A menstrual cup is a type of cup or barrier worn inside the vagina during menstruation to collect menstrual fluid. Unlike tampons and pads, the cup collects menstrual fluid rather than absorbing it.
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There are two types of menstrual cup currently available:
The first type is a bell-shaped cup made of rubber (latex), silicone or thermoplastic elastomer (TPE). It is reusable and designed to last for up to 10 years. Some brands recommend replacement each year, as it is a hygiene product. Other brands recommend replacement after 5–10 years, stating that people have been comfortable using them up to 10 years. These bell-shaped silicone or rubber cups must be removed before penetrative vaginal sex.[1]
The second type is made of polyethylene and resembles the shape of a contraceptive diaphragm. There are two types of polyethylene cups: a disposable version designed for disposal after one use, and a reusable version, designed for re-use for one menstrual cycle. These polyethylene cups may be worn during intercourse, though they are not contraceptive devices.[1]
Menstrual cups are safe when used as directed and no health risks related to their use have been found.[2][3] One case report in the journal Gynecologic and obstetric investigation noted that menstrual cups could theoretically increase the likelihood of endometriosis and adenomyosis and described one woman who developed the disorders after use of a menstrual cup.[4] However, the U.S. Food and Drug Administration declined to remove menstrual cups from the market, saying that there was insufficient evidence that the risk was more than merely theoretical.[5] A 2011 randomized controlled trial in Canada measured urovaginal infection in a comparison of menstrual cup and tampon use, and found no significant difference in physician-diagnosed urovaginal symptoms between the 2 groups.[6] The Journal of Women's Health has published a clinical study demonstrating the acceptability and safety of the Instead Softcup in both clinical and pre-clinical testing.[7] There have been no reported cases of toxic shock syndrome occurring with the use of menstrual cups.[8]
Most brands have a smaller and a larger size. The smaller size is normally recommended for persons under 25 or 30 who have not given birth vaginally. The larger size is normally recommended for persons over 25 or 30, or who have given birth vaginally. The menstrual cups with the smallest size diameter are recommended for teenagers. As well as width, length also needs to be considered. If a person's cervix sits particularly low, they may need to consider a shorter length cup. Shape is also important, as people vary in shape preferences for comfort. Capacity is important to people who have heavier flows; however, all of the menstrual cups currently available have higher capacity than a regular tampon.[9]
An early version of a bell-shaped menstrual cup was patented in 1932.[10] Later menstrual cups were patented in 1935, 1937, and 1950.[11][12][13] The Tassaway brand of menstrual cups was introduced in the 1960s, but it was not a commercial success.[14] Early menstrual cups were made of rubber;[2] today, both silicone and rubber models are available.[15]
In 1987, another rubber menstrual cup, The Keeper, was manufactured in the United States. This proved to be the first commercially viable menstrual cup and it is still in manufacture today. The first silicone menstrual cup was the UK-manufactured Mooncup. Most menstrual cups are now manufactured from silicone because of its hypoallergenic properties. The German brand MeLuna manufacture their cup out of TPE (thermoplastic elastomer).
Menstrual cups are more cost-efficient and environmentally friendly than tampons, as they are reusable (with the exception of the Softcup). Some cups have greater capacity than tampons which is beneficial to women with heavy flows. They also have a lower risk of Toxic Shock Syndrome (see section on Rely tampons). Generally, menstrual cups do not significantly affect the population of vaginal flora, including the bacteria responsible for bacterial vaginosis (including yeast infections) or urinary tract infections.[7] Some people opt for a menstrual cup because it does not absorb natural vaginal secretions as a tampon or sponge would.[16]. The cup offers a discreet nature that pads and tampons cannot provide. Rather than carrying these items for the purpose of changing every few hours, one need only wear the one cup and empty it in the comfort of one's home at the end of the day. A 2011 randomized trial in Canada investigated whether menstrual cups are a viable alternative to tampons and found that approximately 91% of women in the menstrual cup group said they would continue to use the cup and recommend it to others.[6] In a 1995 clinical study involving 51 women, 23 of the participants (45%) found menstrual cups to be an acceptable way of managing menstrual flow.[17]
Using menstrual cups can be more time-consuming for those just starting to use them. For some people, menstrual cups are more difficult to insert and remove than tampons [18] and may also be messier.[18] It often takes a few cycles to learn how to efficiently insert and remove the cup, as they create a seal in the vaginal canal. If lubrication is necessary for insertion, it should be water-based, as some lubricant ingredients can be damaging to the silicone. [1] Further time must be spent cleansing: the manufacturers recommend washing the cup every 12 hours with a mild, unscented cleanser. [2]
Cup manufacturers urge the use of clean water for cleansing, which may not be feasible under all conditions in all countries.