Menstrual Cups

What is it?

It is a type of feminine hygiene product used by women during their menstrual cycle. It is a small funnel shaped cup, with an open wide brim on one end and a long narrow closed end. The cup is inserted into and sits in the vaginal canal to catch menstrual blood.


What are menstrual cups made of?

Menstrual cups may be made from rubber, latex, plastic or more commonly medical grade silicone material.


How do they work?

The cup works by establishing a tight seal to the vaginal sidewalls while collecting menstrual blood.


How do you place the menstrual cup?

For women who have used tampons in the past, the technique of placing the cup is quite similar.

  1. Wash your hands with soap and water prior to placing the device. The cup is flexible in nature thereby allowing a user to squeeze and fold the larger end of the device into a size that fits through the opening of the vagina.
  2. Part the labia with one hand and with your dominant hand slide the cup it into and up the vaginal canal. Once released the device reconfigures and molds to the vaginal side walls, and the narrow tip sits in the lower vagina. Like a well-placed tampon, you should not be able to feel the device when it is correctly placed.
  3. Use a finger to ensure a wide brim is fully open and sealed in place. This is especially important in preventing leakage.

There are several techniques one may use to place the cup; some users opt to fold the device lengthwise versus widthwise in order to insert it into the vagina. Most of the brand manufacturers have videos on placement and removal on their websites.

Some users prefer to place and remove the device while standing or squatting over the toilet or with one leg draped over the toilet sit. Lastly, some manufacturers recommend wetting the brim of the cup with water or lube to facilitate placement.


How do you remove the device?

  1. Wash your hands with soap and water prior to removing the device.
  2. Place two fingers into the vagina and while bearing down (similar effort like you are having a bowel movement) grasp the base of the cup (the bottom of the wide brimmed portion of the funnel) and tag gently downwards. The bearing down mechanism helps to bring the device within reach as well as helps break the suction seal on the vagina. Discard the contents into the toilet.

Of note, it may take a new user several tries to get comfortable with placement and removal of the device.

Device Maintenance – wash the device with water and (a mild soap) and store in a cool dry place between use. Wash with water after emptying device during your cycle. The device may be emptied every 4 – 6 hours as needed. Do not go more than 12hours without removing and cleaning the device.

Some brands have recommended cleaning agents for their product line. Given the variety of manufacturers, there are multiple recommendations on how to care for the device. Please read the package insert or manufacturers` recommendations for care.

A single device may be used for several years before needing replacement. It is therefore not uncommon for the device to have some discoloration over time.




Advantages:

  • Cost savings – compared to other hygiene products like pads and tampons, many of the menstrual cup brands are reusable and may help save money over the long run.
  • As collecting receptacles they are able to hold more volume thus requiring less frequent changes.
  • Environmentally friendly given they decrease or even eliminate the number of tampons and pads one uses. Additionally, some brands are made of recyclable materials.
  • Decreased risk of allergies.
  • Decreased risk of toxic shock syndrome.
  • Some brands may be left in place during sexual intercourse. Please see the manufacturer`s instructions.
  • Similar to tampons, cups may be used during swimming, cycling, hiking and other activities.
  • Decreased or no odor.

Disadvantages:

  • There is a learning curve with device insertion and removal and identifying the correct size.
  • There have been a few reported cases of toxic shock syndrome.
  • There are reported cases of injury to the renal system associated with poor device placement.
  • There have been a few cases where device removal was associated with IUD dislodging and/ or inadvertent removal.
  • Leaking and discomfort may occur with poor placement. For women with short vaginas, trimming the narrow end of the cup may help with fitting.
  • Pain and injury to the labial lips, vaginal walls and or cervix due to incorrect technique and poor placement.

How do I select the right size for me?

Picking the right device size will depend on multiple factors including:

  • The number of vaginal deliveries a woman has had.
  • The type of menstrual cycle - light, medium or heavy.
  • The user's age.
  • Size of the device.
  • Pelvic floor muscle strength.
  • Some brands also account for the position and length of the user's cervix.

Because of the above variables and multiple different brands of menstrual cups, it may take a user experimenting with different sizes and/or brands before finding the right fit. For user convenience the cups have markings on them to measure the volume of menstrual blood. Users may use this information to select the best size for them. The average amount of blood volume collected ranges from 20ml to 35ml.


How much do menstrual cups cost?

Cost ranges from $ 20 – 50.




What is the difference between a menstrual cup and a menstrual disc?

A menstrual disc is a disc shaped device with a flexible rim and a thin clear film like bag attached to it. It is worn during sex at the time of menstruation. The disc differs from the menstrual cup by where it is located in the vaginal canal. The disc sits at the base of the cervix (or vaginal fornix) while the cup sits lower in a narrower portion of the vaginal canal. Lastly, menstrual discs are generally intended for single use, but there is a brand that offers reusable discs.

The device is placed similar to the cup with effort made to push it as close to the cervix as possible. Its shape and location in the vaginal canal allow for penetrative sex. However, because of its shape some users have reported some difficulty with removal as well spillage of blood during evacuation. Lastly, the disc usually only comes in a single size.

Cost: Ranges from $14 - 40.


Precautions:

Menstrual Cup and discs are a good alternative to the standard personal hygiene products. Like other hygiene products, cups and discs do not protect you from pregnancy or sexually transmitted diseases and only one device should be worn at a time.

Lastly, they should be not be used:

  • Outside of the menstrual cycle.
  • If you have been diagnosed or suspect you may have toxic shock syndrome. See your doctor if you have symptoms of nausea, vomiting, pain, fever, diarrhea, lethargy, difficulty breathing, skin rash.
  • During an active vaginal infection or if you have current vaginal irritation. Discuss use with your healthcare provider if you have persistent problems with placement or removal.

References:

  1. Menstrual cup use, leakage, acceptability, safety, and availability: a systematic review and meta-analysis.
    • Van Eijk AM, Zulaika G, Lenchner M, Mason L, Sivakami M, Nyothach E, Unger H, Laserson K, Phillips-Howard PA. Lancet Public Health. 2019 Aug;4(8):e376-e393. doi: 10.1016/S2468-2667(19)30111-2. Epub 2019 Jul 16
  2. Menstrual Cups & Menstrual Discs. Health Line.
  3. MoonCup.
  4. Diva cup.
  5. Lilly Cup.
  6. Soft disc.
  7. Flex.