Maybe you want to save the environment - after all, the influx of used menstrual products into landfills rivals that of disposable nappies. Maybe you're tired of spending good money every month on something you really don't enjoy. Or maybe you've even started to develop irritation or rashes from the chemicals used in your pads or tampons. You could be going on a long trip, and not wanting to worry about packing a large supply of disposable supplies or finding them on your travels. Whatever your reasons, you've started to wonder if there are other ways to work with your monthly visitor¹.

Almost Different, But Not Quite

Organic pads definitely seem to feel more comfortable for me, especially as the day wears on and a regular pad would have begun to start 'sticking' in places. I didn't notice a tremendous difference with organic tampons, though.

For some people, just a small change can be enough, especially at first. In some parts of the world, you can buy pads and tampons made with organic cotton - besides the basic material, these products usually don't have the chemicals that reduce odour and increase absorbency that are seen in other products. As a result, they can need to be changed more often, but some women do find them more comfortable.

Menstrual Cups

Menstrual cups are nothing new - they have been around since at least the 1930s. There are a wide variety of menstrual cup products on the market, but they all have some common basics in design and use. They are just what they sound like - small cups inserted into the vagina to collect the menstrual blood, which are emptied when full. Some of these products are disposable and some are reusable; there are also differences in the material used, the ease of insertion, and how securely they fit.

Pros and Cons of Menstrual Cups

In general, menstrual cups tend not to be quite as effective as tampons - especially if they are worn for long periods or during times of heavy bleeding; a small amount of 'spillage' is natural. Most women who use menstrual cups do use some type of pantyliner to protect against this. Depending on the cup you use and your particular anatomy, sometimes the entire cup can tip over inside you - triggers for this can include coughing or exercising the abdominal and pelvic muscles². Trying different types of cups can be a good way to see which one fits you the most comfortably.

On the plus side, cups are not associated with Toxic Shock Syndrome in the way that tampons are. Women who have increased cramping while using tampons usually see some relief from switching to menstrual cups. Additionally, while a number of women experience significant vaginal dryness while using tampons, that usually isn't a problem with menstrual cups, which work by catching the blood rather than absorbing it.

One possible health risk of menstrual cups involves retrograde menstrual flow - especially if the cup is worn while sleeping, it is possible for the menstrual blood to flow back up into the uterus, and even into the fallopian tubes. Some scientists believe that such retrograde flow can increase the risk of endometriosis, but there is considerable disagreement on this issue, and no link between endometriosis and menstrual cup use has ever been shown.

Reusable Cups

It took me a little while to work up the guts to try one of these, but I was really glad I did. I hadn't realised how much the tampons were making my cramps worse until I tried a cup. My partner was pretty freaked out by the cup, though - he'd much rather see me fill the landfills with more 'traditional' products.

The most commonly used of the reusable menstrual cups appear to be those made of natural rubber gum (like the Keeper) or of medical grade silicone (like the Mooncup and the Diva Cup), both of which can hold up to an ounce (about 30 ml) of menstrual flow and only need to be changed every six to 12 hours³. Women looking for the most environmentally sound option might prefer a biodegradable rubber gum cup, and women looking for the most hypoallergenic option may prefer a cup made of silicone. Both are available in two different sizes - one for women who have given birth vaginally, and one for women who have not.

Inserting a reusable menstrual cup is generally not any more difficult than inserting a tampon without an applicator. Some women find that using a lubricant can make insertion easier, especially for the rubber gum cups. Removing the cup without spilling can take a little practice; most women do this over the toilet, and then dump the collected flow into the toilet. Some women choose to rinse the cup out at the sink, and others will wipe the cup with a damp tissue or paper towel. The menstrual cup should be washed daily in hot soapy water during and at the end of the menstrual cycle - silicone cups can be washed in boiling water at the end of each cycle, but rubber gum cups cannot. As with all internal menstrual products, it's a good idea to always wash your hands before each removal and after each insertion.

Reusable menstrual cups tend to create a more secure seal with the vaginal wall than disposable ones, so there is much less fear of spillage. On top of this, a single reusable cup can be all a woman needs for eight to ten years.

Disposable Cups

For me, this was one of those things that seemed like a good idea, but just didn't work for me. I hadn't realised how expensive it would be to use these regularly, and they just didn't seem to fit my shape very well. Really, these ended up being just a stepping stone to reusable cups for me.

The only type of disposable menstrual cup currently on the market is the Instead Softcup. As opposed to the reusable menstrual cups, the softcups consist of two different parts - a semi-rigid ring attached to a polyethylene reservoir that looks a lot like a small plastic bag. While the reusable menstrual cups sit relatively low in the vagina, the disposable softcups are inserted further, fitting against the back wall of the vagina and near the cervix, like a diaphragm.

Each disposable menstrual cup is only considered safe to use once. After use, dispose of the softcup in the same way you would a used menstrual pad - wrap it up and dispose of it in the appropriate receptacle or rubbish bin, and don't attempt to flush it down the toilet.

Because the reservoir is soft and flexible, the softcups can be worn during vaginal intercourse, while other internal menstrual products cannot. However, it's important to be aware that using the cup during sex does not prevent pregnancy. Also unlike the reusable cups, the softcup comes in only one size, and needs to be changed more often than the reusable cups. As disposable cups are more expensive than tampons, and also produce more waste, they may not be the best option for a woman who is prioritising resource conservation.

Wash and Reuse Pads

If using pads can make women feel like they're wearing a nappy, using cloth pads probably doubles that effect. That said, they're far more comfortable, and I've also noticed that I don't get yeast infections nearly as often. It did, however, take me a few months to really feel comfortable with the whole wash-and-wear routine. On the other hand, I just love looking around during a meeting at work, knowing that I'm bleeding on a cute little flannel pad covered in cows or aliens - gotta love having a secret to smile about.

The most common types of washable cloth pads are the two-part pads and the all-in-one pads. The two-part pads consist of a holder - which looks quite a bit like a disposable pad with wings - and inserts that go into the holder, often called liners and shaped like disposable panty-liners. The bottom side of the holder is sometimes lined with nylon or another waterproof material. All-in-one pads are created in a variety of styles and thicknesses, but do not require any inserts. Some women prefer the two-part pads because of the ability to customise thickness by varying the number of inserts, and because it is easier to thoroughly wash the pads when you can separate the layers. Others prefer the all-in-one pads because they are simpler to make and use. Both types of pads are generally made of cotton, with flannel being the most common type of cotton fabric used, followed by terry cloth and fleece. Some cloth pads use a combination of fabric types. You can also buy underwear that has a cloth pad built in - but as this is inherently less flexible, especially when out and about, the idea does not seem to have caught on.

Finding Your Cloth Pads

Cloth menstrual pads can be purchased from many of the same places that sell cloth nappies - after all, there are similarities in material, construction, and target audience. There are also many companies online selling various cloth pads, with most of these companies run by stay-at-home mothers who make and sell the pads in their spare time. If you're looking to save costs or just really want menstrual pads made out of Superman fabric, it really isn't that difficult to make your own.

Using and Washing Cloth Pads

Putting on a cloth pad isn't that difficult - if it is a two-part pad, the first step is inserting the desired number of liners. Both types of pads generally have the 'wings' seen in some disposable pads; for cloth pads, these fold under the panty and fasten together, often with a snap. It's also possible to attach cloth pads using an old-fashioned menstrual belt, but that appears considerably less common.

Of course, what most people think about first when you mention cloth pads is how do you wash them? The first step is to rinse and then soak them in cold water - ideally as soon as you remove the pad, but otherwise when you return home for the day⁴. If you're using two-part pads, you should remove the liners from the holder before soaking. Rinsing and soaking should always be done in cold water, not warm or hot, as higher temperatures will set the stains and make them difficult to remove. There are many popular household tips for removing blood stains, but it can be difficult to know whether these will have an affect on the durability or absorbency of your pads.

Pads should soak for at least two hours before washing - some women keep several days' worth of pads soaking in cold water and then wash them all at once. You can use any old plastic tub for soaking, but some people prefer something with a lid - even a nappy bucket! Ceramic pots with lids are favoured by many women, since the ceramic keeps the water quite cool, and they can be a decorative addition to your bathroom. After they've soaked, the pads can be washed either by hand or in a washing machine; standard laundry soap is fine, as are oxygen-based stain-lifters, but no bleach! Drying can be done by machine (on low heat) or you can hang dry them. Don't use fabric softener, as this can ruin the absorbency of the pads. While there are women out there who choose to iron their cloth menstrual pads, we promise that this really isn't necessary.

Reusable Cloth Tampons

Unfortunately, we were unable to find any women using this method who were willing to speak for the record.

While reusable cloth menstrual pads are becoming increasingly common, reusable cloth tampons seem to be mostly a pipe dream - that said, some women have created their own cloth tampons using rolled up baby socks. For all the women out there whose partners are grossed out by their menstrual products, you can always tell them to be glad that you don't just stuff their socks in your vagina!

Going Completely Back to Nature

While products like menstrual cups and washable pads may seem extreme to some, others feel like those options just don't go quite far enough.

Sponges

Hmmmm.... In some ways a lot like tampons, in other ways totally different. I tried it on the urging of a friend who was convinced she'd found the 'ideal natural solution for every woman', but I ended up going back to my cup in less than a week. The cup was just as easy to get in and out, it could be left in for longer, didn't cause the same dryness, and was a lot easier to clean.

Yup, that is indeed real sea sponges we're talking about - they can be used as a natural and reusable tampon. They need to be thoroughly cleaned and sanitised before first use and changed every few hours. Some people find these more difficult to wash than other reusable menstrual products, and they also don't last quite as long, needing be replaced every six to nine months. And of course, some people are squeamish about putting dead animal bits in their vaginas. On a more serious note, because sea sponges work by absorbing the flow, there is still a risk of Toxic Shock syndrome, just as with tampons.

Going it Solo

This is one of those things that seemed like a good idea until I climbed into a friend's car - and was suddenly consumed with an incredible anxiety about whether I might stain her seats. I could maybe see going this way at night, though, at least on all but my heaviest nights.

Across the world today and throughout history, many women have gone without using any products whatsoever - simply letting the blood flow where it may. In today's hygiene-focused culture, it seems like there are far fewer situations in which this would be practical. Still, never let it be said that we didn't mention the option - there are definitely women out there today who appreciate being able to bleed freely.

Putting it All Together

I like to be prepared, and I never know what I'm going to feel like using, so I keep just about everything on hand. I probably use my cup and my cloth pads more than anything else, though.

It's not uncommon for a woman to have several of these products in her menstruation arsenal - for example, a woman might use a menstrual cup with a cloth reusable panty liner during the day, and an organic cotton pad at night. While these menstrual alternatives may seem too 'out there' or 'gross' to some, they are definitely seeing a surge in popularity, even in teens. Some women use alternative menstrual options in part because other people feel that they are in some way 'dirty'; as a rebellion against the view that menstruation is something to be hidden.