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Better menstrual management options for adolescents needed in south Africa: what about the menstrual cup?

To the Editor: Providing forms of menstrual management to women and girls in need has been on the South African (SA) government's agenda for the past 4 years.[1] A sanitary pads campaign launched in 2014 reported that almost nine million SA girls aged 13-19 miss time at school because of lack of sanitary products.!21 In 2010, the World Health Organization reported that the lack of school toilets with privacy and facilities for menstrual hygiene contributes to sporadic attendance and drop-out among young women in Africa.[3] Several other SA initiatives have focused on disposable sanitary towels, as the environmental impact of menstrual waste on sewage systems is considerable.[4] Menstrual pads, tampons and rags routinely block pipes and joints, which is costly, takes time to resolve and imposes health hazards.[4]

The menstrual cup (MCup) is a non-absorbent reusable barrier cup that collects menstrual blood, is typically made of flexible medical-grade silicone, and has been approved by the US Food and Drug Administration. Unlike tampons, there have been no reports of toxic shock syndrome or other infectious sequelae resulting from use.

Many studies on MCups indicate that women found the device acceptable.[5-111] To date only one of these studies has been conducted in Africa.[11] This recent randomised cross-over trial conducted in KwaZulu-Natal Province, SA, compared the acceptability and performance of the MPower MCup (Fig. 1) among 110 women with those of sanitary towels or tampons. In comparison with the menstrual hygiene product used most often, the MCup was rated better in respect of comfort, quality, menstrual blood collection capacity, appearance and preference. Participating students and working women were comfortable using the MCup in their place of work/study. Owing to the high-volume capacity of MCups, many of the women preferred to wait until they got home to wash their cups, as the MCup can be emptied and wiped out during the day and washed later.

Although MCups are made in SA (Fig 1.), and can be ordered on the internet or through a limited number of pharmacies, they have not been provided or mentioned in most of the SA menstrual management campaigns to date. Like many other MCups the SA MPower MCup comes in two sizes, the smaller size being recommended for adolescents. The cost of tampons for one woman per year has been calculated as approximately the same as one MCup at current SA retail prices.[12] In SA the MPower MCup retails for R265.00, while a box of 32 tampons costs approximately R40.00. As the lifespan of one MCup is typically 5 years, MCup use would represent a considerable cost saving over time.

DOI: 10.7196/SAMJ.9205

Mags Beksinska

Maternal, Adolescent and Child Health Research, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa, and Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, UK

Jennifer Smit

Maternal, Adolescent and Child Health Research, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa, and Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu-Natal, Durban

Ross Greener, Virginia Maphumulo, Zonke Mabude

Maternal, Adolescent and Child Health Research, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa

[1.] Matlala A, Mabuza K. Zuma promises free towels for women. The Sowetan, 10 January 2011. http:// (accessed 3 February 2014).

[2.] South African Government News Agency. Campaign brings sanitary dignity for school girls. SANews., 18 September 2014. (accessed 14 November 2014).

[3.] Brocklehurst C, Bartram J. Swimming upstream: Why sanitation, hygiene and water are so important to mothers and their daughters. Bull World Health Organ 2010; 88(7):482-482. [http://dx.doi. org/10.2471/BLT.10.080077j

[4.] Marni S, Kjellen M, Pensulo C. Girls' and women's unmet needs for menstrual hygiene management (MHM): The interactions between MHM and sanitation systems in low-income countries. Journal of Water, Sanitation and Hygiene for Development 2013; 3(3):283-297. [ washdev.2013.1011

[5.] Liswood R. Internal menstrual protection: Use of a safe and sanitary menstrual cup. Obstet Gynecol 1959; 13(5):539-543.

[6.] Karnaky KJ. Internal menstrual protection with the rubber menstrual cup. Obstet Gynecol 1962; 19(5):688-691.

[7.] Pena EF. Menstrual protection: Advantages of the menstrual cup. Obstet Gynecol 1962; 19(5):684-687.

[8.] Parker J, Bushell RW, Behrman SJ. Hygienic control of menorrhagia: Use of rubber menstrual cup. Int J Fertil 1964; 9:619-621.

[9.] Cheng M, Kung R, Hannah M, Wilansky D, Shime J. Menses cup evaluation study. Fertil Steril 1995; 64(3):661-663.

[10.] Stewart K, Greer R, Powell M. Women's experience of using the Mooncup. J Obstet Gynaecol 2010; 30(3):285-287. 1

[11.] Beksinska M, Smit J, Greener R, et al. Acceptability and performance of the menstrual cup in South Africa: A randomized cross-over trial comparing the menstrual cup to tampons or sanitary pads. J Women's Health 2015; 24(2):151-158. 1

[12.] Howard C, Rose CL, Trouton K, et al. FLOW (finding lasting options for women): Multicentre randomized controlled trial comparing tampons with menstrual cups. Can Fam Physician 2011; 57(6):e208-215.
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Author:Beksinska, Mags; Smit, Jennifer; Greener, Ross; Maphumulo, Virginia; Mabude, Zonke
Publication:South African Medical Journal
Article Type:Letter to the editor
Date:May 1, 2015
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