When Are You Most Fertile? Cycle Myths Busted | Elina Bergland

Elina Bergland: [00:00:00] Ovulation unlocks so much insights about your body. Tracking ovulation and really knowing when ovulation happens rather than guessing when ovulation happens, is really the key to both being able to prevent pregnancy naturally or to plan a pregnancy. If you track your menstrual cycle, you can guess that it happens somewhere in the middle, but it's really a myth and a misconception that it's usually on day 14.

It's only in 13% of cycles that you ovulate on day 14. 

Dr. Brighten: During that fertile window, you need to be using protection. We can only get pregnant one day outta the month. The egg only survives 24 hours. So why do we have this fertile window? 

Narrator 1: Dr. Alina Bergland Sheitel 

Dr. Brighten: is a visionary, physicist turned entrepreneur who revolutionized women's health by creating 

Narrator 2: the world's first FDA cleared birth.

Control app, natural Cycles before transforming contraception. She was part of the groundbreaking CERN team that discovered the Higgs Bo song, an achievement that led to the 2013 Nobel [00:01:00] Prize in physics. Now as the co-founder and co CEO of Natural Cycles, she's using science to give women a hormone free, data-driven way to take 

Dr. Brighten: control of their fertility.

Narrator 1: Empowering over 4 million users across 162 countries. 

Elina Bergland: The fertile window is indeed that day the egg survives, plus the five days that the sperm can survive. When you're using N Cycles to plan a pregnancy, we highlight the most fertile days, which is really 

Dr. Brighten: for most women, when they decide they wanna get pregnant, they're like, I already want it to be pregnant.

But as we know, not everybody does wanna get pregnant. So how do you adapt fertility awareness method for people who, you know, maybe are trying to prevent pregnancy, who do wanna get pregnant, or who are just wanting to know more about their body and their health? 

Elina Bergland: So we have different modes in the Natural Cycles app, but if you're planning a pregnancy, 

Dr. Brighten: welcome back to the Dr.

Brighton Show. I'm your host, Dr. Jolene Brighton. I'm board certified in naturopathic endocrinology, a nutrition scientist, a [00:02:00] certified sex counselor, and a certified menopause specialist. As always, I'm bringing you the latest, most up-to-date information to help you take charge of your health and take back your hormones.

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Don't forget to subscribe, leave a comment, or share this with a friend because it helps this podcast get out to everyone who needs it. [00:03:00] Alright, let's dive in. All right, I'm welcoming today. One of the most brilliant minds in fem tech, the founder and the brain. One of the many brains right behind natural cycles.

Welcome Alina to the podcast. Thank you so much. Thanks for having me. Yes, I'm super excited for today's conversation because we're gonna be breaking down a lot of taboo, a lot of myths, but giving women the information that they should have gotten before they even got their period on how to track their cycle, understand when they're ovulating, get pregnant when they want to, and prevent pregnancy when they don't want to.

So I think everybody listening who have someone in your life that you can share this with, I really, really wanna encourage you to help us get this information out. I wanna start though, I think one of the most confusing things is knowing the difference between tracking ovulation and tracking the menstrual cycle.

Can you help us break down the differences between those two and why does it even matter? [00:04:00] 

Elina Bergland: So tracking ovulation and, and really knowing when ovulation happens rather than guessing when ovulation happens, is really the key to both being able to prevent pregnancy naturally or to plan a pregnancy. Because ovulation is, when conception happens, it's really the key.

Mm-hmm. And if you track your menstrual cycle and just your period, uh, you can, you can guess that it happens somewhere in the middle, but it's really a myth and a misconception that is usually on day 14. We actually published a, a clinical study on that, um, in nature, analyzing over 600,000 cycles showing that it's only in 13% of cycles that you ovulate on day 14.

So understanding when you ovulate, um, by, for instance, tracking your, uh, body temperature. With natural cycles, um, is really key to so many things. Also, for instance, knowing if you have PCOS starting to go through perimenopause, like it's ovulation, unlocks so much insight about your body. [00:05:00] 

Dr. Brighten: Yes, and that's so true.

I think sometimes when we talk about fertility awareness method, pregnancy prevention, these kinds of conversations, women in perimenopause start to tune out without recognizing that there is no good test to diagnose perimenopause. However, if you are tracking ovulation and you start to see anovulatory cycles and you are in your forties, that's a hint that you are now entering into perimenopause and you are gonna know that before your doctor does.

I really wanna underscore for everybody listening what you said about your trial. Uh, and the study that you published, 13% are actually ovulating on day 14. And what I find wild about this is that we know still within the United States, the estimated delivery date of, or estimated due date of a baby is based on the notion that you ovulated on day 14.

And they'll ask, when was your last menstrual period? And base everything off of that. And I think that [00:06:00] has major implications in terms of induction rates and what we are telling women when they're pregnant. We know, for instance, in France, they actually will adjust the due date, but we haven't seen that yet in the United States.

What thoughts do you have around that? Yeah, we, we 

Elina Bergland: see it a lot in our Natural cycles users that. Um, they know when they ovulate, right? Mm-hmm. So they know when conception happen and they get then frustrated with their healthcare provider when they, um, like you said, they might be induced too early, because it's quite common for women to ovulate quite a bit later.

Of course, you cannot ovulate so much earlier, but you can several weeks later, and that makes a big difference because maybe that baby isn't ready to come out yet. Um, personally, I. Adjusted my last menstrual period to match my ovulation when I told the doctor. So when they asked me for my last menstrual period, I'm like, okay, I will now calculate [00:07:00] 14 days before when I actually ovulate and then I will get the right due date.

SO'S be a tip. 

Dr. Brighten: Yeah. Well, and sharing my own personal story. So I use natural cycles to get pregnant with my second son and I ovulated, it was day 19, so if you consider that here I am, five days later, he came, you know, a week late based on how they had calculated things. But really it was only two days later than what we might have expected because of when I had ovulated and even when I told my doctors this, they were like, it doesn't matter and you can't know when you ovulate.

And I, I, these were not, they, they did not end up being my birth providers because that was one of the many things that made me lose confidence in them. I'm like, no, I can tell you when I ovulate. They're like, it's impossible for you to know. That's false. Why? How do we know when we ovulate? Why is that false?

Elina Bergland: Well, with natural cycles we have a, an algorithm that analyzes, um, different biomarkers. [00:08:00] Um, the most important one is body temperature. So we measure it either like you sleeping with an a wearable, like an aura ring or an Apple watch. And then we extract You're wearing yours? I'm wearing mine, yes. Both Apple watch and or same.

Um, and we extract, um, temperature data from that. Um, also heart rate because heart rate can change more than temperature if you have some glasses of wine, et cetera. And then we use that to correct the temperature. Um, optionally, you can also use, um, lithion izing hormone tests. So like ovulation test, uh, which is a urine test, but you don't have to.

Uh, and based on these biomarkers, um, for instance, the temperature rises right after ovulation. So we can see that with the algorithm. And the algorithm also gets to know your personal cycle, your personal temperature curve, and that way we can know, of course there might always be like some uncertainty.

Maybe you ovulate the day after or the day before, [00:09:00] depending on how messy the data is. But it gives you a pretty accurate idea. 

Dr. Brighten: Okay. There's gonna be two questions people have from that. So one is like, how do you account for the fact that maybe ovulation, it's not totally accurate. 

Elina Bergland: So that's maybe the most important part of the algorithm that only NRO Cycles has because we're the only.

App intended to use for birth control and the only one that's a medical device cleared by FDA for birth control. And that is that as soon as there's some uncertainty, whether it's like when you ovulate it or there's missing data 'cause you forgot to measure your temperature or your cycle is irregular, the algorithm then takes that into account and gives more red days.

And the red days a day when, um, you should use protection or abstain from sex when you're preventing pregnancy. Uh, and the green days are very safe. So, um, like we've, we've, um, published several clinical studies on [00:10:00] how effective natural cycles is as a birth control method and it's 93% effective with typical use mean like pregnancy for any reason and, um, not using protection on a red ail.

Common reason, uh, 98% effective with perfect use, meaning that you actually do use protection on that red. A but it's 99.5% effective if you only account for the algorithm failure. Um, so it's very effective in terms of, uh, providing you with, uh, uh, safe green base, basically. 

Dr. Brighten: Yeah, I think it's important for people to understand too that human error is what contributes the most to failure rate of all contraceptives.

IUDs are out because we know those are, those are very effective, but not without side effects. Hi, I am someone with endometriosis, so I can't use, um, you know, a copper IUD for instance, but for people to understand as well that the typical use of the birth control pill [00:11:00] is 93%, and that is how the majority of people are using it.

And so when your doctor says the birth control pill is 99% effective. That is only if you are a perfect user. And many of us who have been on the pill or are on the pill are absolutely not perfect users because we are human. And I don't think you should feel bad about that. You should just recognize that the real actual, you know, efficacy of the pill is 93%.

And I don't think we, we talk about that enough. And so when you compare it to something like Natural Cycles or you know, using fertility awareness method, I think, you know, you can have a more informed decision about, okay, this is the efficacy rate and what actually works best for me. The second thing that I wanted to bring up from what you said is you mentioned a glass of wine or two can affect your heart rate.

People are gonna be like, wait, what, what is wine doing to my heart rate? Because for anybody who's using fertility awareness method and just going by temperature, if you are drinking [00:12:00] alcohol, that could have an impact on the readings that you're getting. So can you explain what does alcohol do to our heart rate?

Elina Bergland: If you are a A or a reducer, you notice this quite well. I think in the day Aura will tell you, Ora will tell you, but the indeed the, it increases your sleeping heart rates and it also increases your temperature a little bit, but much less so even if you. Don't use an aura ring. So you, you use just a thermometer in the morning Natural cycles algorithm, uh, is still as effective and as accurate and takes that into account.

But if we do have the heart rate data, it means that we can kind of detect how many glass of wine you had and we can adjust the temperature, which in the end means that you might end up with an extra green day. But it doesn't make it less effective if we don't have that heart 

Dr. Brighten: rate data. Okay. That's good to know.

That's very important to know. And I think anybody in perimenopause who has two glasses of wine knows how it raises your heart rate, wrecks your sleep [00:13:00] and your body temperature goes up, can be one of the most common reasons for night sweats and hot flashes while you're sleeping. Now I wanna go into the definition of fertility awareness method and helping people understand it more because there's a common misconception and you hear a lot of people say fertility method is just the rhythm method.

Why is that incorrect? And what's the difference between them? 

Elina Bergland: The rhythm method is, is basically just a calendar method that you track your period and then you guess, and assume that your ovulation happens somewhere in the middle. So it is not, it's not very effective method, and it's also not very user friendly because you, um, you have to, for the first six cycles, have basically just red days, and then you still get a lot of red days because you don't detect ovulation.

So you don't know, so you just guess. So you same time hoping for the best, but you still need to then use protection basically most time of the month. And we, um, we did publish another [00:14:00] study comparing natural cycles algorithm to, uh, two different calendar methods. So the rhythm methods, uh, and also the standard base method.

And it really shows that the effectiveness is much higher, um, because we detect ovulation, but also you get more of those green days, we actually don't need to use protection. So the, the satisfaction of the method is also much higher. 

Dr. Brighten: And you've mentioned several times how you need to use protection. So during that fertile window, you need to be using protection.

We can only get pregnant one day outta the month. The egg only survives 24 hours. So why do we have this fertile window? 

Elina Bergland: So the fertile window is indeed, uh, that day the egg survives, plus the five days that the sperm can survive. And the algorithm also takes into account that it's less likely for the sperm to survive five days, but it can happen.

So like, um, when you're using nitro cycles to plan a pregnancy, we [00:15:00] highlight the most fer days, which is really. Ovulation day in the two days before, because it's still rather unlikely to get pregnant in the beginning of the fertile window. You definitely don't wanna risk it if you use it for birth control, but if you're planning a pregnancy, you wanna kind of hit those three days.

Dr. Brighten: Yes. And that's, I think, really important because, uh, I've had too many patients where doctors just say, oh, you wanna get pregnant? Just have sex every other day. And it really, it doesn't work that way. There's one time that you can get pregnant out of the entire cycle, and with that you, you have to basically capture the sperm to be present for when you ovulate.

And so that three days before and the day of ovulation, like looking at that window, is really one of the best ways to ensure that you are able to conceive it for people listening. Getting pregnant is really inefficient. Like humans are just not very good at getting pregnant. Um, and so I just want everyone to understand that like, this is one [00:16:00] thing that you can remove as a barrier to increase the odds because for most women, when they decide they wanna get pregnant, they're like, I already want it to be pregnant.

Like, I wanna be pregnant right now. And it can be so frustrating to go month after month, but as we know, not everybody does wanna get pregnant. So how do you adapt fertility awareness method for people who, you know, maybe are trying to prevent pregnancy, who do wanna get pregnant or who are just wanting to know more about their body and their health?

Elina Bergland: So we have different modes in the Natural Cycles app. So, um, natural cycles, birth control, uh, where you only get the green and the red days and we make sure those green days are safe. And then you have the, the natural cycles planned pregnancy mode. Uh, and there you get like. Uh, a different fertility scale each day.

So a different shade of red, uh, which peaks at that day before ovulation, because as you say, you want the sperm to be present when that egg is, is released. Um, and then we also have a follow pregnancy mode, uh, a postpartum mode, which we [00:17:00] launched last year and now we're working on the, a perimenopause mode as well.

Dr. Brighten: Oh, I love that. Tell us, give us the insight. What's coming for perimenopause? Well, it's, I must say it's so exciting 

Elina Bergland: to, to work on like, uh, something for us more new. And I feel like perimenopause is really an area where we need more innovation in general. Women's health, it's, you know, underserved and under research, I feel like perimenopause and menopause is where, uh, there's even more opportunity to, to help women.

Um, and we at natural cycles, we can really. Follow women through a very long time. We see how slowly her cycle changes. Uh, we might see if she has increasingly a ovulatory cycle or, or maybe the follicular phase is getting shorter. And you can also track symptoms in natural cycles. So we we're building out this mode's really focused on women, um, thinking about perimenopause, maybe soon entering perimenopause [00:18:00] or in perimenopause so they can understand their symptoms, understand where they are in this perimenopausal journey 'cause it is several years long.

And also get the education, understand what's, what's to come, what is normal, what's normal, not normal, what might actually not be a perimenopausal symptom, and when should I see a doctor and try to handhold her through that journey. 

Dr. Brighten: Yeah. I have a whole episode I did on perimenopause that I'll link to for everybody listening.

I'll put that on the show notes where I go through the stages of perimenopause. And so much of that is based on. How many days have, you know, happened between, you know, one period to the next? So how are your cycles lengthening? And so we, um, are able to classify things and somewhat predict how close you are getting to menopause based on that.

None of that is information that you can gather from going to your doctor. This is all information coming directly from you. And in fact, how we treat perimenopause symptoms is by the patient's symptoms. [00:19:00] We don't do it based on just lab tests alone, of course, like cardiometabolic markers and different aspects.

But because it's such a moving target with FSHO, follicle stimulating hormone and estradiol like month to month can look completely different. We can't really target it that way. And that is where knowing your body and having your symptoms tracked is so, so important. Can you tell us a little bit more about what happens when someone gets pregnant or when they enter postpartum?

Elina Bergland: Yeah. So when someone does get pregnant. Uh, she will enter the fall pregnancy mode and get information about like, what's happening in her body and the baby. And we, you know, again, try to handhold the woman through that journey. Uh, and as she gives birth, she then enters the postpartum mode because this is a, you know, a very special time in a woman's life where she needs so much support.

So we're trying to give her both the mental support that she needs and also, uh, the education, understanding the, the physical [00:20:00] symptoms, and, um, of course also tracking her temperature and cycle to understand when, when is the body coming back to ovulating again, which she can then detect before her first period.

Mm-hmm. 

Dr. Brighten: I also wanna say that I appreciate how sensitive the app is like in, in terms of the emotional level. So I got pregnant another time with Natural Cycles, uh, four times actually. Um, I appreciated all the prompts of like, here's where you're at and this is what baby's doing. And like, you know, it was just fun to have those insights.

But also when I had miscarriages, the app was like really sensitive to that. And I had used apps in the past. There was a miscarriage I had, you know, over a decade ago, and I remember my app, I could not get it to stop prompting me. And that was so difficult to deal with as I was going through a miscarriage.

And then the app is like, this is what's happening. I'm like, no, I'm telling you I'm not pregnant anymore. Stop. And your team [00:21:00] really did a good job on accounting for that and making sure that they were holding me through that process and that nothing coming through was insensitive or triggering because.

You know, let's face it, like when you go through a miscarriage, you don't even know the things that are going to be triggering to you. And yet, I feel like you all really took the time to think that through and make sure that the app held a woman through that. 

Elina Bergland: Thank you. Yeah. The, our team found that, um, both rewarding and heartbreaking to work on the, what we call then the, uh, recovery mode.

Uh, at the same time, and indeed like this, exactly what we were trying to do, to have a mode where we don't stress the woman so she can decide when she's ready to see the fertility status again and handhold her through that process, educating her and just be there for her until she's ready to either try again or not.

Dr. Brighten: Yeah. So, you know, you, [00:22:00] you mentioned stress right there, that, that promised me to think about how environmental factors like travel or stress, like significant stressors, illness, how those can impact our temperature, our heart rate, our readings. How does this cycle app, you know, account for that and, and what can women expect?

Like what changes with these significant stressors? 

Elina Bergland: Yeah, and these are, some stressors can change the cycle and some stressors can change, um, the temperature value. Um, and indeed, like, um, this is also why it's very useful to measure with a wearable because then more things can also be taken into account, like the time you sleep, et cetera.

But even if you just measure with a simple thermometer, um, again, the algorithm always airs on the side of caution. So if the temperature looks out of range, we exclude it completely from the algorithm. Like for instance, if you have a fever, if you're sick, the algorithm detects that and tells you. It looks like you're sick.

We're [00:23:00] not gonna include that temperature, but you can also tell the app yourself if you're slept differently, if you're had too many glass of wine, or if you're sick. And then the, the algorithm knows based on what you're telling it as well. 

Dr. Brighten: Mm-hmm. It's nice that it will course correct for you and that you don't have to, because I think, like, you know, when I'm sick, the last thing I want to do is have to worry about anything else.

Like Right, you're on like low power mode. You're like, I, I can't worry about anything extra. And so to have it, just accounting for that I think is just a really big relief for a lot of people. You know, as we're talking about this, uh, as you're aware, I'm aware, I think a lot of women are aware. This information is just not taught.

We're not taught in reproductive health education. We're not taught in general health education overall. Why do you think it is women are not taught about fertility awareness method and given the tools to really understand their body? 

Elina Bergland: Yeah, tracking your psycho ambulation is really an essential tool [00:24:00] for understanding one's body that's often overlooked in, in general health education, which is a shame.

And I guess the reason behind is multifaceted, but I guess a large part comes down to the historical gaps and how we've approached women's health. Um, you know, I think still today, unfortunately, society's not entirely comfortable with women having the understanding of control of their own bodies.

Unfortunately, I think society's more comfortable with like, okay, we, we. Take women's bodies and we, we remove their fertility when they don't wanna get pregnant by either stopping their ovulation or inserting IUD and then, you know, we can, we can relax. Mm-hmm. Um, but what we see is that women are great at handling a tool like NRO Cycles that makes you understand your fertility, your body, when you're fertile, you're not.

Um, we often get the comment that with younger women, they probably would [00:25:00] get pregnant. They cannot handle such a tool of taking your temperature and knowing when you ovulate and when to use protection. Um, you do have to be 18 to use natural cycles because we have no clinical data, uh, from below 18. But what we see is that our youngest cohort, 18 to 25, they actually have the best perlin.

So the best effectiveness because they, they want to avoid pregnancy and they do a great job at it. So I think it's wrong to not think that women. Can handle the control of their own bodies. They can. And we should trust women, uh, and we should not underestimate their intelligence. 

Dr. Brighten: Mm-hmm. I so agree with that last statement, because I have literally heard doctors say, women are not smart enough to be able to do this.

And I'm like, are, are you kidding me? Like a woman who doesn't wanna get pregnant is very, very invested in that. And they, I think a big problem is that, you know, doctors spouting like 99% [00:26:00] effective is the pill. So just take it and then acting as if you can take a backseat to your fertility and, and you can't.

I, but I love hearing that, you know, that window of, you know. The 20 somethings being, you know, so good at this. I, we really have seen the younger generations wanting and craving this information. And I think, you know, there's a big pushback right now on the idea where doctors lie to women. It is a lie. And the, and when we tell women you can get pregnant anytime in your cycle, that's not true.

And if you know that's not true. And you say that anyways, you're, you're being dishonest. And even if you think, well, I'm being dishonest for her, the betterment of her, that's not your choice to make, you don't get to decide what information she does and does get, doesn't get. And you don't get to be the one who decides her contraceptives that you know, to prevent pregnancy.

You have to present all the [00:27:00] information to her in an unbiased way and allow her to decide for herself. And certainly, I think doctors should always give their expert opinion. Like for instance, you have polycystic ovarian syndrome. Your cycles are very irregular. Fertility awareness method may not work for you if you, you know, aren't, you know, being educated by a fertility awareness educator, you're not taking extra steps in that.

However, we know it's not true just because you have PCOS or hypothyroidism that you can't use, uh, fertility Awareness method. So can you talk about how the app helps account for those conditions? 

Elina Bergland: Yeah. We have a lot of women using natural cycles with PCOS or hypothyroidism, and they then often use natural cycles in a way to monitor, well, in the case of PCOS, uh, for those that have very long, very regular cycles, they can still see whether they ovulate or not.

Because what we see in the data is they often do, even if they have a three month [00:28:00] long cycle, they are still quite likely to ovulate at the end. And this is very crucial information if you want, they want to get pregnant. So, um. I would say it's better to, uh, monitor your PCOS rather than masking it with a pill.

And then many women think that the bleeding is your period. Um, and then they think it's all normal because I get it every 28 days. And that's, again, like misinformation, that's just masking the problem. And for a hypothyroidism, um, tracking the temperature also really helps to kind of monitor, uh, how the thyroid is doing.

And if it's getting, temperature is getting very low, maybe they wanna change something in their lifestyle to, to get it up and see. And also, many people say that ovulation is a, it's like another vital sign. So if you stop ovulating, yeah, maybe that's a good time to try to understand why. And, you know, it's a key part of [00:29:00] your health.

Dr. Brighten: And I've had patients with PCOS who are using fertility awareness method, and they notice things. They say, okay, so if I'm taking my acetol at like 2000 milligrams and I'm consistent with that, I notice that my cycles are changing and I'm ovulating more regularly. Or you know, if it's something where I start eating more carbohydrates in my diet, more refined sugars in my diet, um, you know, for whatever reason, not judging anybody, but they'll start to notice like things are shifting.

And I think getting that data back to understand what interventions are working for your body is so, so crucial, especially when we consider that women's medicine is underfunded. There's very little research coming out on us compared to our male counterparts. So you have to be your own scientist. And you and I will also say just because the study comes out doesn't mean it applies to you.

It doesn't mean that it's true for you. And so having this kind of feedback is super helpful. And [00:30:00] to the point of hypothyroidism, I've had patients using natural cycles who come in and they're like, my basal body temperature's going down, something's wrong. And then we are able to test and see what's going on.

I think it's so, so important for women to understand that the, one of the big reasons why thyroid hormone declining can affect ovulation is because the follicular fluid. So the fluid around the egg is actually rich in thyroid hormone. It's helping fuel that process. And so if you start to see ovulation issues, it may be time to test your thyroid.

So another good reason to be tracking all this and understanding this. We talked about the myth of like 13% of women are ovulating around day 14. You brought up the 28 day cycle. How many women are actually on a 28 day cycle? 

Elina Bergland: Well, it is something similar to that. That's, um, because. You, you say women, but in reality, no one has the perfect regular cycle.

So Yeah, even if a woman sometimes has 28 days and [00:31:00] sometimes ovulates on day 14, um, it's, it is not gonna be perfectly regular and consistent. So the 13% ovulating on day 14 are cycles, not women. I think there's almost basically no women that has consistently every cycle ovulating day 14 and 28 day. Yeah.

Um, that doesn't really exist. 

Dr. Brighten: Yeah. Well, I think that's just important to understand because we're, we use 28 days as a framework to teach about the menstrual cycle, right? We have to have a starting place, just like we teach the menstrual cycle, starting from day one that you bleed. But really the start is ovulation.

Um, we do all this so that you can understand, wrap your mind around it, but then it lends itself to everyone thinking. But the period is the main reason that we have a cycle, which it's not. The ovulation is the key. If you, if you lose your period, it's because you've lost ovulation. But also women are like, something's wrong with me because I'm not having 28 day cycles.

But we know 25 days might be your norm, or 34 days might be your norm. [00:32:00] And it's more about the consistency that we are not seeing wild swings of 21 days to like, you know, 65 days that we are seeing, you know, this, this ish, like it's around this kind of window, uh, you brought up about the periods that we're having on the pill.

They're not actually periods. Can you explain that? 'cause I think that's gonna be news to some people. 

Elina Bergland: Yeah. So the, the bleeding that you get when on the pill is, um, is induced by the hormones in the pill and it's called a withdrawal bleed. So it's basically when you, on that week, when you take the sugar pill, the placebo pill, um, the body bleeds because of the withdrawal or hormones.

It's not a period because you did not ovulate. So a period is the bleeding due to ovulation happening, uh, around two weeks before. 

Dr. Brighten: Yeah. It's so important to understand because so many women will come off the pill. They're like, I got my period, but then it went away. And I have to explain to them, actually, [00:33:00] that was never your period.

I need you to go all the way back to where before you started the pill. And as you said. You know, we know a big problem in women's medicine is passing them the pill and dismissing their symptoms and not giving them a proper workup and evaluation. As you said, with TCOS, that's not a real period. So when women come off the pill, they expect that they can get pregnant, but then they're unable to.

We also know that using the pill for PCOS is very shortsighted, given that we have insulin dysregulation, we have inflammation, we have cardiometabolic parameters that can be downright scary, putting you at risk for diabetes, for cardiovascular disease. And so I really take issue with being like, you have TCOS, here's the pill.

Oh, you're bleeding regularly. We fixed the problem, and it's like you didn't do anything except maybe prevent endometrial hyperplasia. For people listening. That is when the uterus goes, long time exposure to estrogen grows, grows, grows, grows, grows. And then [00:34:00] usually when you do get a period, it is heavy and cloudy and it's horrible.

If that goes for a very long period of time, that puts you at risk for endometrial cancer. And I'll see a lot of doctors say, well, we have to use that in TCS because the risk of endometrial cancer. And I'm like, we can do progesterone withdrawals. We can actually fix the the anovulatory cycles and work with her on that to get her period back.

And I just think it's really important for people to know that like you can, you can always use the pill that is your option, and I will always support you in making the best decision for yourself, but you need to be informed about what is really going on there. Because I think too often we're taught the pill is our savior and we're just told that it can fix everything.

When in reality, like you said, it's masking a lot of things. So. What I heard from you women with PCOS hypothyroidism, they can still use natural cycles, they can use this fertility awareness method and it can still have benefits and utility outside of temperature. What other signs are people looking for?

For [00:35:00] ovulation? 

Elina Bergland: You mean to track ovulation? 

Dr. Brighten: Yeah. So the signs that you, you ovulate because we know fertility awareness is a symptom. Uh, yeah, thermal method. So it's temperature, but there's also symptoms 

Elina Bergland: Indeed. So, um, in your fertile window, when your estrogen rises, your cervical mucus changes, it gets more like this egg white, uh, consistency, and you get more.

And this is what's actually needed for the sperm to survive. So, uh, your cervix opens, you get the more fertile type of cervical mucus until, um, your, your, you have ovulated and your fertile window is over. And that's something that's. Uh, women can track to track their fertility as well is something you can also log and track in the Natural Cycles app.

But we don't use it in the algorithm because it's, uh, it can have a human error that is outside of our control. So we, um, only take into, uh, more [00:36:00] quantitative data, like lithium hormone tests, uh, temperature, heart rate into the algorithm. But what we notice is that, uh, and also personally with women using natural cycles and knowing when they ovulate, they also start noticing these other signs.

Like for instance, the, the fertile, uh, cervical mucus. And then they, they get to know their body better and then it doesn't feel so scary anymore. It doesn't feel like rocket science because in the end it's just your body and how it's working and you'll see the science more yourself. 

Dr. Brighten: Mm-hmm. I, uh, have observed that many times as well.

It's once women see the temp spike, they understand the fertile window, that they feel more confident in assessing the cervical mucus. And certainly when you're never taught about this cervical mucus seems like this weird, bizarre thing. And, uh, I will tell patients sometimes just crack an egg open, put it in a bowl and put your fingers in there and pick up that egg white.

That's what, that's what we're going for, because it, it just, [00:37:00] you know, it's, it's such an odd thing to be assessing and also like when you're assessing it, when you're going to the bathroom and maybe you're not wanting to hang out and they're like, check out your cervical mucus. And so I really do think it is a good way to get your, to know your body.

The other thing that. I will have patients notice as they're like, I am more in the mood. Like I actually want to have sex more when I, you know, when I see that fertile mucus and I'm like, that's estrogen on the brain telling you like, this is a good idea. Testosterone's coming up. Everybody, all your hormones are working for your against you, depending on how you look at it.

Um, I wanna, you know, you've brought up, you need to use protection during the fertile window. Why is that in so important? Because sometimes people are under the impression that they just, they can use the pullout method, for example, during that fertile window. 

Elina Bergland: Yeah. And um, of course some, um, of our users do use to pull out method during the fertile window, even though that's not what we [00:38:00] recommend.

So we recommend condoms, uh, for those fertile red days. Um, it's interesting with the pull out method, because. For some couples, it, it doesn't work because it can be challenging. You know, it's, um, it's, but for those couples that it's male driven too. Yes, yes. Like women don't have control, don't know to know what they're doing.

Yeah. But what we see is that couples that used to pull up method before using natural cycles, they actually achieve very high effectiveness while using the pullup method during natural cycles. So it seems like some guys probably have figured out how to do this while, for instance, we see the women that come directly from using the pill and start using natural cycles, then using the pullup method's not a good idea because that's not what the guy was used to.

And you don't wanna take that gamble. So then I think it's better to be diligent and use condoms, um, when you are fertile. 

Dr. Brighten: Or you [00:39:00] can have other types of sex, non-penetrating sex as well. I mean, the primary way that women orgasm is through clitoral stimulation. So no penetration actually needed. Uh, that's an option as well.

And so I bring that up just because, um, I'm just out myself. We have all found ourselves in a place where it's like I'm in the mood, but I don't have a condom situation. And so you may wanna opt for something else. It's interesting to hear you say that when women actually understand their cycle, they're more effective using the pullout method.

You mentioned coming off the pill. How long, if you come off the pill, how long does it take until the algorithm actually learns your cycle? So you can start 

Elina Bergland: using natural cycles right away, coming off the pill. And we ask about that in the onboarding. So we take into account that it can take some time for you to ovulate again.

So then you get more red days in the beginning until you actually start ovulating. Uh, but the effectiveness is the same. Um, you just have to understand that if you don't [00:40:00] ovulate, you're gonna get red days until you do. And the pill can, for some women, they start ovulating right away when they quit the pill.

And for some it can take some time before the body starts working again. 

Dr. Brighten: Yeah. Have you guys done a study yet? Have you collected data on how many cycles it takes to start ovulating again on average after stopping the pill? 

Elina Bergland: Yeah, we, we have studied that data and it's not like it takes some cycles, right?

Because it's more that the cycles are very long. Um, so it's, it's highly, highly individual. For some women it can take a year before they get their first real period and, and have ovulated. Uh, for most women though, it's, it's. It starts up quite quickly, so like, you know, maybe your first cycle is slightly longer, maybe more like 35 days on average, but, uh, it's not a big difference.

Um, we also, uh, published another study on how long it takes to get pregnant when you come off [00:41:00] the pill versus not. Um, and there we see that it does take a bit longer in the first 12 cycles, but after 12 cycles off the pill, you have the same chance as someone not coming off the pill to get pregnant. 

Dr. Brighten: So in your research you have found that if you come off the pill, it can take up to t uh, 12 months or more to get pregnant?

No. 

Elina Bergland: No. So like in the first 12 cycles after coming off the pill, on average, it takes you a little longer, but not 12 cycles longer. Okay. Okay. Uh, but it's on average, it takes you a bit longer to get pregnant coming off the pill. Four, 12 cycles after that, you have the same probability of getting pregnant as someone that did not come off the pill.

So like there is an effect of, um, it time to pregnancy being a bit longer if you come off the pill, but at least that effect goes away once you've had 12 cycles off the pill. 

Dr. Brighten: That is so important for women to know because one of the issues [00:42:00] that I will speak to when someone says, like the pill made me infertile is, when did you come off the pill?

Because if you decided you wanted to get pregnant at 38, we are all told this by doctors, when we're put on the pill, you can come off, you get pregnant right away. That's not true for anyone who has been through that experience. Myself included, it took me, uh, three months before I got back to ovulating again and got a period again when I came off the pill that there's, there's some people who get pregnant on the pill who get pregnant immediately.

I find more often they are outliers, but what is not told to women is that as we. Age, you know, our quality of eggs are going down our, you know, our coq 10, which is very, very important for egg quality that's diminishing. Um, there, there's all of these factors coming into play, but the other thing I will say to women is that if you plan on getting pregnant at 38, you need to come off that pill at least a year in advance.

Now, this is something I've seen clinically, so it's so interesting to hear that data of, okay, once we get to [00:43:00] that 12 month mark, now you got about the same chance as anybody else, and it's important to consider your age in that. Listen, everybody listening, I'm in my forties, so I, I know I hate that as much as you do of like, oh, we have to think about that, that, you know, if you are at age 35 and you're like, I wanna be pregnant, my goal is 37, 35 is a good time to start thinking about coming off of that, uh, pill.

Tracking your cycle, preparing your body because there is so much that you can do to improve your odds, your chances of conception, but also. Having a healthy pregnancy, a healthy baby, a healthy postpartum, all of those things are equally important. Um, you, you mentioned, you know about it taking about 12 months for, for some people to be able to get back to cycling.

I think it's important for people to just understand that something like the Depo-Provera shot, if we give that to you after your last shot has worn off, it's [00:44:00] not abnormal for it to take 18 months before you cycle again. So there's certain forms of contraceptives that it can take a lot longer and you should be aware of that if pregnancy is on the agenda.

Have you guys, um, ever like pieced out, I mean depo is not as common, but I'm just curious of like whether people are using the ring, the pill, the implant, like the shot. Have you guys like pieced that out to see the differences? 

Elina Bergland: Yeah, we do ask what they've used. Uh, and indeed the Depo shots not. That common anymore?

Um, so we do, we have studied like the effects, um, depending on also like, is it the combined contraceptive pill or just progesterone? Um, and it, it does make a big bit of a difference. Like the combined pill takes a little bit longer. I don't remember if we looked at the depo shot because I don't think we have that much data.

Dr. Brighten: Yeah. It's not as common as it was about 10 years ago. I think when we started [00:45:00] learning about bone density issues that really halted a lot of people from choosing that method. I mean, that's kind of the limitation, right? Getting enough data, uh, to, to be able to have something inclusive. And so for people to understand that, that limitation, can you explain why it's important to have like a significant number of users that you're analyzing?

Elina Bergland: Yeah, that's, I think as a scientist, this is like really the most important thing is to have a critical. Amount of data and being a, a digital birth control really helps with that because mm-hmm. Um, with the consent of our users and, uh, after anonymization of their data, we can do so much with it. We can, you know, publish clinical studies to, to get women's health questions forward.

Like for instance, we published a study, um, together with NIH on how the, uh, covid vaccine impacts the, the cycle, for instance, something many women were asking about. [00:46:00] And we were able to do that rather easily because, you know, we have a plat digital platform of women that has all this wonderful data. Um, and similarly, you know, it's really important for being a medical device, for contraception birth control, and regulated by the FDA and, and also similarly in Europe and Canada.

Australia is the clinical studies we've published, um, and. Done on how effective is Natural Cycles, who is effective for, um, but we also follow up monthly to make sure that our effectiveness rates are in line with our claims and our published studies. And that's only possible because we're a digital product.

Like with the traditional birth control methods, like the pill, you make a a, a study, um, and then you don't really know what happens in the wild. Like if you get pregnant on the pill or on the condom, there's not even a way to, to contact the company and let them know. Well, for us, we can follow our users [00:47:00] very closely.

So if they do have an unintended pregnancy, we, um, we ask them if they wanna contact us and discuss it and see how we can help and like understand and get to the bottom how this happened. 

Dr. Brighten: How does the Covid vaccine affect someone's menstrual cycle? 

Elina Bergland: So what we found is really interesting, um, because it depends when you take it in your cycle.

Mm-hmm. Uh, so if you take it in the beginning of the cycle, it can, uh, impact ovulation that it's slightly postponed. Mm-hmm. Uh, and that's what's women, um, what women also notice, uh, so before the, the CDC was actually re recommending to take it towards the end of the cycle, uh, but now they changed that because of our study.

Um, and then we've also studied on how it, it can also increase bleeding for some women, for instance. Um, and I think this is also often what happens when you have a real infection. So they, [00:48:00] personally, I had the flu last month and it definitely impacted my cycle. So I think that's part of the body's response, uh, immune response to the vaccine or an infection.

Dr. Brighten: I think what it, it, it led it to some distrust, but also what women were so frustrated with was that this vaccine was expedited. It was pushed out. And then as they shared their stories, a lot of people were like, you're not, you don't know your body. You're not telling the truth. It took, I think, 50,000 women speaking up before they were like, oh, maybe, maybe it does affect your cycle.

Uh, and yet I think two things are really important. One is exactly what you said. If you get sick, if you have immunological response, if you have an immune disease and you have a flare that is going to affect your cycle. The second thing is, is that when you are an emergency global pandemic, the last thing they're gonna think about is your cycle.

Because I mean, let's just be honest, the last thing they think about is women's cycles and pretty much every study, unless it's directly [00:49:00] on the study study. Um, but I do think, you know, some people are like, they were really mad about it. I'm like, we, we do have to give a little leadway that they were in panic, right?

They were in in panic mode and just trying to do what they thought was best in, in that instance. And yet a lot of women reported these issues. And, you know, it was something that even if I, I spoke about it on social media and I, my posts were like banned. Like they, they were not showing it. And my stance was, yes, any vaccine that you get can affect your cycle.

Any illness you get can affect your cycle. Anything that causes an immune response to take place can affect your cycle. And it was just, it became very glaringly obvious that this was a gap in our education that we've provided women. And that's something that again, we should have known back in health ed of like, if you get sick, things can change.

Like just knowing that can put your mind at ease. 

Elina Bergland: Yeah, definitely. I think it's another example how women are not [00:50:00] heard, women's voices are not listened to, and that that is the, I think, the most disturbing part. 

Narrator 2: Mm-hmm. 

Dr. Brighten: No, I definitely agree with that. So that makes me wonder, so you're the founder of Natural Cycles.

You, you know, actually I wanna ask like, why did you even decide to start Natural Cycles? Like, what was the, the moment where you're like, we need to do better here? 

Elina Bergland: Well, the idea of, of Natural Cycles came from a personal unmet need initially. Um, uh, I'm, I'm a physicist, a particle physicist that worked at the CERN laboratory where we.

Discovered the Higgs particle that led to Nobel Prize in 2013. Uh, so, which is amazing. Congratulations. Thank you. Um, it was an exciting time. And around that same time, this was 2012 when we discovered the Higgs particle. I had taken out the hormonal implant, um, which I had when I was young. I, uh, uh, it was time [00:51:00] to take it out.

And I knew we wanted to have kids in a few years and I didn't wanna put in a new one because I wanted my body to have a chance to get back to normal start ovulating, just like you recommended. Um, and I was thinking, what can I use in the meantime? And I was, there must be a, a good natural method I could use.

Um, and as a teenager, I had, uh, I had, uh, had not had the best side effects from the pill. So I had tried then to like, uh, learn a book from the library and understand my cycle of my body and used that contraceptive method. That didn't go so well. And, and then I had the hormonal implant. But now, uh, I was 28, I had a PhD.

I, uh, I was a scientist and I started reading up again about how can I figure out when I'm, when I'm ovulating, when I'm fertile, when I'm definitely not fertile. And I started reading all these, um, articles about how the body temperature changes throughout the menstrual cycle. Something while studied and known for long, but [00:52:00] women used to use very rudimentary, um, not even algorithms, but rules and do it by hand, which didn't make it very effective or easy to use.

And I thought, well, I can create an algorithm. This is kind of my expertise to look at a lot of data. And, uh, so I started to, um, to really get nerdy about all this data and started creating the algorithm that's the Natural Cycles algorithm today. Um, and then my, my husband, who's also my co-founder and my CO CEO, he thought that well.

Actually, you know, this should be available to all women and couples out there and you can use it both to prevent and plan a pregnancy. So, uh, we quit our jobs in physics. He's also a physicist and, uh, thought, oh, let's make this into an app. And it was 2012. So you want to make anything into an app? Uh, yeah, that's how it started.

Dr. Brighten: Yeah. I'm curious, I mean, that's such an amazing story. You're like, yes, I'm out here discovering [00:53:00] particles, but you know what, I'm gonna just change women's health for the better. How has being in this space, in this arena shaped your opinion about women's medicine, women's health as a whole? 

Elina Bergland: Oh, I've learned so much.

I mean, this is now, yeah, 12 soon, 13 years ago, and I guess I was a little bit naive. I thought that, okay, I will create this product that clearly women want and need and, you know, problem solved. But I now know so much more about this field that. Women's health is, is a very sensitive topic, very polarizing topic, very political topic.

It's a very political topic and it's a field where innovation is very slow for a reason. Because one thing I wonder is like, why hasn't anyone done this before? Well, now I kind of know. And today we are still the only app out there that is intended to use in cleared as a medical device for birth control and for a reason because I think many companies shy away [00:54:00] from women's health.

They don't want to invest in women's health because of those reasons. And that, that's a shame because then we're always gonna be behind. So I think we need more companies in the field of women's health, purely focusing on women's health, like natural cycles to, to bring us up to speed and do more clinical research, do more innovation, and, yeah.

Yeah, it's needed. 

Dr. Brighten: And when you consider that, I think it's, it's somewhere around 2% of like VC funding goes to women founded companies. It's no wonder, because I, I'm gonna be very blunt here. Men cannot solve women's problems. They just can't because they don't understand the problems that we're facing. I mean, one, you just start by listening to women, but you know, as you know, you, you were like, it wasn't until I was experiencing this myself that I was like, we have a problem.

I need to solve this. And I think that. There is also this mindset in women's medicine that you have the pill. So just be grateful for it. Like, we gave you [00:55:00] this, why would you want anything more? It works. And as you said, you suffered side effects. I struggled with side effects for a decade before I realized that like, I can't even get pregnant every day outta the month.

I was operating under that assumption. And I think, you know, we need as many choices as possible. One thing that comes up when it comes to an app is people are very concerned about their data, very concerned about where their data is going, whose is being shared with and who can access it. Does natural cycles take steps to pro, like protect the data of its users?

Elina Bergland: Definitely. This is a very important part, uh, especially in women's health. And natural cycles take data privacy very seriously. Um, we're based in Europe, uh, so we're under GDPR, but even before GDPR as a medical device. It also has, uh, special data processing, uh, parts of it. And, um, we wanna go as far as we can with protecting our user's data.

So [00:56:00] we've developed, um, NC Secure, which is a comprehensive privacy program designed to keep your data safe. And we have a dedicated data protection officer. Uh, and their team also employs the most advanced, uh, security protocols there is, which includes encryption and pseudonym immunization of women's data.

Um, and after Roe VV Wade was overturned, uh, we went even one step further and we developed what we call Go anonymous. So this adds a, an extra layer of protection by ensuring. That, um, even we ourselves cannot link a woman's personal data with their sensitive data. So we basically split our database in two, uh, and only the user has the key on her phone to like link the two again.

So, um, it has never happened. But if the American government would come one day and ask us for a user's data, we don't know what data [00:57:00] she has because we have that separation in place. 

Dr. Brighten: That's so smart. I love that. Uh, people in the US may not know what GDPR is. Can you explain to them what that is? So, GDPR 

Elina Bergland: is, um, the European data privacy law that came into place, was it 2018, I wanna say.

And it's, uh, it's very strict, so it's much more strict than the, the US privacy laws, for instance. Um, so it, it, it's, you need to be, have quite rigorous protocols to follow GDPR and make sure that also, um, it includes that. Basically the data belongs to the user. So, uh, they have the right to ask it to be deleted or to fetch it, and it cannot be misused.

Um, one thing that's very important though, um, that I forgot to mention is that Natural Cycles is not for free. Uh, our users pay to use Natural Cycles. It's $119 a year, um, or [00:58:00] $17 a month. And that also ensures that we don't need to monetize on user's data. Uh, so, uh, our customers are our users, not anyone else.

So as, uh, a woman that's is scared for her data, I would be wary of any free apps because free apps monetize on your data and they are much more risky than any app where you actually. Paid to use it. 

Dr. Brighten: Mm-hmm. That's important for people to understand. So what you're saying is if it's free, the only way they can recoup their costs, they can be profitable as a company, is they have to sell your data.

And we have seen that being a problem many, many times and they don't even disclose it in, in a very transparent or easy to read way. Often it's buried in the terms of service. And so I think that's a good tip to, if you're concerned about your data, your privacy, be wary of the free apps. But I don't know that anyone else, so that's kind of the [00:59:00] issue with, um, US-based companies that are period tracking is that their servers sit in the US where they're collecting all that data.

If they haven't taken the extra steps to divide it the way that you have and unlink it from the user, then that data can fall into the hands of, of, you know, the government or the person paying for it. 

Elina Bergland: Yeah. And we, we also have our data sitting in Europe and not in the us. 

Dr. Brighten: Yeah. So how much, you know, does the feedback of your users influence the development of the app and the new things that you, you know, the new bells and whistles, so to speak, that come out with natural cycles?

Elina Bergland: Oh, a lot. I feel like we have a very close relationship with our users, which is wonderful. And I think also the most motivating part of working for National Cycles for myself, but also for my team, is hearing the feedback from our users. Um, so we have a, we have a Slack channel at work where we directly feed in the app review [01:00:00] notifications from our users.

So we get them in real time and we all read them and, uh, and take them to heart. And we care so deeply, like whether it's a happy user that often they describe how Natural Cycles has changed their life for the better, one way or another, that that motivates us and makes us work harder for our users. But if it's an unhappy user, we, we really.

Uh, go the extra mile to try to, to help her. Uh, and we also have, um, you know, in our customer support team, we, we listen very carefully and we, we have regular meetings on like what's the most common feature that they want to have, and we then try to implement those. So, um, we love our users and we feel they love us too, so it's nice.

Dr. Brighten: Yeah, no, I definitely, as someone who's used the app for a longer period of time, and I've seen the innovations, I do feel like I'm, the only way that you have arrived there is by seeing how we're using it. Listening to feedback. You've brought up a couple of times that I, you're [01:01:00] the only FDA cleared contraceptive device.

What was that process like and what does that even mean for people who might not understand that? 

Elina Bergland: Um, well the process was not straightforward because, uh, we are one of the first app at all to be cleared as a medical device, especially in this risk class. Um, so we are class. Two, uh, which is a medium risk class, which contraception is in general.

So class three is something that's inside your body, and Class one is something you just register with the FDA, so it's even less risk. And when we started Natural Cycles, like there was no app that was a class two device. So we had to really figure out the regulations, both in Europe and with the FDA, kind of as we go.

But what it really helped was that we, um, we had published clinical studies that we were scientists and we had done like rigorous analysis and scientific research on, uh, real world data from thousands of thousands of, of women [01:02:00] to ensure that, you know, our algorithm could reliably predict fertility and provide accurate, um, guidance.

Uh, and the FDA really carefully evaluated all this evidence and, um. It took many years to get to that. Um, but it was a also a interesting and fun process. And I think the FDA did a good job of really diving into, like, for instance, is natural cycles as effective for women with irregular cycles, which we could prove that it was.

Uh, but I think it's actually great that they looked into that. And since then we've had several more, um, FDA clearances for, for instance, the integration with the Ora Ring and the Apple Watch. Initially you could only use a standard, um, thermometer. And now we got through something called the PCCP, which means that we can integrate with any wearable as long as we do, um, an internal, uh, clinical validation.

Um Okay. Which is good. And. 

Dr. Brighten: For people [01:03:00] hearing that it's FDA cleared for contraceptive, like what, like in the layman's terms, like most simplest terms, what does that mean? So it means that it's 

Elina Bergland: intended to be used for contraception. Uh, we can market it as a product for contraception. Um, and it means that it can be used for contraception.

So I wouldn't, so many women unfortunately, use period tracking apps, uh, to prevent pregnancy, but they are not intended to be used for that. They have not done clinical studies, they don't have the processes in place that a medical device company does. Um, yet it's very common and I think it's because many women do, are looking for other options than invasive or hormonal contraception.

And they, they're left with very little options if they don't know that natural cycles exists and then they take things into their own hands. So I think that's a sign that's. Something like Natural Cycles is needed on the market because there is [01:04:00] no one size fits all when it comes to breath control.

Dr. Brighten: What do you say to critics who say, this cannot be accurate? 

Elina Bergland: Well, what we've noticed, we faced a fair share of skepticism over the years and what we noticed that it often comes down to, um, lack of knowledge because mm-hmm. You know, it's hard to know all the new methods that are out there now. We're not so new anymore.

Yeah. Because we've been around for more than 10 years. But initially, you know, we were in new methods and traditionally we've seen that, um, when you use the calendar method or if women used to track their temperature by hand, it wasn't the most effective method. Um, but natural cycles with its algorithm and the app guiding our users is an effective method.

Um, and also, especially now using the wearables, it's also very seamless to just sleep with a wearable and. Track your temperature that way and use the Natural Cycles app. So we, we have very good continuation [01:05:00] rates, um, even as high as the, the IUD lately, uh, better than the pill. And the effectiveness is at similar level as the pill.

So natural cycles is clearly a very good option for contraception. But we have to educate people. We have to bring awareness to this. We have to, uh, talk to the doctors and the midwives and the, all the HCPs because it's not so easy for them to know about every method that comes to the market. 

Dr. Brighten: Definitely.

What is the pitfall? If somebody uses a device that's intended for conception, so to help you get pregnant, what is the pitfall if they use that device as a contraceptive? 

Elina Bergland: So there's a reason why we have a different algorithm for plan a pregnancy and for contraception. Um, because when you want to plan a pregnancy, the most important thing is that you, you find those most fertile days.

Um, of course [01:06:00] it's possible to get pregnant on other days, and that's why it's different optimization for the algorithm for contraception is that you want it to be fail safe. You optimize it to make sure that, um, you, you don't have unprotected sex when you're fertile. So what, what most period trackers do is they basically just track period, they guess when ovulation happened, and then they put five days before as the fertile window.

But in most cases, that will not match your actual fertile window. And then if you use it to prevent pregnancy, you're at risk because most, if you have sex on those days, you, you are fertile in those days. So the, that's why like, um. The risk of getting pregnant is very high and the effectiveness is not high at all.

Dr. Brighten: Mm-hmm. What impact do you hope that natural Cycles will have on reproductive health and women's health broadly? 

Elina Bergland: Well, I hope that natural cycles can [01:07:00] continue to be a catalyst for shifting the conversation around reproductive health and body literacy. Pushing the envelope for women's health in general with our, uh, clinical research, our publications, and also providing women with products that they need throughout their reproductive, um, journey.

Like anything from, I mean, our vision is to help women all the way from puberty until menopause. And little by little we are, we're getting there. Um. And you know, we want to pioneer women's health with research and passion by, uh, helping women understand and their body and make sure they can be in charge of 

Dr. Brighten: their health.

Mm-hmm. I love that women do deserve all the information and they should be in the driver's seat when it comes to their health decisions. This has been such a fantastic conversation. I am gonna tap your team for all of the studies that we talked about today. So everybody [01:08:00] listening, we will put those in the show notes.

I wanna link to all of those because if you do encounter a healthcare provider who pushes back on you, I would like you to be armed with the evidence to support your decision. Thank you so much for sharing your expertise, for developing this app, for stepping out of the lab and into the w world of women's health.

Is there anything that you would like to leave our listeners with today? 

Elina Bergland: Well, thank you for listening and thank you for also caring about women's health, which you clearly do because you're listening to this podcast. 

Dr. Brighten: Fantastic. Well, thank you so much. Thank you.