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APP REVIEWS

Menstrual Cycle Tracking

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Dr. Farahnaz Daya
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As clinicians, we have all had the experience of walking into an exam room when the only note on the chart reads “women’s issue”. At that moment, a whole catalogue of potential diagnoses runs through our minds and the most valuable tool in our armament is a detailed history. We turn to our patient, see the worry on her face and begin to ask questions about an inherently personal topic: her menstruation. The ACOG recommends using the menstrual cycle – frequency, duration and volume of blood loss – as a vital sign (1). But more often than not, our patient is unable to give a detailed menstrual history and this limits our ability to narrow our list of differential diagnoses. So we consider offering some tests and we hand our patient a paper period diary, asking her to return.

Wouldn’t it be great if our patient could easily and accurately track her periods and bring this data to her appointment? Enter the era of smartphone menstrual tracking apps. Period tracking apps are incredibly popular, ranking fourth among health apps (3). But while there are thousands of them out there, the majority of these apps inaccurately calculate cycle length averages and are not evidence-based or developed with a medical expert (4). In addition, many of these apps focus on fertility and ovulation prediction functions, often marketing themselves for avoidance or achievement of pregnancy. However, this has been shown to be ineffective and may increase the chance of unintended pregnancy (5).

This review takes a systematic look at some of the top contenders to give you an edge when recommending menstrual cycle tracking apps.

Apps Reviewed

Glow
4 stars4 stars4 stars4 stars4 stars
Clue
3.5 stars3.5 stars3.5 stars3.5 stars3.5 stars
Period Tracker Lite
2 stars2 stars2 stars2 stars2 stars
Pink Pad Period and Fertility Tracker
2 stars2 stars2 stars2 stars2 stars

Period Tracker Lite

2 stars2 stars2 stars2 stars2 stars

This app, targeted to younger patients, is the simplest menstrual tracking app of the group. It is easy to use with one-click recording of menstrual cycle start and stop dates and it produces simple charts of user data to identify trends. Its cutesy esthetic, cartoonish graphics and multiple app skin options may make it more appealing to a younger age group. However, errors in data entry and abnormalities in symptoms are not well managed. The privacy statement is very sparse and as a result it is not clear how data is handled and shared through this app. Privacy is an especially important discussion if we are considering recommending this app to our younger patients.

Detailed Review View All

Features

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Period Tracker Lite tracks menstrual cycles and does that job well. It also predicts future periods by calculating averages from historical data. It produces great easy-to-read charts of the user’s data. It presents data in calendar, list and chart form. It allows customizable reminders. It does not have a community, interactive features or educational material. Data can be exported to email for sharing with a health care provider.

Effectiveness

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Period Tracker Lite ranked fourth overall in a recent peer-reviewed evaluation of menstrual cycle tracking apps that assessed accuracy, features and functionality (4). This app collects menstrual cycle start date, duration and volume of blood loss as recommended by ACOG (ACOG, 2015). The app offers period reminders and allows the user to create custom reminders within the app. This app markets itself as the simplest period tracking app and it is definitely simple. One push of a button on the homepage allows you to input your first day of period and another tap of a button on the homepage to end period.

Usability

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Period Tracker Lite is easy and very intuitive to use. Data entry is efficient but the app does not handle abnormalities in data very well. For example, it does not allow a period to be logged for longer than the average cycle length. It will allow this data to be entered as “spotting” but not as a prolonged period. It also allows data to be entered for future dates. While graphics are cartoonish and cutesy, they are appropriately matched. Charts are easy to understand and can highlight trends.

Privacy & Security

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The privacy statement is accessible through the app’s website. It is a very concise statement with limited information. It is not stated whether data is shared with third parties, if this is anonymized and if the user can revoke access. It is not stated if this data is encrypted or how it is stored. The app does collect personal information including email and name. The statement confirms that industry standards for safeguards are used in protecting the data. There is the option of password protection.

Reliability

+-

Period Tracker Lite performs well. Fast loading, minimal battery and storage consumption and updates make for a simple and satisfactory user experience. This app has a strong reputation with a five-star rating on iTunes. The app does not address medical emergencies.

Accessibility

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Period Tracker Lite is free and available for both iOS and Android. The Deluxe version has a community feature and offers more extensive charts for other health features. It is available in multiple languages, including French. Language is clear and targeted to a wide range of age groups. The appearance seems to target a younger age group. There is no clear accommodation for disabilities.

Pink Pad Period and Fertility Tracker

2 stars2 stars2 stars2 stars2 stars

Pink Pad Period and Fertility Tracker is the social butterfly of the group. Its most distinguishing feature is its active and vibrant social network. Daily emails give updates on the activity of your social groups and it aims to engage users in women’s health through this feature. However, credibility and accuracy of information that is shared on the social network is not vetted and the app provides no educational material. The menstrual tracking feature accurately uses historical data to calculate future menses, however, if not enough data has been entered it will use default values. Privacy is a concern with this app on multiple levels. The app collects much more than clinically relevant information including: any data that the user posts on the community forum, anonymized usage data, mobile usage data, location and cookies. The permission for this is implicit on usage of the app and this is not well communicated to the user during onboarding. This could present a barrier to recommending this app to patients.

Detailed Review View All

Features

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Pink Pad targets users who want a menstrual and fertility tracker and a social health network for women. It uses data entered to calculate upcoming periods and estimate fertility windows in an overview and calendar. It offers customizable reminders. It also allows email export of data entered in list form, which is tedious to use and difficult to digest in a clinical setting. Where this app falls short is that it relies on the social network to provide the user with information with no credibility check and the app itself provides no educational material.

Effectiveness

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Pink Pad ranked third overall in a recent peer-reviewed evaluation of menstrual cycle tracking apps that assessed accuracy, features and functionality (4). This app collects menstrual cycle start date, duration and volume of blood loss and could be a useful aid in using the menstrual cycle as a vital sign as recommended by ACOG (ACOG, 2015). The app offers period reminders and allows the user to create custom reminders within the app. Although this function is identical to setting an alarm on your smartphone, contraception reminders can be useful tools.

Usability

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The data entry in Pink Pad is very cumbersome. Initially setting up the app with historical data required multiple clicks and significant scrolling as a result of the calendar jumping to today’s date between entries. When entering a current cycle there is a single click button on the overview page that jumps to today’s log but the user is offered the option of recording their average flow and duration in a pop-up alert that could lead to significant inaccuracies in data. There are no error flags and a user can even record periods on future dates. The graphics are appropriate. There is limited communication in this app and most sharing of information is left to the community groups. Overall, this was not a satisfying user experience.

Privacy & Security

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The privacy policy is accessible in app and on the app’s website. It clear states that information is shared with third parties for both analytical and commercial purposes. This app collects much more than the clinically relevant data including: any data that the user posts on the community forum, anonymized usage data, mobile usage data, location and cookies. The permission for this is implicit in usage of the app and the user needs to read the privacy statement to learn that this is being collected. The only way the user can stop the collection of data is by uninstalling the app.

Reliability

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Pink Pad combines the positives of decent loading speed, lower storage and energy consumption and rapid technical support. However, it presents some concerning drawbacks in terms of reliability. Its last update was Nov. 30, 2015. It initially uses default values of duration and cycle length to give predictions of upcoming menses and fertility windows that are inaccurate. Once enough personal data is entered the app creates personalized predictions for future menses and fertility. Pink Pad clearly states that it does not give medical advice and to seek care from a health care provider or call 911 in cases of emergency.

Accessibility

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Pink Pad is free and available for both iOS and Android. It is available in multiple languages, including French. Language is clear and targeted to a wide range of age groups. There is no clear accommodation for disabilities.

Clue

3.5 stars3.5 stars3.5 stars3.5 stars3.5 stars

Our second place app is a close runner up. Clue is the minimalist’s menstrual tracking app, from the clean, crisp esthetic to the simplicity of data entry and charting. With a bent toward evidence-based education and data analysis, this app feels more scientific and more academic in its language. Clue doesn’t boast a community but allows users to connect their app with people they know. One of the features that stood out from the rest was the PDF data summary sheet that can be exported for sharing with a health care provider. It was elegant, easy to digest and contained all the pertinent information on a single page. This app has research collaborations with some of the world’s leading academic institutions and shares anonymized data for the purposes of this research. A full list of collaborators and research projects is available. Users cannot opt out of this data sharing if they have an account but are still able to use the app without creating an account. If at any time they change their minds they can email Clue and have their account deleted.

Detailed Review View All

Features

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Clue has everything you need in a menstrual tracking app – no more, no less. Users can track periods and the app provides analysis of current and past cycles, giving trends. The more data that’s entered, the “smarter” Clue gets. The app allows users to track 31 health features generating charts and summaries for these. It has a calendar and cycle view. Clue also offers customizable reminders of upcoming PMS, periods, fertility windows and medications. Clue Connect lets users link with another person’s app to get reminders of their cycles. Educational material is evidence-based but text heavy and not very customized. It comes in prefabricated topic units and if the app recognizes an abnormality in the data entry, a small information icon pops up in the corner of the cycle view with a related topic unit. Data summaries are very nicely done, concise, give good advice on when to see your health care provider and can be emailed as a PDF.

Effectiveness

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Clue ranked first overall in a recent peer-reviewed evaluation of menstrual cycle tracking apps that assessed accuracy, features and functionality (4). In line with the ACOG Committee Opinion (December 2015), which recommends using the menstrual cycle as a marker of health, this app collects menstrual cycle start date, duration and volume of blood loss along with several other health markers. Contraception reminders are useful clinical aids. Analysis and graphics allow easy identification of abnormal patterns and are detailed in PDF summary for sharing with HCP.

Usability

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Clue’s data entry is really well thought out. A simple click of a large button at the centre of the cycle view brings you to today’s log with colour and pictorial coded single-touch buttons for recording symptoms. Clue’s interface is easy to learn with minimal clicks and scrolling and appropriate error management. Language is concise but a little academic and material is a little too text-heavy to be appealing to all users and age groups. Overall, great experience!

Privacy & Security

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The privacy statement is accessible via the app’s website and clearly states that anonymized data is shared with third parties for research purposes. The academic institutions that Clue collaborates with are of high standing and a list is provided along with the purpose of the research. Clue manages personal and cycle data separately to increase security, uses one-way encryption and stores data on their own servers. Users have the option to email Clue to request their account be deleted and use the app without an account if they do not wish to share their information. Clue offers password protection.

Reliability

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Clue provides an efficient and elegant user experience through speed of data entry and loading, reasonable battery and storage consumption, frequent updates, appropriate handling of errors and strong technical support with most responses in 24 hours. Clue does not enable an online community but allows users to connect with people that they know. Clue does not give advice in cases when data entered signifies a medical emergency.

Accessibility

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Clue is free and available for both iOS and Android. It is available in multiple languages, including French. Language is clear and concise. The simple design, large buttons, colour and pictorial coding make Clue accessible for a wide range of health literacy levels and users with disabilities.

Glow

4 stars4 stars4 stars4 stars4 stars

Glow, our top-scorer, is the ultimate all-rounder. It checks almost every box when it comes to features you would want in a menstrual cycle tracker. It engages users with interactive quizzes and polls, has a comprehensive and active community and personalized evidence-based or expert-informed educational material delivered as daily “insights” and the “daily scoop.” The app is playful, informative and fun to use. The initial onboarding is well managed and not overly time-consuming. However, the app requires certain personal information to be entered before it will allow access. Glow does not sell or rent personal information but it does share anonymized data with third parties. Discussing privacy with patients would be valuable when recommending this app.

Although not the focus of this review, it should also be noted that Glow has features for predicting ovulation and fertility windows. It allows the user the option of avoiding pregnancy or attempting pregnancy but Glow and the Glow Community seem geared toward fertility. This function is less evidence-based.

Detailed Review View All

Features

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This app comes with a lot of bells and whistles. It promotes engagement with interactive quizzes and polls. Its Glow Community connects users to give support and learn from each other. It provides multiple views of the user’s data and uses a data-driven calculator to predict future menstruation; predictions get more accurate as more data gets entered. It has customizable alerts and identifies trends specific to the user’s data. It also allows overall health tracking with more than 40 different health signals. Educational material is referenced and educational alerts are personalized to the user. Data can be exported in PDF format to be shared in clinical visits.

Effectiveness

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Glow ranked second overall in a recent peer-reviewed evaluation of menstrual cycle tracking apps that assessed accuracy, features and functionality (4). Since this review it has updated to include citations of all education information. It is linked with an extensive list of credible health care providers involved in development and maintenance. It collects components of a menstrual history including start date and duration but misses the opportunity to collect volume of blood loss. Contraception and customizable medication reminders are useful clinical aids.

Usability

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Using this app is a dream! It’s easy to learn and intuitive; data entry is fast. Graphics are great and complement functionality. The premium version – a subscription service with a monthly fee of $3.99 if you subscribe for a year – offers more charts and graphs and is more relevant to the fertility function. Links to source material are provided with educational material for users’ further information. The only drawback is that the language used in the headings of the personalized educational “insights” is very direct and could be considered judgmental (e.g. “You smoked a lot of cigarettes”).

Privacy & Security

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The privacy statement is accessible and clearly states that anonymized user data is shared with third parties for service provision, research and advertising purposes. Glow does not sell or rent personal information to third parties. The user has some control of what information they share with Glow and privacy setting. Data is encrypted but there is no clear statement of how data is stored and if it is secure. Glow states that it follows industry standard security measures including electronic, physical and procedural safeguards but also clearly states that the app is not intended for medical advice. Glow is password protected.

Reliability

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This app performs well. Quick loading, reasonable battery and storage consumption, frequent updates and appropriate handling of data entry errors make for a seamless experience. Glow has had a strong reputation throughout its six years in the marketplace. The app clearly establishes that it is not a provider of medical advice in the Terms of Use but this may not be as apparent when using the app as a result of the personalized feedback and educational material provided. The app has no role in identifying or handling medical emergencies and advises users to call their health care provider or 911 in such cases.

Accessibility

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Glow is free and available for both iOS and Android. It is available in multiple languages, including French. Language is clear and targeted to a wide range of age groups. There is no clear accommodation for disabilities.

What Experts Say

Watch our interview with leading specialist Dr. Kirkham regarding menstruation.

Patient Experiences

In “Examining Menstrual Tracking to Inform the Design of Personal Informatics Tools”, a conference paper by Daniel Epstein and others at the University of Washington Seattle, the authors report that women track their menstrual cycles to be aware of how their body is doing, understand their body’s reactions to different phases of their cycle, be prepared, become pregnant and inform conversations with healthcare providers.

Whatever the reason, menstrual tracking apps are having an impact.New York Times blogger Roni Caryn Rabin says mobile app period trackers have helped shift attitudes, demystifying and normalizing menstruation by assigning cute icons to once unmentionables like heavy flow, maxi pads and period pimples. “Most important, the apps transform the input into crunchable data that can tell a young woman when her period is due, when it’s late and even why she might be feeling so blue.

“Many users of period tracker apps rely on them to help schedule their busy lives or for tracking health conditions that fluctuate with their cycle, rather than contraception.”

Ida Tin, who founded Clue, one of the apps reviewed here, is quoted by Rabin: “It’s a navigating tool for your life.”

Writing in the New York Times, Jenna Wortham says menstrual tracking apps are “the rare corner of the trendy quantitative self and health movement that has resonated with me, largely because they provide useful insights into my life, how I’m feeling and what’s going on with my body.

“I now switch between several apps and the information they offer. They have worked their way into the permanent part of my daily digital regime, right alongside services like Instagram, Twitter, Facebook and the like.

“Logging such delicate and intimate information might seem strange or foreign to people or technology users who aren’t used to having to monitor their bodies so closely. But in an era when enthusiastic entrepreneurs promise that technology and their services can improve lives, this is the one instance where that seems to be true.”

References

  1. Menstruation in Girls and Adolescents: Using the Menstrual Cycle as a Vital Sign – ACOG [Internet]. [cited 2017 Feb 6]. Available from: http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Adolescent-Health-Care/Menstruation-in-Girls-and-Adolescents-Using-the-Menstrual-Cycle-as-a-Vital-Sign
  2. Smartphone Behaviour in Canada and the Implications for Marketers in 2016 [Internet]. Catalyst. [cited 2017 Feb 6]. Available from: http://catalyst.ca/2016-canadian-smartphone-behaviour/
  3. Fox S, Duggan M. Main Report [Internet]. Pew Research Center: Internet, Science & Tech. 2013 [cited 2017 Feb 6]. Available from: http://www.pewinternet.org/2013/01/28/main-report-8/
  4. Moglia ML, Nguyen HV, Chyjek K, Chen KT, Castaño PM. Evaluation of Smartphone Menstrual Cycle Tracking Applications Using an Adapted APPLICATIONS Scoring System. Obstet Gynecol. 2016 Jun;127(6):1153–60.
  5. Mangone ER, Lebrun V, Muessig KE. Mobile Phone Apps for the Prevention of Unintended Pregnancy: A Systematic Review and Content Analysis. JMIR MHealth UHealth. 2016 Jan 19;4(1):e6.
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