Menstruation and Fertility Apps

Why do people use menstruation and fertility apps?

• Varied Uses

• May Change over time

• Primary uses include:

  1. Tracking fertility

  2. Planning a pregnancy

  3. Preventing a pregnancy

Users of Tracking of Fertility

• trying to conceive

• trying not to conceive

Why Track Fertility - trying to conceive

• wanting to get pregnant

• women of reproductive age (range is getting wider)

Why Track fertility - not trying to concieve

• using as a contraception

• for medical reasons

• to learn about cycle

• to understand body

What is tracked using tracking apps?

• cycle length and regularity

• rate of menstruation

• dates of menstruation

• basal body temperature

• cervical mucus

• mood

• ovulation tests

• pain related to ovulation

Is tracking of fertility new?

• Self-tracking of menstraution and pregnancy is not new

• ‘Period-tracking apps’ have been increasing

• Over 200 million downloads (2016)

What does tracking of fertility promote?

• personal choice

• self-knowledge

• patient engagement

Tracking of fertility:

• affordable

• digital-based fertility awareness-based methods

  • a viable alternative for women who don’t use hormonal methods of contraception

What are some motivations for tracking fertility?

1. Observing Cycle

2. To Conceive

3. To inform fertility treatment

4. As a method of contraception

• 72% of app users were observing their cycle only

What are some reasons for tracking fertility?

1. to be aware of their body

2. to understand their body in different phases of the menstrual cycle

3. to be prepared

4. to become pregnant

5. to inform conversations with healthcare providers

Why do reasons for tracking fertility change?

• due to (younger) age

• pregnancy

• menopause

Pregnancy Planning App Categories

1. to support pregnancy planning

2. to support pregnancy prevention

3. to support both 1 and 2

• interrelated, but different goals

• motivation and possibly other user differences due to the goal

What are the 3 pregnancy planning app types?

1. Calendar based

2. Calculothermal

3. Symptothermal

What are some pregnancy planning app important factors?

• precision in being able to determine the fertile window

• significance of the use of app information for sexual behavior of couples trying to conceive (outside app control?)

Is Natural Cycles approved by the FDA?

Yes, NaturalCycles is FDA approved as a contraceptive and has CE certification

What kind of information does NaturalCycles require women to enter?

• basal body temperature

• date of menstruation

What does NaturalCycles use and encourage women to do?

• uses a proprietary algorithm to calculate ovulation and fertility

• women are encouraged to purchase lutenising hormone tests that predict ovulation

What is Daysy classified as in Europe?

• classified in Europe as a Class I medical device

• used to ‘facilitate conception’

What is Daysy based on and treated as?

• based on the principle that the use of apps can increase a person’s focus on their health

• Treated as a type of ‘female contraceptive’

What are some app concerns regarding marketing?

• use of social media influencers

What are some app concerns regarding tracking fatigue?

• too many things to track

• concerans about tracking too many variable

What are some app concerns regarding efficacy and evidence base?

• questions surrounding their evidence base and efficacy —> especially in relation to the risk of unintended pregnancies

What is are some global impacts of these apps?

• exponential growth in low and middle income countries

• wireless is sometimes more prevalent than wired

  • “lead-frogged” wired technology phase

• Tracking of current outbreaks and requests for assistance

What are some app challenges: oversight (FDA/otherwise)

• medical mobile application guidelines

• FSRH/BASHH Standards for Online and Remote Providers of Sexual and Reproductive Health Services (2019) —> most consumers do not know about this regulation and choose apps based on populatiry

What is Mobile Medical Application?

• approval via fhr FDA42 43

• FDA has approved many different types of MMAs for use across different health disparities

What is the only fertility apps to be approved as a contraceptive?

NaturalCycles

Which app is approved as a Class I medical device?

In Europe, DaysyView

What are some challenges regarding accuracy?

• quality

• validity of data

• validity of the algorithms used

What are some challenges regarding lack of evidence?

• positive impact on health

• however some mixed results

• no control in development

• no control in use

What are some challenges regarding affordability?

• not all are free

• free apps have issues