Innovations in women’s health are teaching women about their bodies, changing attitudes and breaking taboos around menstruation. Lea von Bidder, the millennial co-founder of ovulation tracker Ava, recalls tampon commercials she watched during her youth. “They were about how even if you had your period, it didn’t matter, because with tampons you could wear the whitest of pants”, she recalls. The ads message was that a women’s ultimate goal was to forget, or never think about, the monthly cycle. Doctor says ‘If I menstruate, I’m a woman’. Trans people and their periods A recent boom in new offerings in the female health space, from period-tracking apps to fertility wearables and feminine hygiene products, are changing perceptions. Worn at night, the ovulation tracking bracelet Ava, measures multiple variables to detect a women’s fertility window and period cycle. Ava debuted in 2016 and recently launched in Hong Kong with a HK$2,388 price tag . The start-up conducted multiple clinical studies with the University Hospital of Zurich that found the bracelet could alert women to their five-day fertility window with 89 per cent accuracy. The rise of femcare innovations have shifted attitudes and awareness of women’s health, particularly around menstruation. According to Von Bidder, women now have a greater interest in understanding what is going on in their body such as hormonal changes during their cycle. Von Bidder says women sometimes find traditional methods of tracking fertility (measuring one’s temperature to pinpoint ovulation or using urine test strips) to be confusing and difficult to detect ovulation. “For me, the main goal is to give women insights about their body and health in an easy and convenient way that was never before possible,” Von Bidder says. To track the ovulation cycle, the Ava bracelet’s sensor gauges the wearers resting pulse rate, skin temperature, breathing rate, and sleep and physiological stress (measured in heart-rate variability). Users wear it nightly and sync the data to their smartphone, via bluetooth, in the morning. Its artificial intelligence-based technology then calculates the five fertile days in the user’s cycle. The device tracks these variables to monitor changes in hormones. “Your heart rate goes up exactly at the beginning of your fertile window, and that informs us what the hormones are doing,” Von Bidder says. She says using Ava helped her to better understand her hormonal symptoms. Von Bidder has long known intuitively her period affected her skin, but now she understands what parts of her cycle cause her skin to breakout. With more bodily awareness she hopes technologies like this lessen the stigma surrounding women’s health, which persist. “There are so many old wives’ tales people tell each other,” she says. “There are so many reasons why women are so uninformed about this topic … Giving them more information is really critical.” Zoe Chan, founder of Happeriod.com, an e-shop focused on modern feminine hygiene products such as menstrual cups, eco-friendly clothpads, period underwear and more, believes that innovations in this area are dispelling misconceptions around women’s health. In Hong Kong, disposable pads are the most commonly used menstrual product, whereas tampons are still not as readily accessible in major retailers across the city. Chan says the lagging adoption of the latter in local women can be attributed to Chinese culture where safeguarding virginity is still paramount. The rural Indian whose invention ended women’s period shame “They feel hesitant to use something that requires them to put something inside the vagina,” she says, adding that inadequate sex education at schools, where students are taught about pads only, is also to blame. Menstrual cups have been available for several years, but in Hong Kong they are hard to find in the city’s major supermarket chains or other mainstream retailers. When Chan first heard about menstrual cups, such as The Diva Cup, in 2014, she and friends ordered them online from overseas. Chan shared her personal experience through social media, which sparked interest from others to join in the next group order for such products. It inspired Chan to launch the e-shop Happeriod, and to host talks and workshops about these choices. A top seller on Happeriod is the Ruby Cup that is part of a “buy one, give one” programme. For each cup that is bought, another cup is provided to a woman in Africa, India or another developing countries. Chan says the market for these modern products is growing, albeit slowly in Hong Kong, thanks to sustainable-minded women, and those seeking more comfortable alternatives to traditional pads. However, many still deem these options, particularly cups as, “dirty,” “horrible” or ineffective. The more intimate contact to one’s body required when using menstrual cups is a major factor that deters many from using them. “It’s quite hard for people to overcome this mental burden; they think it’s quite painful … or if she hasn’t had sex before … she is afraid of putting something in [her vagina],” says Chan. Chan says, at school, most girls are not taught to explore their female anatomy, so more education is required. It prompted Chan to author Things You Never Knew about Your Period , which is available on her e-shop. She used crowd-surfing to raise funds to distribute the booklet to students. She also hosts talks about menstruation, bringing a uterus model with her to demonstrate how the menstrual cup is placed inside the body, for example. Chan says when she asks the audience to pinpoint the hymen’s location on the model, women often get it wrong. “These little games we ask guests … all helps break myths around virginity,” she explains. Nepali teen dies from snakebite after being banished from house for having her period Both Chan and von Bidder are baffled by why innovation in the female health care and tech space remains slow, despite the emergence of these modern solutions. Chan hopes ingenuity in the field intensifies, as even the latest menstrual product such as period panties, do not meet every women’s needs. Chan, for example, says menstrual underwear do not suit women with a heavier flow. “Most period underwear can only hold one or two regular tampon-size [worth of menstrual blood], so some girls don’t think this meets their needs,” she says, adding that as a result, they opt for disposable pads to avoid leaks at work. “I look forward for products that fit those women’s needs,” says Chan. Research says period apps are unreliable Millions of users have adopted such cycle-tracking apps as Clue, Eve, Flo and Period Tracker. However not everyone is convinced these innovations are accurate in forecasting cycles or fertile days. Perhaps the most favoured of all is Clue by Berlin-based BioWink, with more than 8 million users worldwide. The mobile app alerts users on their upcoming cycle, shows their fertility window and features a wealth of options to input data in the app (beside physical and emotional symptoms but moods and more). Users can also share their cycle history with others, be it friends or their doctor. However, researchers at University of Washington, led by Daniel Epstein, looked at 2,000 online app reviews of several popular cycle tracking apps, surveyed 687 participants and conducted interviews. They found these apps fail users in predicting cycles precisely, because of the female health assumptions they were based on. “Existing apps also generally fail to consider life stages that women experience, including young adulthood, pregnancy, and menopause,” noted the paper that was presented at a US conference in 2017.