WoMena receives many questions from the women and girls we reach out to, from our trainers and our partners. Therefore, the team collected a series of questions and answers regarding topics like Menstrual Cups functionality, maintenance, health & safety, economy, and other concerns.
• How does the Menstrual Cup work?
It collects blood, rather than absorbing it such as pads.
• What is it made of?
Menstrual Cups (MCs) are made from different materials (usually rubber, medical grade silicone). WoMena uses those made from medical grade silicone which is a non-allergic material. That is the same material used for the implants put in women’s breasts for breast augmentation, nipples used for baby bottle feeding, or the tubes inserted in the body in hospitals. The material is safe – it contains no harmful substances and will not increase the risk of diseases and allergies when used hygienically.
• Where do I insert and place the MC?
The whole MC has to be inserted into the vagina, where it will create suction around the cervix and the muscles of the vagina. The MC should sit as low as possible in your vagina and feel comfortable. It should be even lower than a tampon. The stem at the bottom of the MC can help you to adjust, as you can use it to gently push the MC higher or lower.
• How is it inserted?
Please take the following steps to insert the MC:
1. Go to the private place
2. Always wash your hands with soap and water
3. Use one of the two folding techniques
• C shape – flat the cup then fold in half
• Punch down – punch down one wall of the cup to fold into the base
4. Relax and take a deep breath
5. Squat down and gently push the MC into your vagina
6. Remember to empty your MC after 4-12 hours depending on your flow
• Should you feel the MC while it is inside the body?
No – if you have inserted it correctly, you will not feel the MC when it is inside.
• How do I know if I have inserted the MC properly?
There are certain indicators that can tell you if the MC is not placed correctly. The MC is very effective at collecting blood, so if the MC is leaking it is most likely not in the right position. MCs are very comfortable to wear, so if there is discomfort, for example, if you feel like the MC is irritating you or poking, it is not placed correctly. Inserting the MC takes practice and you may have to do it several times before figuring out how to insert the MC properly.
• I struggle to insert my MC – is that normal?
Yes, it is completely normal to have difficulties inserting the MC in the first couple of months. As long as you keep practicing you will get it right eventually!
• What position is the best when inserting the MC?
The position that works best differs from woman to woman. However, many find that squatting or propping one leg up on a stool makes insertion easier.
• Should I cut the stem of the MC?
Some may experience that the stem of the MC sticks out of the opening of the vagina. This can be due to a low-sitting cervix or that the vaginal length is short. This is very common. If the stem of your MC is outside the vagina it can be uncomfortable and irritate your labia. In these cases the stem can be trimmed until you find a comfortable fit. But cut gradually – if you cut too much it may become difficult to remove.
• Can the same size fit all?
Vaginal tissue is very elastic. The same MC can be used for 13-year olds as well as 40-year old women. However, the MC often comes in several sizes, where women who have given birth use the bigger MCs. However, the menstrual cup comes in two sizes, and it is recommended that women who have given birth use the regular size and if you have a low cervix you should use the small size.
• Should the MC be lubricated before insertion?
You do not need to use a lubricant before inserting the MC. The vagina is naturally lubricated and the menstrual blood can also function as a lubricant. However, some women find insertion easier if they use a lubricant. Just remember to use a water-based, non-toxic lubricant, such as K-Y jelly. Other products, such as vegetable oils, can damage the MC and cause vaginal infections.
• Will the MC fall out if I walk, run, bend, lift or go to the bathroom?
No, one of the great advantages of a MC is that when it is inserted right the MC will seal with the vaginal walls and you can move, bend or lift as you wish.
• Can you urinate when you are using the MC?
Yes, women have 3 holes; 1 for urinating (urethra), 1 where stool is excreted (anus) and the vagina. The MC is inserted in the vagina, and you can therefore urinate while using the MC.
• How does it feel to sleep with the MC?
You will not notice or feel the MC at all, if it has been inserted correctly On nights with the heavy flow the MC might need back-up (e.g. a pad) but otherwise the MC is all you need to manage your menstruation.
• How often do you have to empty the MC?
You should empty the MC every 4-12 hours depending on your flow, so 2-4 times a day. Look for the manufacturer’s instructions on the MC to be sure you are following them.
• How can I know if the MC is full?
The MC is full when it starts to leak. How quickly it is filled depends on how heavy menstrual flow is. You will quickly learn how often the MC should be emptied.
• How long can you keep the MC inside?
It is recommended that you check whether you need to empty your MC after 4-12 hours depending on your flow when you first start using it. After a while you will have a better idea of how often you need to empty your MC. You use the same MC for the duration of your period (but take it out, empty and re-insert several times a day).
• How do you pull out the MC?
First, wash your hands with water and soap. Squat, insert fingers, and use the stomach muscles that you use to stop and start peeing to push down the MC (not quite like defecating, more with your middle muscles than with your behind muscles). Find the stem and gently pull the stem downwards. Pinch the base of the MC to release suction. Pull gently until you can hear/feel suction is released. Stop and get a better hold of it so when you pull it out, it does not splash.
• I struggle to get my MC out – what can I do?
Merely pulling the stem does not remove the MC. If you are struggling, please follow the steps above. Remember to pinch the base of the MC, so that the suction is released. When you press the walls the little holes in the MC will release air and the vacuum will disappear. This makes it easy to get the MC out. If fingers are dry, it will be easier to pull out. If you have enough toilet paper you can dry your fingers during the process of pulling out the MC. If you have difficulties removing the MC, it is important to stay calm. Just take a deep breath, and remember that it is usually difficult the first time. But you will get it out!
• It feels like I am pulling out my uterus when I take out the MC– what am I doing wrong?
Remember to relax and take some deep breaths. It is important that you release the vacuum by pinching the bottom of the MC before you pull it all the way out.
• My MC is leaking, how do I make it stop?
If the MC is not properly in place, it may leak. Make sure the MC has unfolded properly and made a vacuum and is not inserted too high. It can also be a good idea to check whether your cervix is too low.
• Should I wear a menstrual pad when I am sleeping?
If the MC is inserted correctly you will not notice or feel the MC at all. On nights with heavy flow the MC might need back-up (e.g. a pad), otherwise the MC is all you need to manage your menstruation.
• Can I use the MC after cutting the stem?
If you have only cut the stem of the MC you are able to use it just as before. However, if there are holes in the base of the MC it might leak.
• Can I pee with the MC inside?
Yes, you can even defecate. If you push while defecating it can feel as if it is moving outwards, but it will not fall out. It can be clenched back to its right place.
Women have three holes: 1. Urethra – carries urine from the bladder; 2. Anus – where feces are stored; 3. Vagina – where menstrual blood comes out from and where you insert the MC.
• Should I clean/disinfect my MC before I start using it?
Yes, you should follow one of the disinfecting recommendations before you use the MC for the first time. There are different recommendations on how to disinfect your MC:
• Boil in water for five minutes – remember to use plenty of water so the MC does not get burned
• Pour boiling water on the MC, leave it for 3-5 minutes and empty. Repeat 3-5 times.
• Use disinfecting tablet for 15 minutes
• Wash thoroughly with clean water and perfume-free soap and water
• How do you clean the MC and how often?
While you are in your period, to clean the MC, either rinse the MC with clean water (but without soap) or wipe it off with toilet paper. You will do that 2-4 times a day when you take it out. Between your periods, you need to sterilize the MC.
• How do you sterilize the MC?
To sterilize the MC you place the MC in boiling water for 5 min (either in a saucepan or a tin can that has been used for food). Alternatively, you can place the MC in a container with water and a sterilizing tablet for 15 min or place the MC in a container and pour boiling water over it 3-4 times.
• Can you use soap to sterilize the MC?
You cannot use soap to sterilize the MC as it will damage the material of the MC. Using soap also can cause irritation to your vagina and cause an imbalance to your natural pH. If you want to wash with soap, make sure it is a fragrance-free, mild soap.
• What method for sterilizing the MC is most suitable for women and girls in rural areas?
This depends on the area but most women and girls in rural areas WoMena have distributed MCs to prefer to place the MC in a tin can with boiling water.
• Some blogs suggest no need for water to clean MCs, just use lemon. Is this correct?
It is incorrect. It is recommended to use the manufacturer’s recommendations for the brands that we distribute. Some of them suggest you can use lemon juice to remove the smell, but then you should still boil in water to remove the lemon before use. In general, if you use a blog that recommends something which is different from manufacturer guidelines, you are yourself responsible for any mishap. Users tell us they suffer less from smell than with other products
• Can the MC be shared with friends or family members after being sterilized?
The MC should not be shared! Intimate personal hygiene items (e.g. toothbrushes) should not be shared for hygiene reasons.
• How can I clean the small holes in my MC?
You can fill the MC with water and hold your hand over it while you press it so the water comes out through the holes. You can also clean it with a needle or a toothbrush.
• I dropped my MC on the floor – what do I do?
Re-sterilize the MC as it may have gotten dirty.
• Will there be any bad odor or smell?
No, there is no smell from using an MC. Menstrual flow only begins to smell when it begins to oxidize from being exposed to air – as with menstrual pads. When using the MC, the menstrual flow is not exposed to air so you do not have to worry about emitting an odor.
• How do you store the MC?
Between your periods, you will need to dry and store the MC till the next period. It is best to store your MC in its cotton bag for ventilation purposes – this way the MC will dry by itself inside the bag and it is not necessary to let it dry beforehand. However, if you stay in an area where there are rats or insects, better to store it in an airtight container such as a glass or plastic jar.
• How do I clean the cotton bag?
Every once in awhile it’s nice to clean your cotton bag where you store your menstrual cup while you don’t have your period. You can easily do this by putting it in the washing machine. Make sure to not wash it hotter than 30° C or else it will shrink.
• How long can the MC be used for?
It can be re-used for up to 10 years if you take good care of it.
• The MC has changed color, should I throw it away?
Some discoloring of the MC might happen – this does not mean that your MC cannot be used. Some women have found that their MC becomes a little stained after a number of uses, but it seems that the discoloration is related to the hormones and the unique natural chemical balance of each woman’s vaginal fluids – some women notice staining and others don’t. Some MC users have even found that it is related to contraceptive pills and a change in hormonal levels.
• My MC fell into the toilet! What to do?
That depends on a few things – like was it a public toilet or your private toilet at home, did you flush or do business A or B beforehand? Generally, it should be OK to wash the MC thoroughly and disinfect it before you insert it again. However, as the circumstances can be so diverse and if you are not comfortable using your MC anymore, we suggest that you purchase a new one.
HEALTH & SAFETY-RELATED CONCERNS
• Do MCs cause uterine prolapse?
No, MCs have not been associated in any causal way with pelvic organ prolapse. It also makes no sense physiologically speaking since it’s the uterine ligaments that are stretched and stressed leading to prolapse (that MCs go nowhere near) whereas the vagina is meant to be elastic and stretch in the vaginal walls (e.g. with MC insertion/removal) does not cause prolapse.
• Can the MC crawl up and disappear within the body?
No, the MC stays in the vagina and is too big to squeeze into the cervix and into the body.
• Is it safe for young girls to use the MC? Is there any evidence to show whether it is safe?
The MC is safe to use if it is used according to manufacturer instructions- both for girls and women. Many women have used the MC for many years (it was invented more than 80 years ago). Studies to date on human populations using MCs show high levels of safety, including as compared to other products.
• I have long nails – is it still safe for me to use the MC?
Yes, you can still use the MC when you have long nails. However you do need to be more careful when inserting and pulling out the MC as you might scratch yourself or transfer bacteria from under your nails in the process. Therefore take insertion and the process of pulling the MC out slowly! It is also important that you wash your hands and remember especially to wash carefully under your nails.
• Can I get infections from using the MC?
The MC is made of medical silicone and cannot give you infections. However, if you have not washed hands before inserting or removing the MC, there is a risk of infections.
• Can I get cancer from using the MC?
Cervical cancer is caused by a virus (HPV) which is transmitted sexually. If you want to avoid that cancer, you should get vaccinated against that virus, or abstain.
• Have any MC users developed allergies after using the MC?
No, most MCs, including the Ruby Cup, is made out of a material called medical grade silicone. This is the same material used in the tubes that they insert in people in hospitals, baby nipples or breast implants, and this material is non-allergenic. If you are allergic to silicon products, you will not be able to use the MC.
• Will the MC make me smell?
The MC is made of medical silicone and will not make you smell. Seek a doctor if you smell or if you observe vaginal discharge. Users report that one of the advantages of using MCs is that it reduces smell.
• When the MC is inserted, can it reach the cervix?
When the MC is inserted it creates a suction around the cervix. During menstruation some women’s cervix moves down, especially on days with heavy flow and the MC will therefore surround the cervix instead of being under it. In these cases, the cervix and MC might touch, but this will not affect the cervix. The cervix also stops the MC from moving further up – the MC will not disappear in your body!
• Can I use the MC just after I have given birth to collect blood and discharge?
No, the MC should only be used for menstrual blood. You can start using the MC when you begin to have a normal menstrual flow.
• Does the MC affect menstrual cramps?
Some women have reported that the MC reduces menstrual cramps, others find that it increases cramps. However, no studies have been conducted to explore this relationship.
• Can the MC fall out?
The vagina is an elastic, muscular tube that keeps the MC in place. The MC needs to be folded to be inserted through the vaginal opening, and when the MC unfolds and a vacuum will be created.
• The MC looks very big – can it fit in the vagina?
The vagina is an elastic, muscular tube that can easily expand and retract; most women can wear the MC very comfortably. Vaginas are “potential spaces” which means that they are closed at rest and stretch to accommodate anything inserted.
• I cannot make the MC enter – what is the problem?
If your cervix is very low, it can be difficult – and even impossible to insert the MC. To find out how high your cervix is you can insert your finger into your vagina. You will feel the cervix as a small bump. If you can feel it at your first knuckle, the cervix is very low. At the second knuckle it is medium, at the third knuckle it is high and if not at all, it is extremely high. If your cervix is low, you can try a smaller size of the MC.
• The MC feels very uncomfortable when I insert it, what am I doing wrong?
It takes some time to get used to inserting the MC, try to insert it while you are not on your period to practice. It can take 1-3 months to get comfortable using the MC. If it feels uncomfortable with the MC inside, it can be that the MC has not opened properly or the MC has been inserted too low or too high. Try to rotate the MC from the stem or run your finger around the edge to make sure there are no folds hindering the vacuum to form.
• Can I get Toxic Shock Syndrome (TSS) from using the MC?
TSS is a serious and potentially fatal illness caused by toxin-producing strains of staphylococcus aureus bacterium. It has been linked to the high absorbency and prolonged use of tampons. Although the occurrence is rare, it is preferred to remain cautious and taking the following steps are recommended in order to reduce the risk:
• Do not use any internal vaginal devices if you have previously been diagnosed with TSS
• Clean your MC thoroughly before your first use
• Remove and empty your MC at least every 12 hours during your period
• Wash your hands thoroughly before and after insertion and removal your MC
• Will the MC help alleviate period pains?
For some girls and women, it does! Many women report that using the MC has helped to alleviate some of their pain. This may be because MC prevents the vaginal walls from contracting, or because using an MC strengthens your pelvic floor muscles.
• Can I use the MC after giving birth?
Using internal menstrual products for the first six weeks after giving birth is not recommended. This is because of the increased risk of infection that results from tiny wounds on the vaginal tissues. We would advise you to consult your doctor when you feel you may be ready to resume using your MC after giving birth.
• Can the MC stop/change my period?
No, the MC has no effect on your menstrual cycle.
VIRGINITY,SEX & CONTRACEPTIVE USE
• Will the MC expand the vagina?
No, the vagina consists of flexible tissue and muscles that make the vagina able to expand and contract. The MC will therefore not affect the tightness of the vagina. The hymen is a thin membrane that sometimes (not always) partially covers the opening to the vagina. It is sometimes called the ‘vaginal corona’ to indicate that it often takes the form of a ring, rather than a membrane covering the opening. The appearance of the ‘hymen’ varies among individuals, and its appearance changes over time, for example, hormones make the corona more elastic at puberty. Daily activities (such as cycling, sports, inserting tampons, or MCs) may affect appearance, but there is little evidence for this.
• Are you still a virgin after using the MC?
The definition of ‘virginity’ varies between communities and among religious leaders. Many agree that virginity is defined by first vaginal intercourse. There is no certainty that women will bleed at first sexual intercourse (studies indicate that less than half do). If virginity is understood as penile, penetrative vaginal intercourse, the use of an MC or tampon does not affect virginity. Along with other daily activities, using an MC or tampon may or may not cause the corona to stretch, but that would not constitute ‘loss’ of virginity.
• Can the MC be used as a contraceptive?
No, the MC can only be used as a menstrual management product and is not a contraceptive!
• Can you use a coil (IUD) at the same time as the MC?
Yes, there are many studies that show that using an MC does not affect the coil, including that they do not cause a higher risk that the coil will drop out. Coils have a rather high rate of being expelled (around 10% according to some studies) but that has nothing to do with using coils. However, if you feel concerned about it, consult medical personnel, or choose another method.
• Can you have sex when the MC is inserted?
It is not possible to have penetrative sex with an MC inside. The MC should be removed before sexual intercourse.
• I have heavy flows – will it not leak if I use the MC?
One of the advantages of using an MC is that it has a higher capacity than for example a pad or a tampon (MCs can hold 30 ml, most pads can hold 15 ml). That is, it is a good product if you have a heavy flow. If you have a heavy flow you need to empty it more frequently than girls or women with lighter flows.
• Do I need a bigger size if I have heavier flow?
No, if you have a heavier flow you only need to empty the MC more frequently than women and girls with lighter flow. If you are using a small size MC, you can consider trying the regular size.
• What happens if the MC overflows?
If the MC is full it can start to leak. How quickly it is filled depends on how heavy the menstrual flow is. You will quickly learn how often the MC should be emptied.
• I am using an IUD/coil, can I use an MC?
There is a small risk that your IUD can be affected or moved out of position when removing the MC. But for most women the use of the Ruby Cup while having an IUD has not caused any problems. Still, we advise you to consult your doctor before use.
Try these top tips for using a MC if you have an IUD fitted:
• Position: The MC is designed to sit low in the vagina, and if placed correctly should not disturb your IUD strings. Get to know where your strings are and become familiar with where you need to place your MC.
• Release the seal: Your MC will create a suction seal when inside your vagina – to prevent leaks. Before removing your MC, take care to pinch the walls of your MC together to release the suction.
• Visit your doctor: If you have any concerns, if you have a low cervix, or feel that your IUD has moved position then visit your doctor or gynecologist for a health check before using an MC.
• Is the MC also a family planning method and can I turn the MC around and block sperm from entering?
No, the MC should not be used as a contraceptive. It should only be used for menstruation.
• Does the MC really last up to 10 years?
Yes, if you take care of the MC as instructed it can last up to 10 years. Some discoloring of the MC might happen – this does not mean that your MC cannot be used. Other uses of medical silicone (e.g. breast implants) have been found to last that long. Widespread use of MC is fairly recent, and there are no large scale studies, but many testimonials by long-time MC users.
• You only need the MC and no other methods, such as pads, to manage your menstruation?
On nights with the heavy flow the MC might need backup (a pad) but otherwise, the MC is the only product needed to manage menstruation. It also does not require knickers to be worn.
• In a cost-comparison to other methods – how much cheaper is it?
One MC costs between 7-35 USD depending on where you get it from; disposable pads cost 1.0-1.5 USD per cycle . That means for disposable pads, 13-20 USD/year and for a MC 1-3 USD/year. So it is already cheaper after a few months.
• Where can you buy MCs?
In many countries, people buy MCs over the Internet. There are more than 100 brands available in the market. However, you should watch the local market – e.g. in Denmark very few shops or pharmacies carried MCs 5-10 years ago. However, consumer interest has increased quickly, and now both pharmacies and health/beauty etc shops sell MCs. In Uganda, MCs are difficult to find because there are less consumer awareness and no Ugandan manufacturers; therefore, there is limited stock available in the country. MCs can mainly be purchased at Marie Stopes UG and also are available online, though it is advisable to always research the brand before you purchase.
• Has the MC been approved by national health authorities in Uganda?
National authorities in Kenya have approved the MC. However, in Uganda, so far, a regulation procedure for MCs has not yet been established.
• Which MC should we recommend?
WoMena uses brands made from medical grade silicone, which are highly rated on testing (e.g. by countries such as Sweden, France, Denmark) and consumer feedback. WoMena has used these with good results. We cannot recommend one brand over another on the basis of which country they are from.
• How long do different brands of MCs last?
It may depend on the material from which they are made. WoMena uses MCs made from medical grade silicone. This material is also used for breast implants (which need to last a long time) and is usually estimated and marketed to last a minimum of 10 years. We are not aware of any studies comparing the durability of different brands of MCs, and we do not know whether MCs made from rubber have different durability.
• What are the best ways of disposing of the MC after 10 years?
You can dispose of the MC in the bin. One of the main advantages of MCs is that they are made from a material (medical grade silicone), which is widely used e.g. for baby bottle nipples, breast implants or in hospital settings, and has been widely found to be safe. Therefore we are not aware of any restrictions on their disposal. Another advantage is that there is only one product for 10 years, whereas for disposable pads it would be on the order of 130 per year.
• What are the advantages of the MC?
• It is comparatively cheaper than other products, because it can be used for up to 10 years.
• It can collect two times as much blood as a disposable pad can absorb.
• It does not clog latrines/toilets, because you will only need to dispose of the blood, which also means it has a minimal impact on the environment.
• It can be used without wearing knickers – but you can wear knickers while using it.
• It uses less water than reusable pads for maintenance.
• It gets very comfortable to use after 1-3 months of practicing.
• Can I also use the MC for drinking?
No, the MC should only be used to collect menstrual blood.
We periodically update the questions and answers HERE