HONEST THOUGHTS & A FULL REVIEW OF THE INFORMATION AVAILABLE
A year ago today I sat down to research a new ‘contraceptive’ app that had been causing quite the controversy across social media. Natural Cycles was hailed as a hormone-free way to take control of your body, tracking your fertility using your basal temperature each morning and entering data into an app to show you when it was ‘safe’ to have unprotected sex; what was worrying about this new technology and their promotional posts that were starting to flood social media, was that there was very little discussion around the facts or transparency about the data – just ‘this has changed my life’ and a flurry of #ad declarations. Rightly so it started to cause waves and bloggers were called into question over their paid promotions; in the interests of providing a balanced view (and doing the research the majority of influencers failed to before they took money for promoting something so potentially life changing,) I spent the best part of half a day reading medical journals and research before writing up my thoughts.
The my findings are unedited and below, but one year on I wanted to address the increasing concern and negativity that has surrounded the app – and the number of unplanned pregnancies and abortions that have resulted. A recent article in The Guardian, written by a woman who fell pregnant and had an abortion after using the app, positions Natural Cycles in an increasingly worrying light; rather shockingly, “a major Swedish hospital reported that 37 of the 668 women who had sought an abortion there between September and December 2017 were using Natural Cycles as their sole birth control.” That’s 6% of abortions in one hospital over only a few months being directly attributed to this method of contraception; the number of women that were probably too embarrassed to admit they were using the app (as well as those who fell pregnant and chose to keep the baby) would undoubtedly boost this even more.
What I find quite worrying is that one of the main bloggers who was paid to promote the app is now pregnant herself (planned or otherwise is none of my business,) but has failed to even address the fact she was using Natural Cycles as her method of contraception; what’s even more worrying is how this app is being positioned, with the majority of ambassadors being young aspirational women who have audiences that buy into everything they say. A quote from The Guardian says it all: “One paid-for post I saw featured a still life of a puppy, a pair of on-trend headphones, a self-help book and a thermometer, with a 250-word caption starting with “5 things I need in the morning.”‘ How are they allowed to position such a serious product in such a frivolous manner? Why are us bloggers allowed to get away with unethical, verging on misleading and trivializing something as important as fertility and contraception?*
Unsurprisingly the ASA (Advertising Standards Authority) are now investigating Natural Cycles, their claims and their advertising – and not only because their 93% ‘success rate’ is based off users volunteering to share their stories, not clinical data. The Guardian article states that founder Elina Berglund in an interview “…described her ideal user as a woman who is planning to have children at some point, and who would like a break from hormonal contraception before trying. It’s not a good option for women who want to entirely avoid a pregnancy, she said. But somehow this message has got lost in Natural Cycles’ marketing.” I just can’t even.
My thoughts are now pretty black and white: this is not an effective form of contraception, but a tool by which you can plan a family and understand your body a little better. The risks associated with it are too high and the number of unplanned pregnancies make for worrying reading; I understand that other methods (particularly hormones associated with the pill) aren’t right for everyone and there’s an increasing backlash against them, but choosing to have unprotected sex will undoubtedly open you up to biological risks that you don’t need to be a rocket scientist to understand.
I’ll leave you with this quote from The Guardian as a summary of the downsides of this technology, because it’s all it took to convince me of the dangers: “With Natural Cycles, the slightest motion seemed to count. It was comedic until it became tragic; I got pregnant when the predictions of fertile and infertile changed back and forth in one day, turning from green to red, after I had unprotected sex.” Would you chance it? I know I wouldn’t.
(*NB: some influencers have dealt with Natural Cycles in an ethical, informed and transparent manner, but that’s definitely not the norm.)
READ MY ORIGINAL AND UNEDITED ARTICLE BELOW
—– DATED AUGUST 2ND 2017 —–
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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