Reusable menstrual products have seen growing interest among patients seeking cost-effective, sustainable, and body-conscious alternatives to traditional disposable items. Among these, menstrual cups represent a particularly significant development, offering extended wear time and reduced waste. While silicone has long been the dominant material in this category, thermoplastic elastomer (TPE) is emerging as a viable and potentially safer alternative.
For healthcare professionals counseling patients on menstrual care, understanding the distinctions between materials, risk profiles, and design innovations is essential to supporting informed, individualized choices.
Clinical Benefits and Challenges of Menstrual Cups
Menstrual cups function by collecting menstrual fluid rather than absorbing it. When inserted properly, they form a seal against the vaginal walls and can typically be worn for 8 to 12 hours, depending on flow volume. Advantages include:
- Decreased long-term cost relative to disposables
- Reduced environmental impact
- Lower frequency of changes, especially beneficial during sleep or travel
- Potential reduction in skin irritation and allergic response
Challenges include an initial learning curve with insertion and removal, fit variability, and concerns regarding hygiene and infection risk. Proper patient education is essential to maximize benefits and minimize complications.
Material Considerations: Silicone vs. Thermoplastic Elastomer
Most menstrual cups have historically been manufactured from medical-grade silicone. It is biocompatible, inert, and widely accepted in medical applications. However, thermoplastic elastomer (TPE) has gained traction in recent years due to its favorable thermal and mechanical properties and versatility in design.
TPE, used in medical tubing, infant products, and other sensitive applications, softens slightly at body temperature, allowing the device to mold more precisely to anatomical contours. This thermoreactivity may enhance comfort and seal performance. TPE also enables the production of menstrual cups in varying firmness levels, allowing for tailored recommendations based on pelvic floor strength and user sensitivity.
Notably, TPE cups may carry a lower risk of bacterial proliferation and toxin production in vitro compared to their silicone counterparts.
Toxic Shock Syndrome and Material Safety
Although Toxic Shock Syndrome (TSS) remains rare, concerns persist regarding the potential for menstrual devices to foster conditions conducive to Staphylococcus aureus colonization and toxic shock syndrome toxin-1 (TSST-1) expression.
A 2018 study published in Applied and Environmental Microbiology by Nonfoux et al. evaluated the microbiological behavior of menstrual cups and tampons under simulated vaginal conditions. The findings indicated that cups constructed from thermoplastic elastomer supported significantly lower levels of S. aureus growth and TSST-1 production compared to silicone-based cups Nonfoux et al., 2018.
While these results are not a substitute for in vivo data, they underscore the importance of considering material composition in patient safety discussions. Appropriate hygiene, sterilization, and user education remain critical for risk mitigation.
The MeLuna Cup: A TPE-Based Model
One of the most established manufacturers utilizing TPE exclusively is MeLuna, a German-based company offering a wide spectrum of menstrual cup options. Their product line includes variations in:
- Firmness: The MeLuna Classic suits the general population, while the Sport model, with increased rigidity, is intended for individuals with strong pelvic musculature, such as athletes.
- Size and length: Accommodating variations in vaginal length and cervical position, including menstrual cups for low cervix.
- Removal aids: Options include ball, ring, stem, or no handle, depending on user preference and dexterity
The brand’s modular approach allows for a high degree of customization, which may reduce the incidence of improper fit—a common reason for discontinuation among users.
Guiding Patients: Assessing Fit and Suitability
Accurate menstrual cup fitting can be complex. Factors influencing fit include:
- Vaginal length and cervix height
- Parity and delivery history
- Pelvic floor tone
- Menstrual flow volume
- Bladder or rectal sensitivity
Several manufacturers, including MeLuna, offer evidence-based online fitting quizzes that assess these factors and provide size and model recommendations. These tools can be valuable adjuncts for patients unsure about sizing, particularly for first-time users.
Healthcare providers may also consider offering in-clinic guidance for patients with anatomical variations, previous pelvic surgery, or pelvic organ prolapse.
Cleaning and Maintenance
Reusable menstrual cups require consistent hygiene practices to prevent infection and prolong usability. Standard care involves:
- Washing with mild, fragrance-free soap and warm water after each use during menstruation
- Boiling for 3 to 5 minutes at the end of each cycle
- Storing the device in a breathable, dry pouch to prevent mold or bacterial growth
With appropriate care, most menstrual cups can be used for 5 to 10 years. TPE models may show slight textural changes over time, but clinical performance is generally maintained.
Beyond Cups: Other Reusable Menstrual Options
For patients seeking non-internal solutions, two other reusable products may be appropriate:
- Cloth menstrual pads, which attach to underwear with snaps and come in various absorbency levels. They are often chosen by patients with skin sensitivities or preferences for external protection.
- Period underwear, which integrates absorbent technology into the garment itself. Suitable for light to moderate flow or as backup protection, period underwear is gaining popularity due to ease of use and discretion.
These options may be especially relevant for patients with anatomical contraindications to internal devices or for those in postpartum recovery.
Conclusion
Menstrual care is rapidly evolving, with a growing emphasis on personalization, sustainability, and patient safety. TPE-based menstrual cups represent a noteworthy advancement, both for their adaptable physical properties and their potential microbiological advantages. Brands like MeLuna are at the forefront of this innovation, offering clinicians a broader toolkit for supporting individualized menstrual health.
Healthcare providers can play a vital role in guiding patients through menstrual product choices by staying informed about material science, fit dynamics, and patient-reported outcomes. As interest in reusable products grows, evidence-based counseling and product literacy will become increasingly important aspects of preventive and gynecologic care.