Can a Menstrual Cup Cause Uterine Prolapse?

As Dr. Jen

Is a Diva Cup safe to use? I’ve read it can cause uterine prolapse.

-Via Instagram

Short Take

No, menstrual cups (Diva Cup is one brand) aren’t associated with pelvic organ prolapse.  

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Pelvic organ prolapse is a condition where the tissues and muscles of the pelvic floor are no longer able to support the pelvic organs (meaning one or more of the uterus, bladder, urethra, and rectum). This can lead to these organs and the vagina itself descending, sometimes a bulge can be felt at the vaginal opening and less commonly these tissues may actually hang out of the vaginal opening. Think of the vagina as a sock with a tennis ball sewn in at the top. Now imagine inserting your hand into the sock and from the inside, pulling down at the toe of the sock where the tennis ball is sewn. The part that is telescoping inside the sock is the prolapsing vaginal tissue and the tennis ball that you can feel, but not see by looking inside the sock, represents the organ that is dropping down.

Pelvic organ prolapse is related to age, genetics, injury during childbirth, frequent constipation and straining, menopause, medical conditions that affect connective tissue, obesity, and chronic coughing. 

I can understand how someone who doesn’t know about prolapse could think that a menstrual cup could play a role. It’s true if you pull straight down on a cup, there may be suction, but this isn’t going to damage tissues (you’ll know this is happening, because the cup will seem “stuck” and you’ll need to break the seal). Tugging on a cup that’s formed a seal isn’t going to damage the tissues, making them weak, or even pull the uterus down. In fact, we use pessaries inserted in the vagina to treat pelvic organ prolapse and and some create suction against the vaginal tissues. Pessaries come in many shapes, and it’s the solid looking ones that can create suction.

Assorted pessaries. Huckfinne, Public domain, via Wikimedia Commons

When a pessary is removed to be washed the seal has to be broken, and as with a menstrual cup, sometimes there is tugging before that happens. And yet they don’t make prolapse worse. Quite the opposite, pessaries are very effective at treating prolapse.

Apparently, there are a few pelvic floor physical therapists warning about menstrual cups and prolapse, and this was covered by the BBC a few years back. The concerns raised are not related to any studies or reports in the medical literature, rather, this seems based on the fact that some cup manufacturers recommend bearing down a little (like having a bowel movement) to bring the cup into reach if needed. This isn’t straining, this is a brief bearing down. We often ask people to bear down in the office to see if a prolapse is visible.

Is it possible that some people are straining, like with constipation, when they remove their cup? Sure. That’s not a good idea, because repetitive straining isn’t a good idea. If you need to strain to get your cup out, then it’s not a good fit for you, and try a different size or shape.

If someone has Stage 2 or greater prolapse, it’s possible a cup won’t fit right as this means the prolapse is within a centimeter of the hymen. It’s definitely possible someone could have Stage 2 prolapse and be unaware of that fact. They decide to try a cup, have some symptoms because the cup won’t fit right. They may be come aware of the prolapse that they hadn’t noticed before. Then see their doctor and find out they have prolapse. You can see in that scenario how someone might erroneously think the cup caused their pelvic organ prolapse.

A review of studies on menstrual cups didn’t mention prolapse as an associated risk and I’ve never heard any expert mention a connection.

References

van Eijk et al. Menstrual cup use, leakage, acceptability, safety, and availability: a systematic review and meta-analysis. The Lancet Public Health VOLUME 4, ISSUE 8, E376-E393, AUGUST 01, 2019.