Menstrual cups are seen by many women as an eco-friendly and practical alternative to use during their periods. But can using a menstrual cup increase the risk of IUD expulsion? Despite the growing popularity of the cup, little research has been done on the use of the cup by women who have an IUD. Various cases in literature and practice report women experiencing IUD expulsion while using a menstrual cup. Expulsion is when the IUD is accidentally removed while removing the cup. Expulsions also occur in women who do not use a cup, and this can have various causes. According to the NHG Standard Contraception, the chance of IUD expulsion is approximately 2-5%.
In one of the first studies on this topic from 2011, the risk of expulsion was compared among 743 women who used pads and/or tampons or a cup. Six to eight weeks after IUD placement, 3.7% of women using a cup experienced expulsion. The researchers found that this was comparable to women who used pads and/or tampons. However, the follow-up period in this study was short (6-8 weeks) and used retrospective data.
In May 2020, a longer prospective study by Long et al. showed an increased risk of expulsion for cup users. In this study, 1,092 women were followed for three years after IUD placement. Two years after the start of the study, 17% of the women using a cup experienced expulsion, compared to 5% of women who did not use a cup. Of the women who experienced expulsion with a cup, 30% reported that the expulsion occurred during cup removal. The increased risk of expulsion led the researchers to advise caution regarding the simultaneous use of menstrual cups and IUDs.
Based on this recent publication, it appears that using a menstrual cup carries a higher risk of expulsion (5% without using a menstrual cup and 17% with using a menstrual cup). It helps if you remove the cup carefully by breaking the vacuum first and then removing the cup.
Sources:
NHG Standard Contraception: https://richtlijnen.nhg.org/standaarden/anticonceptie#volledige-tekst
Seale, R., Powers, L., Guiahi, M., Kate Coleman-Minahan, K. (2019). Unintentional IUD expulsion with concomitant menstrual cup use: a case series. Contraception, Volume 100, Issue 1, Pages 85-87. https://doi.org/10.1016/j.contraception.2019.03.047
Wiebe, E. R., & Trouton, K.J. (2012). Does using tampons or menstrual cups increase early IUD expulsion rates? Contraception, 86(2), 119-121. https://doi.org/10.1016/j.contraception.2011.12.002
Long, J., Schreiber, C., Creinin, M.D., Kaneshiro, B., Nanda, K., & Blithe, D. (2020). Menstrual Cup Use and Intrauterine Device Expulsion in a Copper Intrauterine Device Contraceptive Efficacy Trial [OP01-1B]. Obstetrics & Gynecology, 135, 1S. https://doi.org/10.1097/01.aog.0000662872.89062.83
Hormonal IUDs
Copper IUD
