INTRODUCTION:

Menstruation is the visible manifestation of cyclic, physiological uterine bleeding brought on by endometrial shedding as a result of hormone interactions mediated by the hypothalamic-pituitary-ovarian axis. The duration of menstruation is four to five days, and the amount of blood loss is estimated to be 20-80ml.¹ Women utilize clothing, absorbent pads, or tampons to control their menstrual flow. Females face difficulties in washing their clothes or disposing of their pads in a sanitary manner².

However, it can still result in movement restrictions, skin irritation, odor concerns, leaks, and even urogenital infections., also serious environmental problems due to the annual dumping of huge amounts of used pads. The menstrual cup is a non-absorbent reusable material that is inserted into the vagina to collect menstrual flow. It creates a seal and is held in place by the walls of the vagina. It is typically made of medical-grade silicone³. The cup is made in such a way that its stem part helps in easy insertion and removal. Depending on the flow rate, can be taken out, emptied, rinsed in tap water, and then put back in. It only needs to be boiled at the beginning and end of a cycle. According to clinical trial studies, menstrual cups are safe and do not cause discomfort, irritability, or any other negative effects. The estimated duration of single use of the cup ranges from 5 to 10 years.⁴ Moreover, it preserves the pH of the vagina and reduces bacterial growth. Medical studies have shown that cups are a safer option for managing menstruation⁵. According to the findings from the fifth National family health survey 2019-21 in India, 64.5% of women aged 15-24 use sanitary napkins, 49.3% of women use cloth, 15.2% use locally prepared napkins and only 0.3% use menstrual cups⁵.

A cross sectional study conducted in 2021 to assess acceptability and safety of menstrual cups among Iranian women between the age group of 18-50 years with regular menstrual period in 600 samples, study revealed that about 83% of participants reported experiencing menstrual cup leakage. Among the reported health risks, the highest mean score was for vaginal pain during removal (23.9%). Most participants (83.9%) were familiar with the cup via social networks and 98.6% recommended this product to other women. Menstrual cup is a safe and acceptable method for menstrual management and it is environment friendly and cost effective too⁶.

A longitudinal study conducted to assess the adaptability and efficiency of menstrual cups in managing menstrual health and hygiene in Eastern India. Study was conducted in 66 samples over 3 months period and the results showed that 68.9% of participants stated that they would continue the menstrual cup usage. The mean total satisfaction score improved from 5.4 (first cycle) to 12.6 (third cycle) (p<0.001). The majority (67%) had no side effects, 10% (6.6) had irritation and leakage, and 13% (8.58) had an unpleasant odor. Menstrual cups are eco-friendly, durable, comfortable, safe, no need for frequent changing in a day and have no disposal issue⁷.

Despite being inexpensive, reusable, and environment friendly, menstruation cups are not commonly used due to misconceptions and a lack of knowledge⁸.

PROBLEM STATEMENT:

A study to assess the effect of planned teaching program on the level of knowledge regarding the use of menstrual cups and perceived barriers among women in a tertiary care hospital, Thrissur

OBJECTIVES OF THE STUDY:

1. To assess the level of knowledge and barriers regarding the use of menstrual cups among women.

2. To assess the effect of the planned teaching program on the level of knowledge regarding the use of menstrual cups among women.

3. To find the association between the level of knowledge regarding the use of menstrual cups among women with selected sociodemographic and clinical variables.

HYPOTHESES:

H₁: There is significant difference between the pre and post test scores of level of knowledge regarding the use of menstrual cups among women.

H₂: There is significant association between the level of knowledge regarding the use of menstrual cups among women with selected sociodemographic and clinical variables.

MATERIALS AND METHODS:

Research approach:

Quantitative research approach

Research Design:

Pre experimental design and one group pre-test post-test design was adopted

Setting:

The study was conducted in female wards of medical, surgical and gynecological ward of Jubilee mission medical College and research institute. It is a multi-speciality hospital in Thrissur.

Sampling size and sampling technique:

30 women aged between 18-45 years old and non probability convenience sampling technique was used to recruit the samples.

Inclusion criteria: Women who are;

· Between the age group if 18-45 years

· Having regular menstruation didn't use it.

· Willing to participate

· Able to read and write Malayalam

Exclusion criteria: Women who are:

· Already using menstrual cup

· Undergone hysterectomy

· Known cases of reproductive diseases

Description of the tool:

Tools and technique:

The tool consists of three sections: section A, section B, and section C.

Section A: Sociodemographic and clinical variables questionnaire:

Sociodemographic variables consists of like age, religion, education and income.clinical data variables includes marital status, if married number of children, age of menarche, regular menstruation or not, usage of menstrual cup, known anyone using menstrual cup, number of menstrual pads used in a menstrual cycle, previous knowledge of menstrual cup, the source of information and place for purchasing menstrual cup.

Section B: Structured questionnaire to assess the level of knowledge on menstrual cup:

It consists of 25 questions with multiple choices to assess the level of knowledge on the menstrual cup. The questions were organized under 4 domains.

The domains of knowledge on menstrual cup:

S. No.	Domains	No of questions
1	Menstruation	4
2	Basic information about menstrual cup	7
3	Insertion and removal	7
4	Uses and side effects	7
	Total	25

Scoring and interpretation:

For each correct response scored with one mark was given and for the wrong response zero was given. Obtained scores were graded based on the level of knowledge as follows:

Level of knowledge	Range of scoring	Percentage (%)
Adequate	20-25	80-100
Moderate	13-19	51-79
Inadequate	<13	<50

Section C: Checklist for evaluation of barrier regarding menstrual cup usage:

Total 15 items were used to evaluate the barriers of menstrual cup usage, zero score was awarded if women responded to "No" and if women responded "Yes" one score was awarded. Then the frequency and percentage is analyzed. The items were organized under 3 domains.

The domains of barrier regarding the menstrual cup usage:

S. No.	Domains of barriers	No of questions
1.	Cognitive	7
2.	Emotional	4
3.	Practical	4
	Total	15

Description of intervention:

The content of the intervention was prepared by the investigator on the basis of objectives, review of non research literature's and guidance of experts in the subject area. The lesson plan was prepared consist of the following points.

The content of Power Point teaching were organized as follows:

· Introduction regarding menstrual cup

· Different sizes of cup

· Different shapes of menstrual cup

· Materials used to make menstrual cup

· Holding time for menstrual cup

· Points to remember while inserting menstrual cup

· Insertion of menstrual cup

· Removal and emptying of menstrual cup

· Storage and sterilization of menstrual cup

· Benefits of menstrual cup

· Complications of menstrual cup

· Comparison between menstrual cup and sanitary pads

The appropriateness of the content was checked by experts in Malayalam. The power point and a handout was also prepared by researcher in Malayalam for the easy understanding of participants with the contents and images under the above headings.

Content validity:

The tool was validated by four faculties. Three are from obstetrics and gynecology nursing and 1 from medical experts. Necessary modifications were made according to the experts opinion.

Pilot Study:

A pilot study was conducted with 10% samples after obtaining informed consent. During the pilot study, it was found that the structured questionnaire and intervention with demonstration was found to be feasible and no modifications made after pilot study.

Data collection process:

The permission was obtained from hospital authorities before data collection. The data collection period was from 12/09/23 to 23/09/23. After explaining purpose and nature of study informed consent was obtained. Samples were selected using non probability convenience sampling technique. The investigator established rapport with the women and they were assured confidentiality.

Pretest about the level of knowledge before and after intervention regarding the use of menstrual cups was conducted using self-structured knowledge questionnaires. A checklist was used to assess the perceived barriers before intervention regarding the use of menstrual cups. Following that a planned teaching program regarding menstrual cups was given using powerpoint presentations and demonstrations using menstrual cups provided for a period of 15 minutes on individual basis and handouts on menstrual cups were provided for the reinforcement.

On the 4 th day, a post test about knowledge regarding the use of menstrual cup was assessed by using the same questionnaire.

Data analysis and interpretation:

The Study was analyzed using descriptive and inferential statistical analysis on the basis of objectives of the study.

RESULTS:

Table 1: Distribution of samples according to Sociodemographic variables such as age, religion, education and income. N = 30

Sociodemographic variables	Frequency (f)	Percentage (%)
Age in years
18 - 24	9	30
25 - 30	5	16.67
31 - 38	12	40
39 - 45	4	13.33
Religion
Hindu	19	63.33
Muslim	6	20
Christian	5	16.67
Others	0	0
Educational qualification
Primary	10	33.33
Secondary	8	26.67
Graduate	7	23.33
Post graduate	5	16.67
Income ( Rupees)
Below 10,000	3	10
10,000 - 20,000	15	50
20,000 - 30,000	11	36.67
Above 30,000	1	3.33

Table 1 shows that nearly half of the samples 12 (40%) were between the age group of 31 - 38 years, 19 (63.33%) were Hindus, 10 (33%) had primary educational qualification and half of them 15 (50%) had income between Rs. 10,000 - 20,000.

Data presented in figure 1 shows that 17 (56.67%) of the samples had their age of menarche at the age of 14 - 16 years and 13 (43.33%) of the samples had their age of menarche at the age of 10 - 13 years.

Figure 1 : Distribution of women based on age of menarche. N = 30

Table 2 shows that during the pretest majority of the samples 27 (90%) had inadequate knowledge and 3 (10%) had moderate knowledge and none of them had adequate knowledge. During the post- test 15 (50%) had adequate knowledge and 14(46.67%) had moderate knowledge and 1 (3.33%) had inadequate knowledge.

Table 3 reveals that the overall mean post-test knowledge score (19.10) obtained in each domain of knowledge regarding use of menstrual cups among women was higher than the mean pre-test knowledge score (9.73). The calculated paired t test value between overall pre-test and post-test level of knowledge is -17.798 which is highly significant (p<0.001). Hence the research hypothesis H₁ was accepted.

Table 2 : Distribution of level of knowledge on use of menstrual cups among women in pre- test and post -test. N = 30

SL No	Components	Inadequate knowledge				Moderate knowledge				Adequate knowledge
SL No		Pre-test		Post-test		Pre- test		Post-test		Pre-test		Post-test
		N	%	N	%	N	%	N	%	N	%	N	%
1.	Menstruation	5	16.66	0	0	22	73.33	17	56.67	3	10	13	43.33
2.	Basic information about menstrual cup	22	73.33	0	0	8	26.66	6	20	0	0	24	80
3.	Insertion and removal	27	90	4	13.3	3	10	17	56.67	0	0	9	30
4.	Uses and side effects	26	86.67	3	10	4	13.33	16	53.33	0	0	11	36.67
5.	Overall	27	90	3	10	3	10	14	46.67	0	0	15	50

Figure 2: Distribution of mean of pre-test and post-test level of knowledge regarding use of menstrual cup N = 30

Table 3: Distribution of Mean, Standard Deviation and t value of pre-test and post-test level of knowledge regarding the use of menstrual cups among women N =30

Sl No	Domain Knowledge	Pretest		Post test		t value	Df	P value
Sl No	Domain Knowledge	Mean	SD	Mean	SD	t value	Df	P value
1.	Menstruation	2.53	0.900	3.23	0.774	-3.881	29	0.001***
2.	Basic information	2.60	1.102	6.13	0.937	-17.500	29	0.001***
3.	Insertion and removal	2.40	0.968	4.70	1.343	-9.041	29	0.001***
4.	Uses and side effects	2.20	1.157	5.03	1.033	-10.599	29	0.001***
5.	Overall	9.73	2.100	19.10	2.604	-17.798	29	0.001***

***-Highly significant (p<0.001)

Figure 2 shows the highest difference between pretest and post-test knowledge score; the overall mean pretest score was 9.73 whereas post test score was 19.1. The mean post-test knowledge score obtained in each domain of knowledge regarding use of menstrual cups among women was higher than the mean pre-test knowledge score.

Table 4 : Distribution of percentage and frequency on barriers of menstrual cup usage among women. N = 30

Sl No	Perceived Barriers	Frequency (f)	Percentage (%)
	COGNITIVE
1.	Lack of knowledge	22	73 33
2.	Being worried that cup would get stuck	21	70
3.	Pain or discomfort while inserting cup	23	76.67
4.	Feeling difficulty in method of insertion and removal	27	90
5.	Fear of leakage	20	66.67
6.	Fear of getting infection	18	60
7.	Not being advised widely on the use of menstrual cup by the health care team	16	53.33
	EMOTIONAL
8.	Fear of using cup	26	86.66
9.	Fear of getting injury	21	70
10.	Being worried about the future complications	17	56.67
11.	Fear of being infertile	11	36.67
	PRACTICAL
12.	Too cost/expensive	11	36.67
13.	Time consuming	15	50
14.	Being difficulty in sterilisation of cup	13	43.33
15.	It is perceived that one may need a help of others to insert	16	53.33

Table 4 shows that in cognitive barriers the majority 27 (90%) of the samples feel difficulty in the method of insertion and removal. In emotional barriers the majority 26 (86.66%) of the samples had fear of using the cup. In practical barriers the majority 16(53.33%) had perceived that one may need the help of others to insert.

MAJOR FINDINGS:

· Majority 20 (66.67%) samples were married and 12 (40%) had no children. All of them attained menarche between the age 10-16 years. 30(100%) had regular menstruation and none of them uses a menstrual cup.

· Majority 17 (56.67%) of the samples were knowng and others are using a menstrual cup. Half 15 (50%) of the samples use menstrual pads below 10 in a menstrual cycle. Majority 24 (80%) had previous knowledge about menstrual cups and 17 (56.67%) had sources of information from the internet. 13 (43.33%) had knowledge of purchasing it from a medical shop.

· During pre-test the majority of the samples 27 (90%) had inadequate knowledge and 3 (10%) had moderate knowledge and none of them had adequate knowledge. During post- test 15 (50%) of the samples had adequate knowledge and 14(46.67%) had moderate knowledge and 1 (3.33%) of them had inadequate knowledge of usage of menstrual cups.

· The mean post-test knowledge score obtained in each domain of knowledge regarding use of menstrual cups among women was higher than the mean pre-test knowledge score. The calculated paired test value between overall ate-test and post-test level of knowledge is -17.798 which is highly significant at table values(p<0.001). Hence the research hypothesis H, was accepted.

· In the cognitive barriers majority 27 (90%) of the samples feel difficulty in the method of insertion and removal. In emotional barriers the majority 26 (86.66%) of the samples had fear of using the cup. In practical barriers the majority 16(53.33%) had perceived that one may need the help of others to insert.

· There is no significant association between knowledge of menstrual cup with the clinical variables such as marital status, no of children and age of menarche and no significant association between knowledge of menstrual cup with the clinical variables such as known anyone who uses menstrual cup, number of pads used in a menstrual cycle and previous knowledge of menstrual cup.

DISCUSSION:

1. To assess the level of knowledge and barriers regarding the use of menstrual cups among women. The study findings with reference to the objectives and hypothesis. During the pretest, 27(90%) had inadequate knowledge, 3(10%) had moderate knowledge and none of them had adequate knowledge. During the post test, 15(50%) had adequate knowledge, 14(46.67%) had moderate knowledge and 1(3.33%) had inadequate knowledge on usage of menstrual cups. Majority 27 (90%) of samples had a cognitive barrier in feeling difficulty in the method of insertion and removal, 26 (86.66%) of samples had emotional barrier in fear of using cup, 16 (53.33%) had perceived that one may need a help of others to insert in practical barrier.

The study findings were supported by a descriptive study conducted to assess knowledge of menstrual cups among Nursing students in Canossa nursing college, Cherukunnu in Kannur district. The data was collected using a self-administered questionnaire. The sample consisted of 40 nursing students. Among these 3(7.5%) of student nurses had excellent knowledge, 19(47.5%) of student nurses had adequate knowledge, 16(40%) of student nurses had moderately adequate knowledge and 2(5%) of student nurses had inadequate Knowledge.⁹

2. To assess the effect of the planned teaching program on the level of knowledge regarding the use of menstrual cups among women.

The findings of the present study showed that the planned teaching programme was effective in improving the knowledge of women of the age group of 18-45 years. The mean pretest score was 9.73 and post test score 19.10. The mean post-test knowledge score obtained in each domain of knowledge regarding use of menstrual cups among women was higher than the mean pre-test knowledge score. The calculated paired t test value between overall pre-test and post-test level of knowledge is -17.798 which is highly significant at table values (p<0.001). Hence the research hypothesis H₁ was accepted.

Similarly a study was carried out to assess Effectiveness of Structured Teaching Programme on knowledge regarding safe use of menstrual cups among adolescent girls of selected schools at Nashik. Before the intervention, among 450 participants the majority 335 (75%) had poor knowledge, followed by 110 (24%) who had average knowledge, while only 5 (1%) had high knowledge of safe use of menstrual cups. After the intervention, 299 (66%) gained good knowledge of safe menstrual cup use among adolescent girls, followed by 140 (31%) with average knowledge and 11 respondents (3%) with poor knowledge, showing significant improvement. This highlights the impact of structured teaching programs in increasing the awareness of menstrual cups and safe practices of adolescent females.¹⁰

3. To find the association between the level of knowledge regarding the use of menstrual cups among women with a selected social demographic and clinical variables.

There is no significant association between knowledge of menstrual cups with the sociodemographic and clinical variables such as age, religion, educational qualification, income, marital status, no of children and age of menarche, known anyone who uses menstrual cup, number of pads used in a menstrual cycle, previous knowledge of menstrual cup and the source of information and place for purchasing menstrual cup. Hence the research hypothesis H₂ was rejected.

CONCLUSIONS:

The study showed that planned teaching programs were effective p=0.001 in improving the knowledge and also assessing barriers of women on usage of menstrual cup. A study conducted in Maharashtra reveals that rregarding methods of disposal 25(50%) were directly burn, 15(30%) were throw outside and 10(20%) were dumped.¹¹ Since menstrual cup is a better alternative, it is recommended that appropriate health education program can be planned to create awareness on menstrual cup like less costly, convenient etc. Counseling and empowering the women with adequate measures on usage of menstrual cup helps to overcome the barriers.

LIMITATIONS:

The study was conducted only in one setting with a sample size of 30.

RECOMMENDATION:

The study can be replicated on large samples for better generalization.

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10. Ekta Shinde and Jinu K Rajan. A study to assess effectiveness of structured teaching program on knowledge regarding safe use of menstrual cup among adolescent girls of selected schools at Nashik. International Journal of Nursing and Medical Investigation. 2023; 8(3).

11. Dipali Bobade. A study to assess the effectiveness of structured teaching programme on knowledge and expressed practice regarding sanitary napkin among school girls those who attained menarche at a selected school in Akola district. International Journal of Advances in Nursing Management. 2025; 13 (2): 115-2, doi:10.52711/2454-2652, 2025.00023.

Received on 09.07.2025 Revised on 02.08.2025

Accepted on 22.08.2025 Published on 31.10.2025

Available online from November 10, 2025

Int. J. of Advances in Nursing Management. 2025;13(4):201-207.

DOI: 10.52711/2454-2652.2025.00038

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