Q: What exactly is a menstrual cup, and do you recommend using one over other menstrual products?
A: It is a small flexible device, typically made of silicone or latex, that is placed inside the vagina in order to collect, rather than absorb, menstrual flow. It can be a good choice if you follow the manufacturer’s directions carefully, including how to properly clean and store it. Menstrual cups are sold over the counter (brands include Diva Cup and Lunette Cup), and most are reusable.
There are two basic types. One is bell-shaped and sits lower in the vagina; the other type is placed around the cervix, similar to a contraceptive diaphragm. Depending on the amount of blood flow and type of cup, it has to be removed (or replaced if it’s a disposable one) and rinsed every 4 to 12 hours to prevent leakage. Generally, menstrual cups hold more blood than tampons or pads.
Menstrual cups differ in softness, thinness, shape, size, and flexibility. Women who have given birth vaginally should consider using a larger size. If you are sensitive to latex, be sure to check what the cup is made of. Anatomical differences may make insertion more difficult for some women, especially those with pelvic organ prolapse or fibroids. If you have either of those conditions, check with your doctor before trying the cup. If you have an IUD, be careful not to pull its strings when removing the cup.
There are several advantages to using a menstrual cup instead of tampons or pads, as discussed in a paper in the Lancet in August 2019. It looked at 43 studies from around the world in which more than 3,300 girls and women of all income levels were asked about their experiences using one. Among the findings: The cup offered good protection (leakage was similar to or less than with usual products); most users were satisfied (70 percent wanted to continue using one); and, compared with other menstrual products, there was no increased risk of infection. Some users reported irritation, pain, and discomfort; allergic reactions; and difficulty removing the cup—but adverse effects were few overall.
Reusable menstrual cups also offer significant financial savings, with a cost of just 5 and 7 percent that of sanitary pads and tampons, respectively, over 10 years, the researchers calculated. And they significantly reduce waste.
These positive attributes of the menstrual cup are especially valuable in the developing world, where hundreds of millions of girls and women lack access to affordable, safe, and effective menstrual products and consequently face increased risk of infections, transactional sex (to make money to purchase menstrual products), missed school days, and lost employment.
Of note: One concern about menstrual cups is the risk of toxic shock syndrome (TSS) since accumulation of blood in the cup—especially if there is a high volume of blood and irritation of vaginal tissues—can create conditions that allow for growth of Staphylococcus aureus, the bacterium most commonly responsible for this potentially fatal condition. Six cases have been reported in the English-language literature. But given the widespread use of these cups (exact numbers of women using them worldwide are not known), the risk of developing TSS from their use appears to be very low.