title: Acceptability and performance of the menstrual cup in South Africa: a randomized crossover trial comparing the menstrual cup to tampons or sanitary pads.
abstract: BACKGROUND
  In low-income settings, many women and girls face activity restrictions during menses, owing to lack of affordable menstrual products. The menstrual cup (MC) is a nonabsorbent reusable cup that collects menstrual blood. We assessed the acceptability and performance of the MPower® MC compared to pads or tampons among women in a low-resource setting.
  
  
  METHODS
  We conducted a randomized two-period crossover trial at one site in Durban, South Africa, between January and November 2013. Participants aged 18-45 years with regular menstrual cycles were eligible for inclusion if they had no intention of becoming pregnant, were using an effective contraceptive method, had water from the municipal system as their primary water source, and had no sexually transmitted infections. We used a computer-generated randomization sequence to assign participants to one of two sequences of menstrual product use, with allocation concealed only from the study investigators. Participants used each method over three menstrual cycles (total 6 months) and were interviewed at baseline and monthly follow-up visits. The product acceptability outcome compared product satisfaction question scores using an ordinal logistic regression model with individual random effects. This study is registered on the South African Clinical Trials database: number DOH-27-01134273.
  
  
  RESULTS
  Of 124 women assessed, 110 were eligible and randomly assigned to selected menstrual products. One hundred and five women completed all follow-up visits. By comparison to pads/tampons (usual product used), the MC was rated significantly better for comfort, quality, menstrual blood collection, appearance, and preference. Both of these comparative outcome measures, along with likelihood of continued use, recommending the product, and future purchase, increased for the MC over time.
  
  
  CONCLUSIONS
  MC acceptance in a population of novice users, many with limited experience with tampons, indicates that there is a pool of potential users in low-resource settings.
authors: 1 Department of Obstetrics and Gynaecology, Maternal, Adolescent and Child Health Research, University of the Witwatersrand , Durban, South Africa .
authors: Mags E
authors: ME
authors: Beksinska
authors: Jenni
authors: J
authors: Smit
authors: Ross
authors: R
authors: Greener
authors: Catherine S
authors: CS
authors: Todd
authors: Mei-ling Ting
authors: ML
authors: Lee
authors: Virginia
authors: V
authors: Maphumulo
authors: Vivian
authors: V
authors: Hoffmann
mesh_terms: D041342:Absorbent Pads; D000293:Adolescent; D000328:Adult; D018592:Cross-Over Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D052576:Menstrual Hygiene Products; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D017060:Patient Satisfaction; D013019:South Africa