• Period tracking apps like Flo offer accessible and personalised health insights, but recent research shows they often lack transparency around data use, and sometimes sell intimate personal information without informed consent
• Many apps are designed with narrow assumptions, typically of cisgender, heterosexual, and perfectly healthy users, which can marginalise LGBTQ+ individuals and those with specific health needs, leading to inaccurate advice
• Researchers call for the ethical development of FemTech, emphasising the need for further research into the ethics of AI algorithms, broader data representation, and user education to ensure these apps can empower users rather than exploit or mislead them

Whether seeking the expertise of a healthcare professional, getting advice from a friend or crossing dates off a calendar, how to track your menstrual health is – and should be – a personal choice.

However, increasingly, apps like Flo, with its claim of being “trusted by over 350 million users” have become the default. Generally free to download, convenient and, over time, tailored to your personal needs, it isn’t hard to understand their popularity.

But, are they as trustworthy at traditional methods?

Picture this; it’s a Tuesday night, and you’re catching up with your best friend. You tell them that you cried three times today – twice for no reason and once over a vaguely emotional video of a dog. They nod knowingly and ask when your period is due. They know your history and your lifestyle, and do not judge. Their advice may not always be the best, or medically accurate, but you’re well aware of the fact.

Now, picture this: you’re alone, phone screen glowing like a confessional, inputting your period dates for this month. A flurry of questions pass over your screen. “How are you feeling today?” You tap the frowny face. It gets specific. Cramping? Yes. Acne? Yes. Mood swings? Absolutely. Unflinchingly, you tell it everything and take its recommendations at face value.

Whilst you likely trust your best friend, your period tracking app, with its tailored, seemingly medically accurate guidance also provides reassurance, as well as putting you in charge of your own healthcare. 

However, recent research has raised a key issue when users confide in period tracking apps in a similar manner to their best friends or their doctors. Whereas all of these support systems use what you tell them to offer support and advice, unlike your doctor or friend, your period tracker might sell that information on, and it almost never explains itself.

Trust is earned, not downloaded

The study, authored by Maria Carmen Punzi and Tamara Thuis at the Rotterdam School of Management Erasmus University (RSM) highlights how such services can comprise user both privacy and reproductive autonomy.

Period tracker apps collect intensely intimate data, such as mood changes, sexual activity, and other symptoms, yet, the research says, they offer users very limited insight into how this data is processed, interpreted, or if it’s passed on to others, impacting the ability for users to give suitably informed consent.

Not only are users unknowingly sharing their personal information with third parties, more concerningly the research highlighted limitations on the alogrithms of such apps, resulting in users being exposed to limited or biased information about their personal reproductive health.

Users who do not fit the very limited specifications of the demographic, age range, and physical condition used to train the algorithm of their app of choice, will not receive information which is relevant or helpful for their bodies.

This, while clearly discriminatory, also has the potential to become unsafe for users who may be subject to inaccurate or misleading advice.

What your app remembers, others may buy

This is not a theoretical risk. Data selling, especially without user consent, has already resulted in major legal problems for feminine health apps and the organisations that engage with them. Data on pregnancy is understood to be more than 200 times more valuable than data on age, gender or location for targeted advertising. As well as this, period tracking could also be used to direct specific advertising to target women at different points in their cycle, often without them being made aware of this happening. This means that the health data freely given to and processed by period tracking apps is not just deeply personal and intimate, it is also a commercial asset.

A few years ago, FemTech app Flo came under fire for exactly this activity; sharing user data with marketing and analytics companies like Facebook and Google, without gaining informed user consent, breaching user trust. With this information, advertisers can “data-mine their way into your womb”, in perhaps an even more violating way than in the infamous ‘Target knew I was pregnant first’ story.

As a result, user behaviour may have been subtly influenced under the illusion of gaining helpful, even seemingly medically-sound, expert advice.

Whose cycle is being tracked?

Not only do the typically flowery pink feminine designs of these apps unwittingly exclude or other many more diverse users, Punzi and Thius’ research also highlighted how the algorithms used to create such apps are also subject to practical and ethical challenges. Such tools are often created with very limited datasets and therefore can unintentionally reinforce narrow gendered social norms and values in their assumption of a cis-gender, heterosexual, perfectly healthy user.

Because algorithms limit the app’s assumptions and recommendations, the researchers caution that LGBTQ+ individuals and those with irregular cycles or chronic health conditions are excluded, and can feel alienated as a result.

What’s more, misinformation masquerading as medically accurate fact will alter an individual’s perspective of what a ‘normal’ or ‘healthy’ menstrual cycle should be – and by extension – corrupt their experience of their own body. If someone is unknowingly consuming what appears to be personalised health insights, but is not actually tailored to their needs, they could cause themselves undue harm or worry when following the advice they’ve been given.

It’s not black or white… or pink

So, are period tracking apps all bad?

No, not necessarily. These apps are substantially more convenient than doctors, friends, and manual methods, but the reliability and confidentiality aspects are still a serious concern.

In the words of the researchers; “We live in a time when reproductive rights are at risk and women are increasingly looking for alternatives to hormonal birth control. It is essential that we pay attention to the ethical development and implementation of innovation when it applies to contraception. The influence of algorithms on users’ experience of their menstrual cycle and fertility is sometimes invisible but can still change behaviour related to it.”

The development of FemTech is and should be an aid to women’s health, but the lack of transparency, accountability and regulation of period apps is harmful. The researchers recognise this and call for future research to integrate the ethics of (AI) algorithms into the field of sexual and reproductive health, and to widen the net for data, thereby decreasing the possibility for misinformation to happen.

Making your tech work for you, and not the other way around

These technologies should empower – not discriminate – those who use them, and they do have the potential to do so. The researchers state that further exploration would allow users to learn about their bodies and use the technologies more consciously, and for society to actively scrutinise its biases and achieve health equity.

We do not need to shun period tracking apps, but we do need to use them with open eyes. At this point in time, they can be part of our support system, but they are not reliable enough to be the whole thing.

And, while your best friend may not hold all the answers to your medical questions, it is safe to say they’re not going to monetise your mood swings.

By Ella Coates

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