Birth Control? Yup, There’s an App for That
Using the old-fashioned rhythm method the new-fashioned way
In high school health class, I remember briefly being told of something called “the rhythm method”. It was quickly dismissed, both by the teacher and in my own mind, as something clearly old-fashioned and unreliable. My Dad grew up in a large Irish Catholic family as one of nine kids — yes nine — and I assumed something like the rhythm method was responsible for a brood of that size.
And so, I never put any real consideration into the rhythm method as a viable birth control option. Instead, I relied on condoms and the birth control pill, and they’ve proven to be overwhelmingly reliable in my experience: alone or together they’ve prevented unwanted pregnancy throughout the entirety of my sexual history.
But I’ve found myself at a point in my life where I’d like to come off of hormonal birth control. There are many reasons for this choice, but the most basic explanation is that I’ve been on the pill for over 10 years and I need to know, for the sake of my own mental health, what my body is like without a daily input of hormones.
I considered the IUD long and hard. I had practically decided on the IUD, then against it, then for it, and then against it again.
And then I read about something else. This new thing. A completely non-hormonal method of birth control that claims to be just as effective as the pill.
Could it be true?
Well, I did some more reading and became convinced the science is sound. Or, at least convinced enough to try it. Maybe I’ll give it a go for six months or so and see how it pans out. I can always go back on the pill if I change my mind.
But I’m going for it. I’m giving up the pill and trying this new, non-hormonal birth control method.
I started by downloading the app.
You may have heard of the “Natural Cycles” app when it was certified as a method of birth control in the EU last year, the first app to receive approval by a European health agency. You may also have heard of Natural Cycles because it was in the news very recently for reportedly being the cause of unwanted pregnancies in Sweden, but I’ll get back to that. Let me first describe how the app is intended to work and why I’ve decided to try it.
How does it work?
The idea behind the traditional rhythm method is that you use a calendar to track your cycle. If you record when you get your period each month, you can then estimate the day on which you ovulate, and thus know the days when you are fertile. This is an inexact science, though. Not all women have regular cycles so determining the exact day of ovulation can be difficult.
This is where some science is helpful. Enter: basal body temperature (BBT).
BBT is the lowest body temperature attained during rest, typically during sleep. Taking your temperature first thing in the morning, as soon as you wake up, is a good measurement of BBT.
The use of BBT for tracking fertility is not a new concept. Women have been doing this for years, mostly for the purposes of trying to get pregnant. A woman’s BBT typically rises between 0.5 and 1 degree when ovulating, and it will usually stay elevated throughout the rest of their cycle.
The Natural Cycles app is essentially a more robust version of the rhythm method. It utilizes BBT tracking along with some other algorithms to chart the user’s cycle, predict when ovulation occurs, and flag days as “green” or “red”. Green days are those where it’s safe, according to the app, to have sex without a condom and not get pregnant. Red days are those close to ovulation, or days where uncertainty is high, where the app advises protection be used to prevent pregnancy.
How effective is it?
If it sounds sketchy to you — and, I’ll admit, it does sound a little sketchy at first — there have been several scientific studies to back up the effectiveness of the BBT method, and the Natural Cycles app. I’ll link to some at the bottom of this story.
Those studies show the efficacy of Natural Cycles is comparable to the pill. According to the Natural Cycles website:
During one year, 5 women out of 1000 get pregnant due to a falsely attributed green day. 7 women out of 100 get pregnant during one year due to all possible reasons (e.g. having intercourse without protection on red days or failure of the contraceptive method used on red days).
That works out to a failure rate of 0.5% with perfect use and 7% with imperfect use, which is, in fact, pretty similar if not better than the pill or condoms.
Will I still need to use condoms?
As with the regular rhythm method, the app needs some time to learn your cycle. Since I’ll be coming off of the pill before starting the app, I expect my cycle to be all out of whack for a couple of months. If there is uncertainty surrounding my cycle, it will give me more red days. In the beginning, I’m sure I will have many red days on which I’ll need to rely on condoms. But, over time, assuming my cycle is regular, I could be down to as few as 10 red days.
(Also — obviously — condoms should always be used if you are concerned about STI protection.)
Why I’m trying it
The combination of a non-hormonal birth control method with high efficacy rates and the science to back it up is what sold me on the app. There are some obvious downsides:
- I’ll still need to use condoms on red days, especially in the first few months, and condoms come with their own set of failure rates.
- I can’t waiver on the condom usage: red days mean condoms or no sex.
- I’ll need to be very dedicated to taking my temperature daily in the manner instructed (first thing in the morning, within a +/- 2-hour range from day to day).
I’m confident I can do these things. It’s probably a little arrogant to assume I’m a “perfect user” but given that I’m already accustomed to taking the pill daily, and I’m really good about habitual things in general, plus the fact that I definitely don’t want to risk getting pregnant, I know I’ll make smart choices on red days.
Another important component here is my partner. I’ve talked about this with my boyfriend, and he’s totally supportive of me trying a different birth control method. He understands the risks too, so we’re in this together.
What about that story about women getting pregnant while using the app?
Well, like I said, I’m being arrogant about this and assuming I’ll be a better user than those women were. That may sound callous, but I also think I’m being honest.
It’s true that a hospital in Stockholm reported 37 out of 668 women seeking abortions since September used Natural Cycles as their primary form of contraception, but there is no evidence or explanation (yet) as to why they got pregnant. If they had unprotected sex on green days and became pregnant, that could be concerning. However, if they became pregnant because they failed to use condoms on red days, because the condoms failed, or because they were improperly recording their BBT, that is not a failure of the app — it’s a failure of the user.
I imagine telling people I’m doing away with all hormonal contraceptives and relying on tracking my cycle using an app probably sounds a little crazy.
However, I’m confident the science behind the app is sound. Every birth control method comes with its own pros and cons, its own benefits and risks. I’ve weighed those things and made a choice that feels right for me at this time. Maybe I’ll love it or maybe I’ll hate it. Maybe it will work out just fine or maybe I’ll end up having to deal with an unplanned pregnancy. That’s always a risk that comes with sex, and I’m very aware of those possibilities.
I’ve begun recording my temperature daily so that I’m in the habit of doing so. I’m on the last week of my final pack of birth control pills and then I’ll be relying on an app for birth control for the next few months.
Yeah, it does sound crazy.
Research articles:
- Scherwitzl et al. 2017. “Perfect-use and typical-use Pearl Index of a contraceptive mobile app.” Contraception, 96(16). DOI:10.1016/j.contraception.2017.08.014
- Scherwitzl et al. 2016. “Fertility awareness-based mobile application for contraception.” The European Journal of Contraception & Reproductive Health Care, 21(3). DOI:10.3109/13625187.2016.1154143
