Is expulsion of an IUD more common in women who use a menstrual cup?

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

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

One of the first studies on this topic in 2011 compared the risk of expulsion in 743 women using pads and/or tampons or a cup. Six to eight weeks after IUD insertion, 3.7% of women using a cup had experienced an expulsion. The researchers found that this was similar in women who used 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, as many as 1,092 women were followed for three years after IUD placement. Two years after the start of the study, 17% in the group of women using a cup had experienced an expulsion, compared to 5% of the women not using a cup. Of the women who had experienced an expulsion with a cup, 30% reported that the expulsion occurred during cup removal. The increased risk of expulsion has prompted the researchers to advise caution regarding the simultaneous use of menstrual cups and IUDs.

Based on this recent publication, it appears that the use of a menstrual cup has a higher 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