Today’s women care for the environment. Also when they’re menstruating. So we all use a menstrual cup. The flexible and reusable little cup that collects menstrual blood instead of absorbing it has never been more popular. Its advantages: you can keep it in for up to 12 hours, it doesn’t dry out the vagina and it doesn’t produce a lot of waste every month. In the Netherlands, there’s even been a petition to include the menstrual cup in the basic health insurance package. Because, according to the initiors: ‘Current menstrual products like tampons and sanitary pads are expensive, bad for the environment and cause health issues. The menstrual cup is the solution for all these problems.’

From ‘iiiiiiiew’ reactions to big business

From something that mainly caused ‘iieeeew!’ reactions just a few years ago, it’s become a true hype. Looking at the Google-searches in the UK for ‘menstrual cup’ in the last 15 years), there’s a clear upward trend. (The numbers from 1 to 100 represent search interest relative to the highest point on the chart for the given region and time, not the actual searches). Nowadays the cup is a must-have status symbol for environmentally friendly menstruators. Available in all kinds of cute colours and stored in a bag from – of course – eco-cotton, it’s almost Instagrammable. New users might have a little trouble inserting (Yes, it fits easily, just fold it) and removing (Help, it’s stuck??! Oh no, it isn’t. Phew!) the first few times, but after a few cycles, most women don’t want anything else anymore. (This has actually been researched: already in 2011 a Canadian study aiming to determine whether menstrual cups are a viable alternative to tampons found that 91% of the participants said they’d continue to use the cup and recommend it to friends).

The menstrual cup is so popular that in October 2018 even tampon brand Tampax introduces a cup to the market. Of course this little chalice comes in a discreet carry case. Menstruating environmentally friendly is big business. Just look at the numbers: global revenue of menstrual cups in 2017 was nearly 38 million US$, states the 2018 Global Menstrual Cups Market Research Report with Industry Forecast 2025 and Outlook. It’s expected the global menstrual cups market will be worth 48 million US$ by the end of 2025. In 2017, North America (with a production market share of 48.7%) and Europe (45%) were the largest cup suppliers.

Less waste doesn’t automatically mean better for the environment

The reusable menstrual cup is presented as the environmentally friendly alternative to sanitary pads and tampons. And indeed, using a cup for five to ten years produces a lot less waste than the enormous heap of disposable pads and tampons you’d use in that same time. That’s crystal clear. (Want to know the exact waste difference? Check out this study which compares the DivaCup to four other menstrual products).

But does less waste also automatically mean the menstrual cup is better for the environment? Dutch environmental information and education foundation Milieu Centraal isn’t sure, seeing as cleaning the cups uses a lot of energy. ‘Manufacturers advise washing it with warm water after every use; this costs a lot of energy. There’s also the need to sterilise the cup in boiling water before and after every menstrual period. These things make it hard to say if there’s an environmental advantage.’ Their conclusion about menstrual products: ‘Not enough research has yet been done to say for sure that reusing is better for the environment than throwing away.’

The greenest way to menstruate? That’s probably using washable sanitary pads. But only when you rinse them in cold water before throwing them into the washing machine. (Using warm water won’t only make the blood stains set it, it also uses a lot of energy). The environmental impact of washable sanitary pads can be compared to that of washable diapers and research has proven those are definitely better for the environment than disposable diapers, even when including the energy costs of washing and production. Something else to keep in mind, whichever (menstrual) product you use: the country of manufacture. Whether your cup is produced in the same country or has to be transported halfway around the world makes a huge difference for its ecological footprint.

Silicone: made in China

Almost all menstrual cups are made of medical grade silicone. Exceptions are The Keeper (made of natural gum rubber (latex), the OIcup and MeLuna (both made of medical grade thermoplastic elastomer (TPE) and therefore easier to recycle than silicone cups). And this silicone, that’s where the problem lies, says Susie Hewson. Founder of biodegradable menstrual products brand Natracare, Hewson is one of the few people who aren’t positive about the menstrual cup’s environmental impact.

‘The biggest hypocrisy of the ecological claims made for menstrual cups sits squarely in the extraction and manufacture of the raw material used to make silicone menstrual cups,’ says Hewson. Silicone is made from the element silicon. About 60% of the global supply of silicon comes from China, where also much of the silicone production takes place, largely in production facilities owned by international corporations. Both silicon extraction and silicone manufacture aren’t sustainable and have a negative impact on the environment, claims Hewson. ‘This mineral extraction in China, a country that already faces about 1.6 million premature deaths a year as a result of air pollution, has a huge global warming impact.’

In the meantime, China has introduced the 2020 Air Pollution Action Plan to reduce pollution. Because of these strict new environmental regulations factories are shut down or unable to obtain permits from the Chinese government, which leads to reduced silicone supply and increased prices. Reason for all the European, American and Asian companies to search for a more environmentally friendly alternative? Not yet. Because the demand for silicon stays the same. Hewson – of course – prefers her certified organic tampons. ‘This conversation will no doubt make me very unpopular, but whilst advocates of reusable menstrual cups are extolling the local environmental virtues of their five year menstrual plan, the devastating environmental consequences of that choice is pushed onto regions and populations of the world where extraction and manufacture of silicone is taking place.’

What happens afterwards?

What to do with your cup after five to ten years of loyal service? Sea sponges and organic pads and tampons are biodegradable, but a menstrual cup isn’t. Eventually it ends up in the trash. Which isn’t a big deal when you immediately find the right cup and use it until it’s time for a new one. But how long can you actually use it for? Some manufacturers say up to ten years, while others recommend changing cups every two years. That makes quite a difference for the total amount of cups you need in your fertile life: four or twenty.

Despite the many guidelines on the internet, finding the right cup can be quite tricky. Every body is different and there are more possibilities than just ‘have or haven’t given birth’ and ‘younger or older than 25’. The length of your vagina for example. If you can easily reach your cervix with your fingers. Whether you have strong or weak pelvic floor muscles. Questions that might not be so easy to answer, but that play a big role in finding the make and size that’s right for your body. Several women buy a few misfits, that end up gathering dust in the bathroom closet or go straight in the bin, until they find the perfect cup.

Giving away free cups against period poverty? Nice, but nearly always useless

Spend 25 euros on a cup once or spend €2.50 on tampons or pads every single month. You don’t have to be a mathematician to see that, despite the higher initial expense, the menstrual cup is way cheaper in the long run. Already after a year you’re saving money. Do some calculations and be amazed at the amount you’ll be saving when using the cup ten years. Give every woman a menstrual cup and that’s the end of period poverty worldwide! What a great simple solution. Or isn’t it..?

Dozens of initiatives distribute free menstrual cups to girls and women who can’t afford sanitary products. A nice idea, but what’s sometimes forgotten is that some girls or women can’t or don’t want to use a cup. ‘Forcing’ poor people into using a cup by offering it for free as only option and throwing in some facts about how harmful disposable products are isn’t the way to get rid of period poverty, says Andrea Nielsen-Vold, the founder of Go With The Flow Hawke’s Bay (a not-for-profit organisation that provides menstrual products to those who can’t afford them) and a menstrual cup user herself, in The Spinoff. ‘Unless the person we are giving a free cup to is fully aware of their flow volume, where their cervix sits when they have their period and what firmness their body prefers, then I think giving cups to these people is almost pointless.’ Nielsen-Vold knows what she’s talking about; menstrual cups that were donated Go With The Flow Hawke’s Bay over a year ago are still there because nobody wants them.

Not suitable for developing countries

Apart from personal reasons, in some culture it’s just not done to speak about menstruation, let alone insert something in your vagina. In certain rural parts of Nepal, menstruating women are banned from the house every month because they’re considered impure. Probably not the best area to boil your menstrual cup in a pan of water in the kitchen to sterilise it… In some parts of Kashmir (India) it’s even forbidden for women on their period to use water sources as that would be bad luck.

Luckily, these female-unfriendly ideas are changing. But even if all the prejudices about menstruation would suddenly disappear, it’s still unsure if women in so-called third world countries would really benefit from free menstrual cups. Of course, it’s more hygienic than trying to manage your menstruation with leaves or old rags, but if there’s no opportunity to rinse out and sterilise the cup before using, it’s actually pretty gross. Women living in poor and remote areas without access to clean water or soap, would be better off with a borehole, water pumps and proper sanitation than with a menstrual cup. Even manufacturer The Keeper says on its website their cups aren’t a good option for women in third world countries.

The bfree cup might be the solution. This menstrual cup, currently still a crowdfunding project, is made of special antibacterial medical silicone which prevents the formation of biofilms. Seeing as bacteria can’t attach themselves to this material, it’s not necessary to sterilise the cup before each cycle. The first batch of bfree cups should be delivered to the Kickstarter-backers in September 2019 and ordering one will be possible soon afterwards. To be continued.

Cup hygiene

For now though, better clean your menstrual cup thoroughly. But when you’ve done that, you have a very vagina-friendly product. The cup doesn’t absorb any liquid, so it doesn’t dry out the vagina, disturb your pH or mess with the vaginal flora. Unlike some tampons and sanitary pads, it doesn’t contain any chemicals, plastics, perfumes or super absorbent polymer. No pad rash, no itching, no shedding fibres. There are many reasons to love the menstrual cup.

In 2018, a French study briefly caused panic by stating that compared to tampons, menstrual cups would actually come with a higher TSS risk. (Read the entire story about cups and TSS here). Currently, there are two known cases of menstrual cup usage linked to the Toxic Shock Syndrome. Reason to not use a menstrual cup anymore? No. Because you can also get TSS when using other menstrual products. (You can even get it when you don’t menstruate:  – around half of all TSS cases are menopausal women, children and men). But a good reason to never keep your cup in for longer than 12 hours.

Other things that are important for good cup hygiene: following the instructions on the packaging. Of course washing your hands before inserting. Making sure the cup itself is clean by sterilising it in boiling water before each menstrual cycle. Rinsing it out after every use. Removing any debris that might be stuck in the little holes. Be aware: cups with a hollow stem can be harder to clean than those with a solid stem. Regularly check your cup for damage. Are there little tears in the materials? Cracks? Does its surface suddenly feel sticky? Is the flexibility gone? All reasons to discard it immediately. A slight discolouration of the cup doesn’t mean you have to replace it right away.

Glitter & rainbow colours

So a little discolouration after using it for a while is normal. But how about the colour of the cup itself? Nowadays, menstrual cups come in lots of different shades. Not that anybody can see this when you’re wearing one inside your vagina, but OK. Real glamour lovers go for a glitter cup, like this one from Me Luna or order a cup in rainbow colours like this one from Yuuki. Because a pretty cup makes such a difference when menstrua… oh, no, wait it doesn’t. Oh well, at least it looks nice in your bathroom closet. But how safe are these multi-coloured and sparkling cups?

Totally safe, according to the manufacturers. Yuuki points out their dyes are based on food colouring and all their cups are thoroughly tested and safe to use. Also Me Luna doesn’t see any reason to worry: their cups, which are completely produced in Germany, ‘meet all the requirements we have in the EU for such products’. The company explains the glitter particles used in the cup can also be found in certain cosmetics, like lipsticks or eyeshadows. In these cosmetic products, the particles come in direct contact with your body. In the menstrual cups, however, they’re completely enclosed by the medical grade TPE (Thermoplastic Elastomer, the product where the Me Luna cups are made of) and therefore can’t come in contact with the vagina when using the glitter cup as intended. Make sure to wash and boil a new menstrual cup, so any loose particles that may be on the outside of the cup as a result of the production process are removed.

Other manufacturers make a statement by not selling any coloured cups. Mooncup says they’ve ‘chosen to avoid adding food colourings or pigments that may compromise the health, ethical and environmental benefits’. Another reason is that a transparent cup can help in observing your flow. Diva International states on their website that the sensitive skin of the vaginal walls shouldn’t be exposed to dyes or chemicals. The company doesn’t want to take an unnecessary risk ‘as there is still a possibility that the particles or other chemicals may not bind properly and could leach into the body’ – hence why the DivaCup is only available in unpigmented silicone.

You get what you pay for?

Want to buy a menstrual cup? A few clicks on the internet and you’ll get hundreds of offers from all over the world. Which leads to the question: why pay 25 to 30 euros for something that can also be bought for less than 1 euro? Well, apart from exceptions from medical grade thermoplastic elastomer (TPE) and latex (natural rubber), nearly all menstrual cups are made of medical grade silicone. The addition ‘medical grade’ means that the product has been tested and approved for biocompatibility. In other words: that it’s safe to use inside the body for longer periods of time. (Other products made of medical silicone are catheters, sex toys and implants). Some super cheap cups aren’t made of medical grade silicone, but rather of food grade silicone. Perfect material for a baking tray, but perhaps not something you’d want to wear inside your body one week a month…

Also a lot of these low budget cups lack certificates, so there’s no way to know if they have passed any safety tests. These rules and regulations aren’t the same for every country by the way. This website lets you check whether the product is registered with the American Food and Drug Association (FDA). Many cheap menstrual cups are produced in China, a country known for its not so great working conditions. Investing in quality and paying a few euros more for a cup is also a good idea if it gets you proper customer service. ‘Is this particular cup suitable if I’m wearing an IUD?’ is best asked directly via the brand’s support helpline, not in an internet forum. A lower price doesn’t automatically mean a bad cup (maybe the manufacturer saves money by not spending it all on advertisements), but in most cases you’ll get what you pay for.

Also read:
How to use a menstrual cup?
Environmentally friendly menstruating
Why not try something different
Plastics & periods…
What a mess!