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Women, girls and transgender people need effective, safe, affordable and comfortable menstrual products to live healthy, productive lives.

“Yet, despite the fact that 1.9 billion women globally are of menstruating age – spending an average of 65 days a year dealing with menstrual blood flow – few good quality studies exist that compare sanitary products,” says Penelope Phillips-Howard, an epidemiologist at the Liverpool School of Tropical Medicine.

The absence of data on a topic that affects one in four people on the planet for two months a year is a glaring example of how the health concerns of women are systematically neglected in research.

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But Dr. Phillips-Howard and her team have taken a small step in rectifying that with a new study that examines the practicality, safety and cost of menstrual cups.

The research, published in the journal Lancet Public Health, shows that menstrual cups are as safe and effective as other sanitary products, and can also generate significant environmental and financial benefits.

But it also underscores that awareness is low. While menstrual cups have been available since the 1930s, fewer than one-third of women in high-income countries have even heard of them.

While pads and tampons absorb blood, menstrual cups collect blood flow, and then they are emptied every four to 12 hours. While there are hundreds of brands available, there are two principal types of menstrual cups, a bell-shaped vaginal cup, and a cervical cup that is placed around the cervix like a contraceptive diaphragm.

The products, which are made of medical-grade silicone, rubber or latex, can last up to 10 years.

Costs also vary around the world, from as little as 72 cents to around $50. (The DivaCup, a product that is popular in Canada, costs roughly $35.)

While the upfront cost can be non-negligible, the research shows that, over time, menstrual cups cost about 95 per cent less than pads and tampons. Pads cost about 31 cents each, and tampons 21 cents, and women use, on average, 12 per period, for about four decades.

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Much of the interest in menstrual cups, however, is driven by environmental concerns.

The authors of the new study suggest that plastic waste in particular can be reduced markedly. Over a decade, a cup creates 0.4 per cent of the plastic waste generated by single-use pads, and 6 per cent of that produced by tampons.

The research, which compiled and reviewed 43 studies involving more than 3,300 women and girls, found that the greatest barrier to women using menstrual cups is lack of familiarity.

For example, a review of educational websites that focus on puberty found that 77 per cent of them discuss the use of pads, 65 per cent tampons, but only 30 per cent mentioned menstrual cups.

There are also concerns about practicality and safety – especially leakage. But the new study found that leakage from menstrual cups, pads and tampons is roughly the same and so, too, are rates of infection and toxic shock syndrome.

Menstruation is a normal bodily function and the options for managing it should be discussed more openly.

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The researchers said that peer support and training is essential, especially at menarche (first menstruation) but that, once women or girls tried a menstrual cup, 70 per cent wanted to continue. That was true even in challenging conditions, where there is little access to water or privacy.

Availability and choice in menstrual products is not merely an issue of comfort.

In large parts of the developing world, girls and women who are menstruating are denied access to education and work, and are more vulnerable to assault when they seek out private space for toileting.

Because of the costs of pads and tampons, many women and girls rely on makeshift menstrual products such as cloth rags, cotton wool, tissue paper and other materials, or stay home from work or school during their periods.

In recent years, there has been an effort to reduce period poverty and, more generally, to combat the stigma and shame too often associated with menstruation.

Even in wealthy countries in Canada, there have been political debates about making menstrual products available in workplaces and public bathrooms and about the inequity of taxing of pads and tampons.

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Beyond providing free or lower-cost products, attention should be paid to ensuring that women, girls and transgender people have access to products best suited to their needs.

Like every other aspect of reproductive and women’s health, access and choice matter.

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