Birthcycle |

(What are these reviews all about? See my “Introductory Concepts” post.)

Let’s start at the very beginning, a very good place to start. Although if we were honestly going to start at the beginning, we’d need to start with the menstrual cups patented in the 1930s. Here’s a patent for a menstrual cup from 1932!

But for our purposes, and for me personally, the beginning of the modern, commercially viable menstrual cup is The Keeper, which was first manufactured in the US in 1987.

A Keeper menstrual cup stylishly presented on a piece of wood, maybe? Note the length of the uncut stem.

This is the only cup that was available for me to buy (in 2002, in Vancouver, British Columbia, Canada) when I wanted to find a safe, cheaper, less wasteful option for dealing with menstrual fluid. The Keeper is still available from their website (from whence I have also borrowed the above photo, since I no longer have my own to take a picture of). It came in 2 sizes, and I bought the smaller of the two, as this was what was recommended for menstruators who had never given birth vaginally, which was true of me then.

I used my Keeper for every period I had between the summer of 2002 and fall of 2004, and then used it part-time from 2004 to 2008,  when I conceived my kid and stopped menstruating for a while. When my periods returned in 2010, I decided that the “gum rubber” of the cup had degraded too much to use it any longer and discarded it.

1. Material Quality – 4/10

The Keeper has always been described as being made of “natural gum rubber”, though I note the current addition of the parenthetical “(latex)” at the end of that description. The Keeper has also always been touted as having a usable life of up to 10 years.

As regards material strength and rigidity, the gum rubber used in the Keeper is not a bad choice. When using any menstrual cup that shares some slight variation of the bell-shaped cup with the Keeper, you generally insert it folded in one of several ways, and it’s important for the material that a cup is made of to have enough strength to consistently and without drama unfold again inside of the vagina.

Two more views of the Keeper. In the foreground, a side view showing the somewhat steeply conical bell shape of the cup, and the long untrimmed stem. You can just see one of the tiny air holes under the ridge below the rim, on the right-hand side. In the background is an image of a hand holding a Keeper that has been folded for insertion. It is shown end-on, perhaps to reassure the viewer that when folded, it isn’t too different in size to a standard tampon applicator.

Basically, the material of the cup needs to be able to resist the pressure of the vaginal walls enough to pop back into a cup shape, because it can’t catch menstrual fluid if it doesn’t. The gum rubber in the Keeper is sufficiently flexible to allow it to be easily folded without damaging the material, and sufficiently firm to be pretty reliable at popping back to its intended in-use shape. Almost as important, it also has enough rigidity to prevent the worst possible disaster of menstrual cup use: the dreaded “accidentally pushing it out of your vagina into the toilet while bearing down to poop” event. This can happen more easily if the material combined with the design of a menstrual cup allows too much  horizontal (side-to-side) flex. This tragic event never once happened to me when using the Keeper.

But let’s get right to the critical point, here: gum rubber, natural or not, is simply not the best material for something you’re using this intimately and for this long. A menstrual cup is a device that you wear inside your body 24 hours per day for up to a week at a time. Ideally, you would want that device to be non-reactive, non-porous, and sterilizable in case of disasters as described above. Gum rubber is porous, so it is reactive and changeable in a way that medical grade silicone (the material used for almost all modern cups) simply isn’t. The gum rubber reacts to your vagina and its chemistry over time and can get darker or discolour. The Keeper website suggests that, “this natural discoloration is a sign that you are giving your cup a long and happy life. A discolored cup is still clean and very usable.” Perhaps so, but it can still be a little offputting to use a darkly mottled cup, and discolouration inevitably makes it harder to determine cleanliness through visual inspection. Is it darker under the rim because it’s discoloured or because there’s still residue that should be cleaned off? That’s not a pleasant judgment call to have to make.

Relatedly, In my experience and from conversations with friends, it seems that it’s not unusual to find that the Keeper develops a mild odour with use that seems impossible to completely remove by cleaning in the ways recommended by the manufacturer. Because boiling to sterilize the cup is not recommended – it harms the material and shortens its life – if a smell does develop, and you can’t shift it with soap or a mild vinegar solution, so long as it doesn’t become strong or quite unpleasant, you might just have to make the choice to live with it.

As a final point on material, “natural gum rubber (latex)” is also, quite obviously, inappropriate for anyone who has a latex allergy, which research suggests is 1-6% of the general population and 8-12% of workers in health care and other industries where exposure to latex gloves and other products is a constant (like hairdressers). This difference is because increased exposure to latex increases the likelihood of sensitization. This suggests that it’s possible for a menstruating person who uses a Keeper to increase their chances of developing a latex allergy over time, especially if they are also exposed through work. Not good.

2. Design – 4/10

a. General Shape – 9/10

The Keeper has a very standard general design for a menstrual cup, a bell-shaped cup with a thicker band of material around the rim, “air holes” to release suction beneath that rim, and a long stem at the bottom. Most menstrual cups on the market shares these basic qualities, so the design differences come in the subtler details.

The general shape of the cup is fine. It has a somewhat steeper conical bell shape than some cups, but it’s hard to tell what practical difference this kind of variation makes. Certainly, the cup ably contains menstrual fluid in useful quantities.

The rim is a reasonably comfortable shape to insert when folded. The rounded rim and the thicker section of the cup below it, combined with the qualities of the material itself is likely what contributes to the Keeper’s reliability in unfolding once inserted. Basically, enough material has been included in the design to ensure the right degree of material strength.

The Keeper’s stem is comically long prior to first use, and the intention is that the Keeper’s user will trim the stem with scissors to the correct length for their anatomy. Users are supposed to leave the stem long enough so that it can be grasped in order to remove the cup, but short enough for the stem not to cause discomfort regardless of its wearer’s movements when the cup is positioned correctly. Ideally, the users shouldn’t be able to feel the stem at all when the cup is properly inserted. With the Keeper, I prefered a very short stem. Anything longer than around a quarter of an inch meant that I could feel the stem in my vaginal opening, and the sensation of this was unpleasant and sometimes sharply painful. Early experimentation helped me find the right length and I have  found that slightly “beveling” the cut stem end with the scissors so that there were no sharp corners also helped. If I have one criticism of the stem, it is that because it was smooth and untextured, it was difficult to grasp, especially when wet or slippery from menstrual or vaginal fluid, which it usually is.

b. Surface Details – 0/10

Full disclosure: I HATE surface details on a menstrual cup. A menstrual cup is a practical object, spends its in-use time primarily invisible inside the body of its user, and very specifically is inside that body to collect menstrual fluid from the beginning to the end of its user’s period. Decorations are inappropriate, unnecessary, and usually counter-productive. Menstrual fluid is a substance that is perfectly natural and normal, but also sometimes, a bit… messy? Sometimes there are clots, or long gelatinous goo strings, and for some menstruators, menstrual fluid at the start and/or end of a period can be scant, thick, sticky, and brown/grey. Details imposed on the surface of the interior of the cup therefore primarily serve as anchor points for the messier parts of your menstrual fluid.

Note the interior surface details: raised measurement lines and “KEEPER” in all capitals stamped just inside the rim. These details make the Keeper harder to clean.

The Keeper has a plethora of surface details, including measurement markings within the cup and the word “KEEPER” in stamped on the interior of the rim. Measuring the volume of your menstrual fluid is an interesting novelty*, but I’m unconvinced that it’s a benefit that justifies that added time spent cleaning the gunge off these measurement lines with your fingernail. Also, the best way to make me hate and resent the name of your product is to design your product so that I have to spend time scraping sticky brown late-period menstrual fluid off your product name every. fucking. month. No love. This didn’t need to happen.

c. Air Holes – 0/10

Air holes are such a problem. It’s hard to know how important it is to have them in the first place. A few modern menstrual cups are designed without any air holes at all, and still seem perfectly usable. Nonetheless, air holes are pretty ubiquitous. Those in the Keeper are tiny. It seems as though the designer must have been concerned about the air holes permitting menstrual fluid leakage, as the air holes are just pin holes really.

Because the holes are so small and narrow they rapidly become clogged, and they’re too small to properly clean with any kind of tool you’re likely to have in your house. It’s also difficult to tell if they’re actually blocked, because they’re small and weirdly angled so it’s very difficult to get water to visibly flow through them even when they’re not clogged. Since the “natural gum rubber” is opaque, you can’t even tell by looking closely. It seems inevitable that a Keeper’s air holes probably function mainly as repositories for bacteria, which is a pretty unpleasant thought.

3. Ease of Use and Comfort (8/10)

The Keeper was my first cup, so it’s the one that taught me about cups. In using a cup there are a number of important considerations for ease of use. A few obvious considerations are if it is difficult to insert or remove, if it causes pain or discomfort, and whether or not the cup commonly leaks during standard usage. But perhaps most importantly to me is whether it is possible to unambiguously assess whether the cup has been inserted properly before you leave the bathroom. A cup that leaves this ambiguous is a cup that is introducing unnecessary stress into your life.

The Keeper, for the most part, was solid on this point. To insert it, I would generally sit on the toilet with legs spread, fold the Keeper into a tight “U” shape as shown in the image, wet it with water from the tap for minor lubrication, and pushed it into my vagina with my thumb and two fingers. Once inside, it usually only took a little bit of gentle nudging and repositioning to get it to sort of “pop” open inside, and this was accompanied by a very noticeable physical sensation. When I felt that sensation, I could then turn the cup with my fingers and it would rotate easily and smoothly inside my vagina, which confirmed that it was inserted properly and ready to go.

This insertion technique was relatively easy to learn and not painful. The tricky part was figuring out how to hold the Keeper once it was folded so that it didn’t pop open prematurely, and figuring out the right angle and pressure for comfortable insertion.

I did experience occasional leaks on heavy days, which is why I always work cloth pads on those days as a back-up. Leaks were more likely if I was sneezing or coughing frequently, while I was lying down for a long sleep overnight on a heavy day, or if I had to wait too long between emptying the cup on a heavy day. Occasionally it seemed as if the presence of a stool in my anus may have disrupted the Keeper’s position in my vagina and caused a leak. Completely leak-free periods were, for me, in the minority with the Keeper, perhaps only one in four, but the leaks were rarely catastrophic with the cloth pads as backups.

The Keeper was incredibly comfortable. Once I’d sorted out the stem length and figured out how to tell when the cup was properly inserted, I would usually not feel it at all when wearing it, except occasionally when laughing, coughing, or sneezing.

Conclusion

The Keeper was a great product in its time, and for over a decade, pretty much the only product of its kind available. But I truly believe its time has passed, mainly because of the problems inherent in the “natural gum rubber” still being used to make it. If it was somehow once again the only menstrual cup available in the world and I needed to get a cup, I would buy it again in a heartbeat, because it did work for me for a long time despite its problems, and it has worked for many other menstruating folks as well. But given almost any other option, and especially given the many excellent options available today, I cannot recommend it except as a museum piece. Sorry, Keeper.

*It’s important to note that the volume of your menstrual fluid is not the volume of your blood loss as a result of menstruating. Around half of this fluid is made up of other fluids, expelled uterine lining, etc.

Yes, this is definitely how blogging begins again. I’m sure of it.

So, from time to time and on no predictable schedule at all, I will be posting reviews of various menstrual cups here. It’s actually a pretty exciting time in the reusable menstrual cup world, with many types and variations of cups available, unlike 15 years ago. I suspect, but have no data to back this up, that this is due to a generational shift, with many younger menstruating folks have a greater awareness of their own anatomy and being perhaps much more comfortable with touching their own genitals than past generations, along with an increased desire to have a lower environmental impact. Regardless of why though, it’s awesome.

First Principles

In these reviews I’m going to be super real with you, readers. There will be descriptions of menstrual fluids, of anatomy, and of sensations. There will, inevitably, be occasional mention of urine and feces (proximity sometimes demands it, after all). There may be swearing, for emphasis, when I’m feeling particularly passionate about something.

When describing anatomy, I’ll be using the fairly universally understood words “vagina”, “labia”, “vulva”, etc., for clarity, but please note that I don’t intend this usage to imply any gender essentialism. For myself, I identify as genderqueer/non-binary, and have some small knowledge of how menstruation can be a complicated thing to fit into a non-cis-female gender identity (though I do not wish to presume that I necessarily know anyone else’s experience). If those anatomical words don’t resonate for you or don’t fit your understanding of your body I invite you to use any terms you’d prefer in comments.

Menstruating is a fine and ordinary thing for a person to do. It’s not a curse or a punishment or something that makes you unclean, incompetent, or monstrous in some way. It’s also, thanks to science, not an obligation. Menstruating is sometimes uncomfortable, physically or psychologically or socially or in relation to a menstruator’s practiced religion. There are menstruators who enjoy it, just as there are menstruators who despise it. I will always affirm anyone’s right to take advantage of the choices offered by science to avoid menstruating regularly, or to alter a menstrual cycle in whatever way makes sense for them, to use reusable products such as a cup, cloth pads, or natural sea sponge, or to use disposable pads or tampons or cups, or anything else. Being the possessor of a uterus that, left to its own devices, would likely menstruate in a culture that associates that uterus with femaleness and associates femaleness with inferiority is complicated enough without judgment.

Why Me?

First, let me establish myself as a bit of an expert on the subject: I’ve been using menstrual cups as my primary tool (backed up by cloth menstrual pads when necessary) for dealing with menstruation since 2002, when I started menstruating again after a four-year gap thanks to hormonal contraception. Except for during my pregnancy and for the 18 months following, when I experienced Lactational amenorrhea, I’ve been menstruating somewhat regularly ever since, and I’ve used a menstrual cup every single time. I estimate that I have menstruated 130 times since 2002 (my cycles run a little long, and I occasionally skip). I would also estimate that during the five to six days I menstruate each time, I insert and remove a menstrual cup approximately 10-14 times. That makes for a total of around 1300-1820 insertion/removal episodes in total.

I’ve also used a cup in a lot of varied circumstances. I have inserted and/or removed a menstrual cup in my own home, at work, in hotels, at the mall, at the homes of friends and relatives, in hostels, in dormitories, on moving greyhound buses, on moving trains, dozens of times on airplanes and in airports. I have done so in Canada, the United States, New Zealand, Australia, India, England, France, Japan, Ireland, and the Czech Republic. I have used a cup while glamping/car camping/middle-of-nowhere camping, at conferences and retreats, while motorcycle touring, in shared bathrooms and private ones, with no running water, with no running potable water, with no access to laundry, with either hand, and several times (out of desperation) with a nursing toddler on my lap. I have done it well and I have done it badly. I have dropped the cup in the toilet and on the ground. I have managed everything tidily many hundreds of times and I have also spilled menstrual blood on the floor or on my clothing, more than once.

I have an awful lot of experiencing using cups, and I’ve also used a bunch of different cups over varying periods of time. This means that my reviews won’t be based on a a single fumbling first try, nor on longer use of only one product. I can offer observations and comparisons based on long-term regular use in many situations.

Why Menstrual Cups?

What it comes down to is this: for me, even with occasional mishaps, a menstrual cup is far and away the best solution to the problem of dealing with menstrual fluid. No other options even comes close. Cups can be life-changing. For example, while I have reason to believe that my periods have always been in the longer and heavier end of the normal range, they’re not outrageous. But as a teenager, in addition to further complicating my already stressful relationship with gender, they were a significant practical inconvenience, and the products available to me to deal with them were inadequate in a number of important ways that made every period an unnecessary trial.

Disposable pads, even the most absorbent ones, could never keep up with the two heavy days in my period (in which I’d need to change my pad at least every hour, sometimes hard to manage at school) and they often shifted in my underwear unpredictably, allowing sometimes catastrophic leaks to happen. On light days, the extreme absorbency of some pads left my vulva uncomfortably dry, sore, and irritated. The adhesive on pads pulled the fibers out of my underwear, making them threadbare much more quickly than might otherwise be the case, and many times it also stuck to my public hair or my delicate inner thigh skin, causing completely unnecessary pain.

Tampons are superior to pads, not least because they make swimming an option. But for me, tampons either also couldn’t keep up with my heaviest menstrual flow days, requiring too frequent changes, or were far too absorbent for my lighter days (even the supposed “Light Day” versions), when they irritated my vagina and caused sometimes intense pain during removal.

Cloth pads, which I started using at the same time as my cup, and which I love as a backup for my cup, are better than disposable pads in many ways – more reliably absorbent of menstrual fluid, paradoxically somewhat better at staying in place, not damaging to underwear or self, not irritating or painful. Care is unbelievably simple, since I just wash and dry mine in my ordinary laundry with no special treatment, so they don’t add any extra work to my life. And of course, they’re much much cheaper than disposal products over the long term – I’m still using some of the original pads I bought in 2002 15 years later, which really puts the $12 I paid for them in perspective. But, just like disposable products, cloth pads can’t keep up with my heaviest flow days with any reasonable replacement schedule (running out to replace your menstrual product once per hour or once every two hours is not reasonable, in my opinion), they do shift sometimes and allow leaks, and swimming is, of course, not an option.

But using a menstrual cup completely changed my relationship with my menstruating body. Menstrual cups made menstruating “okay” for me in a way that disposable pads and tampons never could. Because absorbency isn’t even a part of the equation, cups don’t cause irritation and pain as a result of dryness. They’re equally comfortably on heavy and light days, and don’t irritate my anatomy. Even on my heaviest days, I can go four hours between emptying the cup without worrying about leaks, which means I can get through a full morning or afternoon at work. On lighter days, I can get through an entire work day without needing to worry about it. I never run out and need to run to the store, hoping they’ll have the brand I like at a decent price. By not relying on disposable products I’ve both saved hundreds if not thousands of dollars over the years, and I haven’t sent thousands of disposable products to landfills. All of that is well worth the occasional mishaps.

Cups work! But some work better than others. Which is why I’m posting these reviews.

How This is All Going to Work

I’m going to rate the menstrual cups I review in three main categories, with a few sub-categories:

1. Material Quality – The material of which the cup is made, its qualities, and how well-suited those qualities make it for the purpose. Will include observations on things like durability, sterilizability, rigidity, discolouration probability, and so on.
2. Design – All of the properties of the cup as a designed physical object with an incredibly practical intended use, such as shape, features, size, and how it interacts with its wearer’s body and function during insertion, internal use, removal, emptying, and cleaning. This categories will be split into three sub-categories:
   1. General Shape – The shape and size of the cup itself, its rim, and its stem.
   2. Surface Details – Any textural details, measurement markings, etc.
   3. Air Holes – Size, angle, other qualities.
3. Ease of Use and Comfort – How likely I think it is that the cup will be easy and comfortable to use for all the various categories of menstruators.

Those ratings will be on a scale of 1-10, and are likely to be imperfectly objective at best. I’ll probably also maunder on for far too long about specific details, because I am a person for whom the details always matter. I’ll try to be thoughtful about when any specific criticism or approval is likely going to be a universal one, versus when it might be unique to me, or limited to people who share certain qualities with me.

I have no monetary or commercial relationship with anyone involved in the manufacture or sale of menstrual cups, nor am I seeking such a relationship. If I criticize or enthusiastically endorse a product in a review, it’s because I genuinely feel critical or enthusiastic about it.

I invite you to comment if you wish. Ask questions, offer feedback, contribute your own experiences with a product. Agree with me, disagree with me. Let’s try to remember that not all women menstruate and not all menstruators are women, and keep the language used gender-neutral as much as possible. Feel free to use whatever terminology makes sense for you for anatomy. Good-natured engagement with language and concepts is never off limits, and making mistakes is understandable, but pointless trolling will result in comment deletion regardless of the specific verbiage used.

Let’s do this.