Key Takeaways
A misplaced menstrual cup led to ureterohydronephrosis in a woman, causing months of pain and haematuria. A case report by urologist Dr Clara Maarup Prip and colleagues from Aarhus University Hospital in Aarhus, Denmark, highlights this rare but serious complication.
Doctors emphasise the need to choose the right size, shape, and insertion method to avoid similar risks.
The Patient and Her History
A sexually active woman in her 30s presented to the hospital with blood in her urine and intermittent right flank and lower abdominal pain. Her medical history included obesity, treated with sleeve gastrectomy, and a ureteral stone that had been removed endoscopically 3 years earlier. She denied having a fever or any other accompanying symptoms.
The patient reported that she was sexually active and had not previously experienced pregnancy. The flank and lower abdominal pain had been intermittently present for the past 6 months, with episodes occurring 2-5 times a week, each lasting about an hour. These pain episodes were often accompanied by an urge to urinate.
Over the same period, she had noticed macroscopic haematuria several times. The haematuria was not associated with the pain episodes or her menstruation. She denied fever or any lower urinary tract symptoms.
The patient’s medication, family, social, drug, and travel history were unremarkable.
Findings
- The patient’s vital signs were measured and found to be normal.
- Physical examination and laboratory tests, including serum creatinine levels, were normal (44 µmol/L).
- Urinalysis revealed haematuria and proteinuria.
- Flexible cystoscopy showed no abnormalities.
- CT urography showed right ureterohydronephrosis with a narrow inlet to the bladder, a well-placed intrauterine device, and a menstrual cup placed in the right side of the vagina in close proximity to the right ureteral ostium.
- No urinary stones or other possible causes of haematuria were identified.
Diagnosis
Two differential diagnoses were initially considered. First, the close proximity between the menstrual cup and the right ureteral ostium suggested a mechanical effect of the menstrual cup, potentially obstructing urine drainage from the right kidney to the bladder.
Second, the patient had previously undergone removal of a 9-mm stone in the right ureter, close to the ostium, 3 years ago.
The patient was informed of these potential diagnoses and advised to remove the menstrual cup as a trial intervention.
A follow-up ultrasound performed 1 month after the cup removal showed complete regression of ureterohydronephrosis. Renography revealed normal shape, size, placement, activity, and drainage of both kidneys, with a functional distribution of 52% to the right kidney and 48% to the left. The patient had not experienced any further episodes of flank pain or haematuria during this period.
The complete relief of symptoms and regression of ureterohydronephrosis supported the working diagnosis that the menstrual cup had mechanically obstructed the right ureter.
Discussion
A meta-analysis documented the potential complications of menstrual cup use, including pain, vaginal injuries, allergic reactions, leakage, urinary incontinence, displacement of intrauterine devices, and infections. However, an increased risk for infection has not yet been demonstrated.
“Our case represents a rare case of ureterohydronephrosis due to incorrect positioning of a menstrual cup. To our knowledge, only a few similar cases have previously been reported,” the authors wrote.
This case underscores the importance of selecting the correct shape, size, and insertion method to avoid complications.
This article was translated from Univadis Germany using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.