Time to Disc-uss: Menstrual Discs

Move over, tampons, a new period contender has stepped onto the stage — the menstrual disc.  According to a recent study published in the journal BMJ Sexual & Reproductive Health, this diaphragm-shaped innovation might hold the key to managing heavy menstrual flow while providing a potential indicator of excessive blood loss. The menstrual disc can be a game-changer, especially in the face of the diverse capacities of menstrual hygiene products.

Disc? More like Broken Record…

Over 800 million women worldwide experience menstruation, but astonishing that the subject remains ensnared in taboo. The stigma associated with a natural and inevitable process has hindered research, and has even caused many women to normalize menstrual pain. There is a need to shift away from menstrual taboos— a transition towards open conversations and informed choices.

Heavy menstrual bleeding affects up to 1 in 3 women. While common, it may be an indicator of underlying health problems, such as a bleeding disorder, fibroids, or endometriosis. Heavy bleeding is defined using the Pictorial Blood Loss Assessment Chart (PBAC) the standard tool for assessing heaviness based on pad and tampon utilization. However alternative menstrual hygiene products such as discs, cups, and advanced absorbent pants are inexplicably absent from this framework, despite their rising popularity. 

The PBAC capacity assessment has focused on tampons due to toxic shock syndrome. In manufacturing, capacity evaluations are made using saline water, even though menstrual blood is more viscous and includes blood cells, secretions, tissues, and endometrial lining. The lag in reproductive discussions is sparking a crucial conversation around testing standards. 

No Disc-omfort Necessary

Menstrual discs are made from medical-grade silicone or elastomers – it’s a great reusable product for those trying to be more eco-conscious. This revolutionary option first graced the market in the early 2000s, and although a disc will cost more than a few boxes of tampons ($20 - $40), they’re built to last for a few years. 

Unlike menstrual cups that use suction to sit in the vaginal canal, discs are tucked behind the pelvic bone and are held by gravity. Discs can be worn longer than a tampon, around 12 hours for most brands. And because they sit higher in the vaginal canal, they can allow for less-mess period sex. 

Disc-tinctly better alternatives?

The study focused on the absorbency/fillable capacity of 21 currently available and commonly used menstrual hygiene products, using human red blood cells.

Menstrual discs held the most blood, with an average of 61 mL. One brand (Jiggy) was able to hold 80 mL, which can be indicative of excessive blood loss. Absorbent pants/underwear, on average, held the least at 2 mL. Tampons, pads, and menstrual cups held similar amounts: 20-50 mL.

But lab test results aren't the same as those obtained on people. Women are likely to change their products before saturation due to comfort or convenience, which may overestimate heavy blood flow.

And while red blood cells more closely resemble menstrual blood than either water or saline, they still fall short of the real thing.

Discs for women with endometriosis?

For women who suffer from endometriosis, finding suitable menstrual products can be difficult. Menstrual discs might be a good alternative for those who suffer from severe cramping. This is because they sit in the vaginal fornix—the very back of the vagina, where there are fewer nerve endings—and do not block the vaginal canal. The disc collects the period and flexes the body, but it does not expand or put active pressure on vaginal walls unlike a tampon. 

Menstrual discs are safe alternatives, but many women with endometriosis still fear discs and cups. This may stem from a study published in 2003 that reported one woman who, after four years of cup usage, developed endometriosis. The study focused on menstrual collective devices that blocked menstrual flow and suggested an increase in retrograde menstruation, thus theoretically increasing the likelihood of developing endometriosis or adenomyosis. The FDA rejected this assertion and deemed it implausible, and there have not been other reported cases of this effect. 

Disc usage for suspected heavy blood loss during a period?

Though the fillable capacity for menstrual discs is higher than tampons or pads, most women choose not to wear menstrual discs for the fully allotted time that is required for filling. And although discs can be worn longer, it is important to follow cleaning and sanitation guidelines provided by the manufacturer. 

It’s important to have open conversations with your health care providers regarding your menstrual habits. With so many future possibilities for deriving clinical value from menstrual blood, we need to reduce the stigma associated with menstruation and replace it with opportunities for clinical knowledge.