title: FLOW (finding lasting options for women): multicentre randomized controlled trial comparing tampons with menstrual cups.
abstract: OBJECTIVE
  To determine whether menstrual cups are a viable alternative to tampons.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  Prince George, Victoria, and Vancouver, BC.
  
  
  METHODS
  A total of 110 women aged 19 to 40 years who had previously used tampons as their main method of menstrual management.
  
  
  METHODS
  Participants were randomized into 2 groups, a tampon group and a menstrual cup group. Using online diaries, participants tracked 1 menstrual cycle using their regular method and 3 menstrual cycles using the method of their allocated group.
  
  
  METHODS
  Overall satisfaction; secondary outcomes included discomfort, urovaginal infection, cost, and waste.
  
  
  RESULTS
  Forty-seven women in each group completed the final survey, 5 of whom were subsequently excluded from analysis (3 from the tampon group and 2 from the menstrual cup group). Overall satisfaction on a 7-point Likert scale was higher for the menstrual cup group than for the tampon group (mean [standard deviation] score 5.4 [1.5] vs 5.0 [1.0], respectively; P=.04). Approximately 91% of women in the menstrual cup group said they would continue to use the cup and recommend it to others. Women used a median of 13 menstrual products per cycle, or 169 products per year, which corresponds to approximately 771,248,400 products used annually in Canada. Estimated cost for tampon use was $37.44 a year (similar to the retail cost of 1 menstrual cup). Subjective vaginal discomfort was initially higher in the menstrual cup group, but the discomfort decreased with continued use. There was no significant difference in physician-diagnosed urovaginal symptoms between the 2 groups.
  
  
  CONCLUSIONS
  Both of the menstrual management methods evaluated were well tolerated by subjects. Menstrual cups are a satisfactory alternative to tampons and have the potential to be a sustainable solution to menstrual management, with moderate cost savings and much-reduced environmental effects compared with tampons. Trial registration number C06-0478 (ClinicalTrials.gov).
authors.affiliation: Vancouver Island Women's Clinic, 104-284 Helmcken Rd, View Royal, BC V9B 1T2. flowbyflow@gmail.com
authors.forename: Courtney
authors.initials: C
authors.lastname: Howard
authors.forename: Caren Lee
authors.initials: CL
authors.lastname: Rose
authors.forename: Konia
authors.initials: K
authors.lastname: Trouton
authors.forename: Holly
authors.initials: H
authors.lastname: Stamm
authors.forename: Danielle
authors.initials: D
authors.lastname: Marentette
authors.forename: Nicole
authors.initials: N
authors.lastname: Kirkpatrick
authors.forename: Sanja
authors.initials: S
authors.lastname: Karalic
authors.forename: Renee
authors.initials: R
authors.lastname: Fernandez
authors.forename: Julie
authors.initials: J
authors.lastname: Paget
mesh_terms: D000328:Adult; D001955:British Columbia; D005260:Female; D006801:Humans; D052576:Menstrual Hygiene Products / Q000009:adverse effects / Q000191:economics; D017060:Patient Satisfaction; D057566:Self Report; D014739:Victoria