When we launched the Flo app in 2016, we knew that we wanted our content and app features to be medically accurate — we are in the business of improving health education, after all.
Over the years, we’ve heard from many of our members how Flo has helped them learn more about their menstrual cycles and their bodies and how this has improved their health.
But we wanted to do more.
Pharmaceutical companies put new drugs through rigorous testing. Yet health and wellness apps are generally not required to do this, and most don’t bother with the time, effort, and cost of assessing if their product has measurable benefits.
Randomized controlled trials (RCTs) are the gold standard way of testing how well a health intervention works — whether that’s a new drug, a health and wellness app, or a medical device.
Flo’s science team has now published the results of our RCT putting Flo to the test.
Working in collaboration with experts at Johns Hopkins University, the University of Virginia, and Texas Christian University, we tested if using Flo can improve knowledge, menstrual health, and well-being outcomes in menstruating individuals with and without premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD).
Keep reading for more details about our study.
Trial 1: Users in cycle-tracking mode: What did we do?
Our study actually includes two RCTs. For our first trial, we worked with Sarah Hill, PhD — a professor in the psychology department at Texas Christian University, US — to understand if using Flo can improve health knowledge and well-being when people use our cycle-tracking mode.
We recruited 321 participants, aged 18 to 44, who lived in the US. Roughly half were asked to use Flo for 12 weeks, while the other half were asked not to use Flo during this time period. None of the participants had used Flo previously
At the start and at the end of the study, we asked all participants questions about their health knowledge, or health literacy as scientists call it. We also asked them about several other things, including their menstrual health awareness, their general health and well-being, and their body image.
Trial 1: What did we find?
Using Flo for 12 weeks led to greater improvements in health literacy, menstrual health awareness, and health and well-being scores in the group that used Flo compared with the group that didn’t.
All three of these measures also went up in the control group that didn’t use Flo. This might be because taking part in our study could have prompted participants in our control group to pay closer attention to their health, even if they didn’t use Flo.
“The improvements were much greater in those who used Flo,” commented Adam Cunningham, PhD, lead research scientist at Flo and first author of the study. “We think that access to Flo’s wealth of health content and features is the key to these results.”
If you’re wondering what all of these improvements translate to in reality — health literacy and health and well-being scores are pretty abstract scientific terms, after all — here are some examples of the statements and questions we asked our study participants:
- I always know when I am about to get my period.
- I understand when in my cycle I can become pregnant from sex.
- How long does a normal menstrual cycle typically last?
- Approximately what percentage of women say they can have an orgasm from vaginal penetration alone?
Once the Flo group had spent 12 weeks using the app, they were able to answer significantly more of these questions correctly than before, and their scores for the statements were higher.
We also asked questions about the participants’ health and well-being, and the scores were higher after using the app for 12 weeks compared with not using the app. These are some of the questions we asked:
- How satisfied are you with your health?
- How much do you enjoy life?
- How satisfied are you with your sex life?
At the end of the study, we also saw a number of other improvements that were greater in the group that used the app compared with the control group. These included feelings of control and management over health, communication about health, lower menstrual cycle stigma, and lower fear of unplanned pregnancies.
But we didn’t see any improvements in body image scores in either group.
“Body image is a complex topic and may need a more targeted approach than we provided in this study. While the Flo app does have some content that addresses this, a longer period of app use may be needed to see a difference,” Adam commented on the findings.
Trial 1: Why are our results important?
Having a good level of understanding of our own bodies is important when it comes to making informed decisions about our health as well as the health of our families and communities.
This includes understanding the menstrual cycle and our reproductive health.
The World Health Organization (WHO) recently reported that digital health technologies, which include digital health apps like Flo, can improve women’s health and positively impact empowerment and gender equality, in part through providing women with health information.
With our study, we proved that access to the Flo app, with its extensive medically reviewed content library, can help women improve their knowledge and their health.
Trial 2: Users with PMS/PMDD: What did we do?
In our second study, we collaborated with Dr. Jennifer Payne, a professor of psychiatry and neurobehavioral sciences at the University of Virginia, US, and Liisa Hantsoo, PhD, an assistant professor of psychiatry and behavioral sciences at Johns Hopkins University, US.
We recruited 117 participants, aged 18 to 54, who lived in the US and had either PMS or PMDD. Similar to our first trial, around half of our participants used Flo for three months, and the other half didn’t. None had used Flo before.
We asked our participants questions at the start and the end of the trial to measure their PMS- and PMDD-related health literacy and how high they rated what scientists and doctors call their symptom burden. We also asked them how much time they had recently taken off from work or studying due to their PMS and PMDD symptoms, their work productivity, and their quality of life.
Trial 2: What did we find?
For people with PMS or PMDD, using Flo for three months resulted in greater improvements in symptom burden, time off from work or study, and knowledge about their condition.
Similar to trial 1, we also saw improvements in symptom burden and knowledge about PMS and PMDD in the group that didn’t use Flo, but the group using the Flo app saw significantly greater improvements.
Here are some of the questions that we asked:
- How do you know whether swollen breasts and pain are due to PMS?
- What can you supplement or increase intake of during PMS to reduce symptoms?
- What usually helps with PMDD symptoms?
- How many days of absence have you taken from work or university/school in the past three months due to your mental health or issues related to your menstrual cycle?
- Taking everything into consideration, during the past month, how satisfied have you been with your physical health, ability to function in daily life, and overall life satisfaction and contentment?
While the group using the Flo app had a reduction in the number of absent days from work or education by an average of 1.6 days, there was no change in the control group.
We didn’t see any changes in quality of life or work productivity scores in either of the groups.
“As we saw in our first trial, some of the issues we looked at in our study, including quality of life and work productivity, are very complex,” Adam said. “It may be that these measures change if someone uses the app for a longer time period, or it may be that more tailored content for these issues is needed. It’s something we’re keen to look into in a future study.”
Trial 2: Why are our results important?
Nearly half of women with periods across the globe have PMS, and nearly 1 in 10 have PMDD.
Together, these two reproductive health conditions have a greater impact on quality of life than type 2 diabetes and high blood pressure in terms of pain.
Many women accept PMS and PMDD as part of their life. But there are ways to manage both.
Knowing more about these conditions — like which symptoms are normal and which to discuss with a health care professional — is key to empowering women with PMS and PMDD to improve their quality of life.
Our study proves that using Flo helps women gain more knowledge about their condition, and — importantly — it reduces the burden of symptoms and the number of days absent from work or education.
What’s next?
Whether you’ve been using Flo for a while, you’re here to find out about our science, or you’re a health care professional wondering if your patients might benefit from using Flo, you’ve now got the evidence that having access to Flo can help women improve their knowledge and their health.
“Medical accuracy and efficacy are at the root of Flo. We work with an international team of 120+ doctors, health experts, and scientific researchers to ensure that everything at Flo — from the content to app features — is medically accurate and scientifically proven to be effective for our users,” commented Liudmila Zhaunova, PhD, director of science at Flo.
“This study has given us further confidence and evidence that using Flo can lead to improved health outcomes,” Liudmila continued.
The science team is currently busy conducting a follow-up study with a greater number of participants to understand how Flo can help women in even more detail.
