictions — versus other apps that don’t necessarily make those claims.

I’ll start right off the bat by sharing my view of what role I think apps should be playing in your fertility awareness journey. I am from the old school, and I think the most important part of charting for any woman is having a true understanding of what’s going on. I have always been of the opinion that we should learn how to track our cycles — especially if this is something you’re wanting to use for birth control or conception. If you’re planning to rely on fertility awareness for birth control, it’s important to have the foundational information you need to understand how the method works and how to identify your fertile signs. And I think that needs to happen before jumping into apps.

So one of the key questions we need to be asking is: what role should the app play? Should it be a place where you go to enter your data — more of a data entry tool? Or should the app be something you’re relying on more heavily? Should the app be telling you which days to have unprotected sex and which days to use protection? Should the app be the birth control? I think these are really important questions, and the answers are going to differ depending on who you’re talking to. Today we’re going to get into an interesting study that looked at this question and actually evaluated 40 or more charting apps.

I also wanted to go through some of the pros and cons of charting apps. I’ll start with the pros because I do think there are quite a lot. The study notes that the field of women’s health and fertility tracking applications has recently exploded, with nearly 100 apps available to help women track their cycle. The most popular apps have been downloaded over one million times each, and up to 60% of women express interest in using natural or fertility awareness-based methods to prevent pregnancy.

One of the big pros of charting apps is that they have brought fertility awareness charting to a whole new group of women who potentially otherwise wouldn’t have heard about it. Apps are a really great PR agent for raising awareness about fertility awareness and cycle tracking. And even within that, there are pros and cons — you end up with a lot of people who have just a tiny bit of knowledge, just enough to be dangerous, you could say. But overall I think it’s a positive, because with so many women being exposed to fertility awareness through these apps — potentially as their first exposure — it does welcome a whole lot of women into this conversation. Hopefully that means many women don’t have to wait until they’re in their 30s or 40s to discover this method.

Of course, apps are also generally convenient. We can have them on our phones, and who isn’t connected to their phone all the time these days? To have it right there with you makes it really easy to chart your signs, and some apps are incredibly user-friendly — you can really customize them and add in whatever settings you want. Some apps even have community features where you can join groups, have conversations, or share charts. And features like syncing with your thermometer so you can easily amalgamate data without manually entering it every day — there are a lot of really positive, convenient reasons why apps can be great.

But there are some cons I want to put out there. When you’re using an app that predicts your ovulation or tells you when your fertile window is, it can create a lot of confusion — especially if you’ve been charting and you already know that your cycles aren’t always predictable. Sometimes your ovulation will happen earlier or later. And what can happen is that if your app is telling you that you’re supposed to ovulate on a certain day, it can cause you to pay more attention to what the app is telling you than what’s actually happening in your body. For example, if you’re trying to avoid pregnancy and the app tells you you’re not fertile when you really are — that could lead to an unplanned pregnancy.

Another con is that most of these apps create their own algorithms and their own ways of predicting the fertile window. As the study we’re about to get into mentions, we don’t really have a way of knowing if that’s accurate. Many of these apps haven’t gone through peer-reviewed research to verify their efficacy. So if you plan to use an app for birth control, you’d have to do your research and ensure the app at least has some evidence behind it. But even the best apps still have limitations — the app doesn’t know what’s happening in your body today. There will always be a limit as to how effective they can be depending on how they’ve been programmed.

I think another con is that apps can take the place of fertility education. You can have people who think they understand more than they do — a false sense of security, or false confidence in the method, when they haven’t actually learned it properly. And in some ways, tech can cause us to become more dependent on the screen than comfortable with our own bodies — trusting the app more than our observations, paying more attention to the display than what’s actually happening.

But overall, my solution isn’t “don’t use apps.” My solution is that we should be marrying the knowledge of charting with the app. In my ideal world, the app is more of a data entry tool — you learn how to chart and understand the basics first, and then you use the app to enter data. My preference is for apps that don’t have the predictor setting, or that allow you to turn the predictions off, so you can truly use it as a data entry tool and you can be at the helm.

Should we be relying on an app to tell us which days are fertile? I would say no. Especially if you’re planning to use the method for birth control, you really want to get a handle on the rules yourself. If the app glitches or tells you something incorrect, and you don’t have the knowledge, you wouldn’t know. It’s never really a good idea to rely entirely on an app to tell you when to have sex or not without first taking some time to learn from an instructor.

Moving on to the study. This is a study by Dr. Marguerite Duane and colleagues. Dr. Duane has been on the podcast a number of times and she is the founder of FACTS — the Fertility Awareness Collaborative to Teach the Science. The study is called “The Performance of Fertility Awareness-Based Method Apps Marketed to Avoid Pregnancy.” The researchers identified 95 apps through iTunes and Google Play searches and ultimately selected 40 apps. They rated them based on accuracy, whether they were using evidence-based criteria, and a variety of other factors.

Of the 40 apps, 30 predicted the days of fertility for their users and 10 did not. Some apps had disclaimers that they were not to be used for birth control — those were excluded — leaving the researchers with apps that were actively promoting fertile window prediction. They compared the windows generated by these apps to what the window would be based on evidence and guidelines related to fertility awareness-based methods. Although there was a lot of overlap, there was a discrepancy: the apps were saying the fertile window opened later — missing some of those early fertile days — and were also adding extra fertile days outside of the evidence-based window. So the apps were not always right on point.

This is something I know from experience. Although apps may be right a lot of the time, they’re not right 100% of the time. And when it comes to using an app for birth control — even if you’ve been charting for just a few months, you’ll already notice that ovulation doesn’t happen at the same time every cycle. If you’re tracking cervical mucus, you’ll notice some cycles have more days of mucus or less, starting earlier or later. If you’re relying on an app entirely for birth control, the evidence is telling us there is a discrepancy. The apps were not always accurate with their predictions, which is why having the knowledge and understanding of the rules as your primary guide — with the app as secondary — remains a good recommendation.

The researchers concluded in their discussion that the majority of fertility apps are not designed for avoiding pregnancy, nor are they founded on evidence-based fertility awareness-based methods. The study started with about 95 apps, whittled down to 40, and concluded that the majority really aren’t designed specifically for birth control and don’t follow specific evidence-based methods. They also noted that several popular apps use their own algorithms, which are difficult to assess because they have not been evaluated in peer-reviewed literature. It’s modern-day rhythm method. And this has been what I’ve been talking about since I started the podcast — I’m skeptical of relying completely on apps without having the foundational knowledge.

The researchers also note that even if apps don’t predict the days, they may still be useful for experienced users to electronically record their data. Similar to what I’ve been saying — the prediction part isn’t always what users need. Many experienced users just need a place to record what they’re doing, and using it that way makes perfect sense. I’ve heard clients say it’s fun to have the prediction on as a secondary observation — comparing the app’s guess to what’s actually happening. But I’ve also spoken to many clients who look at what the app tells them and get really confused. It told them they were supposed to ovulate earlier, and then they misinterpreted an outlier temperature as ovulation because the app had primed them to expect it. So it’s worth thinking about both sides and where you fall.

The researchers also say that relying on fertility awareness-based method apps may not be sufficient to prevent pregnancy — and that some of the best-looking and most attractive apps aren’t necessarily the most effective. The message from this study is clear: use apps to record your data and take advantage of their features, but educate yourself about fertility awareness-based methods.

So rather than concluding with a recommendation for a specific app, the purpose of this episode was really just to have this conversation. I find it so interesting that when I started the podcast in 2014, there was literally a handful of apps available. Fast forward 10 years and there are hundreds of period tracker apps and hundreds of fertility awareness apps. I do have a few general guidelines for what to look for — whether for yourself or for your clients.

First and foremost, look for an app that is designed for fertility awareness-based methods — one that allows you to track the main fertile signs: cervical mucus, basal body temperature, and cervical position. If you’re instructing clients in a specific fertility awareness-based method, look for an app with the flexibility to chart within that method. The app I currently recommend for my clients is Read Your Body — it was specifically designed for fertility awareness-based methods and has templates and flexibility for any method I’m aware of.

Another feature to look for is the ability to turn off the prediction setting. If an app gives you little stars or notifications about when you’re supposed to be ovulating or fertile, look for one that allows you to turn that off — so you can use it purely as a data entry tool and stay at the helm of your own chart. This is also why I still really like paper charting. When it’s just you and a piece of paper, you have to learn to draw the coverline, identify the shift between pre- and post-ovulatory temperatures, confirm ovulation, and do a crosscheck. Paper forces you to develop those skills. So ideally, the app functions like a substitute for paper — a tool of data entry rather than a decision-maker.

Other helpful features include: the ability to add comments and custom categories, thermometer syncing, the option to record more than one temperature (useful for clients using TempDrop alongside oral temperature), and the flexibility to track whatever signs matter to you — sleep, mucus details, breast tenderness, PMS symptoms, period pain, and so on. And for those of you who prefer paper charting — which is still about 15% of my clients — the Fertility Awareness Mastery Charting Workbook is available in Celsius and Fahrenheit, in coil-bound and paperback formats, and also as an ebook with printable charts. You can find details at fertilityfriday.com/workbook.

The name of the study we looked at today is “The Performance of Fertility Awareness-Based Method Apps Marketed to Avoid Pregnancy.” If you want to have a peek at the study, you’ll find the link over at fertilityfriday.com/505. If you’re enjoying the FAMM research series and want to listen to prior episodes, head to fertilityfriday.com/research for the full list.

I hope you have a wonderful week — and as always, until next time, be well and happy charting.