Are Tampons Safe for my Health?
Here’s the deal. That menstrual period thing. You know it, you hate it, you probably wish it would disappear. Good news, you’re not alone. Almost every woman experiences this in her lifetime, unless, by special case, they do not have the necessary functioning organs to menstruate. There are endless books on what to do when a girl encounters her first period. Instructions typically begin with asking her mother for help and trying to wrap her head around what is going on. Next, the books move on to how to manage her period. The fix? Pads. As she becomes more comfortable, she graduates to the tampon, the most widely used feminine product.
[Oh, the preteen years. Here’s an example of some books commonly gifted by mothers.]
Of course, this is a western tradition, many cultures do it differently. The average American woman uses 12,000 tampons in her lifetime (Dudley, et al., 2017). 12,000! However, the health and side effects are seldom questioned. This post aims to discover if a consensus exists about the risks of tampon use. Upon reviewing the literature for the overarching topic of tampons, some patterns emerged that makes it reasonable to divide the review into varying categories; see below.
My interest in this topic began when I saw an advertisement on my social media feed for 100% organic cotton tampons with no additives. “That’s what they all are, right?”, I pondered, as I searched through my own bathroom to check a box of tampons. “Rayon and/or cotton blend”, it said. And/or? Shouldn’t the tampon manufacturers know what they’re putting into their own product? I investigated this, it turns out that the FDA has classified tampons as a medical device, saying, “products classified as medical devices need not disclose ingredients on the packaging” (Nicole, 2014). It seems contradictory that it is necessary to name ingredients in foods, ingested by humans, but is not in tampons, also put into the body.
Route of Exposure
The route of exposure for traditional feminine products (tampon and menstrual cup) is transvaginal, meaning through the vagina. This organ is self-cleaning, with a highly water permeable membrane that is capable of absorbing fluids at a higher rate than the skin. This could be a key to some medical advances, for example, fast-acting drug delivery. Researchers have tested this, finding levels of intake to be, “10 times higher than those following oral dosing”, speculating the reasoning is because, “these membranes rapidly absorb chemicals without metabolizing” (Nicole, 2014). This research also highlights the vulnerability of the woman when chemicals are inserted in the vaginal area through menstrual products such as tampons.
Tampon Composition: So, what are they made of?
Rayon/Cotton: Many common brands of tampons use cotton and rayon materials to build their tampon, further, they add chemicals that are rarely advertised to the women using them. A recent report by the nonprofit Women’s Voices for the Earth points out that feminine hygiene products may use ingredients that are, “known or suspected endocrine-disrupting chemicals (EDCs), carcinogens, or allergens” (Nicole, 2014). WVE is a non-profit that seeks to, “amplify women’s voices to eliminate the toxic chemicals that harm our health and communities (“Who We Are,” n.d.). Their work ranges from conducting research, hosting rallies, lobbying, filing lawsuits, using marketing campaigns and much more to gain attention and make influential change with issues and products that are negatively impacting health; in this case, disclosing ingredients on the packaging of tampons. A study done in 1998 determined that because synthetic fibers are more absorbent than cotton, they “concentrate menstrual proteins to a greater degree than cotton and provide perfect physio-chemical environment for toxin production” (Tierno & Hanna, 1998), concluding that cotton is inherently safer than rayon.
Bleaching: Rayon is made of wood pulp, which needs to meet a purity standard for manufacture. Removing impurities is done through a process called bleaching. Think about it, how does paper get so white? All major tampon manufacturers in North America now use rayon made from pulp bleached with chlorine dioxide, a process that began in the late 1980s. A 2001 study found that, “when chlorine dioxide is used to purify wood pulp, TCDD, a dioxin, is not found in the final pulp fibers at limits of detection as low as 0.1 to 1.0 parts per trillion” (Scialli, 2001). According to this data, effects on human health due to chlorine dioxide bleaching are expected to be minimal. Cotton tampons are void of bleach, as they are not a paper-pulp product, but can be exposed to pesticides with similar negligible amounts after purification. Organic tampons are void of both bleaching and pesticides.
Dioxins: Dioxins are a persistent organic pollutant that stays in the body and the food chain for long time. According to the World Health Organization, “Dioxins are highly toxic and can cause reproductive and developmental problems, damage the immune system, interfere with hormones and also cause cancer” (World Health Organization, n.d.). When tested for in four different tampon brands, dioxins were present at trace concentrations. Multiple studies found that samples were not statistically significant, and we are at a greater exposure to dioxins by eating food. A different experiment testing for Polychlorinated Dibenzo-p-dioxins in sanitary products detected PCDD in tampon samples, similar in wood pulp based and cotton products. While the bleaching process results in minimal dioxins out of the factory, PCDD detection suggests that, “the dioxins present in these products may be derived from low-level, diffuse background contamination present in many different matrices and not from the pulp manufacturing process” (Shin & Ahn, 2007).
So, we have lots of scientific information. What does it mean and how does it apply to you? It means you will hardly be exposed to dioxins using tampons, and if dioxins are a large concern, you should consider evaluating your diet for excess consumption of meat and poultry products. In fact, “over 90% of human exposure to dioxins occurs through the diet, especially with fats from animal origin” (Green Facts, n.d.). Essentially, almost any consumer product contains dioxins by way of environmental contamination. However, Scialli claims, “because tampons are designed to absorb menstrual blood rather than desorb materials in the tampons themselves, there is no evidence that materials in tampons are absorbed by the woman using them” (Scialli, 2001). This lack of evidence for the effects on health from dioxins in tampons fails to acknowledge that “all tampons can cause tiny tears in the vagina, which may provide entry for chemicals” (Nicole, 2014), therefore exposing women to dioxins. This is typically how women develop toxic shock syndrome, which shows us the magnitude of what can result from a tiny tear.
Absorption: We’ve all heard about the dangers of leaving a tampon in too long, but is greater absorption more dangerous? From light to regular, super to plus and ultra, no tampon is created to be used for more than 8 hours. Research proves absorbency to be a negligible factor affecting human health, finding that tampon material is more influential in health effects (Nonfoux et al., 2018).
Environmental Effects
There is a significant difference in the relative decay of different products over time. Data shows that “tampons stand out as being most resistant to decay, in comparison to toilet paper and tissues” (Bridle & Kirkpatrick, 2005). Season and rainfall affect this, of course, as well as burial depth. While this may apply to camp and Leave No Trace principles, the greater question is the impact on the Earth of the average 12,000 tampons an American woman uses in her lifetime. This adds up to 250 to 300 pounds of pads, plugs and applicators. In low-income areas, menstrual pads, tampons and rags “routinely block pipes and joints, which is costly, takes time to resolve and imposes health hazards” (Beksinska, Smit, Greener, Maphumulo, & Madube, 2015). Some alternatives are buying pads and liners that aren’t individually wrapped or tampons without the applicators. Further, there are reusable, machine-washable underwear with built-in pads. The option that seems to best benefit the environment, and your pocket book, is the menstrual cup.
Seeking an alternative: The Menstrual Cup
A proposed alternative, the menstrual cup, is made of non-absorbent materials such as silicone or latex rubber. The lack of cases of Toxic Shock Syndrome (TSS) in menstrual cup users suggests a lower risk of negative health effects than in tampon users.
[Cute, huh? (agmeeable, 2011)]
The menstrual cup as we know it today was invented in 1937, however, during World War II, a shortage of latex rubber forced the production of menstrual cups to stop (“Short History of Menstrual Cups,” n.d.). The market was difficult to tap back into, as many women did not like the idea of having to empty and clean the cup and deferred to disposable options like the tampon later in the 60’s.
The menstrual cup significantly reduces the amount of sanitary product waste produced. Remember those 16,000 tampons mentioned earlier? One menstrual cup at $20.00 can last up to 10 years if it is kept in good condition. A $7.99 box of tampons lasts two months. The average age a woman begins her period is 12, and she finishes around the age of 52. That is 40 years of the monthly gift, with either a minimum of 4 menstrual cups or 240 boxes of tampons. A difference of over $1,000 dollars spent in a lifetime.
A sanitary pads campaign launched in 2014 reported that almost nine million girls aged 13–19 miss time at school because of the lack of sanitary products (Beksinska et al., 2015). In low-income areas, this contributes to improving sanitation issues and allowing women and young girls to continue going to school and work while being able to afford a feminine hygiene product.
Tampons in the media
Not going to lie, when I see Serena Williams dominating on the tennis court in a white dress, I’d like to buy the tampons she uses. Alas, I’m no professional athlete, but I appreciate the notion that the “monthly gift” can be managed.
This Tampax ad kicks away the stereotype that women are somehow weaker when they’re on their period. Yet, there are a lack of tampon ads that address the potential risks of tampons.
“Way back when, periods were taboo — hardly talked about and kept under wraps — especially in the media. Heck, it was all done so strangely that it took decades for companies to stop using blue liquid instead of actual blood to depict a menstrual cycle.” — The Revelist
The first tampon ad ran in 1920, and it wasn’t until 2017 that they used red liquid to depict period blood in a commercial. Take a look at this timeline of the history of tampon advertisements.
So, is there a risk to women’s health by using tampons?
While tampons contain chlorine dioxide, other dioxides, and pesticides, there is a consensus among researchers that the concentrations are too small to negatively affect women’s health. The vaginal area is a vulnerable place as it “rapidly absorbs chemicals” at a higher rate than the skin (Nicole, 2014) and can be easily torn by the insertion of a tampon. Many women are naturally hesitant about products that do not list their ingredients. When it comes to a product like a tampon that is used in a vulnerable area of the body, more research needs to be done on the effects of tampons to identify if women are at risk. In 1999, the Tampon Safety and Research Act was established, “to provide for research to determine the extent to which the presence of dioxin, synthetic fibers, and other additives in tampons…pose any risks to the health of women…” (Scialli, 2001). In 2008, legislation was introduced to require studies of tampon safety, and as of 2017, an updated version of the 1999 bill, the Robin Danielson Feminine Hygiene Product Safety Act of 2017 requires the National Institutes of Health to, “…study the contaminants and substances used, such as dioxins and synthetic fibers, among other components, in feminine hygiene products to determine if they pose health risks to women who use the products…” (“Tampon Safety,” 2017). Today, there is a disconnect between tampon research, the chemicals in them and their health effects on women.
agmeeable. (2011). Diva Cup animated ad. Retrieved from https://www.youtube.com/watch?v=IwY_boKVOJ8
Beksinska, M., Smit, J., Greener, R., Maphumulo, V., & Madube, Z. (2015). Better menstrual management options for adolescents needed in south Africa: what about the menstrual cup? SAJM South African Medical Journal, p331.
Bridle, K. L., & Kirkpatrick, J. B. (2005). An analysis of the breakdown of paper products (toilet paper, tissues and tampons) in natural environments, Tasmania, Australia. Journal of Environmental Management, 74(1), 21–30. https://doi.org/10.1016/j.jenvman.2004.08.004
Dudley, S., Nassar, S., Hartman, E., & Wang, S. (2017, January 24). Tampon Safety. Retrieved October 21, 2018, from http://www.center4research.org/tampon-safety/
Green Facts. (n.d.). Dioxins: 2. How are humans exposed to dioxins? Retrieved November 18, 2018, from https://www.greenfacts.org/en/dioxins/l-2/dioxins-2.htm
Nicole, W. (2014). A Question for Women’s Health: Chemicals in Feminine Hygiene Products and Personal Lubricants. Environmental Health Perspectives (Online); Research Triangle Park, 122(3), A70. http://dx.doi.org.ezproxy.lib.utexas.edu/10.1289/ehp.122-A70
Nonfoux, L., Chiaruzzi, M., Badiou, C., Baude, J., Tristan, A., Thioulouse, J., … Lina, G. (2018). Impact of Currently Marketed Tampons and Menstrual Cups on Staphylococcus aureus Growth and Toxic Shock Syndrome Toxin 1 Production In Vitro. Appl. Environ. Microbiol., 84(12), e00351–18. https://doi.org/10.1128/AEM.00351-18
Scialli, A. R. (2001). Tampons, dioxins, and endometriosis. Reproductive Toxicology, 15(3), 231–238. https://doi.org/10.1016/S0890-6238(01)00134-4
Shin, J. H., & Ahn, Y. G. (2007). Analysis of Polychlorinated Dibenzo-p-dioxins and Dibenzo-furans in Sanitary Products of Women. Textile Research Journal; Princeton, 77(8), 597–603.
Short History of Menstrual Cups. (n.d.). Retrieved November 18, 2018, from https://www.lunette.com/blogs/news/short-history-of-menstrual-cups
Tierno, P. M., & Hanna, B. A. (1998). Viscose Rayon versus Cotton Tampons. The Journal of Infectious Diseases, 177(3), 824–825. https://doi.org/10.1086/517804
Who We Are. (n.d.). Retrieved October 21, 2018, from http://www.womensvoices.org/about/who-we-are/
World Health Organization. (n.d.). Dioxins and their effects on human health. Retrieved October 4, 2018, from http://www.who.int/news-room/fact-sheets/detail/dioxins-and-their-effects-on-human-health
