Published: 01-02-2021 11:06 | Updated: 01-02-2021 12:04

Pilot of the use of menstrual cups among schoolgirls in rural Nepal

Set Menstrual cup icon isolated on black and white background.

A new study conducted in Nepal, offers some first local evidence to inform local decision-making and contribute to setting a research agenda for the use of menstrual cups in low- and middle-income countries. First author is Diksha Pokhrel, Kathmandu Medical College, Nepal, and corresponding author is Olivia Biermann, Karolinska Institutet. The results of the study were published in Reproductive Health.

Based on a new pilot study conducted in Thokarpa, Sindupalchowk, Nepal, menstrual cups appear feasible and acceptable for menstrual hygiene management due to perceived practical, economic, and environmental advantages. At the same time, implementation and scale-up of menstrual cups in the described setting will require resolving mentioned concerns and discomfort and fostering peer and family support.

Menstrual hygiene management can be challenging in low-income settings, such as Nepal, and among school-aged girls due to traditional beliefs, lack of knowledge and information on best hygienic practices, and limited access to appropriate and affordable menstrual hygiene products such as sanitary pads or tampons. The use of unhygienic clothes to replace pads or tampons may cause restriction in movement, skin irritation, concerns about leaking and odor, and increase the risk of urogenital infections. The menstrual cup is a bell-shaped device made of high-grade medical silicon, which is inserted into the vagina during menstruation. 

This was a qualitative study based on four focus group discussions with a purposive sample of 28 schoolgirls between 13-19 years exploring the acceptability and feasibility of using vaginal menstrual cups for menstrual hygiene management in Thokarpa, Sindupalchowk, Nepal. 

Based on the findings, most girls perceived the menstrual cup positively and recommended it to their friends. Not missing a single class in school due to problems related to menstrual hygiene management was described as a major benefit. The participants found using the menstrual cup easy and convenient, e.g., when being outdoors, they would not have to be concerned about changing, washing or disposing a homemade sanitary pad.

The participants described economic and environmental advantages of using the menstrual cup, e.g., a girl described how, since using the menstrual cup, she could use the money she would spend on sanitary pads to buy herself lunch instead.

'Changing and washing the cup is not a problem as such because we usually do that in the toilet of our own home. Moreover, it also doesn't take as much effort and water as homemade pads do.'

Participant in a Focus Group Discussion

The findings also revealed some discomforts described by the participants, such as pain while inserting the menstrual cup, feeling a constant urge to urinate when the menstrual cup is in situ, feeling of the menstrual cup to be sticking out of the vagina and the fear that the menstrual cup might “get stuck” in the vagina. Misconceptions which were said to have been brought up by parents and relatives of the participants included reduced fertility and losing virginity.

'Everybody was very supportive including our parents. The only reason of not using it [the menstrual cup] was because we could not get it inside [the vagina].'

Participant in a Focus Group Discussion

The participants of the study acknowledged and elaborated on the significance of support from peers and family members, as well as the nurse and teacher who acted as the contact persons within this project. They also highlighted the importance of the health education class that was provided to them before distributing the cup.


Acceptability and feasibility of using vaginal menstrual cups among schoolgirls in rural Nepal: a qualitative pilot study.
Pokhrel D, Bhattarai S, Emgård M, von Schickfus M, Forsberg BC, Biermann O
Reprod Health 2021 Jan;18(1):20

Text by Diksha Pokhrel, Kathmandu Medical College, Nepal, and Olivia Biermann, Karolinska Institutet, Sweden


Olivia Biermann Postdoctoral Researcher