How I Rely on It for Birth Control

As a thirty-something-year-old, I’m at the stage where engagement parties, weekend-long weddings, and baby showers fill my weekends. But while many of my partnered pals have been outfitting their fingers with bling and going off birth control in hopes of expanding their families, I’ve been wearing a smart ring that works overtime to help me prevent unwanted pregnancy: the Oura Ring.

For the uninitiated, the Oura Ring is a smart tracker that collects an impressive volume of data for such a small, non-obtrusive device. The belly of the ring is lined with a series of sensors, which collect data on a laundry list of metrics, including heart rate, heart rate variability, body temperature, blood oxygen levels, activity levels, steps, and more. However, it isn’t just the non-obtrusive size of the ring that sets it apart from other fitness trackers that utilize similar technology. It’s the fact that the device syncs with Natural Cycles to help menstruating users (like me!) make choices with their sexual health goals in mind. 

Given that birth control commonly involves daily pills or potentially painful insertions, you may have questions about this alternative option, including how a smart ring could possibly prevent an unwanted pregnancy. Below, board-certified obstetrician-gynecologist Dr. Kerry Krauss, MD, OB-GYN, the Medical Director with Natural Cycles, dives deep into this birth control strategy.

How the Oura Ring Can Be Part of a Birth Control Strategy

“The Oura Ring is not intended to be used for birth control alone,” says Dr. Krauss. However, the smart ring can offer users access to a modernized version of a fertility awareness method (FAM) called basal body temperature (BBT) tracking. How? By syncing with an outside tracking app called Natural Cycles, which was cleared by the U.S. Food and Drug Administration (FDA) as a birth control method in 2018, she explains.

The Natural Cycles app was designed to pair with a body basal thermometer, which provides highly accurate temperature readings down to the decimal place. Users were instructed to take their body temperature as soon as they woke up — ideally, at the same time every day — and then log into the app. 

In 2022, however, the app became compatible with the Oura Ring. The smart ring, which can replace the do-it-yourself thermometers, has temperature sensors that measure body temperature day and night and can detect minuscule body temperature changes. When the two are paired, this data is automatically uploaded from the ring to the Natural Cycles app. 

“There is a slight rise in body temperature (0.5 to 1°F) immediately after ovulation,” says Dr. Krauss, which remains high until menstruation. Research has shown that this is caused by the increase in progesterone production following the release of an egg. After a few months of consistent usage, the Natural Cycles app uses that temperature data and menstrual cycle inputs to predict your fertility window, which is the only time of month an individual can become pregnant. 

If you have signaled in the Natural Cycle app settings that you wish to avoid unwanted pregnancy, it marks days you likely aren’t fertile as “Green Days” and days when you are as “Red Days.” The idea is that on your non-fertile days, you have the green light to enjoy intercourse without protection. In contrast, during your red, fertile window days, you should stick to outercourse or use another form of birth control (condoms, vaginal gel, spermicide, etc.). 

The Oura Ring Might Be More Accurate Than Other FAM Methods

Historically, fertility awareness methods (FAM) get a bad rap. The reason? “These methods often require the user to be very consistent in tracking changes, measuring temperatures, and charting their periods to be used effectively,” says Dr. Krauss. “Because of this, the typical use effectiveness of FAMs can be as low as 76%, especially for inconsistent or inexperienced users,” she says. 

However, many recent technological advances — including the creation of Natural Cycles and the Oura Ring — have made FAMs more user-friendly, accessible, and effective, says Dr. Krauss. These days, according to the American College of Obstetricians and Gynecologists, fertility awareness methods can be 95 to 99% effective if used perfectly. For those practicing the basal body temperature (BBT) method, perfect use means taking your temperature at the same time every day without fail. 

One study of more than 16 thousand women published in BMJ Open in 2019 found that with typical use, the Natural Cycles app is more than 93 % effective at preventing unwanted pregnancy. The efficacy rates with perfect use, which involves avoiding intercourse or using condoms on days marked ‘Red,’ purportedly climb up to 98 %. A small follow-up study from 2021 looked specifically at the Oura Ring’s ability to transmit reliable BBT to the Natural Cycles and found that the data the smart ring automatically captures is as accurate as that captured from a BBT thermometer and later manually entered into the app.

In addition to a higher effectiveness rate than traditional FAMs, “the Natural Cycles app can also still be used effectively by women with more irregular cycles, which was not always true of fertility awareness methods,” says Dr. Krauss. A review of data from over 20,000 Natural Cycles users published by the European Society of Contraception and Reproductive Health found the efficacy was the same for those with regular and irregular cycles. That’s because the app could correctly read the BBT inputs from all users to predict ovulation. 

The fact that Natural Cycles is integrated with Oura Ring also means that users don’t have to take their temperature with a thermometer every morning, adds Dr. Krauss, which helps increase user compliance. Personally, I find it much easier to wear a ring that I only have to charge once per week than to remember to take my temperature with a thermometer manually each morning. “The [ring] also removes some of the human error that can accompany using a thermometer incorrectly,” says Dr. Krauss.

My Experience Using the Oura Ring as Part of Birth Control

Whether or not to use birth control, as well as which to use, is an incredibly personal decision. While I’m not currently interested in becoming pregnant, neither hormonal birth control nor long-acting reversible contraception makes sense for me. I’m a high-level athlete with big goals, so my doctor and I decided that the potential muscle gain impairments and reduced VO2 max that some individuals experience on hormonal contraception weren’t worth the risk for me. Additionally, most hormonal options stop your natural cycle, which would keep me from having access to one of the most noticeable signs of overtraining: a late period or a stopped period.

That said, last year, I ultimately decided to use my Oura Ring and accompanying Natural Cycles app as my fertility method of choice. The automatic syncing and color-coded fertility calendar made the option feel more user-friendly than cervical mucus tracking or other BBT tracking options (including arm bands or thermometers). So, a few months after purchasing the Oura Ring and downloading the Natural Cycles app, I began relying on it as birth control. (The app recommended at least two months of wearing the ring before using it as a fertility tracker, as that’s how long the “cycle insights” feature needs to establish your body temperature trends.)

How has a year of using the Oura Ring and Natural Cycles method gone? Well, I haven’t gotten pregnant! On ‘Red Days,’ I avoid penetrative intercourse altogether, while on ‘Green Days,’ I enjoy a full range of activities, including intercourse. The fact that I am a queer person likely plays a role in my ability to forgo vaginal intercourse on risky days in favor of other kinds of play, such as hand and oral sex. I’m also in a loving partnership with someone who is equally invested in helping us prevent unwanted pregnancy as I am, so I don’t have to worry about being pressured into intercourse on my Red Days.

Is The Oura Ring and Natural Cycles Combo For Me?

There is no such thing as a one-size-fits-all birth control option. The Oura Ring and Natural Cycles combination can be great for those who are looking for a non-hormonal, non-invasive birth control method, says Dr. Krauss. However, for it to be effective, you have to wear the ring at all times for accurate data and abstain from sex or use condoms on your fertile, ‘Red Days,’ she says. “If you’re not able to prioritize adhering to those instructions, then it may not be the method for you,” she says. After all, the efficacy rate requires adherence. 

In addition to diligence, your risk tolerance will also impact whether or not this option works for you. 

While data suggests this combo can be quite effective, other options have a higher efficacy rate (even with perfect adherence). The contraceptive implant, copper, and hormonal IUD all have a higher efficacy rate of 99 % because they are a set-it-and-forget option that does not require adherence from users. The birth control pill and patch can all be equally as effective with perfect use, but are usually just 91 % effective due to human error.

Your budget and access to healthcare may also impact your decision. The Oura Ring and Natural Cycles app are both eligible for reimbursement or coverage by some health insurers. However, without insurance, the Oura Ring Gen3 can cost between $249 and $351, and the Oura Ring Gen4 can cost between $349 and $499, while the Natural Cycles app costs $10 per month or $100 per year.

Dr. Krauss recommends talking with your doctor before deciding what option is best for you based on factors like your physiology, personality, finances, and lifestyle.