In a world where “decision fatigue” can set in by 10 a.m., we may not stop to consider why we’re attached to using a certain toothpaste, razor or body lotion. If you’ve been taking that approach to your monthly menstrual period, you may want to reconsider.
Is It Time to Rethink Your Menstruation Management Products?
If you’ve been less than pleased with your tampon or pad but think it’s no big deal because it’s just a few days a month, consider this: The typical North American woman menstruates about 450 times in her life; multiply that by 4 days (the average period lasts 2 to 7 days) and it adds up to 1,800 days, or nearly 5 years of being on your period.
A review published online in the Lancet Public Health journal on July 16, 2019, suggests that many women may be better off using a device they might not even know exists — the menstrual cup.
Menstrual Cups Are a Safe Choice
The paper shows that menstrual cups can be a safe and reliable alternative to traditional menstrual products, says Laura Matthews Glaser, MD, a doctor of obstetrics and gynecology at Northwestern Medicine Lake Forest Hospital, who was not involved in this research. “Reliable protection is important for women, and importantly, this large study showed that rates of leakage with these products are similar to or lower than leakage rates with traditional products,” says Dr. Glaser.
How Menstrual Cups Help a Woman With Her Period
Menstrual cups, usually made of medical grade silicone, are either vaginal or cervical. The vaginal cup is bell-shaped and placed in the vagina, whereas the cervical cup is a flatter design and is inserted around the cervix higher in the vagina.
Once inserted, a seal is created to catch menstrual fluid. The cup needs to be removed, emptied, washed and reinserted every 4 to 12 hours, depending on the heaviness of the flow and the size of the cup. The cup should be sterilized periodically and can last up to 10 years before it needs replacing.
How Do Menstrual Cups Compare With Pads or Tampons?
To conduct the first systematic review and meta-analysis of the international use of menstrual cups, researchers used data from 43 studies that included 3,300 women and girls. Twenty-eight of the studies were conducted in high-income countries and 15 studies were held in low- and middle-income countries. Using this research, authors summarized current knowledge about leakage, safety, and acceptability of menstrual cups to other sanitary products like pads and tampons.
Facts About Fluid Leakage From Menstrual Cups, Tampons, and Sanitary Pads
Four studies compared how reliable cups, disposable pads, and tampons were in preventing leakage of blood. In three of the trials, the amount of leakage was similar among products, and in one trial leakage was significantly less for women using the cup. Heavy bleeding, incorrect placement of the cup, the need for a larger cup size, and the cup becoming full before it was removed and emptied were among the reasons for the blood escaping.
Findings About Infection or Side Effects Related to the Use of Cups, Tampons
The use of menstrual cups didn’t increase the risk of infection, according to the studies. There were five instances of toxic shock syndrome (TSS) with cup use, but the overall number of menstrual cup users is unknown, so researchers weren’t able to say whether this condition was more or less common that what is seen in tampon use.
Toxic shock syndrome is a rare but sometimes life-threatening condition that is caused by certain strains of bacteria that produce toxins. Although TSS is associated with menstruation, about half the cases are nonmenstrual; men and children can contract TSS too, according to the Cleveland Clinic Health Library.
Risks for Toxic Shock Syndrome (TSS) With the Use of Sanitary Products
TSS occurs when Staphylococcus aureus bacteria become trapped in the vagina with tampon or cup use; bacteria can grow on tampons, especially if they are left in too long or if super-absorbent tampons are used when flow is light, according to the Cleveland Clinic. The National Organization for Rare Disorders estimates that TSS occurs in between 1 in 100,000 and 3 in 100,000 menstruating women.
In four studies that considered a total of 507 women, the use of the cup had no adverse effects on vaginal flora or tissue damage to the vagina or cervix.
Study Findings on Ease of Use for Menstrual Cups
In 13 studies, around 70 percent of the women wanted to continue using menstrual cups once they were familiar with how it worked, a process that took several menstrual cycles. In studies that interviewed women, practice, peer support, and training were all factors in women’s satisfaction level and continued use.
There were reports of difficulty removing the cups, and in 49 cases (2 times for vaginal cups and 47 times for cervical cups) women needed professional assistance in removing them.
More Research Is Needed on Cup Use in Women With IUDs
Using the cups with intrauterine devices (IUDs) presented a problem for some women, and in 13 cases removing the cup dislodged an IUD. The authors suggest that using an IUD and cup together might need further study.
Menstrual Cups and Cost, Environmental Impact
Although a menstrual cup might be more expensive upfront, there’s evidence that, over a period of months, the cup is much less expensive than using disposable products. According to the authors, there were 199 brands of cups available in 99 different countries with prices ranging from 72 cents to $46.72. Pads cost an average of 31 cents each, and tampons an average of 21 cents each.
The DivaCup website lists the suggested price of a cup at $39.95. The company estimates that consumers would save an average of $100 to $150 dollars a year by using the reusable cup rather than buying disposable sanitary products.
Menstrual Cups Are Cost-Effective and Cost-Efficient
The cup could be a good option for women who have difficulty affording products every month, says the senior author Penelope Phillips-Howard, PhD, a professor at the Liverpool School of Tropical Medicine in England. “If they receive some financial support for initial purchase of a cup, then the stress of finding funding each month to purchase disposables would be reduced,” she says.
Authors estimate that plastic waste might also be reduced. In the course of one year, a cup is estimated to create .4 percent of the plastic waste generated by single-use pads or 6 percent of that produced by the use of tampons.
Menstrual Cups Could ‘Fit the Bill’ for Many Women in the United States and Around the World
Menstrual cups could be useful in some societies where traditional pads and tampons are difficult to come by, although there may be barriers in the form of expense, access, or societal acceptance, says Glaser.
“In some areas, women and girls use cloth products that aren’t cleaned regularly, and these can be associated with infection,” says Glaser. “Menstrual cups have the potential to provide a safe, lower-cost way to provide menstrual hygiene and are associated with a very low risk of genital or urinary infection,” she adds.
Women want hassle-free menstrual products that fit with an active lifestyle, and these products can fit that bill, says Glaser. Many women find that the cups are discreet and eco-friendly, she adds. The cup can also be appropriate for women who have mild allergic reactions or irritation from traditional pads and tampons, says Glaser. “I recommend the use of menstrual cups for these patients and this often improves their symptoms.”
Getting and Sharing Menstrual Cup Information to Make an Informed Choice
Some women in the United States may not even realize the menstrual cup is an option, says Glaser. “Many of my patients tell me that they have never heard of these products (the cup),” she says.
Ending Period Stigma May Help Menstruating Women Explore Options
Social media campaigns may heighten discussion and trials of the cups, especially by younger people, says Glaser. “Word of mouth may help build trust in these products,” she says. Glaser cites the use of intrauterine devices as an example of that. “The IUD as a form of contraception has really skyrocketed over the past 10 years; I think this is partly due to education in a healthcare setting, partly due to advertising, and partly due to word of mouth,” says Glaser.
Going With the Flow
It’s important to note that in the study, peer support really made a difference in whether women accepted and used the menstrual cup, says Glaser. “I try to normalize discussion about menstrual flow and products when I see patients. We should all work to destigmatize discussion about menstruation in general and about sanitary products,” she says. “Every woman deserves to have access to a range of convenient products that work with her lifestyle,” adds Glaser.