What Runners Need to Know About Menstrual Cups

Many athletes swear by this reusable, long-wearing alternative to pads and tampons.

For at least three of the seven days of her period, runner Annabelle Winters had a routine: “I would run, I would go into the bathroom, and I’d put my shorts in the sink,” she says. Even large tampons couldn’t contain her heavy flow.

That’s before an eco-conscious sister-in-law convinced her to try a device called a menstrual cup this past February. Now, 33-year-old Winters says she’ll probably never run in tampons or pads again. “Instantly it was just more comfortable, and because of the capacity, in the past six months I haven’t had an issue even once,” she says. And having a precise measure of her flow, which the menstrual cup provides, helped her work with her doctor to develop a treatment plan for her painful periods.

Many other female athletes report similar positive experiences, says Elizabeth Stevenson-Gargiulo, D.O., an obstetrician/gynaecologist on the medical staff of Baylor University Medical Centre at Dallas in the US (and a blogger at runningthroughpregnancy.com ). Here, learn the basics about this lesser-known way to cope with your monthly visitor.

Q: A menstrual what, now?

You read it right – a menstrual cup. This flexible device, usually made of silicone, resembles an upside-down bell with a firm ring around the top about the size of a ponytail holder. To use it, you squeeze the ring, fold the cup, and place it in your vagina, rotating and pushing up until it rests right underneath your pubic bone. As you let go, the ring forms a seal inside your vaginal walls, collecting menstrual blood. “It’s kind of like a baggie for your cervix,” says Wendy Conway, M.D., an obstetrician/gynaecologist who’s run 15 marathons.

Once it’s full, you pull it back out, dump the blood into the toilet, wash the cup with warm soapy water, and reinsert. Though they’re not new – one version was invented in the 1930s – many women haven’t heard of this option, Stevenson-Gargiulo says. But like Winters, many who try it become converts.

Q: Really? That sounds way more complicated and intrusive than a tampon…

Inserting the cup properly does take some time to perfect, says runner and University of Washington obstetrician/gynaecologist Sue Lee Moreni, M.D. Many women develop their own techniques and tips. (Browse the instructional videos on YouTube for a sampling.)

Winters, for one, says it took her a few times to get the hang of it. Now, she gives hers a pull to make sure it’s formed a seal, then does a quick wiggle and hop before leaving the bathroom to make sure it won’t move. Insert it correctly and you shouldn’t feel it, even during the impact of running. “If it’s flipping around and you sit down and you feel it when you sit down, it’s not in the right spot – and you’ll know it,” Conway says.

Q: How do you make that work in a portaloo?

Ideally, you won’t have to. Unlike tampons, menstrual cups don’t harbor the bacteria that cause a potentially fatal infection called toxic shock syndrome (the reason you have to switch out tampons every four to eight hours). So you can leave them in for eight to 12 hours – enough time to board a bus or ferry to a big-city marathon, run a four- to six-hour race, and even meet up with your cheering squad for a beer afterward.

Like any other piece of gear, test it out on long runs before using it during a race. Once you’ve got the hang of it, you’ll probably still want a private, indoor bathroom to dump and wash it. Fortunately, most cups hold about 30 milliliters of flow (for perspective, the average woman expels as much as 80 milliliters during her entire cycle), so yours probably won’t overflow before you can reach indoor plumbing, Stevenson-Gargiulo says.

If you do need to change or adjust the cup at a race, make sure you wash your hands first, Conway says. (Avoid sanitiser if you can – the chemicals can irritate your vagina and potentially erode the silicone.) And carry a water bottle in with you to rinse the cup and your hands when you’re finished.

Q: Twelve hours of coverage sounds good. Any other perks?

Like Winters, many women runners find the cup nearly leak-proof and the smooth silicone more comfortable than dry, potentially chafe-producing pads or tampons. Then there’s the environmental aspect – most cups can be reused, meaning fewer products piling up in landfills, Stevenson-Gargiulo says.

As an initial purchase, they’re more expensive than pads or tampons purchase, especially if it doesn’t work out. But if you like the cup, you can keep most brands for a long time. DivaCup, for instance, advises replacing the device annually, but many women keep theirs for far longer. “It doesn’t actually take that much time to pay off the cost of one menstrual cup, considering women may have to buy multiple packages of tampons or pads,” Moreni says.

Q: There are so many brands out there. How to choose? 

DivaCup may be the most popular, but then there’s Softcup, Lunette, Mooncup, Dutchess, and more. Some feel softer and more flexible, others stiffer. You can read up online, but it might take testing a few options to find what feels best, Moreni says.

Most brands offer two different sizes – one for younger women who haven’t had children, and the other for older women who have. “As we age, the laxity in our vagina and what it can hold can change, so we may need a bigger cup,” Moreni says. Smaller sizes might also work better for shorter women, who tend to have narrow pelvises. A too-large cup could put pressure on your bladder or bowels, causing a gotta-go sensation, Stevenson-Gargiulo says.

Some cups come in different lengths as well, depending on how high or low your cervix sits in your vaginal canal. (You can tell this by reaching in and feeling for it with your finger.) When in doubt, check the manufacturer’s website. Most offer detailed charts and instructions about finding the best fit, Stevenson-Gargiulo says.

Q: I’m not sure I can cope with that much of an, um, hands-on process. Should I still try to switch?

If you’re squeamish around blood or don’t even like inserting tampons, the menstrual cup might not be the best choice for you. “Anyone who uses this needs to be comfortable with their own anatomy ‘down there’ and has to be comfortable with putting things in their vagina and then pulling them out,” Stevenson-Gargiulo says.

Other women who may want to steer clear are those with prolapse. In this condition, weak or damaged pelvic floor muscles cause your uterus or bladder to drop down into your vagina, potentially displacing the cup. Also, check with your doctor before using one if you’ve recently given birth or if you have an IUD or other internal birth-control device.

Finally, if you’re perfectly happy with your current menstrual routine, no need to rush out and change it, Moreni says. “There’s not one perfect thing for all women. But I think it’s empowering for women to have a choice when possible. The more options we have, the more benefit we can have from them.”


Subscribe to Runner's World

Related Articles