By Kat Walker
The postnatal period can be an emotional rollercoaster. Often, we notice big changes to our bodies. Our boobs change, our tummy changes, and some of us feel like something isn’t quite right in the vagina.
When it comes to prolapse, it can be a journey of grieving the vagina you once had. After the birth of my son, I knew I had a mild prolapse and even my experience as a pelvic floor physio didn’t save me from these feelings. I was reassured that some degree of prolapse was normal after certain deliveries but I had concerns.
I would worry about how my prolapse might limit me in my new life as a mother. Something I often worried about was whether my prolapse would allow me to use a menstrual cup.
When my period returned, I decided to start by trying a tampon, and to my delight it stayed in.
The next step was to pluck up the courage to try a menstrual cup. All was going well, until I picked up my son later in the day and my cup just descended and started to exit my body. This was devastating, a real low point for me.
Over 50% of women have prolapse and up to 90% have some degree of descent of their pelvic organs (Swift et al. 2003). There are a lot of women in the same boat.
The advice online was overwhelming and sometimes misleading. So, I reached out to the wider pelvic floor physio community and asked for any insights into the success of using menstrual cups and/or discs with mild prolapse. The main messages were:
- menstrual discs, although marketed towards women with prolapse, are not ideal (more about this below) and
- trying a cup designed for a lower cervix had the best success
In the end I tried 3 cups before I committed to the Juju model 4 cup – a lovely Australian made cup marketed to women with a lower cervix.
Common reasons why a menstrual cup may not stay in and/or leak:
- If you are early in the postnatal period. The area between your pelvic floor muscles is wider at this time. It is thought to return to a similar size by 12-months after giving birth, however it does not return to prenatal size (Stær-Jensen et al. 2015). So, it might be a case of waiting until a few months down the track and trying again.
- Your cup might not be sitting around the cervix properly, and if this is the case, it cannot catch the blood.
- Your cervix may be sitting in a different position and/or your vaginal canal may have shortened.
- Your cervix might be tilted and the cup might be bypassing it. There are angled cups you can try if this is the case.
- Your cervix might be sitting inside the cup and reducing the capacity of the cup.
- You may have vaginal wall prolapse causing the cup to slip down and sometimes out with increased pressure in the abdomen.
- The cup might simply be too long for your new anatomy.
- The cup might be too small and thus able to turn sideways or upside down when being worn.
- Your cup may not be opening all the way, and you may need a firmer cup or one with a smaller diameter.
- Weakness in your pelvic floor muscles might be making it difficult to support the cup from below.
- Your flow may have increased, and a menstrual cup might not be ideal in the first few days of your period. Once a cup is full, it will break the seal and overflow. Average cups hold 30mL, but there are some cups on the market that hold 40-50mL.
My top tips if you are returning to menstrual cup use after having a baby:
- Get to know your anatomy
Book in with a pelvic floor physio to have the strength of your pelvic floor muscles and position of your pelvic organs assessed
- Try using an online menstrual cup and disc quiz
- Don’t be scared to try a few different types
It can be devastating when things don’t go the way you hoped. Try not to dwell for too long and try again. Just because one cup didn’t work, it doesn’t mean the next one won’t too.
- Learn how to insert and remove
There are multiple ways to insert a menstrual cup, maybe a different fold will help solve some issues. Most importantly, make sure you are breaking the suction before removing so that you avoid creating a vacuum or downward pressure on your pelvic organs.
- Wear a pad or period undies while you get to know new cups
Leaks are common in the first 2-3 cycles as you get to know your new cup.
Why I wouldn’t recommend a menstrual disc to people with prolapse:
Discs are a great concept, but not for everyone. Discs are soft, and don’t require suction to stay in place. They need to hook behind the pubic bone to stay in place. Therefore, if you have prolapse involving the front of the vaginal wall, it is unlikely to stay in place.
They can be emptied by doing a pelvic floor muscle contraction, which is great if you are sitting on the toilet, but what about if you cough or sneeze? Often women need to wear pads with discs to protect against accidental leakage, which defeats the purpose.
Stær-Jensen, J., Siafarikas, F., Hilde, G., Benth, J.Š., Bø, K. and Engh, M.E. (2015) Postpartum recovery of levator hiatus and bladder neck mobility in relation to pregnancy. Obstet Gynecol 125, 531–539.
Swift, S., Tate, S. and Nicholas, J. (2003) Correlation of symptoms with degree of pelvic organ support in a general population of women: what is pelvic organ prolapse?, American Journal of Obstetrics and Gynecology, Volume 189, Issue 2