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Two years ago, Danielle Castillo decided to end her 13-year relationship with the pill. She had been using hormonal birth control since she was 17, and it often made her nauseous and lowered her libido. Engaged to a supportive partner but not yet ready to have children, the Cleveland-based social media marketer started researching alternatives.

What she found, through online searches and Facebook groups, was Natural Cycles, an app the FDA cleared in 2018 to be marketed as birth control. It’s a form of fertility awareness, which typically carries a higher risk of pregnancy than common hormonal birth control options; Natural Cycles uses daily basal body temperature readings to identify the roughly six-day period leading up to ovulation when having sex can lead to a pregnancy.

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