Substance use disorder: contraceptive options counseling

What’s New in Contraception?

Contraceptive Technology Conference!

Biologic sexism of STIs

Excess breast cancer deaths after COVID-19

Contraception for patients with medical conditions

Pelvic Floor Dysfunction

Treating vulvodynia

Puzzling Over the Hurt Down-Under

Serious Mental Illness and Contraception

New 13-Cycle Vaginal Contraceptive System

The Future of Family Planning in Post-COVID America

New ASCCP Guidelines: Implications for FP

On the alert: mood disorders during 2020 stressors

Sex in the Time of COVID-19

Challenges old and new during the pandemic

Reproductive health in the time of Covid-19

Talking about toys

Missed Pills: The Problem That Hasn’t Gone Away

Find the “yes! . . . and” rather than “no” or “but”

Digital Family Planning: the Future is Now

Irregular Bleeding Due to Contraceptives

When she’s low on libido…

Ouch! Best approaches to menstrual pain

Contraceptive efficacy: understanding how user and method characteristics play their part

Strategizing treatment for chronic heavy menstrual bleeding


Untangling the literature on obesity and contraception

High tech apps for no-tech FABM

Menstrual exacerbation of other medical conditions

From Princeton University: Thomas James Trussell (1949-2018)

The Short and Long of IUD Use Duration

Selecting a Method When Guidance Isn’t Clear-cut

Healthcare in the Time of Digital Expansion

The Scoop on Two New FDA-Approved Contraceptive Methods

Pregnancy of unknown location—meeting the challenge

Big “yes” (with caveats) to CHCs during perimenopause

The role of IUDs (LNG IUDs, too!) in emergency contraception

Combined pills’ effect on mood disorders

Abortion in the U.S.: safe, declining, and under threat

Hope for ovarian cancer screening test

Breast cancer still a small risk with some hormonal contraceptives

New treatment modality for BV

Record rate of HPV-related throat cancer

Viruses in semen potentially transmissible

Don’t Abstain from Your Role in Abstinence

Teens births declining but geographic ‘hotspots’ defy trend

Online Medical Abortion Service Effective and Safe

Do Women Really Need to Wait That Long?

Reassuring news on depression and OC use

PMDD: Genetic clues may lead to improved treatment

Breast cancer risk when there is a family history

Body weight link to breast and endometrial cancers (and 11 others)

Family Planning in 2017 and Beyond

Make Me Cry: Depression Link (Again)?

Managing implant users’ bleeding and spotting

Zika: Updated guidance for providers

Pharmacist-prescribed contraceptives

Hot off the press! 2016 MEC and SPR

Zika virus fears prompt increased request for abortion in nations outlawing abortions

Opioid use epidemic among reproductive-age women

Good news on the family planning home front!

War Against Planned Parenthood Hurts Women

Win-win for both treatment and prevention

Center of the Storm


Menopause, mood, mental acuity, and hormone therapy

Emergency contraception for teens

Postpartum Contraception: Now, Not Later

Reproductive tract infections, sexually transmitted infections, or sexually transmitted diseases: “a rose by any other name…”

Are we practicing what we preach?

Be alert to VTE in hormonal contraceptive users

LARC among teens increased 15-fold, but not enough

Brain cancer and hormonal contraception

Free tools: Easy access to the US Medical Eligibility Criteria for Contraceptive Use

Alcohol consumption when pregnancy is unwanted or unintended

Latest Data on Contraceptive Use in the United States

LateBreaker sampler from Contraceptive Technology conference

Emergency Contraceptive Pill Efficacy and BMI/Body Weight

Handout on Unintended Pregnancy and Contraceptive Choice

Ask About Withdrawal (Really!)

Rules to Practice By: Safety First and Cleanliness is Close to. . .

What’s Vanity Fair Got Against the NuvaRing?

Promising New Treatment for Hepatitis C

Numbers matter, so make them simple for patients

The Recession’s Effect on Unintended Pregnancies

Lessons Learned from the Contraceptive CHOICE Project: The Hull LARC Initiative

Applying the “New” Cervical Cytology Guidelines in Your Practice

Acute Excessive Uterine Bleeding: New Management Strategies

Medical indications for IUD use in teens

Whatever happened to PID?

Update on Emergency Contraception New and Improved

High tech apps for no-tech FABM
March 2019


Over 1,000 smartphone applications are currently available to help people track their menstrual cycles.[1] Most are not appropriate for pregnancy prevention,[2] although the millions of people who have downloaded them do not necessarily understand this.[3] Thus, providers should be prepared to guide their patients in identifying and selecting which apps provide accurate information and are appropriate for their particular needs, advise Contraceptive Technology authors Victoria Jennings and Chelsea Polis.[4]

Some apps facilitate use of an existing FABM (Fertility Awareness Based Method, such as a symptothermal method, the Billings Ovulation Method, or the Standard Days method) by providing a digital platform that serves as an alternative to traditional paper and pencil charts or other tools used to track fertility signs. In order to determine which days are fertile or non-fertile, the person using the app is primarily responsible for interpreting the information they enter into these apps, but those who choose an existing FABM app often find it a convenient tool.

Another category of smartphone apps requires input of information about fertility signs but uses a predictive algorithm embedded within the app itself to determine the fertile time—meaning that the user is not primarily responsible for determining which days are fertile or non-fertile.

One app, Natural Cycles, involves temperature monitoring, with the user entering her basal body temperature into the app daily. Users also enter information about menses and, as an option, urinary hormones. The app stores and analyzes this information over time and provides the user with an assessment of her fertility status. A study found a perfect-use annual probability of pregnancy of approximately 1% and an upper limit (i.e., when participants with unknown pregnancy status were considered pregnant) typical-use probability of 9.8%.[5],[6] The app has been certified in the European Union to be legally sold and used for contraception.

Another app, Dynamic Optimal Timing (Dot) is based on an algorithm developed from a statistical analysis linking cycle length, timing of ovulation, and variable fecundability of the sperm and ovum to identify fertility status.[7] Theoretical efficacy based on this analysis, though not on actual use, is estimated at 1% to 3%. A prospective efficacy study to assess perfect and typical use has been registered and is underway.[8]

Neither of two mini-computers  with predictive algorithms (LadyComp or Daysy) have been assessed through standard prospective effectiveness studies (though some manufacturers do make unsubstantiated claims about effectiveness).

Studies suggest that many people seeking family planning services would be interested in an FABM if it were explained to them appropriately.[9] Fertility awareness-based methods appeal to women who do not wish to use (or cannot use) hormones or devices and are willing to accept a relatively higher contraceptive failure rate.

What do you say to patients who ask about natural family planning? Be aware that the effectiveness rates you quote may be lower than what FABM actually provides. More than 80% of Fertility Awareness-Based methods (FABM) use in recent NSFG surveys is self-reported use of “rhythm.” So these “lumped” estimates of effectiveness may not apply to individual FABMs. Moreover, FABM user instructions—as well as effectiveness—can be enhanced by smartphone apps based upon predictive, embedded algorithms.

Certain conditions that increase the likelihood of irregular cycles may make FABMs more difficult to use, and patients with these conditions require more extensive counseling and follow-up:

  • Recent childbirth
  • Current breastfeeding
  • Recent menarche
  • Anovulatory cycling as with PCOS or obesity-related infrequent cycles
  • Recent discontinuation of hormonal contraceptive methods
  • Approaching menopause


FABMs are also not recommended for persons who are unable to abstain or use other contraceptive methods during the fertile days, for personal, partner, or cultural reasons.

Some couples, providers, and program managers worry that using an FABM will hamper a couple’s sexual life, making the method less acceptable and leading to discontinuation of use. Analysis of intercourse patterns of users of the Standard Days Method and of the TwoDay Method show that people who use these methods have intercourse almost as frequently as do those who use other methods (5.6 and 5.5 coital acts per month, respectively). The pattern differs, however, as the couples who use these two FABMs tend to have sex more frequently during the infertile days before and after the fertile window and avoid sex during their fertile days.[10]

Because unintended pregnancies among couples who use FABMs usually result from having intercourse at the beginning or end of the fertile time, concerns have been raised about the risk of birth defects or poor pregnancy outcomes due to aged ovum or sperm. Research has shown that no such increased risks exist.[11],[12] An exception is that, in one prospective study, women with a history of spontaneous abortion had a greater chance of having another spontaneous abortion when conception occurred very early or late in the fertile time (23% of women with a previous spontaneous abortion compared with 10% to 15% of women who had not experienced a previous spontaneous abortion).10 Providers should reassure any concerned patients that FABMs do not pose a threat to the health of mothers and their children.

A study of about 1,000 births showed no association between the timing of conception and the sex ratio at birth.[13] These results do not substantiate claims that couples can select the sex of their child by timing intercourse.


[1] Moglia ML, Nguyen HV, Chyjek K, Chen KT, Castano PM. Evaluation of smartphone menstrual cycle tracking applications using an adapted APPLICATIONS scoring systems. Obstet Gynecol 2016 Jun;127:1153–1160.

[2] Duane M, Contreras A, Jensen ET, White A. The performance of fertility awareness-based method apps marketed to avoid pregnancy. J Am Board Fam Med 2016;29:508–511.

[3] Simmons RG, Jennings VH, Haile L. Fertility apps: what do women want & need? Presentation at: United States Agency for International Development on App Classification; January 26 2017; Washington, DC.

[4] Jennings V, Polis C. Fertility awareness-based method. In: Hatcher RA, Nelson AL, Trussell J, Cwiak C, Cason P, Policar MS, Edelman A, Aiken ARA, Marrazzo J, Kowal D, eds. Contraceptive technology. 21st ed. New York, NY: Ayer Company Publishers, Inc., 2018.

[5] Berglund SE, Gemzell DK, Sellberg JA, Scherwitzl R. Fertility awareness-based mobile application for contraception. Eur J Contracept Reprod Health Care 2016 Jun;21:234–241.

[6] Berglund Scherwitzl E, Lundberg O, Kopp Kallner H, Trussell J, Scherwitzl R. Perfect-use and typical-use Pearl Index of a contraceptive mobile app. Contraception 2017;96:420–425

[7] Li D, Heyer L, Jennings VH, Smith CA, Dunson DB. Personalised estimation of a woman’s most fertile days. Eur J Contracept Reprod Health Care 2016;21:323–328.

[8] Simmons R, Shattuck D, Jennings V. Assessing the efficacy of an app-based method of family planning: the Dot Study protocol. JMITResearch Protocol, January 2017; 6(10)e5.

[9] Leonard CJ, Chavira W, Coonrod DV, Hart KW, Bay RC. Survey of attitudes regarding natural family planning in an urban Hispanic population. Contraception 2006; 74:313–331.

[10] Stanford JB, Thurman PB, Lemaire JC. Physicians’ knowledge and practices regarding natural family planning. Obstet Gynecol 1999;94:672–678.

[11] Gray RH, Simpson JL, Kambic RT, Queenan JT, Mena P, Perez A, Barbato M. Timing of conception and the risk of spontaneous abortion among pregnancies occurring during use of natural family planning. Am J Obstet Gynecol 1995;172:1567–1572.

[12] Simpson JL, Gray R, Perez A, et al. Fertilization involving aging gametes, major birth defects and Down’s syndrome. Lancet 2002; 359:1670–1671.

[13] Gray RH, Simpson JL, Bitto AC, Queenan JT, Chuanjun L. Sex ratio associated in timing of insemination and length of the follicular phase in planned and unplanned pregnancies during use of NFP. Hum Reprod 1998;13:1397–1400.