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FLOW (finding lasting options for women)

Updated: Mar 15, 2022

Multicenter randomized controlled trial comparing tampons with menstrual cups

Article From CFP

Written By Courtney Howard, Caren Lee Rose, Konia Trouton, Holly Stamm, Danielle Marentette, Nicole Kirkpatrick, Sanja Karalic, Renee Fernandez and Julie Paget Canadian Family Physician

13 May 2021



To determine whether menstrual cups are a viable alternative to tampons.


Randomized controlled trial.


Prince George, Victoria, and Vancouver, BC.


A total of 110 women aged 19 to 40 years who had previously used tampons as their main method of menstrual management.


Participants were randomized into 2 groups, a tampon group and a menstrual cup group. Using online diaries, participants tracked 1 menstrual cycle using their regular method and 3 menstrual cycles using the method of their allocated group.

Main outcome measures

Overall satisfaction; secondary outcomes included discomfort, urovaginal infection, cost, and waste.


Forty-seven women in each group completed the final survey, 5 of whom were subsequently excluded from analysis (3 from the tampon group and 2 from the menstrual cup group). Overall satisfaction on a 7-point Likert scale was higher for the menstrual cup group than for the tampon group (mean [standard deviation] score 5.4 [1.5] vs 5.0 [1.0], respectively; P = .04).

Approximately 91% of women in the menstrual cup group said they would continue to use the cup and recommend it to others. Women used a median of 13 menstrual products per cycle, or 169 products per year, which corresponds to approximately 771 248 400 products used annually in Canada. Estimated cost for tampon use was $37.44 a year (similar to the retail cost of 1 menstrual cup). Subjective vaginal discomfort was initially higher in the menstrual cup group, but the discomfort decreased with continued use. There was no significant difference in physician-diagnosed urovaginal symptoms between the 2 groups.


Both of the menstrual management methods evaluated were well tolerated by subjects. Menstrual cups are a satisfactory alternative to tampons and have the potential to be a sustainable solution to menstrual management, with moderate cost savings and much-reduced environmental effects compared with tampons.


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