The Menstrual Cup

What is the menstrual cup?

The menstrual cup has been steadily gaining popularity over the years as an eco-friendly, healthy and cheaper alternative to pads and tampons. If you’ve heard of it, you may be wondering about what exactly a menstrual cup is and whether you should consider using it?

The menstrual cup is a device worn inside the vagina during your period to collect your menstrual fluid (blood containing your uterine lining) but it doesn’t absorb menstrual fluid the way pads and tampons do.

The menstrual cup, or pads and tampons?

There are many advantages to using the menstrual cup over pads and tampons:

• They are cheaper as it is essentially a one-off purchase lasting for years. Some manufacturers recommend changing it every 1-3 years but you will still be saving money after your initial investment

• They are eco-friendly as most pads and tampons end up in a landfill and generate environmental waste

• They don’t cause dryness or disrupt your pH balance like tampons and pads. Tampons absorb moisture inside your vagina upsetting its pH balance. Any chaffing or mild rash sometimes associated with pads is also avoided

• Tampons and pads can contain traces of harmful chemicals such as pesticides and dioxin, which have been linked to cancer and reproductive hormonal imbalance. The cup does not contain such chemicals 

• The cup does not expose your menstrual fluid to air, so there is less chance of any odours that sometimes occur with pads and tampons

• Tampons are associated with toxic shock syndrome (TSS) that is a potentially life threatening, but rare condition. The risk of TSS is lower with menstrual cups

• There is less leakage in comparison to tampons and pads as the cup forms a seal around the inner wall of your vagina 

• The cup can be more comfortable than bulky pads or tampons

• The cup is more discreet under clothing than bulky pads

• The cup is helpful if you participate regularly in active sports such as swimming or cycling, as it requires less attention than tampons and pads

• The cup is helpful for women with heavy periods as it collects around a third more menstrual fluid than tampons and pads

• The cup can be used to note how much menstrual fluid you are expelling for medical reasons. Some cups have measuring marks on them

• Disposable menstrual cups can be kept in place during sex, but they are not a form of contraception

• Some women embrace the empowerment they feel when using a menstrual cup because it engages them more with their bodies

The main disadvantages to the cup compared to pads or tampons are:

• They are less mainstream so they might be harder to get hold of

• They require some learning compared to reusing old methods – if you are used to pads or tampons then trying out the menstrual cup may be more hassle

Where can I buy the menstrual cup?

You can buy a menstrual cup from one of the major pharmacy chains or through their online stores.

• Due to the growing interest and demand, there are many different varieties, colours and models being manufactured today

• Prices vary between the different brands of cup

• They are usually between £12-25. Most of the popular cups are around the top end of this range

The Mooncup® or DivaCup® brands are the most popular. They are available only in two sizes:

• Size A is recommended for women who are 30 and over and all who have given birth vaginally regardless of age

• Size B is recommended for all those under the age of 30 who have not given birth

You can locate a stockist or online retailer from their websites – www.mooncup.co.uk or www.divacup.com.

Other popular brands include the following:

• Me Luna®

• Lunette® 

• Softcup®  

• LunaCopine®

• Intima Lily® 

There are many online reviews by women who have used the menstrual cup and include their individual pros and cons for deciding to use the cup. There are not many medical studies on the effectiveness between different cups. As each woman’s anatomy is different it may take a few cups before you find the perfect one.

When choosing a menstrual cup it is helpful to know if your cervix sits high, low or at an average height and if it is tilted. If your cervix height is average then most cups will be suitable. If it is high then you would need a longer cup and if it is low then you would need a shorter cup. 

If you have a heavy periods – you should get a cup with a higher capacity. It is always best to overestimate when in doubt about your flow so you do not have to change your menstrual cup too often. There are also small differences in the width and firmness of cups, which you should consider for your comfort.

How do I use a menstrual cup?

The menstrual cup is the shape of an upside down bell with a stem, ball or ring attached to its top. You can usually wear it for a maximum of 8 - 12 hours. Once it’s full, you tip the menstrual fluid down the toilet or a sink, rinse it with water and carry on re-using it. You can wear the cup whilst urinating or passing stools.

Using the menstrual cup comfortably takes a little practice – there is usually more of a learning curve associated with removing the cup than inserting it. Most women find that they are comfortable with their cup after a few times and usually by their second or third cycle.

Inserting your menstrual cup:

• Just before your period begins, the menstrual cup is folded and inserted into your vagina (the manufacturer’s leaflet provided with your cup gives details on how to fold and insert it)

• You should be in a comfortable squatting, kneeling or standing position

• While holding the folded cup in one hand, use your other hand to separate the skin fold around your vagina and gently insert the folded cup up and towards your tailbone

• Once inside your vagina, the cup opens up and sits inside by forming a seal against the inner wall of your vagina

• You can push it gently further up by the bottom of its bulb with your fingertip until it feels comfortable

• You may have to rotate it once or twice by the bulb (not the stem) so that a proper seal is formed to prevent any leaks

• Ensure that the stem is not hanging too far out or is resting against your vaginal wall as this may cause irritation 

Wetting the cup may make it easier to insert –  some cups are also compatible with water-based lubricants and some are not. Your manufacturer’s leaflet will provide specific guidance on what you can apply. Some women find that squatting afterwards like they are exercising helps them to assess if the cup is sitting inside comfortably.

Removing your menstrual cup:

• The stem, ball, or ring helps you to remove your cup 

• It is really important to relax, as you don’t want to tighten the vaginal muscles making it harder to remove your cup  

• When you are in a comfortable position, gently pull the stem to find the base of your cup

• You may need to tense your pelvic muscles and push like you are trying to pass stools. This helps to bring the cup down

• Gently squeeze the base of the cup or slide your finger alongside it to release the seal

• Once that is done, gently pull the cup down so that its base is almost outside your vagina

• You may need to angle it to one side so that there is no spillage.  Always maintain good hand hygiene when using your menstrual cup

Once you are familiar and comfortable with where the cup sits you can trim the stem if you find it is too long before you next insert it.

Once your cycle is finished, you need to sterilise your cup – dip it in boiling water for a few minutes before you store it away. Your manufacturer’s leaflet will provide specific guidance on sterilisation. It is best to use a breathable container rather than an airtight container or plastic bag so any moisture can evaporate. A storage bag is usually supplied with your cup.

Will a menstrual cup improve my periods?

Menstrual cups can help you to manage your period better – especially certain groups of women. Those with a heavy period for example, may consider using the cup as it collects more menstrual fluid than tampons or pads would normally absorb. The cup can also be worn for longer, which is more convenient than changing your pad or tampon every few hours.

Some women notice that their cramps are reduced and that their period is more regular and lighter since using the menstrual cup – one possible explanation is that there is less use of pads and tampons, which can contain harmful chemicals that have been linked to hormonal imbalance.

No chemical disruption – your vaginal system has a really effective blood supply. Any chemicals from pads or tampons are rapidly absorbed from your vagina and distributed to the rest of your body without being broken down first.

With the cup there is less exposure to these chemicals and therefore a positive change in a women’s period and reproductive health. Hormonal imbalances are also linked to conditions that cause heavy, painful or irregular periods such as polycystic ovary syndrome (PCOS), uterine fibroids and endometriosis.

What to do about difficult periods – if you find that your periods are troublesome then speak to your doctor. If you are considering the contraceptive pill then typically women taking the combined contraceptive pill (COC) will have lighter, less painful and less irregular periods. Women who take the mini-pill may have no periods at all, or they may experience some irregular bleeding (also known as ‘spotting’) whilst taking this type of pill.

Does the menstrual cup prevent pregnancy?

No, menstrual cups are not like the contraceptive diaphragm – even if they seem similar. Menstrual cups are not contraceptives and are only used for the purpose of collecting menstrual fluid.

Some can be used during sex though – disposable cups such as the Softcup® can be in place during sex to help create a ‘mess-free’ barrier, but it is not a form of contraception and does not protect you from STI’s.

A reusable menstrual cup should never be worn during sex – it sits lower than a tampon or a contraceptive cap, is firmer than a disposable cup, and can cause abrasions.

For a way of preventing pregnancy – consider a contraceptive pill or other device like the contraceptive diaphragm or contraceptive coil. 

At Superdrug Online Doctor, we offer most UK brands of contraceptive pill, including Yasmin, Cilest, Microgynon, and more.

Where did the menstrual cup come from?

Its history began with the midwives, McGlasson and Perkins, who patented an early version of the menstrual cup in 1932. Later in 1937, an actress, Leona Chalmers patented the first commercial cup. The design was based on latex rubber, but during World War II its production stopped due to a shortage of latex rubber.

Since then a number of brands have made their way into the market with some being more successful than others. The Keeper® is still available today and was first manufactured in the United States in 1987, as a rubber latex cup. The Mooncup® was the first silicone menstrual cup manufactured in the UK and was launched in 2002.

Today most cups are made from medical grade silicone that is both durable and hypoallergenic. A few are also made from TPE (thermoplastic elastomer), which has similar properties and has a lower incidence of silicone allergy.

Sources

FFPRHC Guidance (2005). The use of contraception outside the terms of the product licence. Journal of Family Planning and Reproductive Health Care; 31(3): 225-242.

Howard, C., Lee-Rose, C. and Paget, J. (2011). FLOW (finding lasting options for women). Canadian Family Physician; 57(6): 208-215.

Jess (2017). Best menstrual cup for you: the definitive guide. Parent guide. [online] Available at: https://parent.guide/best-menstrual-cup-the-ultimate-guide/ [accessed 19th December 2017].

Mitchell, M. A. et al (2015) A confirmed case of toxic shock syndrome associated with the use of a menstrual cup. Canadian Journal of Infectious Diseases & Medical Microbiology; 26: 218-220.

North, B. B. and Oldham, M. J. (2011). Preclinical, clinical, and over-the-counter postmarketing experience with a new vaginal cup: menstrual collection. Journal of Women’s Health; 20(2): 303-311.

Spechler, S. et al (2003). The Keeper, a menstrual collection device, as a potential cause of endometriosis and adenomyosis. Gynaecologic and Obstetric Investigation; 56(1): 35-37.

https://www.me-luna.eu/ [accessed 19th December 2017].