Long considered a taboo topic, menstruation is out of the closet. Need proof? You’ll find ads for one new menstrual product, Thinx underwear, prominently displayed in glossy magazines, along city streets, and in New York City’s subways. And a London marathoner was recently profiled in The New York Times for running the race while menstruating and deliberately not using any feminine product (a practice known as “free bleeding”).
After decades of relying on disposable sanitary pads or tampons, many women are in search of alternative options—including some reusable ones—that are more economical and more eco-friendly in terms of reducing landfill waste. That makes sense when you consider that women spend some $2 billion a year on these products in the U.S. alone—and the average woman uses close to 17,000 pads and tampons over the course of her life.
Here’s a sampling of some of the alternative menstrual products now on the market. A note on safety: Pads, tampons, and other feminine hygiene products aren’t required to be tested for safety before they are sold in the marketplace. A U.S. congresswoman from New York has reintroduced a bill, the Robin Danielson Act (originally introduced in 1999 and named for a woman who died of toxic shock syndrome in 1998), that would, among other things, require the National Institutes of Health (NIH) to allocate resources for research into the safety of feminine hygiene products. But as yet this bill has not passed. (Toxic shock syndrome is a rare but potentially fatal bacterial infection that’s been linked with tampons and other menstrual products that are inserted into the vagina.) Where relevant, we’ve included available safety information on the products.
This is a flexible, bell-shaped cup that is inserted into the vagina to collect, rather than absorb, menstrual blood. Most are made of rubber or silicone, so if you are sensitive to latex, only use a cup made entirely of silicone. Depending on your flow, you will likely have to remove and rinse the cup (or replace it if it’s a disposable one) at least every 12 hours, to prevent leakage. Make sure you read the package to determine whether the cup you’ve chosen is reusable or disposable.
If you’ve never used either a tampon or a diaphragm, there might be a bit of a learning curve in terms of folding the cup and inserting it into your vagina, where it will open up. Once it’s properly inserted, you shouldn’t feel anything, just like with a tampon. And there’s no unpleasant odor because the blood isn’t exposed to the air.
Some women may feel squeamish about emptying the cup, especially in public bathrooms. But most get over it. And anatomical differences may make insertion more difficult for some women than others, especially if they have pelvic organ prolapse or fibroids. These women should check with their doctor before trying the cup. Women who use an IUD should be careful not to pull the strings of the IUD when removing the cup.
There are many different types of cups on the market, including the DivaCup and Lunette Cup. They differ in terms of the ease of folding or collapsing them, their softness, thinness, shape, and size. Women who have delivered a baby should consider using a larger size.
Safety note: A paper published in 2015 in the Canadian Journal of Infectious Diseases and Medical Microbiology reporteda rare case of toxic shock syndrome associated with a woman using a menstrual cup as instructed. The authors noted that the accumulation of blood (especially if there’s a heavy flow) in the cup inserted high up within the vagina (especially if the vaginal tissues become irritated from cup insertion) can create conditions that allow for the growth of Staphylococcus aureus, the bacterium most commonly responsible for toxic shock. (This is true of anything inserted into the vagina.) But this appears to be an isolated case, and we could find no other reports of risks from properly using a menstrual cup.
These irregularly shaped products—most harvested from the sea floor, though synthetic options are also available—are first dampened with water, then compressed before being inserted into the vagina, where they work in the same way as a tampon. The sponges come in different sizes and can be trimmed to allow for a better fit. Some are reusable and can be used for several months, while others are disposable. (One example is the Beppy sponge, a synthetic, single-use sponge that’s also referred to as a string-free or wet tampon.) As with the menstrual cup, the sponge can be messy since it has to be removed and washed every few hours.
Safety note: Sponges that come from the sea floor (aka natural sponges) can be contaminated with anything found in their environment, from dirt and sand to bacteria. It’s up to the manufacturer to disinfect the sponge. Because of the potential health risks, the FDA doesn’t allow companies to sell natural (sea) menstrual sponges in the U.S. without premarket approval. The agency cites on its website research done in the late 1980s in which samples of natural menstrual sponges were found to contain grit, sand, mold, and bacteria, among other contaminants. Around the same time, the CDC reported a case of toxic shock syndromeassociated with menstrual sea sponge use. But some of these products are still sold online despite lacking premarket approval. (See this 2014 FDA warning letter to one sea sponge maker.)
These cloth pads are an option for women looking for a comfortable, more economical, “natural” alternative to synthetic disposable sanitary pads. GladRags, Lunapads, and pads made of bamboo and charcoal (to help minimize odor) are some of the many products in the marketplace. As with typical synthetic pads, they come in different sizes and absorbencies. There’s a bit of a learning curve for using some of these, since they rely on tabs and snaps to keep the pad in place rather than an adhesive that sticks to your underwear (as found on disposable pads). But it’s hardly rocket science. You’ll have to change the pads as often as you would a comparable disposable pad, washing them in the laundry at home or, if you’re on the go, bringing along extras and putting the used ones in a sealable carry bag until you are able to wash them.
Hormonal Contraceptives to Eliminate Periods?
Some women can use oral contraceptives or other forms of hormonal birth control (such as a patch, insertable ring, or injection) to eliminate regular periods altogether or reduce the number of periods they experience annually.
The latest addition to the market, Thinx is a special washable underwear made with several different layers of fabric in the crotch that are designed to absorb blood (light to medium flow) as well as prevent odor, leakage, and unpleasant wetness. They provide an alternative to tampons (or the menstrual cup or sponge) for women who prefer not to insert a product into their vagina or who want to avoid certain chemicals or materials in traditional feminine hygiene products. And, compared to wearing pads, the underwear is slim and won’t shift around as you move.
Thinx is not cheap, with the high-waist panty costing close to $40, but it’s still a relative bargain compared to the cost of buying boxes of tampons and pads over a lifetime. The panties are attractive and stylish, and online reviews tout their limited odor (even when sniffed up close, some say) and minimized feelings of wetness, depending on how long you wear them and how heavy your flow is. (They’re marketed as being able to hold two regular tampons’ worth of fluid.)
This option, which is exactly what it sounds like, definitely isn’t for everyone. But there’s no question it’s the most “natural” alternative of all. And though this method (or non-method) of managing menstruation might seem primitive, marathoner Kiran Gandhi notably ran the 2015 London Marathon without using any feminine hygiene product. The free bleeding movement is growing in popularity, for three main reasons: concern for the environment, not wanting to wear or insert a menstrual product, and believing that bleeding from the vagina should be viewed as something normal rather than a source of shame.
Our experts don’t recommend using natural sea sponges because of safety concerns. If you try a reusable cup, make sure you properly clean and store it according to manufacturer’s directions. Never share it with anyone. And if you want to try an alternative menstrual product that doesn't require inserting anything into your vagina—and don’t mind the cost—Thinx panties or the reusable pads are both reasonable options, if they suit your lifestyle.
Also see Menstrual Cramps: Causes and Treatments.
Published June 21, 2017