Reusable menstrual products, such as menstrual cups, washable underwear, and pads, are receiving increasing attention for their environmental and economic benefits; however, their uptake remains limited. However, major barriers continue to restrict their wider use, according to a study published in BMJ Open.

The research, led by Emma Johnson of the University of Cambridge School of Clinical Medicine, Cambridge, England, examined university students’ perceptions of these products and their frequency of use during their menstrual cycle.

“Menstrual hygiene is a public health, environmental, and gender equity issue. Inadequate menstrual hygiene management can lead to missed educational or work opportunities, reinforcement of gender-based stigma and inequality, as well as reproductive and urinary tract infections, mental health problems, and plastic waste from disposable products,” the authors noted.

Global Barriers

In recent years, several reusable menstrual products have been developed and have gained popularity, largely for their environmental benefits and lower costs than traditional disposable products. Social studies indicate that their use could help alleviate “menstrual poverty” and improve menstrual hygiene in low-income countries.

However, many barriers, including economic ones, still limit global access to these products. As lack of access to menstrual hygiene products is also recognised as a barrier to education and training, several governments and universities provide them free of charge to female students. However, these initiatives rarely include reusable options, such as menstrual cups.

Johnson and colleagues conducted the first systematic review on perceptions and barriers to reusable menstrual products among university students in different countries. The review included 10 studies with 4721 participants aged 19-22 years.

The findings showed that disposable pads were the most widely used, with rates of up to 90%, while regular use of menstrual cups was under 5%.

One major obstacle to using menstrual cups, highlighted in most studies, is the lack of information and awareness. In India, more than 90% of the participants had heard of the cup, whereas in South Africa, only 1 in 5 girls knew about it before a training session.

The analysis found that beyond limited awareness, sociocultural barriers hindered the use of reusable menstrual products. These include concerns regarding the virginity and stigma associated with their use.

Participants reported uncertainty regarding product use, menstruation management, and the impact on urinary or sexual health. In contrast, some participants described menstrual cups as “cool,” either for feminist reasons, such as encouraging open discussions about menstruation, or for their environmental benefits.

The authors concluded that negative perceptions were mainly driven by limited knowledge, misinformation, and a lack of shared experiences.

“Strategies to increase the use of reusable menstrual products could include comprehensive education programs coupled with the provision of a product. Our findings also highlight the importance of peer support programs in promoting use,” the authors concluded.

A 2022 Spanish study published in PLOS One reported that disposable pads were the most commonly used product (60.6%), followed by panty liners (49.7%), menstrual cups (48.4%), tampons (42.6%), washable pads (15%), menstrual panties (8.7%), and sponges (0.7%). Comparable data are not available for Italy; however, commercial reports indicate similar patterns, with the use of menstrual cups increasing by approximately 7% annually.

In Italy, menstrual hygiene has drawn public attention for years, particularly the 10% value-added tax on feminine hygiene products.

As reported by the Ministry of Justice, the “Frescura — Menia Corbanese — Belfi Law” is a popular legislative initiative aimed at reducing VAT on these products and infant formula to 5%. The initiative closed on May 20, 2025, after surpassing the required 50,000 signatures.

This story was translated from Univadis Italy.