I was 17 a when I started taking the Pill. The brand my doctor in the UK prescribed is named Cilest – little blue pills in a friendly looking pink packet – and I’ve been taking them ever since with no serious side effects. But I do have mood swings, and now, aged 33, my breasts have been getting increasingly tender and my libido has gone into free fall.
I’ve begun to wonder if the hormones I’ve been swallowing for 14 years have anything to do with it. Would I, and the 758 million* women who currently take the Pill worldwide, be better off trying something else?
So, for the past few months, I’ve been testing something very different indeed: an app. It might sound improbable – and more than a little risky – but Natural Cycles has an excellent pedigree. Created by Dr Elina Berglund, 32, a physicist who was part of the team that found the Higgs boson at Cern in Switzerland, and her husband Dr Raoul Scherwitzl, a postdoctoral researcher, it was launched at the end of 2013 and now has 150,000 users around the world.
And little wonder. The app has just been granted medical approval, from certification body Tuv Sud, to be used as a contraceptive in the European Union. It is the first time that such technology has been classified as being effective in preventing pregnancy and a breakthrough that could spell the end for hormonal and intrusive birth control measures. Last year, research by the Karolinska Institute, one of Sweden’s most renowned medical institutes found the app is as effective as the contraceptive pill at preventing pregnancy, without any of the side effects.
In 2015 a campaign called Take Back Birth Control was launched in the UK, aiming to empower women to choose the best type of contraception for them – not just what’s offered first by the doctor or what a friend recommends. In association with the British Pregnancy Advisory Service, the survey asked 1,000 women aged between 16 and 45 about their contraception choices, and, the results showed I wasn’t alone in my concerns. More than a quarter of women said that they feel “worried or nervous” about the hormonal contraception they’re taking and “don’t know what it is doing to my body.” About a third said they think women are expected to “put up with” the side-effects of hormonal contraception and that they would prefer not to use it.
There is no question that the Pill, which celebrated its 55th birthday in March 2016, liberated women and revolutionised how we think about sex. If taken correctly it is more than 99 per cent effective (although, in real-world terms, it works about 92 per cent of the time) and, contrary to a widely held belief, can be taken safely up to the age of 50 provided there are no other risk factors such as smoking or high blood pressure. There is some evidence that it may reduce the risk of some cancers, heart disease and stroke.
But there are also well-documented physical side-effects – which differ for every brand of the Pill and for every woman, and can include weight gain, nausea, breast tenderness, increased blood pressure and, in rare cases, blood clots such as deep-vein thrombosis. Some studies have also shown a link with emotional issues, including depression and loss of sex drive.
I had been considering changing to one of the 14 other types of contraception, from the coil to the diaphragm, when I read about Natural Cycles, a natural family-planning (NFP) method that works by calculating where you are in your cycle through the temperature readings you input. It then tells you whether or not you could get pregnant on that day. Berglund originally created it for her own use, having realised there was nothing very sophisticated on the market (most available apps, such as Clue, are basically period trackers).
She wrote the algorithm and recruited female colleagues at Cern to test it before launching it as an app that can be used to prevent or try for pregnancy: 70 per cent of its users are in the former camp.
Natural Cycles, which costs around Dh230 a year, is incredibly easy to use: you take your temperature each morning and log it in the app. The science behind it is simple: post-ovulation, progesterone warms our bodies by up to 0.45°C. The app’s calendar labels fertile days red (when you should abstain or use a condom) and the rest green, when you’re “safe”. To begin with, I am told my red days will almost match the number of green, but these will lessen as I feed the app more data, and after a few months I should have only eight red days each month. The app, I’m reassured, won’t assign a day “red” or “green”, unless it is 99.95 per cent certain. If in doubt, it goes red.
But could it really be that easy – or accurate? After all, it is one thing to use an app to assist you in getting pregnant, but if you are trying to prevent that from happening, the app failing carries great consequences.
Natural Cycles isn’t the first of its kind; the Daysy monitor works in a similar way, claiming 99.3 per cent accuracy and costing around Dh1,400, while the hand-held monitor Persona only promises that it will work if your cycle is between 23 and 35 days and can’t be used during menopause.
Berglund’s app can be used by anyone; if your periods are erratic or you have polycystic ovary syndrome, you will just end up with more red days. Last summer, Berglund told me that since its launch, only one woman had become pregnant on a green, or supposedly safe, day. Even she was surprised. “I expected there to be slightly more.”
Despite all the reassurances, when I start using it, I can’t quite bring myself to trust it, and use condoms no matter what my traffic light indicator says. My paranoia may, however, be fuelled by an onslaught of physical symptoms that come after stopping the Pill. For the first week, I have a headache that proves resistant to every painkiller and very nearly drives me back into the arms of Cilest. Then come the cramps that I haven’t had since I was a teenager. Now, a few months in, I am more or less back to normal and my breasts are less painful.
I ask Anne MacGregor, a professor specialising in sexual and reproductive healthcare at Barts Sexual Health Centre, whether she considers it advisable to use the app. “I have nothing against this sort of app for people who are interested in Natural Family Planning (NFP),” she says. “But given that sperm can survive in the womb for up to seven days, sex without condoms during the first stage [before ovulation] can be risky, as you can’t predict that you are going to ovulate on the same day of the cycle every month. If you happen to ovulate early, it’s too late to do anything about the sex you’ve already had. As with all NFP, I recommend that barrier methods are used until a few days after ovulation has been confirmed.”
Berglund counters that her algorithm takes into account ovulation-day irregularity, sperm survival in the body, recent use of hormonal contraception and temperature fluctuations (when the app considers my temperature readings to be too up-and-down, it prompts me to make sure I’m taking it as soon as I wake up and am entering accurate data). Together, she says, these account for its greater accuracy compared to the competition. And it is initially very cautious; frankly,I could have used more green days.
“Many pregnant women keep taking their temperature to monitor their hormone levels, so anything unusual will be flagged up,” Berglund says. “One woman went to the midwife after taking an unusual reading and was told she would have lost her baby if she hadn’t. The midwife didn’t believe she’d got the information from an app.” She also tells me about a woman who used Natural Cycles to track how her new coil was affecting her cycle and was annoyed when the app kept telling her she was pregnant. You’ve guessed it: she was.
Berglund herself is perhaps her app’s biggest success story; having used it as a contraceptive for 18 months before deciding to try for a baby, she got pregnant on her first red day. “That’s the really revolutionary part,” she explains. “You can use the app over your reproductive lifetime. When you want to get pregnant, the data accumulated during the time spent on [using the app for] contraception can be used to pinpoint your most fertile days.”
As for me? A few months in, I’ve pretty much mastered the morning routine of taking my temperature. But one of the best – and entirely unexpected – side effects is that I feel better informed about my own body, something that 70 per cent of Natural Cycles users agreed with in a 2014 survey. The same survey also found that three quarters of users felt happier overall.
Somehow I also feel liberated, as though I’m finally in control of my body. So, for now at least, I am sticking. And soon I’ll find out whether any bad moods or uncontrollable crying can be blamed on hormones – or my personality.
See Naturalcycles.com to sign up to the app and receive your thermometer. Orders ship to the UAE within seven to 10 days.
*United Nations, Department of Economic and Social Affairs, (2015). Trends in Contraceptive Use Worldwide 2015
Photos by Shutterstock. Text my Jemma Blundell/The Telegraph Group LTD, London 2017