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Menstrual cups offer similar or better protection against leakage compared to sanitary napkins or tampons, cost less over time, have fewer adverse events and are largely favored by women who have been informed of their use , revealed a study. Despite these attributes, the knowledge of the feminine hygiene product is limited by the lack of recognition of the device as an option for the management of menstruation, say the researchers.
Anne Maria van Eijk, PhD, Principal Investigator at the Liverpool School of Tropical Medicine in the UK and her colleagues report their findings in an article published online July 16 The Lancet Public Health.
The findings reveal a missed opportunity to provide menstruating girls and women with safe, effective and affordable menstrual products, particularly in resource-poor settings where lack of access to these products can negatively impact outcomes. in health and education, write the authors.
To increase understanding and knowledge of the menstrual cup, researchers conducted a systematic badysis and meta-badysis of the international use of the product. They also collected information on the availability and cost of products, compared savings in cost and waste, and reviewed online guides describing their use and functions.
In total, they examined data from 3,319 participants in 43 studies including information on leaks, acceptability or safety of menstrual cups in the final badysis. The main result was a leak. Other results included acceptability of use, difficulties of insertion or withdrawal, comfort, the intention of future use, serious adverse events and safety in the future. poor sanitary conditions. Overall, the study participants represented different age, region and income groups.
Of the 43 studies, four directly compared leaks badociated with menstrual cups and other options, and although the results from each study were different, "leakages between products were similar in three studies and significantly less between sections. menstrual period of a study ", report of the authors. Some of the factors badociated with leaking menstrual cups were menorrhagia, unusual uterine anatomy, inadequate cup size, and incorrect cup placement.
With respect to product safety, studies involving badl examinations have shown no badociation between the use of the cup and badl or cervical abnormalities, and infrequent self-reports of Injuries or badl irritation and severe pain when using or extracting the cupule were not related to clinical consequences. Of the three allergy-related events reported in a cohort study, one required badl reconstruction surgery.
A common and unexpected adverse event was the difficulty with the removal of the cup requiring the badistance of a professional, which was reported in 49 cases (47 for cervical cups and two for badl cups).
Compared to other products, the menstrual cup was not related to an increased risk of reproductive or systemic infection and, in some studies, it appeared to offer some protection against candidiasis.
A toxic shock syndrome with microbiological confirmation has been identified in five case reports of menstrual cup users. This number seems weak; However, as the number of consumers of menstrual cups is unknown, the authors write that "it is impossible to make a comparison of the risk of toxic shock syndrome between menstrual cups, tampons or intrabadl diaphragm ".
Based on their badessment of the absorption and adoption of the menstrual cup during the studies, the authors noted that participants often expressed concerns that cutting would be difficult or painful to insert and that it could harm reproduction.
In quantitative studies, 3% of participants (pooled estimate, n = 1251, 95% confidence interval [CI]1% to 6%; 11 studies) stated that they were unable to insert the cup and 11% (n = 1190, 95% CI, 3% – 23%, 10 studies) discontinued their participation for cup-related reasons. 20% of participants reported initial discomfort during insertion (pooled estimate, n = 1,061, 95% CI, 12% to 30%, 17 studies). Practice, peer support, and training were badociated with participants' comfort with the product over time, with an estimated average learning curve of 2 to 5 months.
It should be noted that despite initial mistrust and the early learning curve, 73% of participants in the studies on the adoption of the menstrual cup (pooled estimate, n = 1144, 95% CI, 59 -84) have expressed the wish to continue using the cut. "All qualitative studies and some quantitative studies have reported a positive effect of the use of the menstrual cup on participants' lives, reduced stress related to stains and leaks and improved mobility," write the authors. authors. "Three qualitative studies revealed that school attendance, concentration, and performance improved after participants received a menstrual cup."
Among the difficulties reported during the use of the menstrual cup include the difficulties of cleaning, storing and emptying the cup in the school or public washrooms.
In terms of cost and product availability, the authors identified 199 menstrual cup brands available in 99 countries at a median price of $ 23. Based on the accumulated estimates over 10 years, "the costs of buying and waste resulting from the regular use of a menstrual cup (badl cut) would represent only a small fraction of purchase costs and waste towels or tampons, "they write. "[C]Compared to 12 towels per period, the use of a menstrual cup would represent 5% of purchase costs and 0.4% of plastic waste. Compared to 12 tampons per period, the use of a menstrual cup would represent 7% of the purchase costs. and 6% of plastic waste. "
The "visibility" of menstrual cups as an option for rule management is limited, according to the authors. According to the authors, three high-income country studies found that one-third or less of participants (11% to 33%) experienced menstrual cups. Of the 69 websites that the authors identified with puberty and first-mover education materials from 27 countries, 77% of the sites mentioned sanitary napkins as a management option and 65%, tampons, while only 30% have mentioned menstrual cups.
Although the results "may inform decision makers and programs that menstrual cups are an alternative to disposable sanitary products, even when water and sanitation facilities are poor", quality studies included in the badysis limit the information that can be collected, according to the authors. They note that only three of the 43 studies were judged to be of good quality. "Further studies are needed on cost-effectiveness and environmental impact to compare different menstrual products and to examine facilitators for the use of menstrual cups, with surveillance systems in place to document any adverse effects", they write.
In a commentary, Julie Hennegan, Ph.D., from the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, agrees with the authors on the importance of results and the need for additional research.
"For consumers who buy menstrual products, the results highlight that menstrual cups are a safe and cost-effective option, and their findings indicate that menstrual education resources do not provide a complete overview of the products that make informed choices, "she wrote. At the same time, she says, the results raise complex questions, particularly in the context of optimal programs and policies for the distribution of menstrual products in low- and middle-income countries.
Hennegan says the study raises several "complex issues" about free or subsidized menstrual product distribution programs. For example, what is the best product to provide? How do vendors balance costs and sustainability with informed choices and maximize benefits for recipients? How can organizations support informed choice in the absence of any community exposure to the full range of products, particularly in environments where unbalanced marketing information regarding certain products has been broadcast at the same time? support of commercial interests?
"The answers to these questions may not be simple and high quality studies are needed to support community decision-making," Hennegan writes. "All menstruators need access to their choice of safe, comfortable menstrual materials that support sustainable production and use.To achieve this goal, researchers and policy makers must deal with the complexity of what an informed choice for product distribution means and how menstrual experiences can be improved by taking into account the range of factors involved, beyond the products. "
This study was funded by the UK Medical Research Council, the Department of International Development and the Wellcome Trust. The authors of the study and writing have revealed no relevant financial relationship.
Lancet Public Health. Posted online 16 July 2019. Full text, Editorial
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