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Jul 25, 2023

What’s the Best Period Product for Heavy Bleeding?

Although period cups and discs may be convenient and effective, experts caution they might mask underlying health issues. Looking for the best way to manage heavy periods? A product you may have never

Although period cups and discs may be convenient and effective, experts caution they might mask underlying health issues.

Looking for the best way to manage heavy periods? A product you may have never used — or even heard of — is apparently working much better than pads, tampons, and even menstrual cups when it comes to how much flow it can handle.

A study published online August 7 in the journal BMJ Sexual & Reproductive Health found that a menstrual disc, an insertable product that collects period blood instead of absorbing it, held the most — in some cases, more than twice as much as a tampon or pad.

These findings also found that menstrual products like cups or discs, while perhaps more convenient for heavy bleeders, may lead to underrecognition of how heavy a person’s periods can be, says the lead author, Bethany Samuelson Bannow, MD, a hematologist at the Center for Women’s Health at Oregon Health & Science University in Portland.

Heavy menstrual bleeding is very common. Per Cleveland Clinic, it’s estimated that anywhere from 27 to 54 percent of menstruating people experience heavy period bleeding in any given month.

It also seems to be something people come to tolerate: Only about 1 in 3 women seek treatment, according to the American College of Obstetricians and Gynecologists (ACOG) — even though it can be a sign of underlying health issues such as a bleeding disorder or fibroids.

It can also be challenging to diagnose heavy bleeding. One reason is that the tools used to assess it aren’t necessarily accurate or up-to-date, according to the authors of the new study.

“We have noticed that a lot of folks — particularly those with heavy periods — are moving toward cups and discs, and [we] realized we don’t really have a good metric to diagnose heavy bleeding utilizing those methods, as all the currently available methods are dependent on pads and tampons,” says Dr. Bannow. But doctors — and women — need to know how to recognize heavy bleeding, regardless of the products people use, so that it can be recognized and treated, she says.

To address this issue, Bannow and her team set out to test new or lesser-known period products, but with an innovative twist: They used expired red blood cells to measure what the products can contain or absorb, rather than the water or saline that’s typically used in the lab.

The idea to use expired red blood cells rather than the usual water or saline was both “unique and ingenious,” says Nichole Tyson, MD, a clinical professor of obstetrics and gynecology at Stanford University School of Medicine in Palo Alto, California, who specializes in pediatric and adolescent gynecology. Though not involved in this study, Dr. Tyson was a coauthor of an editorial that was published along with the study.

Even though the red blood cells aren’t exactly the same as menstrual blood, it’s much closer than saline or water, and gives us a better understanding of the capacity of these products, she says.

“The use of blood matters, as it is, literally, thicker than water and therefore we expected — and we saw — different absorption with blood instead of water,” Bannow says.

Menstrual pads and tampons face a growing list of competitors: Menstrual cups, menstrual discs, and period-proof underwear have all grown in popularity in recent years.

Menstrual cups and menstrual discs both collect blood rather than absorbing it like a tampon. Cups are typically made of medical grade silicone, and after being inserted into the vagina, they’re held in place with a seal. Unlike tampons, a cup can be left in for up to 12 hours, then emptied, rinsed, and reused, according to Nationwide Children’s.

Most menstrual discs are disposable (although a reusable disc has recently come to market) and made from a medical-grade polymer that heats inside the body and molds to the wearer's unique shape. The disc rests at the base of the cervix, the widest part of the vaginal canal, and stays in place without a suctioned seal. Discs can be worn for up to 12 hours. Typically, women use about eight discs per cycle. One unique feature of the disc: It can be kept in during intercourse, without either partner noticing.

Period underwear is pretty much what it sounds like: There’s an absorbent area in the underwear where you would normally wear a pad that absorbs menstrual blood and prevents leaks from getting on clothes.

Different brands and sizes of the products were evaluated, and investigators tested a total of 21 products.

The test results showed that, on average, menstrual discs held the most blood at 61 mL, with one brand holding as much as 80 mL, according to the authors.

Period underwear, on average, held the least at 2 mL, no matter what the size. Tampons, pads, and menstrual cups held similar amounts: 20 to 50 mL.

As expected, researchers found that the majority of products didn’t absorb as much as what was previously reported when they were tested using water or saline.

“Anyone who fills a menstrual cup to the top three times during a menstrual cycle qualifies as having heavy periods. It’s harder to know with the discs because they likely don’t hold as much in the body as they did in the lab, but they also have the potential to hide heavy bleeding,” says Bannow.

Other signs of heavy bleeding, according to ACOG:

Anyone with heavy periods should talk to their doctor about whether they need to be evaluated for a potential underlying cause, if they might have iron deficiency or anemia, and to discuss what can be done to reduce menstrual losses, says Bannow. This could include hormonal medications like birth control, says Tyson.

“This study highlights that people with uteruses have periods, often every single month, for a really long time. This is our lived experience, and we should be talking about it more,” says Tyson.

Bannow recommends starting with your doctor. “I always encourage people just to talk about periods more. So many people suffer from menstrual concerns like heavy menstrual bleeding because of the stigma and taboo around discussion. They just don’t know what is ‘normal’ or what is okay. The more we talk about periods and normalize that discussion, the better off everyone will be,” says Bannow.

Beyond healthcare providers and friends, the researcher community at large needs to join in the conversation as well, according to the authors of the BMJ editorial. Only one study on menstrual blood was published between 1941 and 1950, and only 400 total over the past several decades. Compare that tally to the 10,000 or so studies on erectile dysfunction during the same time frame, they point out.

The factors that influence what period product or products a person chooses are as unique as the individuals themselves, says Bannow. “Many consider convenience and practicality. For example, teachers want products that don’t have to be changed frequently,” she says.

How much you exercise and your preferred activities play a role as well, she says. “Folks who do a lot of yoga, swimming, or other physical activity may prefer something that can be inserted, rather than a pad that moves,” says Bannow.

Considerations like cost and sustainability are of growing importance to many people as well, she says. “In Oregon, I think many consider the sustainability of products, which perhaps leads to higher rates of cup usage and lower rates of disposable product usage.”

Another good source if you're weighing the pros and cons of period products is the website Period Nirvana, she says.

If you’re considering switching to a cup or a disc specifically because of heavy bleeding, Bannow recommends discussing treatment strategies to reduce blood loss with a doctor in addition to switching products.

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