FLOW (finding lasting options for women): multicentre randomized controlled trial comparing tampons with menstrual cups

Abstract

Objective: To determine whether menstrual cups are a viable alternative to tampons.

Design: Randomized controlled trial.

Setting: Prince George, Victoria, and Vancouver, BC.

Participants: A total of 110 women aged 19 to 40 years who had previously used tampons as their main method of menstrual management.

Intervention: Participants were randomized into 2 groups, a tampon group and a menstrual cup group. Using online diaries, participants tracked 1 menstrual cycle using their regular method and 3 menstrual cycles using the method of their allocated group.

Main outcome measures: Overall satisfaction; secondary outcomes included discomfort, urovaginal infection, cost, and waste.

Results: Forty-seven women in each group completed the final survey, 5 of whom were subsequently excluded from analysis (3 from the tampon group and 2 from the menstrual cup group). Overall satisfaction on a 7-point Likert scale was higher for the menstrual cup group than for the tampon group (mean [standard deviation] score 5.4 [1.5] vs 5.0 [1.0], respectively; P=.04). Approximately 91% of women in the menstrual cup group said they would continue to use the cup and recommend it to others. Women used a median of 13 menstrual products per cycle, or 169 products per year, which corresponds to approximately 771,248,400 products used annually in Canada. Estimated cost for tampon use was $37.44 a year (similar to the retail cost of 1 menstrual cup). Subjective vaginal discomfort was initially higher in the menstrual cup group, but the discomfort decreased with continued use. There was no significant difference in physician-diagnosed urovaginal symptoms between the 2 groups.

Conclusion: Both of the menstrual management methods evaluated were well tolerated by subjects. Menstrual cups are a satisfactory alternative to tampons and have the potential to be a sustainable solution to menstrual management, with moderate cost savings and much-reduced environmental effects compared with tampons. Trial registration number C06-0478 (ClinicalTrials.gov).

Trial registration: ClinicalTrials.gov NCT00397202.

Figures

Figure 1

Selection process for study participants

Figure 2

Final survey results: Median scores on a 7-point Likert scale with error bars representing interquartile ranges; N=89. *P < .05

Figure 3

End-of-cycle results, by month, as measured by mean scores on a 7-point Likert scale: A) Overall satisfaction, by study cycle; N=89. B) Tampon satisfaction data, by study cycle; N=44. C) Menstrual cup satisfaction data, by study cycle; N=45. *P < .05