The evidence on using a menstrual cup or disc with an IUD is mixed. Some studies found no increased risk of expulsion, while others suggest a possible association, particularly in the months following insertion. The current consensus among researchers is that more high-quality studies are needed before definitive conclusions can be drawn. If you have an IUD and are considering a cup or disc, speaking with your healthcare provider first is strongly recommended.
Key Takeaways
- Research on menstrual cups and IUD expulsion is inconclusive - some studies found no increased risk, others found a possible association.
- The risk of IUD expulsion is highest in the first few months after insertion, regardless of which period product is used.
- Always break the suction seal fully before removing a menstrual cup - this is the most important safety step.
- Menstrual discs do not create suction and may carry a lower risk, though formal research on discs specifically is very limited.
- Always discuss using an internal period product with your healthcare provider before doing so with an IUD in place.
What is an IUD?
An IUD is a small, T-shaped device inserted into the uterus by a healthcare provider. IUDs are a highly effective, long-acting and reversible form of contraception. There are two main types.
Hormonal IUDs (such as Mirena, Kyleena or Jaydess) release a low dose of progestogen, which thickens cervical mucus and thins the uterine lining. Many people find their periods become lighter or stop altogether.
Copper IUDs are hormone-free and work by creating an environment that is inhospitable to sperm. They tend to make periods heavier, particularly in the first few months after insertion.
Both types have a thin string (or strings) that hangs through the cervix into the upper vagina. These strings allow you and your provider to confirm the IUD is correctly positioned and are used during removal.
What does the research actually say?
This is where it is important to be clear: the research is genuinely mixed and there is no definitive answer yet.
An early study by Wiebe and Trouton (2012), published in Contraception, followed 930 people with newly inserted IUDs and found no difference in early expulsion rates within the first six weeks between those using menstrual cups, tampons or pads. This is the study most commonly cited to support compatibility.
However, later research raised more questions. A 2019 US survey published in the European Journal of Contraception and Reproductive Health Care (Schnyer et al.) found a statistically significant association between concurrent menstrual cup use and IUD expulsion, with cup users reporting expulsions at a meaningfully higher rate than non-cup users. The authors noted that prospective research was needed to properly establish the relationship.
A 2023 systematic review by Bowman and Thwaites, published in Contraception and Reproductive Medicine, reviewed seven studies and found 73 expulsion events among people using IUDs and menstrual cups. Their conclusion was that a possible association exists, but that evidence is scarce and inconsistent — with the three studies that reported expulsion rates disagreeing on whether the link was statistically significant. They called for high-quality randomised controlled trials to resolve the question.
More recently, a secondary analysis of a US copper IUD trial (published in Contraception, 2024) reported enough observed expulsions in cup users during the study that participants were advised against using menstrual cups partway through the trial.
The honest position: we do not yet have the high-quality evidence needed to say definitively whether menstrual cups increase IUD expulsion risk or by how much. What we do know is that the risk is not clearly zero and that the early months after insertion are the highest-risk period, regardless of which product is used.
Menstrual discs and IUDs
Menstrual discs sit differently in the body to cups. They rest in the vaginal fornix, the space behind the cervix, rather than forming a suction seal in the vaginal canal. Because discs do not create suction, some clinicians consider them a potentially lower-risk option for people with IUDs.
That said, formal research specifically on discs and IUD expulsion is very limited. The available studies focused almost exclusively on menstrual cups. Discs require careful removal too, by hooking a finger under the rim and guiding the disc out horizontally and it is still possible to accidentally catch IUD strings during this process.
If you use a disc, the same principles apply: take your time, remove slowly and carefully, and check in with your healthcare provider regularly.
How to reduce risk if you choose to use a cup or disc with an IUD
If you have discussed the option with your healthcare provider and have decided to use a menstrual cup or disc alongside your IUD, the following steps can help reduce risk.
Ask about your IUD strings. Some providers will trim strings shorter for people who use cups or discs, so they sit inside or close to the cervix rather than dangling into the vaginal canal. Ask about this at your insertion appointment or next check-up.
Wait after insertion. Most healthcare providers recommend waiting until after your first period post-insertion, at a minimum, before using a cup or disc. The first few months carry the highest risk of expulsion.
Insert your cup low. Fold, insert and allow your cup to open just inside the vaginal opening, then gently guide it upward into position. This reduces the chance of IUD strings becoming trapped between the cup and the vaginal wall.
Always break the suction seal. Before removing your cup, pinch the base firmly with your thumb and forefinger to release the suction seal completely. Never remove the cup by pulling the stem alone — this is the most likely way to inadvertently tug on the IUD strings.
Remove slowly and carefully. Whether using a cup or disc, take your time. Tip the cup as you remove it; guide the disc out horizontally. Avoid any sudden movements.
Check in regularly. Have your healthcare provider confirm your IUD is correctly positioned, especially in the first few months of using a cup or disc together with your IUD.
When to contact your healthcare provider
Reach out promptly if:
- You can feel your IUD strings are longer than usual, or you cannot feel them at all
- You experience unusual pain or cramping when using or removing your cup or disc
- You suspect your IUD may have moved
- You want personalised advice before starting to use an internal product with your IUD
Frequently asked questions
Can I use a menstrual cup or disc straight after IUD insertion? Most healthcare providers recommend waiting until after your first period post-insertion before using an internal period product. The early months carry the highest risk of expulsion, so waiting until your provider has confirmed the IUD is correctly positioned is sensible.
Does the type of IUD affect the risk? Some research suggests copper IUD users may be more likely to also use menstrual cups. However, it is not yet clear whether the type of IUD meaningfully changes the expulsion risk associated with cup use. Speak with your provider about your specific device.
Are menstrual discs safer than cups for IUD users? Because discs do not create suction, some clinicians consider them a potentially lower-risk option. However, formal comparative research is very limited. Careful removal technique matters with both products.
What should I do if I think my cup or disc has dislodged my IUD? Remove your cup or disc carefully, stop using internal products, and contact your healthcare provider promptly. Signs that your IUD may have moved include more intense cramping than usual, strings that feel longer than before, or being unable to feel the strings at all.
Can I feel my IUD strings when I use a cup? You should not be able to feel your IUD strings with your cup in place. If you can, speak with your healthcare provider — your strings may need to be trimmed.
Is there any way to know for sure it is safe for me personally? The best approach is a conversation with your healthcare provider. They can assess your individual anatomy, the position of your IUD strings and your personal risk factors, and give you advice tailored to your situation.
The bottom line
The research on menstrual cups and IUD expulsion is mixed and ongoing. A possible association exists, though the evidence is not yet conclusive. The risk appears to be highest in the first months after insertion and correct removal technique, especially fully breaking the suction seal on a cup, is important.
If you have an IUD and want to use a cup or disc, the most important step is to have a conversation with your healthcare provider before you do. With their guidance, personalised to your anatomy and circumstances, you can make an informed choice that works for you.
This article is for informational purposes only and is not a substitute for professional medical advice. Always consult a qualified healthcare provider for guidance specific to your situation.
References
- Wiebe ER, Trouton KJ. Does using tampons or menstrual cups increase early IUD expulsion rates? Contraception. 2012;86(2):119–121. doi:10.1016/j.contraception.2011.12.002
- Schnyer AN, Jensen JT, Edelman A, Han L. Do menstrual cups increase risk of IUD expulsion? A survey of self-reported IUD and menstrual hygiene product use in the United States. Eur J Contracept Reprod Health Care. 2019;24(5):353–357. doi:10.1080/13625187.2019.1643836
- Bowman N, Thwaites A. Menstrual cup and risk of IUD expulsion – a systematic review. Contracept Reprod Med. 2023;8:4. doi:10.1186/s40834-022-00203-x
- Creinin MD et al. Menstrual cup use and intrauterine device expulsion in a copper intrauterine device randomized trial. Contraception. 2024. doi:10.1016/j.contraception.2024.110266
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