It’s one thing if your cup runneth over. It’s another if it obstructeth your organs.
Last year, doctors treated a woman in her 30s who presented with occasional pain in her side and abdomen, and blood in her urine. When it wasn’t immediately clear what was behind her symptoms, they ordered a CT scan.
Her medical history, which included a gastric sleeve operation and the removal of a kidney stone three years earlier, led them to wonder if she might be experiencing a kidney stone relapse.
But what they saw in the scan alerted them not to a stony culprit, but a silicone one.
The urography revealed some ureterohydronephrosis, a kind of swelling of the ureters (which are separate from the urethra) that occurs when the urinary tract is obstructed. It’s a condition that can happen during pregnancy, but can also be an indication of kidney stones or tumors.
For this woman, the swelling seemed to be the result of how she’d positioned her menstrual cup, a little too tightly on the right side of the vagina, and dangerously close to her right ureter.
The scan also showed a copper intrauterine device (IUD) that had been properly inserted into the woman’s uterus, meaning it wouldn’t have been to blame.
While there’s some knowledge of potential complications associated with menstrual cups and disks, this particular kind of trouble is extremely rare, and has only been recorded five other times.
A handful of menstrual cup users have complained of pain, vaginal wounds, allergic reactions, leakage, dislodgement of IUDs, urinary incontinence and infection of the upper urinary tract, according to this report.
And, though also extremely rare, there has been more than one known case of toxic shock syndrome (TSS) related to menstrual cup use, first ever reported in Canada in 2015. If left untreated, TSS can lead to severe infection, amputation or death.
But in general, it’s thought that using a menstrual cup, which collects period blood instead of absorbing it, is safer than other menstrual products like tampons, which in some cases create the conditions for staph infections like TSS to flourish.
Some women also prefer menstrual cups because many are reusable for up to 10 years, which means they have the potential to replace thousands of single-use products. Some disks can also be worn during penetrative sex.
In three of the five recorded cases of cup-related ureter swelling, the women reportedly resumed menstrual cup use — likely after taking them out first and repositioning them — with no symptoms. It was reported that at least one of them replaced hers with a smaller sized cup for a less problematic fit.
In this most recent case, the woman said she’d experienced mild abdominal pain sporadically over a stretch of six months, usually happening anywhere from two to five times a week, and lasting for an hour. It would also often be paired with an urge to pee, though she experienced no other urinary tract symptoms.
The blood she saw in her urine was unrelated to her period, and didn’t always align with the abdominal pain.
The doctors had her remove the menstrual cup on site, and return a month later to assess the symptoms. By the time she returned, they’d completely dissipated.
Despite the lifestyle, financial and environmental benefits that many women experience with their menstrual cups, reports like these are a good reminder that no period product is entirely safe without proper education and guidance around application.
“Correct positioning along with choosing the correct cup shape and size is important to prevent negative effects on the upper urinary tract,” the authors of the report, Clara Maarup Prip and Dr. Lotte Kaasgaard Jakobsen, said.
But given that all of these products are available over-the-counter and come with little information about proper placement, many users are left to experiment with trial and error that could be putting their urinary tracts at risk — or worse.
