Girls, women, and transgender people need hygienic menstrual products monthly to live healthy and productive lives [1].

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Menstrual cup is a device for menstrual flow management and is claimed to be a health and environment friendly alternative to the conventional menstrual sanitary protections. Vaginal devices have a long and intriguing history [2].

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Menstrual cups have been available for decades, are widely available these days and can be used without any clinical advice [3].  The first menstrual cup was invented by an American actor, Leona Chalmers in 1937 [4]. Studies shows that the menstrual cups can replace the current methods of menstrual sanitation due to lower cost and improved hygiene [2].  Menstrual cups are easy to clean and, therefore, more hygienic than cloth pads.  They also require less water for cleansing. Internal placement of cups avoids the odor and discomfort of an external pad [2].

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Menstrual cups are manufactured using health-grade non-toxic non-allergic silicone and are absolutely inert and smooth thereby almost nullifying the problems like infections, allergies, rashes, and excoriations. It is worn internally hence it eliminates foul odour and feeling of wetness. It can also be worn for long hours because of its capacity and the ability to adapt to the body completely. Menstrual cup can be sterilized/autoclaved before use and thus is most hygienic and safe menstrual sanitary protection. It is a reusable device which can last through the menstrual life-cycle of a woman if used carefully [2].

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Recent scientific empirical studies show that menstrual cups are a safe option for menstruation management and are being used internationally [1,2,5,6].  Menstrual cups could be an eco-friendly option in comparison to other used vaginal devices which have great disposal problems [2].

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Unlike tampons or pads that absorb the menstrual flow, menstrual cups collect it.  Menstrual cups can collect more blood than tampons or sanitary pads [1].  If menstrual cup is used correctly, the woman shouldn’t feel the cup.  Menstrual cups don’t provoce cramps, pressure complaints or signs of irritation upon vaginal examinations [7]. There are no objections to use menstrual cup by virgins [7]. Allergies to the materials used in menstrual cups are not common, but women should be aware of the possibility and keep this in mind when starting use [1].

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A study was conducted with 158 participants aged between ages of 20 to 50 years with regular menstrual cycle in India. Participants were provided menstrual cups to be used for three consecutive menstrual cycles. They were given detailed explanation/information about how to use it. Feedback was obtained after every cycle for three cycles through a structured questionnaire.  The findings of the study indicated that the cup was preferred for comfort, dryness, and less odor. Insertion was easy for 80% participants and 90% participants found removal easy. Problem of leakage was encountered in 3-6%. There were few side effects like rashes, dryness or infection. Overall, women preferred the cup to their current method of menstrual management. Clearly, a major barrier to menstrual cup acceptance is the requirement that the menstrual cup be manipulated into and out of the vaginal vault, necessitating contract with genital tissues and with menstrual fluid. Obviously, women who are uncomfortable, mostly with this aspect of menstrual cup use.This problem can be overcome by proper counseling of the users regarding its use [2]. Cited advantages include overall convenience, portability and easy storage, extended wear time, and greater freedom of movement. These results showed that menstrual cups have no significant health risks and is acceptable to many women without the need for fitting or other medical services [2].

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In studies that examined the vagina and cervix during follow-up after the use of menstrual cup, no mechanical harm was evident from use of a menstrual cup. Infection risk did not appear to increase with use of a menstrual cup, and compared with pads and tampons, some studies indicated a decreased infection risk. A study in Kenya that detected lower bacterial vaginosis in users of a menstrual cup than in those who used sanitary pads postulated that the inert material of the menstrual cup might assist in maintaining a healthy vaginal pH and microbiome. Reported pain might relate to variations in the pelvic anatomy or wrong positioning of the menstrual cup leading to internal pressure[1].

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Another study in Kenya was conducted with 192 school girls between 14 and 16.  Girls were provided with menstrual cups in addition to training and guidance on use, puberty education, and instructions for menstrual hygiene [6].  The data of the study indicated that schoolgirls and young girls recently transitioning through menarche, are able and willing to embrace the use of an insertable menstrual solution to manage their monthly periods in a rural African setting. It may take up to 6 months before confidence to use is established. There was no evidence of high risk of damage or loss of product, and hygiene standards were reportedly maintained [6].

The first confirmed case of TTS related to the menstrual cup was reported in 2007 by a 37 years old woman within ten days of her first use of menstrual cup [8]. Laboratory studies have shown contradicting results on the possibility of development of TSST-1 in the presence of menstrual cups but clinical data in humans using cups have so far not shown reason for concern. The reported risk of toxic shock syndrome with use of a menstrual cup seems low[1].

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There are no evidence that menstrual cup should not be used with an IUD, although the combination of an IUD and use of a menstrual cup might need further study [1].