Period products have made headlines in recent years, as reports have come out saying that items such as tampons and sanitary pads contain dangerous chemicals. The way you use a menstrual product could be potentially harmful, too.
Learn about period product safety so you can make informed choices about your health.
How Often Do People Use Period Products?
People can be exposed to period products throughout a majority of their lifetimes, as the average age of starting a period is 12 and it can continue through menopause, which occurs at 50 on average.
About 43 million people in the United States alone use tampons, and they’ll use about 11,000 tampons during their lives.
What Are Menstrual Products?
Period products are designed to absorb blood during the menstrual cycle. Options include include:
- Tampons: These disposable pieces of cotton or rayon (or a blend of both) are inserted into the vagina to absorb menstrual blood.
- Sanitary pads: Disposable pads made of various materials like cotton or superabsorbent polymers attach to underwear to absorb menstrual blood when it is released from your body. These have the highest environmental impact, as they’re made mostly from plastic.
- Menstrual cups: Some people use a reusable, bell-shaped cup to collect menstrual blood. The cup is made of medical-grade silicone, rubber, or latex. It is inserted into the vagina and sits below the cervix.
- Menstrual discs: These flexible, reusable discs are flat and disc-shaped, made of silicone or polyethylene, and inserted vaginally at the base of the cervix to prevent leaks.
- Period underwear: These reusable underwear have built-in absorbent layers to collect menstrual blood.
Do Period Products Contain Harmful Substances?
Concerns about substances in the products are based on recent studies. Some product testing also included diapers and found harmful chemicals and metals in them, too.
Metals
One study examined 14 brands of tampons for 16 metals including arsenic, mercury, and lead. None of the tampons contained all 16 metals, but all of the metals were found among the various products tested. Exposure to heavy metals is associated with higher cancer risk, liver and kidney damage, abnormal heartbeat, miscarriage, and brain impairments, among others.
Some reports showed that period underwear products include the nanoparticle silver – microscopic particles of silver that are about 1,000 times smaller than the width of a human hair. The material has antibacterial properties, but there’s no research that it is safe if the metal enters the vagina. It may have a negative effect on good bacteria in the vagina.
Chemicals
Before period products are ever made, those made from cotton may contain pesticides to help the plants grow. The World Health Organization notes that many chemicals used in farming cotton are extremely or highly hazardous. The Environmental Protection Agency noted that seven of the top 15 pesticides used on cotton are possibly or probably known human carcinogens.
A review on 15 previous studies found that tampons and sanitary pads contained measurable levels of a range of endocrine-disrupting chemicals including phthalates, phenols, parabens, and dioxin. The FDA states that tampons don’t contain dioxin. Older tampon manufacturing processes to make rayon produced dioxin, but the processes have been replaced with safer ones, the FDA says. The National Center for Health Research says on their website that even 100% cotton tampons may contain dioxin. The FDA says the process prevents the products from having dangerous levels of dioxin.
Endocrine-disrupting chemicals that can interrupt the hormonal system may affect your reproductive, metabolic, and immune systems, to name a few. Other studies have uncovered similar findings, one finding that volatile organic compounds (VOCs) and phthalates in sanitary pads (and diapers).
Testing on some brands of period underwear found that the absorbent layers, especially the outer layers closest to skin, contained the endocrine-disruptor PFAS (per- and polyfluoroalkyl substances). The same evaluation revealed that tampon and sanitary pad wrappers contained fluorine, which indicates PFAS are present.
Menstrual cups and discs can be an eco-friendly alternative, but pay attention to the materials they contain. Opt for 100% medical grade silicone only, avoiding thermoplastics that may contain toxic chemicals like bisphenol A (BPA) and phthalates, which can be harmful.
Can Period Products Be Harmful Based on How I Use Them?
In addition to what may be in the products, there are other ways that they can potentially be harmful.
More awareness about a rare bacterial infection called toxic shock syndrome (TSS) may have helped lower the incidence of the bacterial infection caused by leaving a tampon in too long. Generally, you shouldn’t keep one in your body for more than eight hours. A published case report shows you can get TSS from prolonged menstrual cup use, too.
TSS isn’t the only infection caused by wearing a tampon too long. Bacterial vaginosis or vulvitis (irritation of the vulva, which is on the exterior of the vagina) can be a result of prolonged tampon use.
A concern with period underwear is that they may contain harmful substances but also can become damp and irritate the genital area.
How Are Period Products Regulated?
Tampons, pads, menstrual discs, and cups are regulated as medical devices by the FDA, which reviews products before they’re sold. But the FDA doesn’t have to regularly test the products for harmful substances including chemicals or metals, nor does it require that manufacturers list ingredients on the label. The labels have to warn about TSS and specify the absorbency capacity of the product.
In response to a recent study that found toxic substances in tampons, the FDA reviewed scientific studies. The agency says more studies were needed to determine if tampon use, specifically, was linked to contaminant exposure. The FDA cites small numbers of participants in the studies it reviewed, missing brand data, and low levels of harmful substances (among other factors) in their conclusion.
How Can Harmful Substances From Period Products Enter the Body?
Your body can be exposed to harmful chemicals or metals whether you insert a period product (as with a tampon or menstrual cup) or wear one alongside your skin (as with a pad).
It's easy for period product substances to pass through vaginal (internal) and vulvar tissue (external). Putting products directly into the vagina can lead to higher amounts of the substance in the uterus. Because these products can go directly to the reproductive organs, they don’t pass through the metabolism as it happens when you take a pill, researchers say.
Which Period Products Are Safest?
A variety of organic cotton products are on the market, and more may be transparent about their ingredients so you can make an informed choice and avoid ones with substances known to be harmful.
One type of menstrual product isn’t necessarily better than the other, such as choosing period underwear over tampons completely. In one study, young girls who used menstrual cups were less likely to get certain kinds of vaginal infections and were more apt to have a healthy vaginal microbiome.
Research on the topic of menstrual product safety is fairly new, so stay tuned for new reports. In the meantime, talk to your doctor about which period product is right for you.
How Can I Reduce the Risk From Potentially Harmful Period Products
Some states have taken action to reduce harmful substances or make manufacturers list all ingredients so you can tell what’s in a product.
A few tips for staying safe when using period products:
- Opt for chlorine-free bleached or unbleached cotton tampons and pads.
- Look for brands that share all ingredients on the packaging.
- Choose unscented products.
- Don’t keep tampons in your body for more than eight hours.
- Make sure you have extra products on hand to change into when needed.
- Wash period underwear before putting it on.
- Browse the list at Madesafe.org to find certified products that don’t contain harmful substances.
- Wash your hands before and after using a menstrual product to lower the spread of germs.
- If you believe discomfort or illness was from a period product, report it to MedWatch, the FDA’s adverse event reporting program.
