Health Science Reviews

By Candice Watkins

For many girls around the world, periods don’t just bring cramps, they bring missed school, stigma, and serious health risks. In low-income countries, there is a massive lack of adequate access to affordable menstrual hygiene products. In desperate situations, some girls reuse pads for days, or even share used pads, putting their health at risk.

Inside the vagina lives a community of microorganisms, like a peaceful village guarded by a strong immune system army. Poor menstrual hygiene acts like a hurricane sweeping through the village. The storm disrupts the balance, wiping out defences and triggering inflammation. One major result  of such disruptions is bacterial vaginosis (BV), a condition that affects up to 30% of women globally, and as many as 1 in 2 women in low-income regions. In this vulnerable state, external threats like Chlamydia, Gonorrhoea, HIV and other sexually transmitted infections (STIs) can sneak through the body’s natural defences and more easily establish an infection.

So, what if we had a simple, affordable solution to help protect this village? We do! Menstrual cups – these small, reusable silicone devices may look unassuming, but they have the potential to transform menstrual health. A group of researchers in Kenya set out to explore whether menstrual cups could reduce BV, STIs, and increase abundance of Lactobacillus species in the vaginal microbiome – these are ‘hard workers’ of vaginal bacteria who keep the pH low and prevent harmful microbes from taking over.

To find out, 449 schoolgirls (age 14-16) were randomly assigned to either receive a menstrual cup, or no intervention. Both groups also received STI testing and treatment, handwashing education, and menstrual health education. The cup group was trained on proper menstrual cup use, which included proper storage, disinfection, insertion, duration, and disposal of contents. The participants collected their own vaginal swabs throughout the study which were tested for STIs and BV. Bacterial composition was determined using a method called 16s rRNA gene sequencing – this is a technique widely used to detect bacteria in a sample by reading part of their genetic code and comparing it to known bacteria in a reference database.

One year later, the group using menstrual cups had fewer cases of BV and were about a quarter less likely to get BV than the girls who didn’t use cups. On top of that, the cup group also had more stable vaginal bacteria, with higher Lactobacillus crispatus (the bacterial ‘star student’ who offers the most health benefits). At first, there seemed to be no big difference in STI rates but after adjusting for other factors (like age, sexual activity, socioeconomic status) they found that this group was also less likely to get an STI. These findings could have a huge impact in Africa, and worldwide, but this is just the beginning. What’s next? Larger trials will follow, involving broader age groups and populations. While young girls are disproportionately affected by period poverty, this issue also extends to older women who face similar issues.

Beyond menstrual health, menstrual cups offer a much lower environmental impact than other menstrual hygiene products. When used correctly, they are safe, affordable and long-lasting, empowering the user to take control of their health with comfort and confidence. I’m excited to see how this field evolves, and even more excited to personally contribute through my own research. There is massive potential to transform lives with something as simple, yet powerful, as a menstrual cup.

Reference: Mehta, S.D., Zulaika, G., Agingu, W., Nyothach, E., Bhaumik, R., Green, S.J., van Eijk, A.M., Kwaro, D., Otieno, F., Phillips-Howard, P., 2023. Analysis of bacterial vaginosis, the vaginal microbiome, and sexually transmitted infections following the provision of menstrual cups in Kenyan schools: Results of a nested study within a cluster randomized controlled trial. PLoS Med 20, e1004258. https://doi.org/10.1371/journal.pmed.1004258