Background: Menstrual cups are reusable devices that are inserted vaginally to collect menstrual flow. Their popularity is increasing in Australia because of their reduced environmental impact, financial benefits and convenience. Clinical staff at Sexual Health Quarters (SHQ) had reported an anecdotal increase in the number of patients experiencing intrauterine device (IUD) expulsion following concurrent menstrual cup use. Although few studies have been published on this topic, recent research suggests menstrual cup use may increase the risk of IUD expulsion. The mechanisms posited are that cup removal may catch the IUD strings or apply negative pressure to the cervix. The purpose of this review was to determine the proportion of IUD expulsions at SHQ associated with concurrent menstrual cup use.
Method: A retrospective chart review of SHQ patients with IUDs inserted from 31.1.19 to 31.1.20 was conducted. The following was documented for each patient: demographics, IUD type, whether IUD expulsion occurred, and whether expulsion was documented as associated with menstrual cup use.
Results: 520 IUDs were inserted over the time period: 352 Mirena, 144 Copper T standard, 21 Copper T short, 4 Multiload. There were 22 IUD expulsions (4.23% of IUDs inserted), with 10 (45.5%) associated with menstrual cup use (6 Copper T standard and 4 Mirena).
Discussion: The next stage of the investigation will involve determining the proportion of cup users amongst the study population, with an eventual aim of establishing whether concurrent cup use is a risk factor for IUD expulsion. Future studies will aim to clarify whether there is evidence supporting recommendations including cutting IUD strings flush with the cervix.
Implications for practice: SHQ clinicians now routinely ask patients about menstrual product use, and menstrual cup users are counselled about the correct removal technique (breaking the seal and avoiding IUD strings).