Today The Lancet released the largest and most comprehensive review of menstrual cup studies to date. The analysis examined 43 studies (narrowed from 436) that met their criteria for deeper review an inclusion. This. is. huge! Here at PACII HQ you’d think it was Christmas, because WHAT A GIFT THIS IS!
While we have known, or suspected, much of the findings all along, this study has done a deep analytical dive that backs up our most ardent claims about why the menstrual cup is truly the better menstrual care option for most users. The full study is eighteen pages long, so we’ve done the reading for you and have included our take on the highlights below!
The Basis for Analysis
The Lancet’s review is an analysis of 43 studies, which includes a total of 3,319 participants. The participants are from a wide range of income levels and are from all over the globe. While it does bring the combined information from these studies into clearer view it’s worth noting that the relatively low number of studies, and their size, might contribute to a bit of bias. Additionally, this review was of studies published in English only, leaving off any published in other languages.
Menstrual Cup Effectiveness Findings
One of the key factors that this review looked at was the effectiveness of cups as reliable menstrual care. While only four of the studies made a direct comparison between cups and other products, three found that leakage was similar to other products and one found that there was actually significantly less leakage.
Data also showed that menstrual cups were as effective as products used previously (pads or tampons), with leaks decreasing as the user became more familiar and comfortable with using a cup. Because menstrual cups can collect more blood than tampons or pads, they have also been well received by those with extremely heavy periods.
An interesting find: One thing we are often asked about is menstrual cups with valves for emptying. We were quite surprised to find a 1995 study of them mentioned, where they found that nearly half of those participating experienced leakage. We have long felt that valve cups pose usage challenges and safety risks, so seeing this noted in this study was rather comforting in a sense.
All in, the studies reported that more than 70% of the participants indicated a willingness to continue using the cup — citing a positive impact on their lives from increased mobility and less stress and worry about leaks. What’s perhaps more interesting is that despite challenges (like a lack of sanitation, hygiene, and/or privacy), these things did not stop participants from using the cup. As we have suspected, having friends or other support absolutely made a difference in how well users took to the cup. This doesn’t take a study to decipher, but we’re glad they did — people who use menstrual cups share what they’ve found and they encourage friends to try them as well! This is a global effect that we have witnessed ourselves. We are awfully proud of our Put A Cup In It Facebook Community, and it’s amazing to see, in black and white, how much of a difference it can really make.
Menstrual Cup Safety Findings
In contrast to a 2018 study that used artificial means (read: plastic bags instead of vaginas) to claim that menstrual cups create a greater risk for TSS (toxic shock syndrome), the analysis of these studies, which use human bodies and experiences, actually shows that cups pose less risk of TSS. While neither of these studies are as comprehensive as we would like, the findings of this most recent analysis is quite encouraging and reaffirming regarding the safety of cups.
Of all of the studies, there were just five reported cases of TSS with only one of them being medically confirmed and documented. One study even showed that the prevalence of the bacteria that causes TSS was no different between cups and other forms of menstrual protection.
For statistics lovers, US rates of TSS are between 0.8 & 3.4 incidents per 100k population. The ultra-absorbent tampons that caused a stir in the 80s had a rate of 6 to 12 cases per 100k. By contrast, the rate for medical grade silicone and latex contraceptives (which cups are often made from) is extremely low at just 2.25 cases per 100k.
Beyond TSS, there were other exciting findings. In two of four studies, that investigated infections, there was a reported decrease in candidiasis (yeast infections) as well as bacterial vaginosis among those who had used cups for nine months or more. It was suggested that perhaps the porous and non-toxic materials used to create cups might actually help maintain a healthy vaginal environment and pH.
Lastly, while there were few negative reports, most consisted of internal pressure that caused urinary incontinence or an inability to fully empty the bladder — both of which were alleviated once the cup was removed. Not to toot our own horn, but we’d feel remiss if we didn’t mention that choosing the right cup for your body certainly plays a role in how the cup fits in the vaginal canal and whether or not it’s comfortable or causes unpleasant pressure. Our menstrual cup quiz is the best way to begin narrowing down the choices to meet your unique needs.
Menstrual Cup Cost & Environmental Effectiveness
Cost and environmental impact are two of the most common reasons we hear that people initially switch to a menstrual cup. The results of this study were quite eye-opening in this regard!
As compared to tampons (12 per period), consistent use of a cup can reduce the overall cost by 93% and waste by 94%
As compared to pads (12 per period), consistent use of a cup can reduce the overall cost by 95% and waste by 96%
They noted cup availability in 99 countries with a median price of $24 USD across 145 brands. After the initial investment is made, a cup can be safely used for up to 10 years!
Unexpected Menstrual Cup Findings
Along with the expected, there were some pretty interesting findings from this study analysis. Like that fact that one study showed that cup users reported a significant decrease in time spent doing laundry (and cost savings on soaps!) compared to pads and rags. Likewise, while cloth pads are a good option, the ability to wash and dry them privately is a concern and big hurdle for some.
While we have often heard about access to period products helping make it possible for girls to attend school, one aspect that we had never considered, or been made aware of, was the possibility that programs that provide access to period products could decrease the need for transactional sex (which according to STRIVE, “refers to non-commercial, non-marital sexual relationships motivated by the implicit assumption that sex will be exchanged for material benefit or status”) in order to be able to purchase menstrual protection. One study of schoolgirls in rural Kenya noted significantly lower rates of STIs among the students who were given cups or pads by programs, citing a lower exposure to transactional sex as the likely reason.
Next Steps for Menstrual Cups
It’s wonderful, as advocates, to see the culmination of so much work and research. With cups still being relatively new to the scene (despite being invented more than 80 years ago) we understand how difficult it can be to put together studies, so a review like this that puts so much effort into combining though all of the hard work that has been done over the years is such a gift. We are proud to be in this space and to have something concrete to point to that shows that menstrual cups really are as effective and safe as other menstrual care products, perhaps more-so.
As noted in the study, we would also love to see menstrual cups included in unbiased digital and printed materials that are used in puberty education, as well as menstrual and reproductive health programs. Education and peer support can be vital to the successful, long-term use of menstrual cups.
There are organizations on the ground doing this work and New Zealand recently made a progressive step, announcing the inclusion of menstrual cups to their assistance program. It’s clear how far we have to go when it comes to menstrual cup education, but this study can help propel us to new levels of access and information. We are only just beginning to see the start of an amazing new chapter for menstrual health!
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