Menstrual cup guide: sizes, safety and what the research shows
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- DivaCup Model 0. Best for: First-time users or slim vaginal canals. See options on Amazon
- DivaCup Model 1. Best for: Medium to heavy flow days. See options on Amazon
- DivaCup Model 2. Best for: Ages 35+, wider vaginal canals or post-partum. See options on Amazon
What the research found
A systematic review and meta-analysis in Lancet Public Health looked at 43 studies with 3319 participants. Four studies directly compared cups with usual products and found leakage was similar or lower for menstrual cups than for disposable pads or tampons. In 13 studies, 73% of participants wished to continue using the cup, and four studies with 507 women found no adverse effects on the vaginal flora.
The review also noted that adopting a cup took a familiarization phase over several menstrual cycles. It identified 199 brands of menstrual cup available in 99 countries.
Most studies looked at vaginal cups: 27 of the 43 studies (63%), compared with five (12%) on cervical cups and 11 (25%) on mixed or unknown types. Removal was rarely a problem for vaginal cups: the review found professional help to remove a cup was reported for 47 cervical cup users but only two vaginal cup users.
Choosing a size
| DivaCup model | Holds | Maker guidance |
|---|---|---|
| Model 0 | 4 regular tampons of flow | First-time users or slim vaginal canals |
| Model 1 | 5 regular tampons of flow | Medium to heavy flow days |
| Model 2 | 6 regular tampons of flow | Ages 35+ or wider vaginal canals; post-partum |
Details are from DivaCup product pages. DivaCup says all three are made of flexible 100% medical grade silicone that folds for insertion, have visible flow lines to track your period, and are safe for up to 12 hours of continuous wear. Other brands size their cups differently, so read each maker's chart.
DivaCup also says its cups are designed to provide 12 hours of comfort and leak protection; the review's independent leakage data is the better guide.
Getting used to a cup
- Expect a learning curve. The review found adoption required a familiarization phase over several cycles, and peer support improved uptake in two studies.
- Fold to insert. DivaCup says its silicone folds for easy insertion and that air holes help create a seal that holds the cup in place.
- Grip to remove. DivaCup describes its cups as easy to grip for removal.
- Time it. Empty it within the maker's wear limit; DivaCup's is 12 hours.
Safety: what to know
The review identified five women who reported severe pain or vaginal wounds, six reports of allergies or rashes, nine of urinary tract complaints and five of toxic shock syndrome after using a menstrual cup. It also found dislodgement of an intrauterine device (IUD) reported in 13 women who used a cup, between 1 week and 13 months after IUD insertion.
If you have an IUD, ask your clinician whether a cup is right for you. Because toxic shock syndrome was among the rare reports, seek urgent care if you suddenly feel very unwell while using a cup.
Cleaning and storage
Follow the maker's cleaning instructions between uses and between cycles, and store the cup dry in a breathable pouch; DivaCup includes an organic cotton pouch and user guide with its cups. Wash your hands before inserting or removing the cup.
Do not use scented products or douches around the vagina; the Office on Women's Health warns they may raise infection risk. See our feminine wash guide for gentle external care.
Is a cup right for you?
The review concluded cups are a safe option for menstruation management that is being used internationally. A cup may suit you if you want a reusable product and are comfortable inserting one. It may not suit you if you cannot use internal products, have pelvic pain, or have an IUD and have not talked to your clinician.
For gentle external care, see our body wash guide.
What to look for when you buy
DivaCup Model 0
Best for: First-time users or slim vaginal canals
DivaCup says Model 0 holds 4 regular tampons of flow and is best for first-time users.
Watch out: Expect a few cycles to get used to it.
See options on AmazonDivaCup Model 1
Best for: Medium to heavy flow days
DivaCup says Model 1 holds 5 regular tampons of flow.
Watch out: Empty it within 12 hours, per DivaCup.
See options on AmazonDivaCup Model 2
Best for: Ages 35+, wider vaginal canals or post-partum
DivaCup says Model 2 holds 6 regular tampons of flow.
Watch out: Talk to your clinician first if you have an IUD.
See options on AmazonQuestions people ask
- Are menstrual cups safe?
- A 2019 review called them a safe option, but noted rare reports of pain, allergies, urinary complaints, toxic shock syndrome and IUD dislodgement.
- Do menstrual cups leak?
- In four direct comparisons, leakage was similar or lower than with pads or tampons.
- How long can I wear a menstrual cup?
- DivaCup says up to 12 hours of continuous wear; follow your own cup's limit.
- Can I use a menstrual cup with an IUD?
- Ask your clinician first; the review found 13 reports of IUD dislodgement in cup users.
- Which size menstrual cup should I get?
- DivaCup suggests Model 0 for first-timers or slim canals, Model 1 for medium to heavy flow, and Model 2 for ages 35+ or post-partum.
Sources
- Menstrual cup use, leakage, acceptability, safety, and availability: a systematic review and meta-analysis (pmc.ncbi.nlm.nih.gov), Lancet Public Health (PMC6669309)
- DIVA Cup Model 0 (divacup.com), DivaCup
- DIVA Cup Model 1 (divacup.com), DivaCup
- DIVA Cup Model 2 (divacup.com), DivaCup
- Douching (womenshealth.gov), Office on Women's Health, HHS