I have been getting a lot of questions regarding safety of menstrual cups lately, especially surrounding prolapse and it seems like a perfect opportunity to bring some light to the issue. During menses, we have several options when it comes to products to help collect blood. Some of the most common are pads, tampons, cups, discs and period panties. In this blog, we are going to more specifically talk about cups and discs and how they can influence (or not influence) potential pelvic organ prolapse.
I would like to start with some anatomy to help understand the mechanisms of both cups and discs for blood collection. This is a view of the pelvis, pelvic floor and organs from the side. Just behind the pubic bone sits the bladder, supported in place by the anterior wall of the vagina. On the opposite side, sitting in front of the coccyx (tail bone) and sacrum is the rectum which is supported in place by the posterior wall of the vagina. At the top of the vaginal wall sits the cervix and uterus. There are also ligamentous structures that provide additional support for all of these structures as well. Additionally, the pelvic floor muscles play a large role in proper support as a “hammock” for these organs.
The period cup is typically made out of silicone, rubber or latex depending on the brand. There are many brands out there of varying sizes and shapes that will differ slightly and may even have several size options to accommodate different vaginal depths (lower cervix vs higher cervix). Cups will also have a stem at the end of the cup closest to the vaginal opening to help with removal. Cups typically collect between 10-30 mL of blood at a time and hold in place by creating suction in the vaginal canal. This suction is what some have come to believe to cause issues concerning prolapse with use. Depending on the length of the vaginal canal, the cup may sit further up and even with a stem make it difficult to remove. Some manufacturers will instruct to “bear down” in order to grip the cup and ultimately remove it. If someone already has a history or risk of prolapse and has the tendency to bear down really hard, you may say that there is a chance this could create or worsen a prolapse. Speaking from experience and clinically, this would have to be A LOT of pressure though. Some recommendations with using a cup would be to make sure you are comfortable with good connection breathing focusing on lengthening the pelvic floor during removal instead of a full bearing down movements. Second, it is recommended to “break the seal or suction” prior to removing the cup from the vaginal canal. In the end, there is not a lot of great research that directly links cup usage directly to prolapse, but there are definitely small considerations to take that would help offset that small risk.
With that being said, If you are still concerned about using the cup because of the suction, but want to still go the reusable route (not pads or tampons) an alternative might be the period disc. The disc does not use suction to stay in place and sits up at the vaginal fornix (which is the widest part of the vaginal canal up by the cervix) and can typically hold around 50mL of liquid at a time. Because it sits higher in the vaginal canal, you can still have sex with the disc in place. For some, the disc is a little bit harder to remove because of how high it sits and may be a little bit messier when changing it. They do hold a greater amount of fluid, so there is a good chance you can change every 12 hours and I would recommend doing this in the shower to make cleaning up a little easier.
In the end, if you choose to go the cup route, know there may be some trial and error with sizing due to women’s bodies all being different. Consider for yourself, vaginal vault length (you may want a longer stem if you have a longer vault), whether or not your cervix sits high or low (may change the size of the cup) and whether or not you’ve had children (can also change the size of the cup). Because cups do have suction and can create some pressure imbalances with removal, it is often recommended to use an alternative type of protection if you have an IUD, this is where a disc might be a better option. Again, if you already know you have a prolapse, it is important to practice good breath mechanics and pressure management in all aspects of your daily functional life. If the small amount of lengthening or bearing down that should be utilized during removal of a cup concerns you – consider a disc instead.