It’s that time of the month again, where we ready ourselves for the inevitable cramps, food cravings and mood swings, not to mention the potential leaking. In the menstruating process, we also have to take extra care of our hygiene to keep things clean, using products such as sanitary pads, tampons or period cups. In fact, these are the three most common choices among us ladies¹ to combat menstruation. But which is better?
Sanitary pads
Sanitary pads are rectangular pieces of absorbent material that are stuck to the underwear to absorb menstrual flow from the vagina. It retains the flow absorbed and needs to be thrown away and replaced after some time. Although reusable cloth pads exist if you are looking for a more environmentally-friendly version (they still need to be washed every few hours). Unlike tampons or menstrual cups, pads provide an external method of absorbing menstrual flow as they are not inserted into the vagina.
Pros: Compared to tampons, sanitary pads may be easier and more comfortable to use as they are simply stuck onto the underwear without requiring any sort of insertion. Depending on the size of pads used, pads can also absorb and retain more menstrual flow compared to tampons. The risk of getting Toxic Shock Syndrome (TSS) is also lower when using pads compared to tampons⁶, since they don’t disturb the inner vaginal environment via insertion.
Cons: Since sanitary pads are worn externally, they are more visible than tampons and may be seen under more translucent clothing, which may be undesirable to some females. Choosing the right size of sanitary pad may be difficult at times too, as menstrual flow can be heavier from time to time and is hard to predict. Moreover, the wrong size may dislodge from the underwear and shift leading to stains on our clothing or bedding. Pads also take up more space compared to tampons, and are difficult to use when swimming as they soak up water and expand.
Pads can still lead to urogenital infections if they are not changed regularly. The American College of Obstetricians and Gynecologists (ACOG) recommends changing sanitary pads every 4 to 8 hours⁷ to reduce the risks of urogenital infections.
Tampons
Tampons are small plugs with the absorbent part made out of cotton, rayon or both of these materials². They are meant to be inserted into the vagina to absorb menstrual flow. The string attached is left outside the vagina so that you can pull the tampon out during its removal. The absorbent material is initially compressed into a small cylinder for it to be inserted, but expands when it starts absorbing the menstrual flow.
Pros: Tampons triumph over sanitary pads or period cups in terms of their visibility (or lack thereof). Tampons aren’t easily seen under clothing, and they certainly don’t give the feeling of wearing a diaper unlike pads. They are smaller than pads too, which makes them easier and more discreet to carry around. For swimmers, tampons may be a better option compared to pads or menstrual cups as tampons don’t inflate outside of the vagina when swimming (as compared to pads).
Cons: It may be difficult and uncomfortable to insert tampons into the vagina, though you can get used to it. Tampons are also more likely to irritate the vagina and cause urogenital infections³. Perhaps the most worrying disadvantage of tampons is the risk of getting Toxic Shock Syndrome (TSS). TSS is a life-threatening condition caused by bad bacteria entering the body and releasing harmful toxins⁴. TSS is commonly associated with tampon usage as tampons can change the inner vaginal environment and make it more susceptible to bacterial infections⁵. Though TSS is rare and tampon products are generally checked for safety before being sold, inappropriate use of tampons (e.g. leaving tampons inside your vagina for too long) can also potentially cause TSS.
Menstrual cups
Menstrual cups are small, bell-shaped cups made of a flexible material (e.g. silicone or rubber) and are to be inserted into the vagina during menstruation. Rather than absorbing menstrual flow, these cups collect menstrual flow. A small stem protrudes from the cup’s bottom for users to grab to pull the cup out after some time. Every time the menstrual cup is filled and removed, it needs to be emptied and rinsed before it can be reinserted into the vagina.
Pros
Though the initial cost of menstrual cups is higher upfront, their long-term cost ends up lower than disposable tampons or pads as you can reuse these cups. They also generate less waste, which makes it an environmentally-friendlier option. In comparison to tampons or pads, there is no unpleasant odor generated from using these cups. Menstrual cups generally do not cause leakage either, as long as they are inserted correctly.
Cons
For those living more fast-paced lives, menstrual cups may be a more inconvenient option considering that you will need to wash them every time they are removed. Menstrual cups also require insertion which may be uncomfortable to some females. The size and type of cup used may be inappropriate and may require some trial and error before you find the right one for yourself. If your skin is sensitive to the cup’s material, it can also cause mild irritation.
However, menstrual cups don’t necessarily carry a higher risk of infection. In fact, studies have shown that the use of menstrual cups are safe, provided that they are used and washed appropriately⁸.
Comparing the three methods
In keeping our vagina clean and infection free, sanitary pads or menstrual cups may be a better option than tampons since they do not disturb the inner vaginal environment. However, all 3 options can cause infections if their usage instructions are not followed well, such as regularly replacing and changing them, because leaving them in for too long increases the risk of vaginal infections.
At the end of the day however, it is your body, your menstrual hygiene and your choice. If you prefer a smaller, less visible method and are alright with insertion, use tampons! If you prefer an external method without insertion, use pads! If you would like a reusable option without odor, use menstrual cups! Choose whatever option you are comfortable with which best meet your needs and lifestyle, as long as you practice good menstrual hygiene.
References
Kaunitz AM. Patient education: Hormonal methods of birth control (Beyond the Basics). In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA, 2021.
Kaunitz AM. Patient education: Long-acting methods of birth control (Beyond the Basics). In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA, 2021.
Centers for Disease Control and Prevention. Birth Control Methods.U.S. Department of Health and Human Services [reviewed 2020 Aug 13; cited 2021 Sep 23]. Available from: https://www.cdc.gov/reproductivehealth/contraception/index.htm.
Rezk M, Sayyed T, Masood A et al. Risk of bacterial vaginosis, Trichomonas vaginalis and Candida albicans infection among new users of combined hormonal contraception vs LNG-IUS. Eur J Contracept Reprod Health Care. 2017 May;22(5): 344-348
Anukam K, Osazuwa E, Ahonkhai I et al. Augmentation of antimicrobial metronidazole therapy of bacterial vaginosis with oral probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14: randomized, double-blind, placebo controlled trial. Microbes Infect. 2006 May;8(6):1450-4
Rafael C, Martinez RC, Franceschini SA et al. Improved cure of bacterial vaginosis with single dose of tinidazole (2 g), Lactobacillus rhamnosus GR-1, and Lactobacillus reuteri RC-14: a randomized, double-blind, placebo-controlled trial. Canadian Journal of Microbiology. 55(2): 133-138
Martinez RC, Franceschini SA, Patta MC et al. Improved treatment of vulvovaginal candidiasis with fluconazole plus probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14. Lett Appl Microbiol. 2009 Mar;48(3):269-74
Kingsley C. Anukam, Martin U. Duru, Clinton C. Eze, Johnbull Egharevba, Alfred Aiyebelehin, Andrew Bruce & Gregor Reid (2009) Oral use of probiotics as an adjunctive therapy to fluconazole in the treatment of yeast
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