The acceptability of a mobile application for contraception
ESC Congress Library. Lundberg O. May 11, 2018; 208266
Disclosure(s): EBS and RS are the scientists behind the application Natural Cycles and the founders of the company with stock ownership. OL is employed by NaturalCycles Nordic AB. KGD serves on the medical advisory board of NC, and have received honorarium for participating in advisory boards and/or as giving presentations for matters related to contraception and fertility regulation for MSD/Merck, Bayer AG, Gedeon Richter, Exeltis, Actavis, Ferring, Exelgyn, HRA-Pharma and Mithra.
Dr. Olof Lundberg
Dr. Olof Lundberg
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Abstract
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Objective: To estimate to what extent women with non-standard cycle characteristics are able and willing to use the mobile contraceptive application Natural Cycles, and to compare the contraceptive effectiveness during typical use in such cohorts to that among women with more standard cycle characteristics. Design and methods: This is a prospective observational study based on real-life data from 22,875 users of the Fertility Awareness-Based digital contraceptive application Natural Cycles. This data set was previously examined by Berglund Scherwitzl et al. (Contraception 2017) who found a first-year typical-use Pearl Index of 6.8 pregnancies per 100 woman-years, confirming the results of a 2016 article in the European Journal of Contraception and Reproductive Health Care. In this study the sample was divided into cohorts based on menstrual cycle data. When measuring first-year contraceptive effectiveness we divided the users by self-reported cycle length and variance. To measure the effect of the length and variance of the cycles prospectively entered into the application on the contraceptive effectiveness we compared second-year and second half-year exposure. For each cohort the contraceptive effectiveness was calculated using Kaplan-Meier life-table analysis. The cohorts were compared using log-rank tests and Cox regression. All results were corrected for the confounding of age. Results: We found no significant effect of cycle length on contraceptive effectiveness or on discontinuation rates. We found no significant effect of very irregular menstrual cycles on the contraceptive effectiveness, neither for the self-reported cycle variance nor for the in-app measured cycle variance. We found that discontinuation rates were significantly higher in groups with very irregular cycles (p Conclusions: The presence of highly irregular menstrual cycle lengths has no significant impact on the contraceptive effectiveness of Natural Cycles, but does however have a significant effect on discontinuation rates. These facts are likely both related to the higher rate of fertile days attributed to the user by the application to cover the uncertainty in the prediction of the ovulation day. Health care professionals as well as women choosing a contraceptive method should be aware of this when discussing the pros and cons of using a method like Natural Cycles. The fact that non-standard cycle lengths do not negatively impact the contraceptive effectiveness is also important for women with such cycle characteristics who consider using the Natural Cycles application.
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