The menstrual cup is moving into the mainstream as a growing number of people look for a more environmentally friendly way to manage their periods. But the bell-shaped silicon cups are anything but a new idea. The earliest versions date all the way back to 1867, with a receptacle suspended from a belt worn around the waist.
Despite a long history and hundreds of modern models available for purchase, menstrual cups still get far less attention than pads and tampons. But now, more than a century and a half after their first iteration, scientists have scoured all available evidence to give us the scoop. Their verdict: Cups really are greener, safer, and perhaps even more effective than more mainstream products.
For the review, published this month in by The Lancet, epidemiologist Annemieke van Eijk and her co-authors analyzed 43 studies and reports on the leakage, acceptability, and safety of menstrual cups. Here’s what they found:
Cups don’t leak more than tampons or pads do, and you can wear most of them for up to 12 hours.
Menstrual cups don’t harm the vaginal microbiome. In fact, some studies and reports found that vaginal infections were reduced with their use.
They’re cheap: $40 will get you a product that lasts a decade. Assuming 20 tampons per cycle (changing every four to eight hours as recommended), that’s approximately 2,400 tampons you won’t have to buy.
Compared to using pads or tampons over the same 10-year period, a menstrual cup cuts down on plastic waste by 94 to 99.6 percent. On average, each person who menstruates disposes of 11,000 tampons between their first period and when they reach menopause. Tampons are the quickest to break down in the landfill, taking around 6 months, but pads and plastic applicators can take 500 to 800 years to decompose.
Keeping a menstrual cup clean isn’t that bad: The researchers found that rinsing and cleaning between every use wasn’t absolutely necessary. “Take it out, empty it, and put it back in,” says van Eijk. “Just don’t put it down anywhere.” Rinsing with water whenever possible is still ideal, however, and you should sanitize them at the end of your period. This can be accomplished by boiling them briefly on the stove or even giving them a zap in a cup of water in the microwave.
Insertion is easier than you might think. Menstrual cups may seem large, but that’s generally due to a misunderstanding of vaginal anatomy, says Janie Hampton, an author and advocate whose been working in reproductive health in Africa for 40 years. The silicon is soft, so you can fold the cup to insert it. Because it can generally hold 12 hours of flow, you only have to worry about the insertion process a couple times a day.
There’s still the issue of toxic shock syndrome (TSS), a dangerous immune response instigated by bacteria that can grow on a tampon used for too long. The rapid spread of immune cells can send your body into shock, which causes a dangerous drop in blood pressure. Unfortunately, this is still possible with a reusable product: The researchers found five recorded cases of TSS involving menstrual cup use. They didn’t have data for how many people were using menstrual cups in total during that period of time, so they couldn’t calculate how frequently this occurs. For reference, TSS occurs in up to 3 per 100,000 people who menstruate in the U.S. The condition is very rare regardless of its source, but people using insertable menstrual products should be aware of the symptoms and keep an eye out for signs of trouble.
In rare instances, a menstrual cup can knock intrauterine birth control devices (IUDs) out of place. If an IUD is your preferred form of birth control and you want to use a menstrual cup, talk to your doctor about proper insertion and removal to minimize your risk.
It’s kind of bizarre, says van Eijk, that the tampon took off and the menstrual cup didn’t. The two technologies were developed around the same time and faced a lot of the same obstacles. Some experts think the real difference could be that tampons were ultimately more profitable—nothing is better, from a company’s perspective, than a product its consumers have to keep buying. But that’s just speculation.
The cup takes a couple cycles to get used to, van Eijk says, “It’s not as easy as a disposable pad.” But even after some trial and error, around 73 percent of women decide to stick with their menstrual cup, according to the review.
The new research isn’t meant to suggest that everyone should switch to menstrual cups. Van Eijk and her colleagues just want to provide people with the information they need to make the right choice for themselves. Somewhere between 11 and 33 percent of women know about menstrual cups, according to the study. They aren’t for everyone, van Eijk says, but most people don’t even know about this safe, effective, cheap, and environmentally friendly option. That needs to change.