Tampons, toxins, and the future of menstrual safety

As a hygiene tool with a history and influence far greater than its compact size, tampons have proven to be of critical importance in matters of public health, ranging from deadly infections to socioeconomic challenges. This impact grows with time; tampons have recently been linked to grave health concerns, such as dementia, infertility, diabetes, and cancer. As history and current studies suggest, the potential for further health concerns to emerge means that preventative measures, such as greater funding for relevant research and implementation of laws and regulations that promote the safety of consumers, need to be undertaken.  

The earliest model of tampons dates as far back as 1500 B.C.E. They were a crude variation of current commercial tampons made from naturally occurring plant fibers, as documented in early societies in Africa, Asia, the Roman Empire, and the Pacific Islands. Throughout the following centuries, the design of tampons gradually evolved while attitudes toward tampons slowly shifted to include their health and socio-political implications. In 1933, the tampon, as we know it today, was created and patented, and tampon technology has continued to grow ever since. In fact, the desire to create tampons that would absorb more menstrual flow and could be used for longer time periods created one of the first tampon related health concerns. 

The desire to create more efficient tampons led to designs of increased absorption. In 1979, the Centers for Disease Control (CDC) identified high-absorbency tampons as a co-factor in numerous cases of Toxic Shock Syndrome (TSS). High-absorbency tampons are not sufficient to cause TSS alone; rather, the presence of the bacteria Staphylococcus aureus in vaginal flora and the absence of the necessary immune system proteins to neutralize the flora are also required. Tampons do create the environment that leads to a higher risk of Staphylococcus aureus, with risk correlated to tampon absorbency.  

Furthermore, the tissue in the vaginal wall is highly permeable and unprotected by metabolic filtering, which increases the susceptibility of the vaginal and vulvar walls to the chemical content of the tampon core. This can be harmful as the chemical content of current commercially available tampons contains endocrine disrupting chemicals (e.g., phthalates and parabens) that are associated with the occurrence of cancer, fertility challenges, birth defects, and increases in the risk of diabetes. The most recent research from scientists at UC Berkeley adds to this list of potentially dangerous chemicals found in tampons. This includes toxic metals such as arsenic, mercury, nickel, and lead. These metals, which are found in both organic/natural and non-organic tampons, can potentially increase the risk of dementia, cancer, organ damage, and compromised fetal development. This study does not estimate the amount of metal particulates absorbed through vaginal tissue or the subsequent health consequences. However, given that approximately 47% of menstruators use regular tampons—with 33% of those individuals using super-absorbent tampons and 60% using tampons overnight—the presence of such metals and other chemicals warrants heightened concern and vigilance. 

While there are new emerging health and safety issues related to tampons, we would be remiss to leave out a more widespread issue affecting persons who menstruate. Issues with the availability of tampons and menstrual hygiene products manifest from supply chain shortages, socioeconomic barriers to access, and debates over where these products should or should not be made available. Approximately one in four menstruators have or will experience “period poverty,” or difficulty accessing menstrual hygiene products due to cost and taxes on tampons and other menstrual products. This was exacerbated during the COVID-19 pandemic, as supply chain issues further hindered availability through decreased supply and increased cost. However, there has been little mention of the tampon stock-out in comparison to the national discourse on other COVID-19 related stock-outs, such as infant formula and other groceries. This tampon stock-out and related cost increase were further exacerbated by the failure of cotton crops in 2022, as tampons are typically made out of cotton or rayon or a blend of both. 

It is, therefore, no surprise that tampons have entered the political discourse. In the last decade, over 60 state bills or laws that have been passed increased access to sanitary napkins by providing federal incentives for educational and correctional facilities to supply tampons to their learners and residents. Approximately half of these laws have been passed in the past three years. These efforts were prompted in party by unhoused and incarcerated people, as they experience additional challenges in accessing tampons. Others argue that tampons should also be offered in men’s bathrooms to facilitate gender equity.  

In the United States, menstruators who are low income, live in rural areas, or belong to racialized groups are more likely to experience period poverty. These socio-cultural groups are also more likely to experience health issues thought to be caused by the toxic metals recently found in tampons. For example, people of color who menstruate experience increased morbidity and mortality from Alzheimer’s disease and related dementias (ADRD), as well as most cancers, and are less likely to receive timely screening for these conditions.    

As tampon science and safety regulations change, so do their social and political implications, alongside growing health concerns raised by emerging studies highlighted previously.  

These new findings highlight the need for an expanded view on menstrual equity to include advocacy for funding, laws, and regulations that promote product safety without increasing access inequities. To achieve this, advocacy groups, clinicians, and consumers should demand greater transparency and accountability in tampon safety. This can encourage the establishment of new standards that ensure safety information is accessible, up-to-date, and easily understandable, similar to food labeling practices.

Furthermore, an expanded view of menstrual equity also reveals that promoting potentially less safe products does not promote health equity for those who menstruate. Rather, an important step to promote health equity is reducing access inequities. Therefore, there must be a careful balance to prevent higher costs from accompanying improvements in safety. The menstrual hygiene industry should adopt a public health approach combined with business strategies to ensure safer products and promote long-term well-being for all who menstruate.