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Empowerment, privacy and the rise of FemTech

6 December 2021
By Dr Elizabeth Oliver and Dr Avi Lerner
Dr Oliver is a postdoctoral researcher, Karolinska Institute, Sweden and Dr Lerner is an Honorary Lecturer in Reproductive Health and Policy at Imperial College London, UK
Appeared in BioNews 1124

In harmony with great scientific discoveries, technological breakthroughs have transformed the fields of genetics and fertility treatments. Advances in technology provide society with opportunities and risks, and FemTech is no different. FemTech describes the rising trend of technologies designed to improve women's lives and carves out a new space where entrepreneurs and innovators are trying to address the unmet needs of women's health. Here, we set out FemTech in a reproductive health context and highlight how technology can improve ovulation monitoring and fertility tracking and benefit women's health and wellbeing. We touch upon emerging and novel applications of FemTech with a focus on menopause and diagnostics. Finally, we share some thoughts on privacy and data security concerns and the growing need for regulation.

The overwhelming focus of the FemTech industry has so far been on period and fertility tracking. The rapid influx of cycle-related apps broadly centres around smart technology and algorithms that calculate and predict a woman's next period based on various physiological parameters entered by the user. Confidence in FemTech has grown significantly. There is now an FDA-approved fertility tracker that uses a bracelet worn during sleep, enabling the five most fertile days of the menstrual cycle to be extracted from the data to help facilitate conception. One company has developed this concept even further and are now getting ready to launch the first all-digital FDA-approved contraceptive. Another innovative company has launched a mini-lab in combination with their mobile app, which allows users to measure progesterone levels in their saliva to confirm ovulation.

More recently, menopause has started to attract increased financial investment. While an inevitable component of ageing, menopause remains associated with stigma and silence. Women have shown a desire to adopt lifestyle interventions such as exercise, yoga and specific diets to help reduce menopause symptoms alongside hormone pharmacotherapy. The generation of women currently approaching menopause is very much at home with technology, social media and mobile apps, and FemTech start-ups have begun to capitalise on this opportunity.

Mobile apps may help guide menopausal women with lifestyle intervention tips and advice, offer individual or group teleconsultations, and importantly, provide access to an online community of women who are there to listen, share information and offer each other support. FemTech is also focused on alleviating physical symptoms such as hot flushes. Examples of novel technologies include a cooling wristband designed to help menopausal women moderate their temperature at night and cooling pillows that regulate a sleeper's temperature throughout the night via an app.

Improvements in digital diagnostics could be another game-changer for FemTech. One company, for example, has transformed a smartphone camera into a medical device. By combining a urine sample kit, testing strips with colour recognition and artificial intelligence they can potentially revolutionise urinary tract infection testing. Home diagnosis and treatment will ultimately reduce trips to the GP and save health resources. However, home-based clinical diagnostics come with risks and misdiagnosis can be costly.

Whether the explosion of technologies offers any real benefit to the individual is yet to be seen. In terms of convenience, fertility-based app technologies now allow the user to record vital data with a few taps of their smartphone instead of the traditional pen on paper (or calendar) fertility awareness method approach. Many of the apps additionally allow for tracking symptoms beyond that required for fertility awareness, including cramps and changes in skin, hair, and sleep quality, which in theory could prove helpful as clinical co-evidence can potentially aid in diagnosis when visiting health providers.

Further to the potential benefits to the individual, fertility awareness apps and the associated databases of fertility data provide a unique opportunity to examine a large number of menstrual cycles to drive forward women's health research. Certainly, data in this format has been instrumental in examining the potential impact of the COVID-19 pandemic and vaccine use on menstrual cycle dynamics. There are also societal benefits of FemTech becoming more widespread, such as enabling better workplace conversations, reducing stigma around women's reproductive health and allowing women to have greater healthcare choices.

Innovation in FemTech needs to be balanced with the real concerns surrounding privacy and data security. These applications can hold sensitive personal information such as menstrual cycles, sexual activity, pregnancy status and cancer-related health. The international nature of FemTech apps means that consistent regulation or standards are lacking. Several media reports have already described companies misleading users about the extent of their data sharing. FemTech firms need to make a concerted effort to ensure a robust approach to data privacy and security.

Data protection such as decentralisation and anonymisation has to be considered at the earliest stages of app development and built-in from the start. Transparency over user consent, third-party sharing, and algorithmic bias, especially when artificial intelligence and machine learning is being used, is crucial. COVID-19 has illustrated how valuable data submitted to health apps can be used to progress research, but it must be made very clear to users that the data they are submitting will be used for these purposes.

As with so many advances in reproductive health, FemTech heralds great promise but requires a requisite level of caution. In many ways, FemTech delivers on these promises. There are a host of technologies currently available to monitor and regulate female health on the market. These technologies, digital tools and mobile apps have transformed the way many women access reproductive health medicine and have done much to empower women, improve education, reduce stigma and perhaps most important, stimulate conversations around these topics. As FemTech innovation continues, we need to safeguard the patient's right to privacy, ensure transparency and data security, and regulate FemTech companies appropriately.

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