Author: Maria Ibrahim
Reusable menstrual products (ex: homemade cloth pads) have been around for centuries, and their present utilization in low- and middle-income countries is exceedingly sought-after due to limited access to disposable products [1-3]. Single-use sanitary products, such as tampons and sanitary pads, have an environmental impact and production can be very costly, making reusable products more favourable even in higher-income countries [1-3].
With this rise in popularity, it is important to take a step back and analyse the potential effects reusable menstrual products may have on the people who use them. This article will address the association between the use of a reusable menstrual cup and the risk of contracting toxic shock syndrome (TSS). It will also elaborate on the risks of using a reusable menstrual cup with an intrauterine device (IUD).
What is a Reusable Menstrual Cup (RMC)?
In 1867, in the United States, the first prototype was patented for the menstrual cup . The reusable menstrual cup (RMC) is a non-absorbent, while tampons and sanitary pads are [2-4]. An RMC can be inserted into the vagina as a receptacle that can contain 10-38 mL of blood and must be emptied every 4-12 hours [1,4]. The reusable version of the cup can last anywhere from 6 months to 10 years before having to be replaced [1,2]. All of these intervals vary depending on the type of RMC used and the manufacturer. After review of the literature, the most common material used for RMCs is medical grade silicone [1-4]. Other materials such as latex, rubber or elastomer can also be used [1,3]. RMCs are made in a variety of sizes and forms to fit varying anatomy [1,3].
RMC and Menstrual Toxic Shock Syndrome (mTSS)
Menstrual Toxic Shock Syndrome has generally been associated with the use of high-absorbency tampons . mTSS is a severe disease that is caused by a toxin known as Staphylococcus aureus TSS toxin 1 (TSST-1) and causes multiorgan failure in 95% of patients [4,5]. The associations made between high-absorbency tampons and the contraction of mTSS are as follows:
“Accumulation of blood in the polyester foam cubes and chips of carboxymethylcellulose
Increase of vaginal pH in menstruation from 4.2 to around 7.4
Existence of both oxygen and carbon dioxide in the vagina during menstruation” .
RMCs are, in most cases, made of silicone, and silicone is not a material that promotes bacterial growth . That being said, it is believed that the accumulation of blood inside the vagina creates a suitable environment for the growth of TSST-1, as it allows for the same favorable conditions as a high-absorbency tampon, as indicated above [4,5]. The risk of contracting toxic shock syndrome from the RMC might be low, but it is not impossible [1,4,5].
RMC and the Intrauterine Device (IUD)
At this time, few studies exist that explain the associated risks of using a menstrual cup and the dislodgement/expulsion of an IUD. With the RMC gaining popularity, their concomitant use does require and merit further studies to evaluate risk factors and solutions [1,6]. While there are few reported cases of IUD dislodgement/expulsion due concomitant use, the RCM has been shown to be a contributing factor [1,6].
The two mechanisms believed to be the cause of this dislodgement/expulsion are that:
“1. patients may unintentionally pull the IUD strings when removing the cup, and
2. the suction and vacuum created during cup application may dislodge the IUD” .
Due to the lack of literature available, there are no conclusions that can be made to best remediate this problem . The current suggestions given are to cut the string of the IUD attachment with the cervix, which may otherwise make it harder to remove in the future . Alternatively, users can be educated on how to “break the cup seal” before pulling the RCM out . Proper use of the cup is very important because the expulsion of the IUD can cause unwanted pregnancies, adverse symptoms and an increase in health payments .
The current literature suggests that the menstrual cup is a safe and acceptable alternative to disposable menstrual products (e.g. tampons and pads), but they are not as well known . This suggestion is valid for countries of all statures, “even where water and sanitation facilities are poor” . Research has shown that it “[t]akes about 3 cycles for women to feel comfortable with the product” . In the end, it is always important to remember to check-in and discuss any concerns or modifications about your health with your care provider.
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