New technology supports age-old issues with menstruation

It's never been easier to track your monthly cycle, thanks to the development of interactive apps. But do they make a difference? Mary Cate Smith investigates

The digital era has democratised knowledge, ensuring that information on health is never more than a click away. The femtech industry is booming and period trackers aren’t just for family planning anymore. The right app can arm you with the information you need to develop a better relationship with your body.

Founder of period-tracking-cum-wellness app Moody Month Amy Thomson wants to reclaim the idea that “being moody is what makes us human”.

There has to be another way to track our cycles, says Thomson, whose new book Moody: A Woman’s 21st-Century Hormone Guide (Square Peg) was released this month. Thomson investigates the ovulation cycle from the perspective of gynaecologists, endocrinologists, cognitive neuroscientists, fitness experts and nutritionists.

Non-hormonal interventions, such as simple lifestyle changes can be just as effective at managing symptoms as their counterparts, she says. Learning how to tackle stress, eating a balanced diet with plenty of protein and fatty acids and regular exercise are just some of the ways we can regulate our hormones.

“As soon as you start to understand the correlation between your emotional and physical changes and your hormone cycle, you actually have this superpower to prepare and be better aware of the changes that happen. They can be triggered by sleep deprivation, metabolism or even thyroid [issues]. Understanding your negative emotions as much as you understand your positive emotions is how we become more emotionally literate.”

Understanding your cycle

Thomson’s interest connected her with Irish data engineer, Ciara Ferguson. Having studied extensively on the subject of hormones, the pair set about creating a data-driven app. Not just a period tracker, Moody Month offers solutions to help women alleviate hormone-related moods and symptoms. Like a virtual diary, it allows you to log energy levels, cravings, sex drive and emotional responses to your environment.

“Women’s health has really been ignored,” says Thomson. “The whole wellness industry was designed around a 24-hour cycle, which is actually a male cycle.”

In-depth research by endocrinologists has proven that men’s hormones fluctuate on a daily basis in what some call “man-struation”. Men produce oestrogen and progesterone in far smaller quantities than women and testosterone is the over-arching hormone present. Testosterone spikes in the morning, mellows out in the afternoon and dips in the evening.

Through automation and AI, Thomson and Ferguson recognised the ability to personalise the experience for users of the Moody Month app. The merger of the book and the app is almost like “a bible of how your body works,” according to Thomson.

As well as containing a wealth of medical information, Moody Month seeks to quash the taboo surrounding conversations on women’s periods. As someone who avidly follows developments in the wellness industry, Thomson’s book is a comprehensive, cheerful guide to a subject that so often carries a stigma with it. The insights shared in this book provided a blueprint for me to connect my hormonal health to my lifestyle habits and harness this knowledge to adapt my daily routine. (Moody Month is currently available for iPhone and enters the Android sphere this April.)

Getting pregnant

Doctor Maebh Horan is a clinical researcher with a special interest in fertility preservation and endometriosis at the Merrion Fertility Clinic in Dublin. The starting point for any woman trying to get pregnant is to keep a menstrual diary, says Horan and smart technology is making it easier to keep track.

“There’s about five days in your cycle where you can get pregnant. That’s where I find apps really helpful. It gives you a fertile window. Logging other details like whether you’re having a heavier or a lighter bleed, temperature changes and differences in discharge – the app prompts you to check in on these symptoms.”

Hormones affect us in many ways, says Horan, from pain to PMS and mood changes. Medical interventions like mood stabilisers, anti-depressants and hormone replacement therapy (for perimenopausal and menopausal women) can help to restore the balance.

“Mood changes are progesterone linked,” she says. “Breast tenderness, skin changes, bloating – they’re all progesterone-dominant.”

To counteract these effects, Horan recommends trying the oestrogen-dominant or combined pill.

Before turning to hormonal interventions, she suggests figuring out your own cycle and logging your symptoms. This can allow you to see patterns emerging which can then be discussed and analysed by your doctor or gynaecologist.

“A diagnosis requires three months of history. Oftentimes, with endometriosis, the symptoms are nonspecific so anything that’s documented could be helpful.”

Apps are particularly helpful for women who are trying to understand their cycle, says Horan. “Any woman should have a menstrual diary if they’re worried about their period. In fertility, it’s about having sex at the right time, it’s about trying to figure out your own body.”

“I was all over the place”

Shanoife Richards from Tramore, photographed in Waterford. Photo; Mary Browne

Shanoife Richards is 28 years old and lives in Tramore, Co Waterford. She began tracking her periods with the iPhone Health app aged 18 but stopped when she was prescribed the pill. The majority of Richards peers were on the pill and there was a tacit understanding that it was “the thing to do”.

After some trial and error, her doctor prescribed the progesterone-only pill. Containing less hormones than the combined pill, it reduces a woman’s chance of developing blood clots, migraines and high blood pressure.

“It’s not one pill fits all,” says Richards. “I was all over the place. Happy one minute, crying the next. I had to take the mini pill because the combined pill would spike my blood pressure and make me hypertensive.”

However, after almost a decade of experiencing breast pain, mood swings and other symptoms, she decided to discontinue her oral contraceptive. Richards has been using Cycle Tracking, the inbuilt system in the iPhone that syncs up to other devices including her Apple watch. The app predicts the date of her period “to a tee,” along with her ovulation window. It’s largely an “informational” app, she says as it doesn’t recommend ways to alleviate symptoms such as bloating or breast tenderness.

Keen to move on to a new app that is more than just a period tracker, Richards is drawn to Natural Cycles which has consistently been mentioned as one of the most effective natural birth control methods out there.

Natural Cycles comes with a thermometer and measures basal body temperature in conjunction with logged menstruation data to analyse changes in a woman’s hormones. Tracking our menstrual habits isn’t enough to give an overall view of our cycle, according to Natural Cycles CEO Elina Berglund. We need to be logging our temperatures changes in conjunction with our sleep, exercise and dietary patterns.

Does logging such personal information ever worry Richards? It depends on the app, she says.

“Every woman has a period. It wouldn’t bother me unless it got leaked on the internet. As long as it had a proper privacy and security system and you could lock the app.”

I only ask because the app I had been using was recently embroiled in a data mining controversy. The US Federal Trade Commission alleged Flo shared users’ intimate data with third-party companies, including Facebook and Google, without users’ knowledge or consent. Flo settled the complaint, and denied wrongdoing. Questions were also raised about the ethics of monetising a period health app with some suggesting this sort of information should be available to all women.

For those who are struggling to buy basic sanitary products, period trackers can seem like a luxury. A recent government report showed that some 85,000 women and girls are in the high-risk bracket, lacking proper access to sanitary towels and tampons, washing and waste management facilities, and education.

Family history

With a strong history of breast cancer in my DNA, I felt it was imperative for me to come off the contraceptive pill. One of the largest ever epidemiologic studies of women’s health (published in Cancer Research, 2014) found that using oral contraceptives can increase your chances of developing breast cancer by 24%. I discussed options with my doctor and decided against hormonal interventions.

Knowing when I’m getting my period and how it will affect me empowers me to take charge of my own hormonal health. Of the apps I downloaded, Moody Month and Clue were the most suited to my age and preferences. Not only have I been accurately able to predict the date of my cycle, I have also gained a deeper insight into my physiology. Using these apps has helped me understand the way my body works and that in itself, is revolutionary.

Contraception concern

If an unplanned pregnancy would be “a significant crisis in your life, relying on period trackers isn’t a good idea because ovulation does not always happen at the expected time in a cycle,” says Dr Caitriona Henchion, Irish Family Planning Association medical director.

“The most reliable and effective way of avoiding pregnancy is to use a long-acting reversible method (LARC). These include both hormonal methods and the nonhormonal copper coil.”

The right fit

Finding the app that’s right for you will help support your emotional and physical wellbeing. MySysters caters for women in mid-life and is specifically designed to support those with irregular cycles and perimenopausal symptoms such as hot flushes.

Balance is another app primarily aimed at menopausal women. Designed by a doctor, it offers evidence-based advice on pain and mood management, nutrition, exercise and mental wellbeing.

London-based Esther Goldsmith works as a sports scientist and physiologist with the FitrWoman app. Developed by Irish sports and science data company, the app Orreco helps female athletes to optimise their health in harmony with their menstrual cycles.

“We use the app to disseminate scientific evidence into bite-sized nuggets of physiology, nutrition and potential considerations around exercise for each different stage of the menstrual cycle,” says Goldsmith.

Hoping to bridge the gap between elite athletes and women who love to run as a pastime, Goldsmith is eager to empower women of all abilities. “It’s our belief that every menstruating person should have the information and the tools available to them.”

Any woman who is concerned about her period should have a menstrual diary of her symptoms, says Dr Maebh Horan. “It’s about being in tune with your body.”

The top five apps depending on your stage in life

Moody Month: Best for understanding your emotional health

Offering a comprehensive amount of expert knowledge, Moody Month provides the information and the tools to better understand your physical and mental health in relation to your menstrual cycle.

Cost:  €3.99 per month or €35.99 for an annual subscription

Clue: Best for transgender/non-binary people

This inclusive app offers extensive information about how hormone medications can affect your health without gendering the results.

Cost: Free, with in-app purchases. For Clue Plus, pay 99c per month or €39.99 for 12 months.

MySysters: Best for menopausal women

Not just centred on self-care, this app has online communities of women experiencing perimenopausal or menopausal symptoms from their 30s to 60s.

Cost: Free for the basic package, €9.99 for a yearly premium subscription.

Natural Cycles: Best for birth control

Using a thermometer to record body temperature, this app predicts ovulation to a 93% accuracy rate.

Cost: Free demo for the first month, €51.99 yearly fee thereafter with a free thermometer.

Glow: Best for those trying to conceive

Don’t be fooled by the cartoon-like interface, this app actually offers in-depth insights that help bolster your chances of getting pregnant.

Cost: Free, with in-app purchases. €52.99 for the 'ovulation tracker' package, Glow Premium Lifetime, €32.99 with 70% off.