Menstrual cups are seen by many women as an environmentally friendly and practical alternative to use during menstruation. But can the use of a menstrual cup increase the risk of expulsion (expulsion) of an IUD?

Despite the growing popularity of the cup, little research has been done into the use of the cup by women who wear an IUD. In literature and in practice there are several cases known of women using a cup and experiencing an expulsion of an IUD. Expulsions also occur in women who do not use a cup and this can have several causes. According to the NHG Standard Contraception, the chance of an IUD expulsion is about 2 - 5%.

In one of the first studies on this subject in 2011, the risk of expulsions was compared with 743 women using sanitary towels and/or tampons or a cup. Six to eight weeks after placement of the IUD, 3.7% of the women using a cup had experienced an expulsion. The researchers found that this was similar in women using sanitary towels and/or tampons. However, the follow-up period in this study was short (6 - 8 weeks) and retrospective data were used.

In May 2020, a longer prospective study by Long et al. did show an increased risk of expulsion for cup users. In this study no less than 1,092 women were followed for 3 years after placement of the IUD. Two years after the start of the study, 17% experienced an expulsion in the group of women who used a cup, versus 5% of the women who did not use a cup. Of the women who had experienced an expulsion with a cup, 30% indicated that the expulsion took place during cup removal. The increased risk of expulsion was a reason for the researchers to advise caution regarding the concomitant use of menstrual cups and IUD's.

Based on this recent publication, it appears that the use of a menstrual cup increases the risk of expulsion. We advise healthcare professionals to include this information in their counselling.

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