When your period arrives each month, you’re likely rummaging around immediately in your bag for a tampon, along with the reported 70 percent of menstruators in the US who use tampons. If you’re used to using disposable menstrual products, you might not be thinking about their ingredients and how they impact your body or the environment. But tampon production isn’t regulated nearly as much as it should be, which has resulted in the use of some questionable ingredients.
The FDA classifies tampons as “medical devices” (prior to 1976, their classification was as “cosmetics”), which means that the packaging does list health warnings, such as Toxic Shock Syndrome, but the FDA does not require manufacturers to disclose menstrual products’ ingredients on the boxes in the same way you might look to the nutrition label on packaged foods before you buy them.
So are tampons safe? What about menstrual cups or discs? Read on to understand how your menstrual hygiene has an overall impact on your health and what to consider when purchasing period products.
Menstrual hygiene is just like any other health hygiene in that it can provide clues about how your overall health is functioning or why something is off, says Jaclyn Tolentino , DO, a doctor at Parsley Health Los Angeles. Just as you would discuss the ingredients or possible effects of taking certain supplements or medications with your doctor, the ingredients in your menstrual products are equally important. While there isn’t a ton of conclusive research out there proving that certain kinds of tampons, pads, or any other menstrual products are doing harm to your health, it’s important to be informed so you can make the healthiest choices in regard to what you’re putting in your body. At Parsley Health, your provider and health coach can help you make informed decisions about your health like what period products are right for you.
There isn’t a concrete rule stating that one menstrual product is more “dangerous” than another. However, there might be more of a risk associated with inserting products directly in the vagina as opposed to collecting blood by using pads, liners, or absorbent underwear. Since vaginal tissue is so permeable, it can absorb things more easily into the bloodstream (for example, certain medications can be administered via vaginal suppository to bypass digestion, Dr. Tolentino points out). Dr. Tolentino hypothesizes that if a medication can be absorbed that easily, that any chemicals or toxins that enter the vagina can be absorbed just as easily. But there isn’t enough research to know for sure. What we do know is this: Because of the vagina’s permeability, anything left in there for too long (a sponge, tampon, or menstrual cup) can put you at risk for bacterial growth that potentially causes infections like Toxic Shock Syndrome.
Don’t be too concerned though—TSS is a rare condition that’s been linked mainly to the use of super-absorbent tampons that are no longer on the market. You can’t get TSS from leaving a pad or liner on for too long, so your risk lies more with anything that’s inserted, including a menstrual cup, according to Consumer Reports research . 2019 statistics state that only about one to three in 100,000 people get TSS in the U.S., though. Taking out a tampon or cup within the recommended time period (8 hours and 12 hours, respectively) and using the proper absorbency for your flow that day will greatly reduce TSS risk.
Because most manufacturers don’t disclose the ingredients in period products and your vaginal tissue is highly permeable, any potential toxin in menstrual products could pose some risk. Here’s what we know:
–Dioxins: The main concern surrounding chemical exposure in period products is dioxins, certain kinds of carcinogens that are on the EWG’s “dirty dozen” list of endocrine disruptors (and according to the EWG, can negatively affect both your immune system and your reproductive hormones). Older research found that there might be a link between high exposure of environmental toxins like dioxins and a higher likelihood of getting endometriosis, but there hasn’t been enough research recently to confirm this association.
Most tampons are typically made from a non-organic cotton and rayon blend unless explicitly labeled as organic. With these conventional tampons, dioxins were originally found as a by-product of the chlorine bleaching process of the rayon. Menstrual product manufacturers transitioned away from this method in the late 1990s , and now use non-chlorine bleaching, but you may have been exposed in the past from using these products.
–Pesticides: In using non-organic cotton products, there is the potential for exposure to trace amounts of herbicides like glyphosate (the main chemical used in RoundUp) from the cotton farming process. 2018 research published in the journal Sustainability found that there could be trace amounts of glyphosate in feminine hygiene products, along with diapers and medical gauze. The World Health Organization has stated that the herbicide is likely not carcinogenic and hasn’t been able to prove its likelihood of causing cancer, but there is still ongoing research about the damage these pesticides may be doing to human health.
–Phthalates: The tampon itself is not the only problem: Endocrine-disrupting chemicals called phthalates have been found in the plastic applicators of tampons, as well as in the fragrance chemicals used in scented tampons and other scented products. Other studies have detected phthalates in liners and pads that have layers of plastic in them. There have been links between phthalate exposure and breast cancer, asthma, and diabetes, research states, but again, there’s not enough knowledge of the chemicals’ negative impact yet.
–Metals: A 2019 study in Environmental Health discovered that there might be traces of certain metals in tampons due to accumulation in the soil of the cotton plants. For example, tampon users in the study had higher levels of mercury in their bloodstream. This presence of metals may lead to heightened oxidative stress in the body, which is a marker of chronic inflammation .
If you’re finding yourself calculating how many tampons you’ve used in your life thus far and how much chemicals might be in your body right now, it’s pretty impossible to do so. Believe it or not, there may actually be more dioxins in foods that you eat (found commonly in animal products including meat, fish, and eggs), Dr. Tolentino points out. Also, research has found that there’s much more glyphosate in your everyday drinking water than in a tampon. But it’s a lifetime of exposure to these chemicals that you have to be mindful of and reduce wherever possible.
It’s tough to say exactly how menstrual products affect vaginal flora, because everyone’s vaginal microbiome is different. Plus, the microbiome constantly changes throughout the menstrual cycle , Dr. Tolentino adds, which makes it difficult to collect data. Of course, leaving in any product for too long a period of time can lead to bacterial overgrowth, but the bigger problem is more likely certain hygiene products that contain fragrance chemicals (which manufacturers will not disclose the exact ingredients of—the label just reads “fragrance”). That includes scented tampons, pads, or liners, scented feminine washes and wipes, and some personal lubricants (especially those containing glycerin, studies have found), all of which can disrupt your pH and disturb vaginal bacteria. And when bacteria in the vaginal microbiome is out of balance, you could be more likely to get an infection like bacterial vaginosis, or BV, says Dr. Tolentino. So it’s ideal to keep products to a minimum, and as natural as possible, when it comes to the vulvar area.
Switching to organic anything is never a bad idea, because in general, if something is certified organic, it contains fewer chemicals. And you have to think about the total body burden of exposure to chemicals over time, Dr. Tolentino says. Using 100 percent organic cotton tampons (or pads), with a BPA-free plastic applicator would be a great option, as would a biodegradable cardboard applicator, or going applicator-free, she adds. And to reduce the waste you’re creating each month, consider using a menstrual cup. Also, Dr. Tolentino says, organic all-cotton pads or liners might also cause less irritation to the skin, and be more comfortable and breathable for people with sensitive skin.
One thing to remember if you do go all organic is that you are not automatically eliminating TSS risk (it’s still an issue if you leave anything in the vagina for too long—cup, disk, or tampon), but you may be making a healthier choice for your body and the environment, too. Considering the about 9,120 tampons or 350 packages of pads you’ll likely use throughout your menstrual lifetime, choosing the organic option can only benefit you.
Mara is a freelance journalist whose print and digital work has appeared in Shape, Brit+Co, Marie Claire, Prevention, and other wellness outlets.
Most recently, she was a member of the founding team of Bumble Mag, a branded content project for Bumble at Hearst Corporation. She enjoys covering everything from women's health topics and politics to travel. She has a degree in Communications as well as Italian Studies from Fordham University.