Biomechanics and suction force of menstrual cups: implications for IUD users
DOI:
https://doi.org/10.18203/2320-6012.ijrms20260650Keywords:
Menstrual cup biomechanic, IUD expulsion risk, Suction dynamics, Patient safety, Product design innovationAbstract
The concurrent use of menstrual cups and intrauterine devices (IUDs) is increasingly common due to the ecological, economic, and health benefits associated with menstrual cups. Understanding these biomechanical factors is essential to ensure patient safety and effective contraceptive use. A narrative review of existing literature was conducted to evaluate the biomechanical mechanisms involved in menstrual cup usage among IUD users. Published studies, case reports, and clinical observations were analysed with a focus on suction pressure, vaginal seal formation, force displacement, and user-related factors. Variations in anatomical characteristics, menstrual cup design, IUD type, and insertion–removal techniques were examined to assess their influence on IUD stability and expulsion risk. The review indicates that menstrual cups can generate negative pressure within the vaginal canal, which may exert upward forces on IUD strings and the device itself. Improper breaking of suction during cup removal and direct traction on IUD strings were identified as key contributors to IUD displacement and expulsion. The combined use of menstrual cups and IUDs presents potential biomechanical risks, particularly related to suction forces and improper removal techniques. While menstrual cups remain a safe and environmentally sustainable option for menstrual hygiene, increased awareness, proper user education, and careful consideration of cup design and IUD string management are essential. Further clinical and biomechanical studies are needed to establish standardized guidelines and minimize complications among IUD users who choose menstrual cups.
Metrics
References
Babbar K, Martin J, Ruiz J, Parray AA, Sommer M. Menstrual health is a public health and human rights issue. Lancet Public Health. 2022;7(1):e10-11.
Ashwini KM, Kumar A. Effectiveness of structured teaching programme regarding knowledge about uses of menstrual cup among nursing students. Int J Res Med Sci. 2024;12(4):1156-9.
Yu F, Chen M, Cao H, Yang G, Wang W, Wang Y. Intrauterine device (IUD) migration completely into the abdominal cavity and half into the bladder to form a stone: a case report and mini-review. BMC Urol. 2024;24(1):280.
Bowman N, Thwaites A. Menstrual cup and risk of IUD expulsion – a systematic review. Contracept Reprod Med. 2023;8(1):15.
Schnyer AN, Jensen JT, Edelman A, Han L. Do menstrual cups increase risk of IUD expulsion? A survey of self-reported IUD and menstrual hygiene product use in the United States. Eur J Contracept Reprod Health Care. 2019;24(5):368-72.
Tilahun T, Tadesse A, Oljira R. Spontaneously Expelled Lippes Loop IUD After 40 Years of Use: A Case Report and Review of the Literature. Int Med Case Rep J. 2022;15:373-7.
Glenn JK, Goldman J. Task delegation to physician extenders-some comparisons. Am J Public Health. 1976;66(1):64-6.
Shanmugham V, Murugesan A, Vijayakrishnan G. Usage of menstrual cups among the doctors of reproductive age group in a tertiary care centre in Kancheepuram, Tamil Nadu, India- An observational study. Clin Epidemiol Glob Health. 2024;25:101473.
Arenas-Gallo C, Ramírez-Rocha G, González-Hakspiel L, Merlano-Alcendra C, Palomino-Suárez D, Rueda-Espinel S. Acceptability and safety of the menstrual cup: a systematic review of the literature. Revista Colombiana De Obstetricia Y Ginecologia. 2020;71(2):163-77.
Hennegan J, Orozco A, Head A, Marino JL, Jayasinghe Y, Lim MSC. Menstrual cup acceptability and functionality in real‐world use: A cross‐sectional survey of young people in Australia. Aust N Z J Obstet Gynaecol. 2025;65(3):382-9.
Xu X, Ruan X, Rabe T. Intrauterine contraception and menstrual bleeding. Glob Health J. 2021 ;5(2):66-9.
Wildemeersch D. New intrauterine technologies for contraception and treatment in nulliparous/ adolescent and parous women. Facts Views Vis Obgyn. 2009;1(3):223-32.
Foran T, Butcher BE, Kovacs G, Bateson D, O’Connor V. Safety of insertion of the copper IUD and LNG-IUS in nulliparous women: a systematic review. Eur J Contracept Reprod Health Care. 2018 ;23(5):379-86.
Zoi A, Vatopoulou A, Skentou X, Tsonis O, Galaziou G, Koutalia N, et al. Intrauterine device use in adolescence: a narrative review. Minerva Obstet Gynecol. 2025;77(1):45-55.
DeMeester TR, Johnson LF. Evaluation of the Nissen antireflux procedure by esophageal manometry and twenty-four hour pH monitoring. Am J Surg. 1975;129(1):94-100.
Itriyeva K. The normal menstrual cycle. Curr Probl Pediatr Adolesc Health Care. 2022;52(5):101183.
Udapurkar P, Mali K, Bora A. Precluding menstrual cups from the mainstream: a prospective interventional analysis among urban women in India. J Obstetr Gynecol India. 2023;73(Suppl 1):161-5.
Borkar SK, Borkar A, Shaikh MK, Mendhe H, Ambad R, Joshi A. Study of Menstrual Hygiene Practices Among Adolescent Girls in a Tribal Area of Central India. Cureus. 2022;14(10):e30247.
Madar J, Gaucher M, Barbaroux A, Delotte J, Boudy CA. Étude RIESC : risques d’infections uro-génitales et d’expulsion dans l’association stérilet et coupe menstruelle. Gynécologie Obstétrique Fertil Sénologie. 2024;52(12):683-9.
DeMeester TR, Johnson LF. Evaluation of the Nissen antireflux procedure by esophageal manometry and twenty-four hour pH monitoring. Am J Surg. 1975 ;129(1):94-100.
Veshohilova TP. Effect of combined use of steroid preparations with pyrroxane on the gonadotropic function of the hypophysis. Akush Ginekol (Sofiia). 1975;10:10-2.
Singh R, Agarwal M, Sinha S, Chaudhary N, Sinha HH, Anant M. Study of Adaptability and Efficacy of Menstrual Cups in Managing Menstrual Health and Hygiene: A Descriptive Longitudinal Study. Cureus. 2022;14(9):e29690.
Sica VP, Friberg MA, Teufel AG, Streicher-Scott JL, Hu P, Sauer UG, et al. Safety assessment scheme for menstrual cups and application for the evaluation of a menstrual cup comprised of medical grade silicone. eBioMedicine. 2022;86:104339.
Van Eijk AM, Zulaika G, Lenchner M, Mason L, Sivakami M, Nyothach E, et al. Menstrual cup use, leakage, acceptability, safety, and availability: a systematic review and meta-analysis. Lancet Public Health. 2019;4(8):e376-93.
Schevchenco B, Brandão S, Gomes Timbó P, Tonon Da Luz SC, Da Silva Honório GJ, Da Roza T. The influence of the menstrual cup on female pelvic floor muscles variables: a prospective case series. Women Health. 2023;63(1):35-43.
Liberty A, Bannow BS, Matteson K, Edelman A, Colwill A. Menstrual Technology Innovations and the Implications for Heavy Menstrual Bleeding. Obstet Gynecol. 2023;141(4):666-73.
Curtis KM, Peipert JF. Long-Acting Reversible Contraception. N Engl J Med. 2017;376(5):461-8.
Ortiz ME, Croxatto HB, Bardin CW. Mechanisms of Action of Intrauterine Devices. Obstet Gynecol Surv. 1996;51(12):S42-51.
Veshohilova TP. Effect of combined use of steroid preparations with pyrroxane on the gonadotropic function of the hypophysis. Akush Ginekol (Sofiia). 1975;10:10-2.
Manley H, Hunt JA, Santos L, Breedon P. Comparison between menstrual cups: first step to categorization and improved safety. Womens Health. 2021;17:17455065211058553.
Claire J, Mir S, Dumortier I, Liard R, Yavchitz A, Le Cossec C, et al. The use of a menstrual cup as a risk factor for displacement of intrauterine devices: a case-control study. Contracept Reprod Med. 2025;10(1):33.
Brown JE, Creinin MD, Wu H, Hubacher D, Schreiber CA, Kaneshiro B, et al. Menstrual cup use and intrauterine device expulsion in a copper intrauterine device randomized trial. Contraception. 2024;134:110415.
Averbach SH, Ermias Y, Jeng G, Curtis KM, Whiteman MK, Berry-Bibee E, et al. Expulsion of intrauterine devices after postpartum placement by timing of placement, delivery type, and intrauterine device type: a systematic review and meta-analysis. Am J Obstet Gynecol. 2020;223(2):177-88.
Kassa BG, Ayele AD, Belay HG, Tefera AG, Tiruneh GA, Ayenew NT, et al. Postpartum intrauterine contraceptive device use and its associated factors in Ethiopia: systematic review and meta-analysis. Reprod Health. 2021;18(1):225.
Sanders JN, Adkins DE, Kaur S, Storck K, Gawron LM, Turok DK. Bleeding, cramping, and satisfaction among new copper IUD users: A prospective study. PLOS ONE. 2018;13(11):e0199724.
Wakrim S, Lahlou L. Spontaneously expelled IUD and missing fragments in the uterine cavity. Radiol Case Rep. 2020;15(9):1654-6.
Palanca M, Tozzi G, Cristofolini L. The use of digital image correlation in the biomechanical area: a review. Int Biomech. 2016;3(1):1-21.
Veletić M, Apu EH, Simić M, Bergsland J, Balasingham I, Contag CH, et al. Implants with Sensing Capabilities. Chem Rev. 2022 ;122(21):16329-63.
Kakani CR, Bhatt JK. Study of adaptability and efficacy of menstrual cup in managing menstrual health and hygiene. Int J Reprod Contracept Obstet Gynecol. 2017;6(7):3045-53.
Hennegan J, Montgomery P. Do Menstrual Hygiene Management Interventions Improve Education and Psychosocial Outcomes for Women and Girls in Low- and Middle-Income Countries? A Systematic Review. PLOS ONE. 2016;11(2):e0146985.
Mouhanna JN, Simms-Cendan J, Pastor-Carvajal S. The Menstrual Cup: Menstrual Hygiene With Less Environmental Impact. JAMA. 2023;329(13):1114-5.
Rastogi S, Khanna A, Mathur P. Educational interventions to improve menstrual health: approaches and challenges. Int J Adolesc Med Health. 2021;33(5):20190024.
Gharacheh M, Ranjbar F, Hajinasab N, Haghani S. Acceptability and safety of the menstrual cups among Iranian women: a cross-sectional study. BMC Womens Health. 2021;21(1):105.
Muhumuza J, Migisha R, Ngonzi J, Kayondo M, Mugyenyi G. Risk factors for postpartum intrauterine device expulsion among women delivering at a tertiary Hospital in Uganda: a prospective cohort study. Contracept Reprod Med. 2021;6(1):7.
Roden RC. Reversible interventions for menstrual management in adolescents and young adults with gender incongruence. Ther Adv Reprod Health. 2023;17:26334941231158251.
Sarkar A, Gehlawat M. Towards Menstrual Equity: A Review of Sustainable Solutions in Menstrual Hygiene Management. Prev Med Res Rev. 2025.
Efilti P, Timur Ş. Generative Design Research for a Culturally Sensitive Subject: Exploring Menstrual Practices and Product Experiences to Inspire Design. Des Cult. 2025;17(1):1-26.
Hughes SM, Levy CN, Katz R, Lokken EM, Anahtar MN, Hall MB, et al. Changes in concentrations of cervicovaginal immune mediators across the menstrual cycle: a systematic review and meta-analysis of individual patient data. BMC Med. 2022;20(1):353.
Pokhrel D, Bhattarai S, Emgård M, Von Schickfus M, Forsberg BC, Biermann O. Acceptability and feasibility of using vaginal menstrual cups among schoolgirls in rural Nepal: a qualitative pilot study. Reprod Health. 2021;18(1):20.
Yaron M, Legardeur H, Barcellini B, Akhoundova F, Mathevet P. Safety and efficacy of a suction cervical stabilizer for intrauterine contraceptive device insertion: Results from a randomized, controlled study. Contraception. 2023;123:110004.
Mehta SD, Zulaika G, Agingu W, Nyothach E, Bhaumik R, Green SJ, et al. 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. 2023;20(7):e1004258.
Liu D, Schmitt M, Nowara A, Magno C, Ortiz R, Sommer M. The evolving landscape of menstrual product advertisements in the United States: 2008-2018. Health Care Women Int. 2023;44(5):537-65.
Krakowsky Y, Potter E, Hallarn J, Monari B, Wilcox H, Bauer G, et al. The Effect of Gender-Affirming Medical Care on the Vaginal and Neovaginal Microbiomes of Transgender and Gender-Diverse People. Front Cell Infect Microbiol. 2022 ;11:769950.
Patel K, Dwivedy S, Panda N, Swain S, Pati S, Palo SK. Is menstrual cup a sustainable and safe alternative in menstrual hygiene management? A qualitative exploratory study based on user’s experience in India. Clin Epidemiol Glob Health. 2023;20:101212.
Madden AM, Smith S. Body composition and morphological assessment of nutritional status in adults: a review of anthropometric variables. J Hum Nutr Diet. 2016;29(1):7-25.
Gruer C, Hopper K, Smith RC, Kelly E, Maroko A, Sommer M. Seeking menstrual products: a qualitative exploration of the unmet menstrual needs of individuals experiencing homelessness in New York City. Reprod Health. 2021;18(1):77.
Iv Kyrazis CB, Stein EB, Carroll EF, Crissman HP, Kirkpatrick DL, Wasnik AP, et al. Imaging Care for Transgender and Gender Diverse Patients: Best Practices and Recommendations. RadioGraphics. 2023;43(2):e220124.
Gerchow L, Lanier Y, Fayard AL, Squires A. Cocreating First Steps, a Toolkit to Improve Adolescent Sexual and Reproductive Health Services: Qualitative Human-Centered Design Study With Hispanic and Black Adolescent Mothers in New York City. JMIR Pediatr Parent. 2024;7:e60692.
Tasmim S, Baten A, Sivaperuman Kalairaj M, Wang S, Zimmern PE, Ware TH. Magnetoactive elastomer-based dynamic urethral support device for stress urinary incontinence. Acta Biomater. 2025;191:336-51.
Myo MG, Nguyen BT. Intrauterine Device Complications and Their Management. Curr Obstet Gynecol Rep. 2023;12(2):88-95.
Hennegan J. Inserting informed choice into global menstrual product use and provision. Lancet Public Health. 2019;4(8):e361-2.
Shiny Irene D, Indra Priyadharshini S, Tamizh Kuzhali R, Nancy P. An IoT based smart menstrual cup using optimized adaptive CNN model for effective menstrual hygiene management. Artif Intell Rev. 2022;56(2):6705-22.
Shaw MK. Modern, Empowered, but Stigmatized: Analyzing the Construction of Menstrual Cups as Feminist Technologies. Gend Soc. 2023;37(5):699-726.
Davis K, Kumar D. Pelvic floor dysfunction: a conceptual framework for collaborative patient‐centred care. J Adv Nurs. 2003;43(6):555-68.
Srinivas YR, Ramesh TM, Muddanna PK, Jayappa MK. A review on probiotics and mental health: exploring the gut-brain axis and its therapeutic potential. Int J Res Med Sci. 2025;13(9):3921-32.
Muddanna PK, Kumaraswamy M. The impact of smoking on sleep and quality of life: a comprehensive review. Int J Res Med Sci. 2024;12(9):3538-42.
Gölbaşı Koç SD, Yücel E, Sungur S, Metintaş S, Önsüz MF. Use of menstrual cup and awareness of environmental effects of menstrual hygiene products. Local Environ. 2023;28(6):784-92.
Marroquin J, Kiomourtzoglou M, Scranton A, Pollack AZ. Chemicals in menstrual products: A systematic review. BJOG. 2024;131(5):655-64.
Poulose PA, Gaur S. More Than a Period: Creative Engagement and Storytelling to Transform the Menstrual Communication Landscape. 2024.
Downloads
Published
How to Cite
Issue
Section
