Reusable menstrual cups are as reliable as tampons, pads: Lancet Study

Delhi: We have all had our doubts regarding the use and safety of menstrual cup since its popularization. A recent review has put an end to all the doubts by elaborating on the use, availability, leakage and safety of menstrual cups and comparing it with conventionally used tampons and pads.

The meta-analysis published in the journal Lancet Public Health has found menstrual cups to be safe and effective alternative to disposable tampons or pads. The study found that menstrual cups offer similar or better leakage protection, cost less over time and have few adverse events compared to tampons or pads.

According to the researchers, despite all these attributes awareness of this feminine hygiene product is limited by a lack of recognition of the device as an option for the management of menses.

The menstrual cup is feminine hygiene, which is inserted into the vagina just like tampons but instead of absorbing, it collects the menstrual blood and prevents its leaking into the clothes. They are increasingly becoming popular due to its reusability making it an eco-friendly product. One cup can be reused for up to 5 years or more.

They are made up of flexible medical grade silicone and shaped like a bell with a stem. Insertion and removal are done through the stem. Every 4–12 hours (depending on the amount of flow), the cup is removed, emptied, rinsed, and reinserted. After each period, the cup should be boiled for at least 5 minutes and stored for use the next month.

Despite its advantages, the use of the product over tampons and pads has always remained questionable. Anna Maria van Eijk, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, and colleagues reviewed international studies on menstrual cup leakage, acceptability, and safety and explored menstrual cup availability to inform programmes.

For the purpose, the researchers examined 43 qualitative and quantitative studies of 3300 females who used or were asked about the menstrual cup.

The primary outcome was leakage. Additional outcomes included acceptability of use, difficulty with insertion or removal, comfort, intention to use in future, serious adverse events, and safety in poor sanitary conditions. Collectively, the study participants represented a range of ages, regions, and income groups.

Key findings of the study include:

• Four studies made a direct comparison between menstrual cups and usual products for the main outcome of leakage and reported leakage was similar or lower for menstrual cups than for disposable pads or tampons (n=293).


• In all qualitative studies, the adoption of the menstrual cup required a familiarisation phase over several menstrual cycles and peer support improved uptake (two studies in developing countries).


• In 13 studies, 73% of participants wished to continue the use of the menstrual cup at study completion.


• Use of the menstrual cup showed no adverse effects on the vaginal flora (four studies, 507 women).


• The researchers identified five women who reported severe pain or vaginal wounds, six reports of allergies or rashes, nine of urinary tract complaints (three with hydronephrosis), and five of toxic shock syndrome after use of the menstrual cup.


• Dislodgement of an intrauterine device was reported in 13 women who used the menstrual cup (eight in case reports, and five in one study) between 1 week and 13 months of insertion of the intrauterine device.


• Professional assistance to aid removal of the menstrual cup was reported among 47 cervical cup users and two vaginal cup users.


• 199 brands of menstrual cup and availability in 99 countries were identified with prices ranging from US$0·72–46·72 (median $23·3, 145 brands).

Adverse events included five cases of toxic shock syndrome, difficulty with device removal requiring medical assistance, and dislodgment of intrauterine devices (IUDs). The authors write: "Women with IUDs might need to consider an alternative option for either family planning or menstrual flow."

"Our review indicates that menstrual cups are a safe option for menstruation management and are being used internationally. Good quality studies in this field are needed. Further studies are needed on cost-effectiveness and environmental effect comparing different menstrual products," they concluded.