RT Journal Article SR Electronic T1 FLOW (finding lasting options for women) JF Canadian Family Physician JO Can Fam Physician FD The College of Family Physicians of Canada SP e208 OP e215 VO 57 IS 6 A1 Courtney Howard A1 Caren Lee Rose A1 Konia Trouton A1 Holly Stamm A1 Danielle Marentette A1 Nicole Kirkpatrick A1 Sanja Karalic A1 Renee Fernandez A1 Julie Paget YR 2011 UL http://www.cfp.ca/content/57/6/e208.abstract AB Objective To determine whether menstrual cups are a viable alternative to tampons. Design Randomized controlled trial. Setting Prince George, Victoria, and Vancouver, BC. Participants A total of 110 women aged 19 to 40 years who had previously used tampons as their main method of menstrual management. Intervention Participants were randomized into 2 groups, a tampon group and a menstrual cup group. Using online diaries, participants tracked 1 menstrual cycle using their regular method and 3 menstrual cycles using the method of their allocated group. Main outcome measures Overall satisfaction; secondary outcomes included discomfort, urovaginal infection, cost, and waste. Results Forty-seven women in each group completed the final survey, 5 of whom were subsequently excluded from analysis (3 from the tampon group and 2 from the menstrual cup group). Overall satisfaction on a 7-point Likert scale was higher for the menstrual cup group than for the tampon group (mean [standard deviation] score 5.4 [1.5] vs 5.0 [1.0], respectively; P = .04). Approximately 91% of women in the menstrual cup group said they would continue to use the cup and recommend it to others. Women used a median of 13 menstrual products per cycle, or 169 products per year, which corresponds to approximately 771 248 400 products used annually in Canada. Estimated cost for tampon use was $37.44 a year (similar to the retail cost of 1 menstrual cup). Subjective vaginal discomfort was initially higher in the menstrual cup group, but the discomfort decreased with continued use. There was no significant difference in physician-diagnosed urovaginal symptoms between the 2 groups. Conclusion Both of the menstrual management methods evaluated were well tolerated by subjects. Menstrual cups are a satisfactory alternative to tampons and have the potential to be a sustainable solution to menstrual management, with moderate cost savings and much-reduced environmental effects compared with tampons. Trial registration number C06-0478 (ClinicalTrials.gov).