They are among the most popular women’s health monitoring technologies in “rich” countries and are gaining acclaim around the world. What are the pros and cons
They have been hailed as “revolutionaries”. As part of a “Femtech” sector Fast growing, apps that help identify the fertile window are among the most popular women’s health monitoring technologies in high-income countries and are gaining acclaim around the world. A couple of these have also been licensed by the US Food and Drug for use as contraceptives. However, there is no lack of concerns regarding data privacy, the fact that some are paid and their reliability. So let’s try to understand this phenomenon better, with the help of the teacher Rossella Nappi, full professor of Obstetrics and Gynecology Clinic, University of Pavia, and head of Uosd Obstetrics and Gynecology-Pma of the Irccs Policlinico S. Matteo di Pavia.
What are contraception apps?
«An instrument in step with the times that follows in a contemporary key a woman’s desire to control her fertility in a natural way, without the use of drugs, be they pills, vaginal rings, patches, subcutaneous implants, intrauterine spirals. The use of contraception apps it can be combined with barrier methods (condoms) and interrupted coitus, representing in fact an evolution of the so-called natural methods that women use to calculate their fertility window in full autonomy, without having to discuss with the doctor and / or the midwife ».
What calculation methods do they use?
«Depending on the type of app automatic calculation of fertile days it can be based on a number of factors. First of all on the estimate of the moment of ovulation which is obtained by entering the dates of menstruation over the months. How many more months fit e the more punctual the menstruation appears, every 28 days if super regular, the more the ovulation estimate, that is the moment in which the egg cell emerges from the ovary to make its way to the tube, it can be precise around the 14th day of the cycle. However, we must remember that the fertile window is always the fruit ofcrossing between the duration of the egg cell viability, which is about 24 hours, and the ability of the sperm to survive in the internal genital tracts of the woman during their march towards the tuba to meet the egg. The viability of spermatozoa is highly variable from man to man and over the course of life because it is affected by many environmental factors and psycho-physical stress and can reach 5 days. The fertility window can therefore be very large, around 6 days, and become even more so if the woman’s cycle is not perfectly regular, since the release of the egg can occur early or late on the schedule based on age, diet, physical exercise, lifestyle, psycho-physical stress, and this variation is not always predictable during a woman’s reproductive life, especially in adolescence, breastfeeding and premenopause.
Digital thermometers and mucus observation
“To the calendar-based ovulation estimate, the most advanced apps associate the use of a thermometer to measure the basal temperature, i.e. internal to the body that is detected in the morning upon awakening, or also the observation of cervical mucus, that substance that generally comes out of the cervix which is palpable inside the vagina like a ball with a small hole in the middle from which a fluid substance such as egg white comes out. Cervical mucus is the expression of the action of estrogen hormones and indicates that the woman’s body is ready for ovulation. Its fluidity in fact favors the passage of spermatozoa which, deposited in the vagina during sexual intercourse, have an easy game in going up the genital tract and heading towards the tube where the egg waits to be fertilized. Finally, data deriving from urinary determination can be provided to the app by means of a stick similar to what women use to do home pregnancy tests, of hormonal substances that indicate when the time of ovulation will arrive. More and more complex mathematical algorithms depending on the factors taken into consideration, they quickly provide the woman with a response via the “day yes and no day” app, that is, fertile day and non-fertile day ».
What are the differences from “traditional” methods?
“Based on the so-called expert (or artificial) intelligence theoretically, apps should be more precise than so-called natural methods, that is of those methods that the woman uses by marking the dates of the cycle on the calendar, observing the mucus and palpating the cervix, or measuring the basal temperature daily, and which are based only on her judgment ».
How reliable can these apps be?
“These methods they are always to be considered less reliable than hormonal contraception, especially in the long term (implants, spirals) which is not affected by the woman’s ability to remember the daily (pill), weekly (patch), monthly (ring) intake, and which depends on the medical intervention placing contraceptive devices lasting 3 or 5 years”.
What are the risks?
«They are natural methods and therefore there are no health risks, but the woman must take into account the lower efficacy compared to other methods of contraception because a certain possibility of failure exists and varies according to the case studies studied. Therefore the woman who uses them must be aware that pregnancy could occur, wondering how much it would be willing to accept it, a bit like natural methods which, however, are at no cost ».
Do you recommend them to your patients?
“Really It is important to discuss the contraception plan with your doctor which should always have advantages and disadvantages of each contraceptive method following the so-called biopsychosocial model: understand the medical profile of the woman in front of you, but also her desires, needs and fears, taking into consideration the period of reproductive life and the willingness or not to accept a pregnancy even if not planned. Apps can enrich the offer of natural methods and combine very well with the use of condoms, perhaps in those women who cannot use other methods for medical reasons or have had significant side effects related to their use. The important thing is to be aware of the limitations of natural methods, even if supported by apps, especially in the presence of an irregular cycle, avoiding the “do it yourself” because dialogue with the gynecologist must remain a fundamental pillar of prevention in terms of women’s health “.
September 10, 2021 (change September 10, 2021 | 21:15)
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