What you need to know about menstrual cups, as doctors issue warning

Kate Ng
·Trending Lifestyle Reporter
·8 min read
Menstrual cups have gained popularity in recent years as a sustainable alternative to sanitary pads and tampons. (Getty Images)
Menstrual cups have gained popularity in recent years as a sustainable alternative to sanitary pads and tampons. (Getty Images)

Menstrual cups have become highly popular as an alternative to tampons and pads, but doctors are advising women to take care when using them to avoid health issues that may arise from improper use.

Danish doctors said that a patient developed temporary kidney problems while using a menstrual cup because it was not properly aligned. The woman, in her 30s, presented with intermittent pelvic pain and blood in her urine for several months, but did not realise her symptoms were linked to her menstrual cup.

The cup was not positioned correctly inside her vaginal passage and was pressing on nearby structures, including the ureters, which are the tubes that carry urine to the bladder. This resulted in urine drainage being obstructed from her right kidney to the bladder.

While complications from menstrual cups are rare, the doctors called for better education on how to choose the correct cup size and shape, as well as how to insert the menstrual cups correctly.

Writing in their study, which has been published in the British Medical Journal (BMJ), they said: "Correct positioning along with choosing the correct cup shape and size is important to prevent negative effects on the upper urinary tract.

"Presently, menstrual cups can be bought and used without clinical advice from a health professional, which emphasises the importance of detailed and clear patient information material."

The study authors added that clinicians should be made aware of possible complications from incorrect use of menstrual cups and consider it when diagnosing patients.

Here’s everything you need to know about menstrual cups, from what size to choose to how to keep them clean.

Five menstrual cups of different size, shapes and colors in a row on beige background. Sustainable and comfortable menstruation cycle periods. Reusable eco friendly hygiene products
Menstrual cups come in an array of sizes and colours, but all have generally the same shape to collect menstrual fluids. (Getty Images)

Menstrual cups are a reusable menstrual hygiene product that collects blood and fluids during one’s period. Most are made of silicone, but some are made of natural rubber or latex.

They are shaped like a small egg cup with a short stem at the bottom. The flexible material enables users to fold them so they can be inserted into the vaginal passage. Once inside, the cup opens back up to create a suction seal over the vaginal opening and prevent menstrual fluid from leaking.

Menstrual cups have existed since the 19th century, but have only gained popularity in recent years as more people began looking for environmentally friendly alternatives to menstrual hygiene products. Menstrual cups can last for up to 10 years with proper care, so despite the higher upfront cost, they work out cheaper than buying pads and tampons every month in the long run.

According to Which?, switching to menstrual cups from disposable period products is likely to be the cheapest option.

A menstrual cup is made from flexible material that allows users to fold it in order to insert. (Getty Images)
A menstrual cup is made from flexible material that allows users to fold it in order to insert. (Getty Images)

However, sanitary pads and tampons remain the most popular options to manage periods. According to 2022 figures from Mintel, just 7% of women opt for menstrual cups, with hygiene cited as the biggest barrier to use.

Most menstrual cups come in two sizes - Size A and Size B.

Which size is right for you depends on your age and whether you have given birth vaginally before.

  • Size A is the smaller of the two and is recommended for women under the age of 30 and those who have never given birth vaginally.

  • Size B is recommended for women over the age of 30 and/or have given birth vaginally.

However, some brands offer more sizes, in terms of both diameter and length of the cup.

Close up of woman hand holding differently sized menstrual cups. Women health concept, zero waste alternatives.
Menstrual cups generally come in two sizes, but some brands offer a range of sizes to help women find the right fit. (Getty Images)

In order to determine what size of menstrual cup is right for you, there are a few things to consider. These include:

  • How heavy your menstrual flow is

  • How old you are

  • Whether or not you’ve given birth vaginally

  • How high your cervix is

Your age affects how strong your pelvic floor muscles are, Ruth Marsden, founder of the Better Company, explained to Stylist. She said that pelvic floor muscles help keep the cup in place, alongside the suction it forms with the vaginal walls.

As we age, our hormones change and oestrogen levels start to decline as we hit our 30s and beyond. Oestrogen "encourages the elasticity of the pelvic floor muscles", said Marsden, but when it starts to decline, these same muscles become weaker.

If you’ve had a vaginal birth, your pelvic floor muscles may also become weaker. However, it’s important to note that the strength of your pelvic floor muscles also greatly depends on exercise. If you exercise regularly and work specifically on strengthening these muscles, you may find that the smaller size works better for you.

The height of your cervix can also determine which size is best for you. You can measure this by simply inserting your index finger into your vagina until you reach your cervix, which feels like a smooth bump stopping you from inserting your finger any further.

If your finger is fully or almost fully inserted, it means your cervix is high and you may benefit from a larger menstrual cup size. If you can only insert half or part of your finger, it means you have a lower cervix and may benefit from a smaller menstrual cup size.

Woman washing a silicone menstrual cup in a bathroom sink
Women should clean their menstrual cups regularly, at least twice a day, and sterilise them at least once a month. (Getty Images)

Hygiene is one of the biggest barriers to women choosing menstrual cups as their preferred period management method, as the Mintel data shows. Six in 10 women who don’t use menstrual cups believe they are not as hygienic as the disposable options.

However, keeping a menstrual cup clean and safe for use is not difficult, says Amanda Hearn, menstrual health educator and advocate at Put A Cup In It. You can wear a menstrual cup for up to 12 hours, but you may find you want to empty and clean it at least twice a day, particularly during a heavy flow.

You can clean the menstrual cup using water and a gentle soap that is unscented and does not contain antibacterial agents, Hearn told Boots. "A castile soap is a great choice and intimate washes and specialty cup washes can also be used. If you notice irritation, try changing washes.

"Wash your hands before soaping up, rubbing the cup and using your thumbs to gently rub clean the interior. This helps to get the air holes and any grooves cleaned quickly and easily. Rinse well and you’re ready to reuse and get on with your day," she added.

If you need to empty your menstrual cup in a public or shared toilet, you can take a small bottle of water into the cubicle to rinse the cup out before reinserting it. In a pinch, you can wipe it with toilet paper or intimate wipes, but Hearn doesn’t recommend making a habit of this and advises washing it with water.

You should also regularly sterilise your menstrual cup. Most brands recommend doing so before using it for the first time, and at the end of each period.

The easiest way to sterilise a menstrual cup is to boil it in water. This can be done in a pot on the stove - use a dedicated pot specially for sterilising it if you want to - or in a special container in the microwave.

Put A Cup In It recommends boiling the cup for at least three to five minutes. Make sure to agitate the cup every so often to keep it off the bottom of the pot.

You can also sanitise a menstrual cup without boiling it by using a “steam bag”, which are often used for sanitising breast pump parts. You can also use sterilising tablets, such as Milton tablets, which can be used with cold water.

When it's not in use, you should ensure your menstrual cup is clean and dry before storing it in a breathable cotton bag or pouch, in a cool, dry place.

Menstrual cups can last at least a decade with proper care, but it’s important to know when to replace your cup. If it shows any signs of cracking or splitting, gets a chalky residue, or feels sticky to the touch, it’s time to replace it.

Read more about period health:

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