The vaginal ecosystem is a key component of women's health. It also represents an ideal system for ecologists to investigate the consequence of perturbations on species diversity and emerging properties between organizational levels. Here, we study how exposure to different types of menstrual products is linked to microbial, immunological, demographic, and behavioural measurements in a cohort of young adult women who reported using more often tampons (n = 107) or menstrual cups (n = 31). We first found that cup users were older and smoked less than tampon users.When analysing health indicators, we detected potential associations between cups use reporting and fungal genital infection. A multivariate analysis confirmed that in our cohort, reporting using cups over tampons was associated with the higher odds ratio to report a fungal genital infection diagnosis by a medical doctor within the last 3 months. We did not detect significant differences between groups in terms of their | 2593 TESSANDIER et al.

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Menstrual cups are gaining in popularity worldwide as a more environmentally sustainable and affordable alternative to disposable personal hygiene products. However, there is currently a lack of scientific literature regarding their safety and potential effects on women’s health. We analysed biological, demographic, and behavioural data in a cohort of young adult women using either tampons (n = 81) or menstrual cups (n = 22). We identify an increased risk of being diagnosed with fungal infection for women using menstrual cups over tampons. We did not detect significant differences between groups in terms of vaginal microbiota composition or local cytokines expression profile. However we found that depending on the type of menstrual product they use more (cups or tampons), women fall into two different clusters in a factor analysis of mixed data, which potentially reflects differences in their local vaginal environments. These results underline the urgent need for in-depth studies to better understand the potential associations between menstrual product products and women’s health.