World Health Day 2021: Menstrual cup – a healthy alternative to sanitary pads?

“Period. End of sentence” the Oscar winning documentary is a film about the taboo that surrounds menstruation in India (and world over) and the devastating impact that it has had on women and their social standing. It is a story of discontinued education, public shaming and limited or no access to basic sanitary protection during this time of the month.

Traditionally, Indian women have used and continue to use pieces of cloth, sanitary napkins and tampons during their periods.

What is a menstrual cup?

A menstrual cup is a flexible cup designed for use inside the vagina during periods. It actually collects blood unlike cloth, sanitary pads and tampons which absorb blood. Some cups are long-lasting and reusable, while others are disposable. Most cups are made of silicone or rubber.

Common questions that women ask about menstrual cups:

Is it true that menstrual cups are kinder on the environment?

Yes. They do not contribute to the waste that clogs the landfills, fewer trees are cut down and the cost is lower as they can be reused.

How does a menstrual cup stay in place? Will I feel it after wearing it?

It stays in place with a slight suction mechanism. You will not feel it as long as it is applied correctly, and it is sitting properly in the vagina.

I’ve used sanitary napkins before this. Is it advisable to make the shift to a menstrual cup or should I try out with tampons first?

The menstrual cup can be used even if only sanitary napkins have been used in the past. And there is no need to try out with tampons first. It need not be tried before a period and can be used straight away during a period.

It looks big! Does it hurt going in or out?

Remember the menstrual cup is made of silicone. So, it is very pliable and flexible. It has to be folded to be inserted and is no more uncomfortable than using a tampon.

How do I clean the cup?

Wash it with plain water and wipe it with a tissue. At the end of each cycle it must be sterilized and stored ready for the next month. Sterilization is easily done by boiling the cup in a pot of water for 3 minutes.

In order to store it, use a cotton bag that is breathable. Avoid storing it in an airtight container.

What cup sizes are available, and which one should I choose?

Usually the cup sizes available are “small” and “medium”. This is because not all vaginae are the same. The factors to be considered when choosing a cup size are: the flow – heavy or light, age of the user and the position of the cervix.  If the flow is heavy, the medium cup is the preferred one and the small cup for the light days. If the cervix is low, the small cup is suitable as the stem of the cup is shorter and therefore sits better. In younger women, the smaller cup would be a better fit as it would be easier to insert.

Can a virgin use the cup?

Yes certainly.  However, since the hymen is intact in a virgin and the entrance to the vagina is smaller, it may need a bit of practice.

What are the disadvantages of the cup?

One of the main disadvantages that women face is emptying of the cup as this can be messy. Cleaning in a public toilet may cause embarrassment. Some women may have difficulty in inserting and removing the cup till they get used to it.

So, should I use the menstrual cup?

This is a matter of personal choice. The only way to know if a menstrual cup is the right device for you is to buy one and give it a try. They come in various formations and sizes, so sometimes, if the first one doesn’t suit you, the next one will do the trick. You can find them at drug stores or buy them online.

Benefits of switching to a menstrual cup:

·         Menstrual cups can contain twice the amount of blood that is absorbed by a pad or a tampon necessitating fewer changes, lesser leakage and no hassles of disposal.

·         Cups can be worn while swimming with no fear of leakage unlike pads

·         Studies have shown a lower incidence of vaginal infections with the usage of cups when compared to tampons and pads

·         Women experience an odour free period

·         Eco-friendly and pocket friendly

·         Menstrual cups can be re used for as long as 10 years

What size should I pick?

Most brands come in 2 or 3 sizes (small, medium, large)

LARGE:

·         Age >30

·         Previous vaginal birth

·         Heavy menstrual flow

SMALL:

·         Age less than 30

·         No previous vaginal births

·         Moderate amounts of menstrual flow

·         Tight perineal muscles due to pelvic exercise

Some brands offer a smaller size ‘mini’ for teens and virgins , however these cups hold less blood and may require more frequent emptying in those who bleed heavy.

How long can a cup be worn at a time?

A cup can be worn for 4-12 hours continuously depending on the menstrual flow. The cup has to be emptied at least once in 12 hours, rinsed and cleaned with water and re-inserted.  

How do you know if you’ve inserted the cup correctly?

Post insertion, go around the base of the cup. If inserted well, the base is round or oval with no folds. Gently tug the stem to ensure a tight fit and adequate suction.  

When inserted well, a woman is comfortable, able to perform her normal activities and outdoor physical activities with no discomfort.  

Does it leak? What if you have heavy flow?

Leakage is an indicator that the size of the cup is too small or the insertion is faulty. Beginners may find insertion and removal difficult and messy, so it’s advisable to use a pad in the initial few months till they are comfortable with the procedure.  

Trial and error with different sizes and brands till the most suitable cup is obtained for an individual is the best way forward.

Women with heavy flow need to use the large sized cups and may need to empty the cup every 4-6 hours instead of 8-12 hours.

(Author — Dr Prathima Reddy, MBBS, MRCOG (London), FRCOG (London), FACOG (USA) is the director, senior obstetrician and gynaecologist at Fortis La Femme Hospital, Richmond Road, Bengaluru)