Reproductive health tech is going through some growing pains. On the one hand, there’s been a lot of progress now that menstruation—and all it entails—isn’t quite so taboo. For instance, there’s now a wearable that’s conducting clinical studies about how various factors could lead to more accurate fertile window predictions. But there’s also been some troubling developments. Recently, a popular pregnancy tracking app was found handing private data to employers, and another fertility app was found to be funded by anti-abortion groups. At this year's WWDC, Apple threw its hat into the ring by expanding its period tracking options via a new Cycles Tracking feature on the Apple Watch and iPhone. None of it was revolutionary per se, but there’s reason to believe that Apple might be the company that gets it right.
Apple didn’t go into detail about all of the Cycle Tracking feature’s functionality, but from what we know so far, it seems like it would at least be on par with a basic period tracking app. In its watchOS 6 press release and onstage demo, Apple says you’ll be able to log “important information” on menstrual cycles and alerts for your next period. You can also opt into notifications about fertile windows—though, the release is quick to note the feature should not be used as a contraceptive method. And unlike the current set up in the Health app, the Cycle Tracking app will let you log your flow and symptoms. That’s on top of results from ovulation prediction kits and the vaguer “other elements of fertility tracking” the release alludes to. Importantly, it’s not limited to the Apple Watch. Since it’ll be integrated into the Health app, every iPhone user will get the option.
All this has me cautiously optimistic that Apple could be taking real strides toward the period tracking app we deserve—if it can avoid the pitfalls that have made it hard to create the ultimate period app in the first place.
First off, Apple deserves kudos for natively building period tracking into its phones. Right now, anyone who wants to track their menstrual health or try fertility-based awareness methods to conceive has to download a third-party app. Depending on the level of detail and supposed accuracy you want, that can involve paying extra fees and doing lots of independent research. And that’s if you find an app you like right off the bat. I’ve tried no fewer than ten period tracking apps, and none has had everything I’ve wanted. You only need to take a look at this forum of angry Samsung customers to see people really want this feature. Google and other Android smartphone makers should take note.
Of course, the success of Apple’s approach would depend on the underlying science. There’s a reason it took Fitbit until 2018 to introduce period tracking, and Garmin until just a few weeks ago. Smartwatches collect a wealth of data, and while medically speaking, wearables are an intriguing way to learn more about how your entire lifestyle might impact your cycle, aspects of reproductive health tracking can be risky.
Remember: Apple included a footnote about how its Cycles Tracking feature should not be used as a contraceptive. Even if you think you know better, there can be fuzzy logic when tech companies tout a “high degree of accuracy.” It can be easy to fall into the trap of thinking, “The Apple Watch/Fitbit/Garmin is accurate, their algorithms are accurate, it’s based on my data, so this fertile window prediction should be pretty accurate too.”
Nope, nope, and nope. First off, these devices are accurate at tracking heart rate and activity, but it’s not yet clear all the ways your heart rate and your cycle may be linked. The same goes for their algorithms. Right now, there’s not enough information to tell if Cycles Tracking’s predictive algorithms are based on proper medical literature or on a generic understanding of period tracking. From what I can glean, this app in its first iteration will be mostly for awareness—but even awareness needs to be based on a solid medical foundation. If that seems like a “duh, of course,” thing, you should know that this Columbia University Medical Center study in 2016 found only 20 free apps out of over 1,000 surveyed in the App Store were found to be accurate—and of those 20, only five percent consulted medical literature. (One of the study’s authors told me the situation has improved since 2016, but not by much.)
I reached out to Apple to learn more about how its Cycles Tracking app will make its predictions regarding your next period and fertile window, but the company hasn’t provided more details for publication. That said, assuming Apple takes the same level of care it did with heart health in building its ECG feature—as in being cautious, careful, and consulting medical professionals and organisations—I could see this as a gateway to greater things. It was encouraging to see Apple take part in clinical research about atrial fibrillation and then turn that into a feature that could potentially help an at-risk population receive warnings. Given the opportunities here, it would be disappointing if Apple is only repackaging basic period tracking when it could help a wide variety of women who might suffer from reproductive health issues or irregularities.
But here’s another reason why Apple’s cycle tracking could be a good thing. Apple has one thing up its sleeve that many of its competitors lack: It does not mess around when it comes to privacy and security.
Both onstage and in its release, Apple made a point of clarifying that all health data, including reproductive health data, is encrypted on-device. If a user opts for iCloud backup, that data is encrypted in iCloud. Plus, Apple is adamant it’s not selling data to third parties.
It’s probably safe to say you’re not likely to hear about a privacy breach from Apple’s Cycles Tracking. After all, Apple has a history of putting privacy front and centre of its many services.
For something as personal as your period, this is surprisingly not universally true. Period apps often track a wide swath of data that any reasonable person may not want employers, marketers, or app developers to know. That includes your mood, how much you’re bleeding, what birth control you use, the quality of your cervical mucus, details surrounding your last sexual encounter, and how frequently you have sex. As you might imagine, it’s a data goldmine that could potentially be misused in myriad ways. Some free period apps make up the cost by selling the data they collect to third-parties. That’s something you don’t have to worry about from Apple.
Alone, Apple announcing a period tracking app wouldn’t get me jazzed. However, the combination of its dedication to privacy, history of partaking in clinical research, and building this app natively into its phone collectively give me cautious hope that we could see something truly useful from Apple in the future.
Featured image: Screenshot: Andrew Liszewski (Gizmodo)