Alarm over menstrual tracking apps

Menstrual tracking apps have become all the rage, leading the growing field of “femtech” that claims to help women understand — and regulate — their bodies.

But these apps, which rely on users self-reporting the first day of menstrual flow, may promise more than they deliver — and even be harmful to women. According to GenderSci Lab director Sarah Richardson, Aramont Professor of the History of Science and professor of studies of women, gender, and sexuality, the apps can dangerously mislead women while also exposing them to commercial exploitation and legal concerns.

Richardson has a new analysis in the BMJ (formerly the British Medical Journal) outlining the many risks inherent in these tracking apps and calling for increased scrutiny. In an interview with The FAS Current, edited for length and clarity, Richardson, the BMJ paper’s senior author, raised concerns about health misinformation, data privacy, and reproductive autonomy.

Why has femtech become so popular?

There’s been a lot of interest in developing female-specific interventions in medicine and health. Particularly with the growth of women’s sports, we have seen an intensive focus on the menstrual cycle and the notion that people could tailor their training, their nutrition, and their patterns of activity to their menstrual phases.

Why did you and your co-authors focus on menstrual tracking apps?

There was a strong consensus that something needed to be done about the rise in messaging on social media, in wellness discourse, and in sport, which is an enormous marketplace of information suggesting to women and girls that they should be tracking their menstrual cycle and that they should be tailoring their activities and behaviors to their menstrual phase. We felt that there needed to be a strong expert statement in a major medical journal.

This strikes us as a return to an essentialist idea of women’s capacities, vulnerabilities, health that we thought was of a time that had passed. The reality is that variability across the menstrual cycle has been studied for a long time, and there are no generalizable differences across phases.

Why are these apps appealing to women?

There is a history of women feeling that the medical system wasn’t as sensitive as it should be to hormonal fluctuations. To address this, there’s now an interest in having female-specific processes studied, honored, and heard. In addition, we are in a commercial environment promising optimization, tailoring, and personalization, and this notion that there are specific recommendations for menstrual cycle phases fits with that.

Many of the commercial sites that sell these apps also will sell you a kit of supplements, an online coach, all these things. The promise is quite similar to many of the other trends in medicine, promising optimization through individualized changes to behavior.

You say in the BMJ piece that these apps don’t actually offer useful individualization. Would you explain?

Someone might have a menstrual disorder and need care for that, but these tools would be totally inappropriate for managing or detecting menstrual disorders. They mislead people in the behaviors that might enhance their health or detect menstrual disorders.

What kinds of disorders would these apps miss or misdiagnose?

Take RED-S [relative energy deficiency in sport], formerly known as the female athlete triad, although we now know it affects all genders. A common symptom of RED-S [among women] is that menstruation stops.

But prior to that, RED-S would first be detectable by a shortened luteal phase and being anovulatory — not having ovulation. None of this would be detectable using this digital tool that is primarily based on the first day of bleeding. And there’s no evidence that having a specific regime of nutrition during particular parts of one’s menstrual cycle would eliminate or reduce the risk of RED-S.

We also have an issue here where these apps may encourage people to impute more of their symptoms to menstrual phase than is appropriate and also perform quite a bit of labor and gift a lot of data about their bodies to these systems.

These apps give away data?

These apps are marketed as wellness and medical tools, but there are no protections on the data. Data is often sold, raising concerns for reproductive autonomy and privacy. Menstrual apps are unique compared to other kinds of digital trackers because they can expose reproductive and gender status.

It is possible for there to be misuse of this data. This was deeply scrutinized after the Dobbs decision a couple of years ago with many scholars recommending that people not use these tracking apps, because there had been explicit threats made by regulators to try to access that data for use in criminal prosecution.

Menstrual status can be used to give evidence of reproductive status. If the use of one of these apps exposed somebody as having been pregnant and then no longer being pregnant, for example, that could potentially be, in some jurisdictions, used either to discriminate against them or to implicate them criminally under laws that are meant to restrict abortion.

Is there any positive to menstrual tracking?

Menstrual tracking has often been successfully used for fertility management or for predicting fertile windows for people who are interested in getting pregnant. And menstrual tracking — forget the digital — has been used for ages by women. All you need is a pen and a calendar. Usually people are simply tracking bleeding and the length of their cycle.

What’s unique here is the phase-specific recommendations. For example, some of these apps recommend an extreme restriction on physical activity in two of the phases, and that would lead to a really eclipsing of vigorous exercise for a lot of women were they to follow these suggestions, which are not grounded in evidence.

What do the apps recommend?

Some of them recommend lower-intensity activities like just yoga or walking during the luteal phase. That could be up to 14 days of the cycle.

Another possible harm here is the misdirection of our focus. Should we have all female athletes reporting their menstrual cycle data on digital apps? Or should we make sure there are equal playing opportunities and equally rich coaching opportunities and recovery opportunities and pay and child and family leave and so on? We see the enthusiasm for digital menstrual tracking as a distraction — or as even obscuring that broader social context.

Research described in this story was funded by the Radcliffe Institute for Advanced Study.