Because menstrual cups are less common, and this might be your first one, we wanted to include some tips for you.

The learning curve

Every person I talked to who uses a menstrual cup told me that it definitely involves a learning curve. Jackie Bolen, a menstrual cup reviewer, said that her biggest frustration with menstrual cups is that “people give up too soon.” Bolen continued, “Just keep trying and wear a pad while you’re experimenting with it, after 5 or 6 months if it’s really not working, try a different cup.” The learning curve here includes figuring out the best way to insert and remove the cup without spilling blood everywhere, figuring out if the cup is actually open inside you, and knowing when it’s time to take the cup out. Overall, cup evangelists say that it’s worth a few messes, and that anybody who is considering switching from pads and tampons should stick with it for at least four cycles before giving up.

Folding your cup

There are tons of ways to fold up a menstrual cup. You can see a video of some of them. We found that the punch-down fold and the 7 fold were the easiest to use; they made the cup the smallest yet still gave us a spot to grip where the cup wouldn’t open up before we let go.

Insertion and removal

This is the hardest part. Let’s start with insertion. You fold the cup and insert it into your vagina. Then you release the cup, and it should pop open inside you. Figuring out if it’s fully open can be tough. Some cups you can feel pop open, but depending on your musculature and how forceful that opening is, sometimes you can’t tell. Once you’ve inserted the cup, you can reposition it by inserting a finger and moving the cup around a bit. Another good trick to making sure the cup is open and positioned right is to grab the bottom and twist the cup gently. Some people like to squat or jump up and down a little bit after they insert the cup, just to make sure that the cup is secure and isn’t going to move around.

Removal is a little easier overall—but failure can be more, let’s say, dramatic. We recommend squatting over the toilet for this part, especially for the first few times, just in case. It’s important to relax before you try to get the cup out; if you’re tense, your vaginal muscles will be squeezing the cup, which makes it way harder to get out.

We do not recommend just pulling on the stem, whatever the design, to get the cup out.

There are several techniques for removing a cup, but usually it doesn’t work to just grab the stem and yank. Instead, pinch the bottom of the cup, and then slowly remove it. Sometimes you’ll read about “breaking the seal” of a menstrual cup, as if the cup were creating some kind of vacuum seal when it opens up and you have to break that seal to remove it. That’s not really true—there’s no vacuum seal being created. But just as you had to fold the cup a bit to get it in, you’ll need to fold it a bit to get it out, too.

This is an argument for not letting the cup get too full, because you’ll have to squeeze it a bit to get it out. We do not recommend just pulling on the stem, whatever the design, to get the cup out. When we tested the cups this way, it was a disaster every time. Pulling the cup that way requires using a lot more force to get the cup out, and you’re holding the cup only at the very end with two fingers, which means that when it does come out, you can’t easily control what happens. For us, what happened was a lot of blood all over the place.

If you’re just starting to use a cup, try to time your removals when you’re home and in a comfortable space, not in an office or public bathroom.

How to know if a cup fits (and how it should feel)

Once the cup is properly positioned, it should feel the same way a tampon does inside you. If you think about it, you can feel it there. But it shouldn’t be uncomfortable or constantly at the forefront of your mind. It shouldn’t be pressing on your bladder, and you shouldn’t be able to feel the stem at all; if you can, and it’s irritating you, try cutting it shorter.

Before assuming the sizing is wrong, try removing and inserting the cup a couple of times over a couple of cycles. It’s hard to isolate the variables here—a cup might be the right size but sitting awkwardly because it’s not in deep enough or it’s at a weird angle. Dr. Jen Gunter told us that if a cup is very painful to use, you might want to consult your OB-GYN to find out why.

If you’ve trimmed the stem and are sure the cup is in as far as it will go, but the cup is still poking out of your vagina or rubbing uncomfortably, you need a smaller cup.

If the cup migrates up your vagina and you’re having to dig around to fish it out, you need a bigger cup.

If the cup makes you feel like you need to pee all the time or is causing pain in your urethra, you might need a smaller cup or a softer cup. The cup might be the right size, but it might just be too firm and pushing too hard on your vaginal walls. Or it might be too big. If the stem is poking you, trim it.

How do you know when the cup is full?

This takes a bit of learning, but you can help yourself by comparing how much your cup can hold with how much your usual tampons hold. Some people like to wear a thin panty liner while they’re learning their cup schedule, just in case.

What happens if it leaks?

It’s easy to find horror stories about cups online, but a leaking cup is pretty much the same as a leaking tampon or pad. If the cup hasn’t sealed properly or fully opened in your vagina, it won’t catch the blood, and that blood will wind up on your underwear or whatever else you’re wearing. Lots of people recommend wearing a thin panty liner while wearing a menstrual cup for the first few cycles, as you get the hang of it.

In a July 2019 The Lancet Public Health analysis, researchers at the Liverpool School of Tropical Medicine and their colleagues found that cups were as likely—or more likely—to prevent menstrual leaks compared with tampons and pads.

Can you use lube to insert the cup?

Some people like to use lubricant to insert their menstrual cups, and this is totally fine as long as you use a lubricant that plays nicely with silicone (in other words, avoid silicone-based lubricants).

Are menstrual cups FDA approved?

Menstrual cups are considered a Class II medical device, just as pads and tampons are. That doesn’t mean the FDA tests every cup design. Instead, cup manufacturers have to file a form that basically says, “This cup works and performs just like other cups that are already for sale.” As long as a cup doesn’t have any big design changes, and manufacturers can reasonably argue that there’s nothing about this new cup that would pose a threat not already posed by the ones already available, they can get FDA approval. That said, not all the cups we reviewed for this list are technically FDA approved (the Yuuki Cup, for example, is not), but all of our top picks are. This is a coincidence, and you are free to import a non-FDA approved cup to the United States for personal use whenever you please.

Can you use a menstrual cup if …

… you have an IUD?

Probably, though you should discuss this matter with a doctor. The cup should not interfere with your IUD, particularly if you’re sure to break the cup’s seal before removing it. There are very few studies exploring this topic. In one study, researchers found that menstrual cups didn’t increase IUD expulsion rates. But the authors of an ongoing, prospective trial examining, among other things, patient-reported copper IUD expulsions associated with menstrual cup use have recommended that study participants do not continue using menstrual cups with an IUD.

… you use the NuvaRing?

Yes, though you generally shouldn’t wear both the NuvaRing and the menstrual cup at the same time. In theory, you take out the NuvaRing to get your period, so you would just replace the ring with the cup. But some people do find that they need to put the ring back in when they aren’t quite done with their period. We heard from at least one person who does this and says that it works fine. The challenge here may be that the cup can’t sit against your cervix the way it might without the ring in place (there is, after all, only so much space in your vagina), and that might make the seal less reliable. TL;DR, you can try to wear both at once, but the cup might leak a bit.

… you are exercising heavily (hot yoga, biking)?

Yes, with the caveat that you might want to give yourself some practice with the cup first before you do any strenuous biking. Once you’re confident that you’ve got insertion down, and that the cup is open and in the right place, you can definitely do all your normal activities, from hot yoga to football practice. In the learning period, chances are a little higher that you’ll have a mishap and leak a bit. That isn’t the end of the world! If you do a lot of exercising, you might want to try a firmer cup, because your vaginal walls are likely a bit stronger than the average person’s.

… you have a heavy flow?

A note about flow: It might seem like you bleed a lot during your period. But the average person who menstruates usually loses 35 to 50 milliliters of menstrual blood for the three- to five-day stretch (PDF). The smaller menstrual cups can usually hold around 25 milliliters of fluid, and the larger ones around 30 milliliters. And remember, you’re not asking the cup to catch your entire period at once. About 10% of people who menstruate do have heavy periods, something doctors call menorrhagia. Those with menorrhagia lose more than 80 milliliters of blood during their periods. But that simply means changing the cup more often, just as you might change a pad or tampon more often with a heavy flow.

Anyway, this is all to say that the answer here is probably yes. Menstrual cups hold a lot more fluid than tampons do, so if you’re currently using tampons you should be able to use cups. But if you have concerns, talk to your OB-GYN about them, and they can give you guidance for your specific body.

… you have a lot of blood clots during your flow?

Yes. In fact, some people like cups exactly for this reason. Tampons and pads are very good at absorbing liquids, but not so good at absorbing solids. A cup doesn’t discriminate; it just catches whatever comes out of the cervix. So if you’ve ever pulled out a tampon and found a nice clot sticking to the side of it, a cup might be a better option.

… you have a tilted uterus?

Yes. Because the opening of the cup surrounds the cervix, even if your flow tends to wind up on one side of your vagina, the cup will catch it.

… you have never had penetrative sex?

Yes, if you can use tampons, you can use a cup. But you might want to opt for a smaller, softer cup.