By far the most frequently asked question I receive is “can I use a menstrual cup if I have an IUD?” An Intrauterine Device (IUD), also known as “the coil,” is a long-term birth control method and is inserted by a medical professional through the cervix and into the uterus. IUDs are effective birth control but are also given to patients for a variety of reasons, including as a method to reduce heavy and unmanageable periods. Some users experience normal periods, while others with an IUD will have their periods lighten considerably or completely stop. IUDs can be hormonal or non-hormonal in nature, but both are shaped and inserted similarly.
Menstrual cups are worn in the vaginal canal and sit below the cervix to collect menstrual fluid. They stay in place through a combination of “suction” when the opening seals completely with the vaginal walls, and through pelvic floor muscle tone-ness. When you remove a menstrual cup the seal must be broken by pinching the base and introducing air into the cup. This makes removal comfortable for the wearer.
In contrast to menstrual cups, menstrual discs are worn in the vaginal canal but expand within the vaginal fornix area without creating suction. In order to remove a menstrual disc the user only has to grip the disc and pull out — no seal must be broken first. Some disc products also include silicone strings or indentations that aid in gripping the disc for removal.
Can a Menstrual Cup Suction Out an IUD?
You may have heard horror stories of a menstrual cup “suctioning out” an IUD during removal. The fact is, we don’t have enough data and funded research at the level we need to draw concrete conclusions on this matter but we know enough to say that users should use extra caution. In 2020 a small-scale study of 1,092 period-havers by the journal Obstetrics & Gynecology * was conducted to determine if IUD expulsion rates are higher with menstrual cup users compared to those who use other period protection. 17% of menstrual cup users experienced IUD expulsion compared with 5% who used other period products. The study was not large enough to conclude the exact cause and couldn’t determine if the expulsions were from suction (users not breaking the seal during removal) or from users unknowingly pulling their IUD strings.
Overall, 266 (24.4%) women reported menstrual cup use. At 24 months after initiating enrollment, 46 (17.3%) cup users and 43 (5.2%) non-users experienced expulsion (odds ratio 3.81 [95% CI 2.45-5.92]). Fourteen (30.4%) menstrual cup users with expulsion reported the event occurred during menstrual cup removal. At Year 1 of the study, expulsion rates among menstrual cup users and non-users were 14.3% and 4.7%, respectively (P<.001). By the end of Year 2, these rates were 23.2% and 6.5% (P<.001). – Obstetrics & Gynecology excerpt
IUD expulsion can happen for a variety of reasons but it stands to reason that if a user has an improperly placed IUD, or they’re in the process of naturally expelling their IUD, the removal of a menstrual cup could contribute or be linked to the expulsion.
Should Those With An IUD Use a Menstrual Cup?
Ultimately, you want to feel comfortable with the product. Does the removal process cause you anxiety and worry? If so, there are many more options such as reusable menstrual discs to consider. Does even the idea of removing a menstrual disc still give you pause? There are also modern and easy-to-use cloth pads and period underwear that cut down period waste and save you money.
Are Menstrual Discs Safe To Wear With an IUD?
Menstrual discs, which do not create the “vacuum suction” that menstrual cups do, are just now beginning to see a rise in popular use. Since 2020, there have been multiple new disc products hit the market, and foreign brands are gaining US FDA clearance as well. There are no known studies as of the publishing date of this article that can provide us with data. The Instead SoftCup is a disposable disc that’s been commercially available for more than 20 years. Anecdotally, I personally have not encountered any cases of an IUD expulsion reported with a reusable disc in the online communities for cup and disc users yet. Using MAUDE, an online database of adverse effects reports submitted by FDA-registered companies, I was unable to find any instances of an IUD expulsion injury report caused by disposable (SoftDisc, SoftCup, or Flex Disc) or newer reusable discs. That is not to say there’s never been a case – the database relies on brands to submit the claims themselves. The instances of an IUD expulsion reportedly connected to a menstrual cup were numerous.*
Talk to your Doctor
If using a menstrual cup is your goal you should discuss it with your care provider. Unfortunately, many working OB/GYN’s are still uneducated on modern menstrual cups and may outright dismiss your desires because they don’t have enough knowledge to give advice. They’d rather provide you with overly cautious directions than risk their professional reputation on a guess because they lack the experience and education with the product to form an opinion. If you’re not on the same wavelength it might be time to shop around for another provider.
Precautions to take for IUDs and Menstrual Cups or Discs
Your OB/GYN might offer to trim your IUD’s strings closer to your cervix; this reduces the chance of your fingers grabbing your strings during removal. This is a good idea for disc users as well. Shortening your strings can make the removal of the IUD more difficult in the future but not impossible.
Since IUD expulsion is more common within the first three months your doctor may advise you to wait to use a cup until after that timeframe, just to be safe. Nowhere in any literature or study is it suggested that IUDs and menstrual cups are incompatible. With precautions and care, and understanding the possible risks, you can use a cup – that is your call.
If using a menstrual cup is more important to you than having an IUD, you can also discuss contraceptive alternatives. The Caya Diaphragm is similar to reusable menstrual discs. Non-hormonal barrier contraception is growing in popularity.
As for removing your cup, if you have an IUD I would suggest always breaking the cup’s seal fully by pinching the base during removal. If you have reachable IUD strings it’s a good practice to monitor their length. Keep in mind, the cervix changes height throughout your cycle so it will vary to some degree. If at any time you feel your strings are lower than they should be, have your care provider check on your IUD placement to be safe. Never grab the strings during cup or disc removal.
What’s Your Opinion, Kim?
I’d love to tell you that cups are 100% safe to use with an IUD but anecdotal evidence and the few studies we have do give pause. I would personally feel more comfortable using a menstrual disc if I had an IUD. Having a lower cervix would also likely increase your risk factors for expulsion since you’re more likely to unknowingly grab your strings when they’re within reach, compared to someone who is unable to reach them at all. In my 10 years as a menstrual cup educator, I’ve spoken with people who have used cups for many years with their IUDs in place without issue. I’ve also spoken to people who believe a cup removed their IUD. If you have more concerns you can always join the Period Nirvana Community to search for posts on this topic or pose your own question to our helpful cup and disc using members.
The Period Nirvana Quiz is updated to ask users if they have an IUD and guides them towards either their best menstrual cup result or if they prefer, their best reusable menstrual disc result. At PN we constantly look to improve our resources based on the feedback of users and based on updated science. Take the menstrual cup and disc quiz and find the recommended product for you.