Globally ~500 million menstruators experience compromised menstrual health related to insufficient access to high-quality and affordable products. A more robust understanding of how menstrual health affects women’s health, especially as it relates to reproductive and urinary tract infections and the use of difference menstrual health products, is needed.
The Gates Foundation Women’s Health Innovation team engaged the START Center to conduct a literature review to understand the effect of menstrual health product use (menstrual pads, menstrual cups, reusable pads, and homemade alternatives) on infectious outcomes (sexually transmitted infections, urogenital infections, and bacterial vaginosis), and identify corresponding gaps in the literature. This was achieved by screening 335 articles from 3 databases up to March 26, 2024. Two reviewers screened each article and assessed each full text for eligibility in Covidence. Data was extracted from 41 studies. Findings were reviewed by two subject matter experts for credibility.
Results from this project revealed a lack of high-quality evidence regarding menstrual health product use and reproductive and urinary tract infections. At present, no definitive associations have been established between the menstrual products and adverse health outcomes of interest. In addition, product exposures were generally poorly defined. The majority of higher quality safety data comes from recent trials for menstrual cups, as a newer insertable menstrual product. While product safety is important, menstruators health outcomes are influenced by multi- dimensional factors. In order to correctly evaluate product safety, future studies must evaluate the effect of multi-dimensional confounding factors. These include social and behavioral determinants such as sexual practices, including transactional sex.
Final deliverables included a summary report detailing the project background, methods, results (overall and specific product related), discussion, and conclusion, as well as a final presentation at the Gates Foundation to the Women’s Health Innovation Team and collaborating partner teams.
