The Ethics of Period Tracking Apps

Abstract

In a time of transitioning out of male-centric health research, period-tracking apps have great potential for advancing women’s healthcare. They can provide users with better health literacy, informing them of important patterns in their bodies. However, instead of living up to their potential, period trackers are causing great harm. Engineers have a responsibility to take accountability for the impact their technology has on women’s lives; they have a responsibility to create a better version of these apps that can truly benefit women’s healthcare. 

Introduction

Compared to other high-income countries, American women have less access to medical care, the lowest life expectancy, and a one-third higher rate of avoidable deaths [1]. United States women report being generally sicker and under greater mental stress [2].

This may partly be caused by misunderstandings regarding women’s health. Women’s health research remains shockingly underfunded in America [4]. Historically, research studies have prioritized men and disregarded women’s health issues; women are grossly underrepresented in medical research that could otherwise benefit them [3]. The FDA banned pre-menopausal women’s inclusion in all early-phase clinical trials up until 1986. To this day, many researchers avoid using female mice in studies because of the worry that their fluctuating hormones might “confound the study results” [3]. 

Underlying the research gap is the cultural trivialization of women, their bodies, and their unique health concerns. A fantastic example of this can be seen in the rise of femtech and especially period-tracking apps. These apps can be invaluable tools for many women, offering the ability to monitor their menstrual health with unprecedented ease. A local study from the Wrocław Medical University reported that as many as 78% of young women ages 18-30 use them [5]. Period-tracking apps could allow for more bodily awareness, health literacy, and informed conversations with healthcare providers [6]. They have incredible potential for advancing the health and quality of life of a population so marginalized in modern-day medical research. Yet, most cycle-tracking apps disrespect both women and the complexities of their menstrual health. 

Potential Benefits

The menstrual cycle is a complex process. It regulates everything from bone formation and insulin production to heart, respiratory, and metabolic function [7]. Irregularities in one’s menstrual cycle can indicate larger – sometimes life-threatening – health complications. If caught early, these complications can be better managed [7]. A greater understanding of one’s regular cycle can also help manage chronic conditions. For example, many women experience greater asthma symptoms at specific points in their cycle [7]. Migraines also commonly follow a pattern related to the menstrual cycle [7]. Recording relevant data helps women gain an understanding of the new patterns of their hormone cycle and feel more connected to the process rather than alienated from their own changing bodies. Being able to track and predict such patterns could help women feel more connected to their bodies. Tracking symptoms and patterns during pregnancy and menopause – a part of many women’s menstrual cycles – can do the same. 

Some OB/GYNs and researchers see great potential in these apps for not only empowering women and allowing for more informed conversations with healthcare providers, but also for advancing medical understanding of women’s bodies [6, 8, 9]. Already, period-tracking apps have begun to call into question the scientific understanding of what a normal menstrual cycle is. These apps highlight how uncommon it is for women to have what was previously considered a “standard” cycle of 28 days [10]. This technology can act as a giant research study on women’s health. These apps have tens of millions of users who are each providing medical information about their cycle and its peripheral impacts on their lives [5]. 

Focus on Fertility

The menstrual cycle is too often viewed as a reproductive process irrelevant outside of its indications for fertility, even though research has proven otherwise. Unfortunately, period-tracking apps play into these misconceptions. The apps refuse to acknowledge the needs of women and the comprehensive experience of the menstrual cycle. From the beginning, they have been designed with only a small subset of women in mind.

The first period tracking app with any significant funding, Glow, was designed exclusively for women trying to get pregnant [11]. The next iteration of cycle tracking involved apps like Eve, designed for users trying not to get pregnant [11]. While there have been some strides in making the technology more inclusive, to this day, the only FDA-approved women’s cycle-tracking apps are designed for avoiding and promoting pregnancy [12]. 

Fertility in cycle-tracking apps does not reflect the needs and desires of the general user. A 2022 survey of over 300 women found that less than one-third of those using period-tracking apps were primarily interested in any features tracking fertility [13]. 91.2% wanted to “understand their symptoms, changes and concerns about their menstrual cycle” [13]. 

A focus on fertility in cycle-tracking apps is unethical in that it treats women as a means to an end – children. This violates Immanuel Kant’s well-respected concept of moral rights. According to Kant, each human has an innate “dignity” that must be respected by others [14]. This dignity is violated when people are treated as an end rather than as a means to themselves; when people are manipulated or forced into a position where they are used to further someone else’s interests at the expense of their own freedoms [14]. 

Period tracking apps dehumanize the experience of having a menstrual cycle and reduce it to a baby-making process. Popular apps like Glow ask downright invasive questions in the name of promoting fertility, asking women to log when they have sex, “including what position they were in during ejaculation” [11]. The 2015 iteration of Glow sent notifications to women trying to get pregnant to wear nice underwear on their fertile days [11]. Pregnancy-tracking apps also dehumanize the experience of starting a family and have the tendency to treat the woman as simply a vessel for the baby. Glow Nurture asks pregnant women to track their mood, but also encourages women to have their partners provide an “objective” reading of that mood in a mirror app [11]. Such apps presume that the pregnancy went well, pestering the mother with notifications about how she should be caring for her baby after she has potentially suffered great loss [15]. Designs such as these convey that the goal is not truly to inform women about their bodies and empower them to make decisions that benefit them, but to control them and monitor them. The apps seem to distrust the users and display an apparent “underlying lack of respect […] for women, their bodies, reproductive privacy, and intimate relationships” [16]. In many ways, they even position women as “reproductive citizens” [16]. 

There are also justice implications here, as these designs raise the question of who deserves menstrual-tracking technology. Justice ethics, for these purposes, are based on Aristotle’s concept that “equals should be treated equally and unequals unequally” [17]. In other words, as a baseline, people should receive equal benefits and share equal obligations. There may then be grounds upon which it is justified to treat people differently. For example, if someone contributes more to a cause, it makes sense that they should reap more benefits. If someone commits a crime, they alone receive a punishment. In this situation, fertile women are receiving preferential treatment in the development of these apps. Fertility should not be a ground for providing unequal access to menstrual health technology. 

Additionally, these designs violate Care ethics, which emphasize empathetic appreciation of individuals’ circumstances and compassion when creating solutions [18]. It is unempathetic to ignore the individuals behind the screen, whose age or health circumstances should not prohibit meaningful use of this technology. The focus on pregnancy implies that heterosexual, fertile women are the only women worth creating menstrual health technology for. This marginalizes women going through menopause and women with conditions like PCOS, who may not be ovulating. It essentially tells “queer, unpartnered, infertile, and/or women uninterested in procreating that they aren’t even women” [19]. Women use cycle trackers for different reasons and at different points in their lives. These apps crop out the full experience of what it means to have a menstrual cycle. [12]. For example, they tend to lose functionality as soon as women start going through perimenopause, even though the women could benefit just as much – or more – from tracking their cycle health and symptoms [12]. Deborah Lupton, a researcher at the University of Canberra, notes that how fertility- and period-tracking apps are lumped together shows a harmful underlying attitude towards women in different stages of life [11]. 

Unacknowledged Limitations

Many period trackers are not developed with enough research into women’s menstrual cycles. A 2016 investigation by Columbia University found that 95% of 108 free period-tracking apps had totally inaccurate predictions [11]. A 2018 study found that period-tracking apps were only able to successfully predict ovulation date 21% of the time. A more recent study in 2021 evaluated the performance of the 10 most popular tracking apps and also concluded that they are providing insufficient and unhelpful estimates [20]. Most of the apps still rely on the outdated belief that women’s cycles are 28 days long, with ovulation on day 14 [20]. Even for women with regular cycles, that model does not apply. 

Irregular cycles are very common – about 25% of premenopausal women have irregular cycles [21]. Period-tracking apps’ rigid models often make such cycles out to be concerning, causing undue stress to users [10]. Newer updates of Clue and Flo venture to provide risk assessments of PCOS, a health condition that is often associated with irregular cycles. Some experts are concerned with these features, as they attempt to pseudo-diagnose women with serious health issues via simple algorithms. The end result is terrified women rushing to the OB/GYN, distressed by an app’s poor analysis of the normal functions of their bodies [9]. 

Additionally, even though irregular cycles are so common, often only women with regular cycles are studied to evaluate the accuracy of period-tracking apps. This practice becomes especially concerning when the apps are marketed as medical devices. For example, women with irregular cycles were excluded from studies evaluating Natural Cycles, a now FDA-approved contraceptive period tracker. Based on these studies, the app boasts a 93% accuracy rate for preventing pregnancies. However, regular cycles are much easier to track for contraceptive purposes, so this number is deceptive [10]. A significant proportion of women with irregular cycles will likely experience less accurate results. 

Most modern period trackers are misleading and not transparent about their capabilities [13]. Because of this, when the dates don’t line up, women are more likely to doubt their bodies than doubt the app’s ability to provide them with meaningful information [10]. Refusal to acknowledge that an app enforces an unrealistic ideal of what it means to have a menstrual cycle marginalizes people whose cycles don’t fit into that model – which is most women – causing users unnecessary stress and shame [8]. 

Inherently Predatory Design

Multiple studies show that cycle-tracking apps do not increase users’ understanding of their cycles [24, 10], and app features that would be most beneficial to women are not seeing improvement [11]. This is because the apps prioritize profit at the expense of progressing technology in a way that could revolutionize women’s health. Most period-tracking apps were launched in the wake of the 2013 success of Glow’s initial launch [11]. They were created to take advantage of the business opportunities that the femtech industry presents, with a current market value of over $60 billion [6]. Having found financial success, these apps are sticking with what is profitable rather than enhancing their designs to be better for women.

The most profitable design involves collecting sensitive data and selling that data to third parties, taking advantage of the lack of knowledge surrounding women’s health [22]. Buyers use the data to prey on young women’s fears and biology. Sometimes, this is done with predatory advertising and manipulative marketing based on user data. Advertisers now have access to women’s medical information and intimate details. Sensitive information related to women’s menstrual cycles allows for targeted advertising [16]. 

Reproductive health is especially valuable to marketers, as “knowing that someone is preparing to become a parent means knowing that someone is about to enter one of the very few stages in which they’re likely to get ‘hooked on new brands’” [11]. In a 2019 investigation, Flo, a popular cycle-tracking app, was found to be informing Facebook about users’ cycle phase and pregnancy attempts/status [25]. Glow expanded its business into IVF and egg freezing and  began urging its millions of users to consider the invasive procedure even when medical professionals would advise against it [11].

Sometimes, the apps themselves are predatory. Natural Cycles, marketed mostly on Instagram, is designed to prevent pregnancy through cycle-tracking. It is at best 93% accurate in predicting fertility windows [11].  It was intentionally marketed to younger women via social media, taking advantage of common fears surrounding hormonal birth control and offering what amounted to a life-ruining lie for many people. The app advertises itself as an ideal alternative to hormonal birth control, even though its efficacy is not comparable to other modern birth control methods [12]. Its advertisements play on existing and prevalent fears of hormonal birth control [22]. The app was reported to the Swedish authorities shortly after its release by hospitals concerned about the incredible number of women coming in with unwanted pregnancies after relying on Natural Cycles [11, 26]. There are also instances of cycle-tracking apps that receive most of their funding from religious groups, encouraging women to abandon hormones in favor of their product [22]. Such tactics should not be used lightly when the consequences are so serious. 

While there are some apps, like Clue, that do allow women to export their data, there is no interoperability between trackers. Because there are no regulations in place for handling women’s data, women are effectively trapped in whatever app they first started consistently using. Furthermore, many trackers do not offer a way to export user data at all. Period trackers work by incorporating inputted user data into an algorithm-based model of that individual’s cycles [10]. They only get better over time as they receive more data from the user. To switch apps is effectively to lose years of accumulated personalized data. Without some sort of compatibility between the data storage formats of apps, the enormous amount of data would take days to manually transfer. That means that as these apps remove features, change their privacy policies for the worse, delete user data, or put that data behind paywalls, users must either start all over again or submit to the app’s new developments. 

Trivialization of Women’s Health

The interface designs of most period-tracking apps blatantly trivialize women’s health. Although there are trackers with cleaner, professional interfaces, the majority of period tracking apps are rife with pointless flowers, pink, childish designs, floating clouds, and heart patterns [11]. They often dumb down medical terminology and include goofy “faux-empowering” quotes or banners. The 2015 iteration of Eve referred to its users as “girls,” and allowed users to collect gems through engagement that they could then trade in for sex tips [11]. Such designs convey that the designers do not take the topic seriously and do not see their apps as important medical tools. It condescends to women and makes light of the sensitive and serious nature of what those women are entrusting to it. There is no other category of health app that minimizes its subject matter to that extent. 

Menstrual health is trivialized systemically as well. The United States government does not recognize menstrual data as protected health information; period-tracking apps do not have to be HIPAA-compliant and are not protected by FDA rules regarding the transfer of medical data [28, 29]. That allows women’s health data to be sold to third parties and stored on insecure servers [22]. It’s also why most period tracking apps have privacy policies that require “college-level literacy” [16], as they are not held to medical standards of informed consent [30]. This is especially concerning, considering how many young women use these apps as a means to understand their cycle as they begin menstruating [16]. The EU holds period-tracking apps to higher standards of data protection and consent [25, 22]. On the other hand, the United States fails to protect women and their sensitive health data.

After the overturn of Roe v. Wade in 2022, health professionals and legal experts all but begged women to delete period-tracking apps from their devices, especially in states without explicit abortion protections [25, 6]. Period-tracking apps can be used to say that someone is pregnant or has lost a pregnancy. Many of these apps admit their commitment to providing law enforcement with such data upon request [6]. However, there are greater ethical implications for women’s healthcare beyond the obvious. It is clear that menstrual cycles are more complicated than many give them credit for, and the people making these laws and enforcing them do not necessarily have a good understanding of how women’s cycles function. They are unlikely to be able to distinguish normal fluctuations and irregularities from those attributable to medical conditions, miscarriages, and abortions. Experts are concerned that cycle irregularities could be mistaken for abortion evidence, putting innocent women under unnecessary scrutiny [6]. Women are treated more and more as just reproductive citizens [16]. 

It is also unethical for a medical tool with such great potential to be wrenched out of the hands of American women [31]. Although FDA regulation or mandatory HIPAA compliance could make women’s data more secure, without a federal right to abortion, it is impossible for these apps not to be putting women in danger or violating their bodily autonomy, regardless of intent [6]. As American women continue to delete their period-tracking apps to protect themselves [32], America will face incredible setbacks in the potential for greater medical understanding of women’s health issues, as well as individual health literacy and informed healthcare. This will directly impact at least half of the United States population and devastate the wealth of knowledge available to the medical community in the future. 

Engineering Obligations

The National Society of Professional Engineers Code of Ethics states that engineers “shall perform services only in the areas of their competence,” “avoid all conduct or practice that deceives the public,” and “hold paramount the safety, health, and welfare of the public” [23]. It is these tenets that are called into question by the current design of period-tracking technology. Each harkens back to core ethical frameworks.

One could simply argue that period-tracking apps should not promote the monstrous idea that a woman’s value lies in her fertility or be built on the assumption that women want a fertility tool. One could call for more mindful designs to ensure that these apps are usable by people in many stages of life and with various goals, and to ensure that they do not treat the user as a tool for creating life. Engineers are not trained in women’s studies, nor are they competent as medical professionals. It is the same lack of specific expertise that makes these apps worrisome when they are marketed as medical tools or when they presume to give medical advice, such as in cases of PCOS warnings. Too many liberties are being taken in these cases regarding who is qualified to give advice on these topics, and the consequence is products that are merely a source of stress at best, and outright harmful at worst [13]. The only ethical solution is for engineers to consult professionals before making assumptions and leaving the medical advice to them.

Without a change, these apps are deceitful to the public. The designs are hostile to the individual user. The apps do not allow for the normal experience of unidealized cycles [8]. They make women feel like their bodies are imperfect when, in reality, the fault lies in the design. It is critical that engineers behind projects like these make every effort to consult with women’s health experts. However, even with better-informed menstrual models, it is still critical that engineers ensure their product is not marketed as more than it is. 

Another major ethical issue lies in how period-tracking apps take advantage of the unregulated nature of menstrual health data. Although traditionally applied only in medical settings, engineers should consider the principles of Bioethics, as they know their designs will be handling large volumes of highly personal medical data, even though currently such data is not legally recognized as protected medical information. Bioethics covers four standards: Autonomy, Nonmaleficence, Beneficence, and Justice. Period trackers’ predatory designs violate Beneficence in Bioethics. That is the standard that dictates that a patient should be able to trust that a healthcare provider’s chief objective is to help [27]. Users are giving these apps so much information, trusting that they are acting in their best interest, while they are not. The ulterior motives driving the apps also violate respect for Autonomy, which states that patients should have “the capacity to act intentionally, with understanding, and without controlling influences” [27]. Currently, these apps manipulate women into taking action based on the limited and biased information the apps provide. The privacy policies also prevent informed consent with inaccessible language. 

Data stored on company servers is accessible by subpoena, but data stored on a user’s device requires a warrant – a much higher legal standard [25]. Implementing designs that store sensitive data on users’ phones is one example of how engineers can take initiative in protecting the women using their apps. Many steps such as this need to be taken. Especially in a Post-Roe America, it’s critical that engineers decide to handle this sensitive information as if it were protected medical information. Although only federal recognition of menstrual data as medical data can truly protect the user, engineers have the ability to design apps that keep women’s data better secured. 

Conclusion

As it stands, period-tracking apps are characterized by lazy designs and unethical priorities on the part of the engineers designing them. They dehumanize women and treat them as a means to an end. This is seen in designs that only appreciate menstrual cycles as fertility indicators and designs that harm users for profit. They violate the tenets of Bioethics by manipulating women with their own sensitive data. They are unjust, prioritizing only a small subset of women while marginalizing the remainder. Period-tracking apps largely transgress the Engineering Codes of Ethics with shoddy designs and uninformed handling of sensitive data, and they disregard principles of Care ethics by treating users with blatant disrespect. Lax data security threatens the future of women’s health, violating Utilitarian aspirations for a robust medical system. Unless engineers take the issue more seriously, they will continue to harm half of the population that so desperately needs quality medical advancements. With more mindful designs, menstrual trackers could have potential as revolutionary medical tools. 

By Alice Steele, Viterbi School of Engineering, University of Southern California


About the Author: At the time of writing this paper, Alice Steele was a junior majoring in Electrical & Computer Engineering and minoring in Narrative Structure. She enjoys learning languages, backpacking, and baking.

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Further Reading Links

https://bmcmedethics.biomedcentral.com/articles/10.1186/s12910-023-00976-z

https://uofuhealth.utah.edu/notes/2025/01/why-we-know-so-little-about-womens-health#:~:text=Failure%20to%20study%20medications%20and,twice%20the%20rate%20of%20men.

https://www.ncbi.nlm.nih.gov/books/NBK236583