Regular readers at LeafScore.com will know that I don’t shy away from a challenge, but I confess that period products are not easy to research. This is largely because regulators like the US Food and Drug Administration only require a bare minimum of information from manufacturers, which leaves consumers somewhat in the dark.
Because tampons and pads are not ingested (hopefully), they don’t fall under the same regulatory guidelines as foods or medicines. This should not be taken as an indication, however, that these products are harmless.
If you’re looking for a Leaf Score vetted list of natural period products, check out our blog post on the best nontoxic tampons and period products.
Toxic tampons and pads
Tampons are used in an especially permeable part of the body, often for hours at a time. As the walls of the vagina are spongy and porous, substances can quickly pass through the membranes in these walls to enter the bloodstream.
Over a lifetime, this amounts to years of exposure to whatever chemicals are in tampons.
The Robin Danielson Act
Recognizing concerns over tampon safety, largely centered on toxic shock syndrome, Congresswoman Carolyn Maloney (D-NY) introduced bill H.R. 889 (106th), known as the Robin Danielson Act, in 1999. It was named after a woman who died from TSS, and this bill has been reintroduced several times since, including as H.R. 2379, the Robin Danielson Feminine Hygiene Product Safety Act of 2017.
This act “directs the National Institutes of Health (NIH) to research whether feminine hygiene products pose health risks and it encourages the Food and Drug Administration (FDA) to broaden its monitoring efforts and publicly disclose a list of contaminants within the wide range of feminine hygiene products available on the market” (R).
The main safety concerns with toxic tampons
So, what are the main concerns Maloney and others want the FDA to focus on? Well, for a start, the FDA has not yet outright banned the use of chlorine bleaching in the production of tampons and sanitary pads, and this process is known to create dioxins (a known carcinogen) as a by-product.
Some additional clues about possible concerns can be found in the FDA’s guidelines for companies applying for a 510(k) certification for period products. The FDA asks companies to address issues such as:
- Adverse tissue reaction
- Vaginal injury
- Vaginal infection
- Toxic shock syndrome (TSS)
- Chemical residues
- Fiber shedding, tampon integrity, and string strength
While the FDA does not insist that tampons contain no traces of dioxins, it does recommend that products be free of 2,3,7,8- tetrachlorodibenzo-p-dioxin (TCDD)/2,3,7,8-tetrachlorofuran dioxin (TCDF) and any pesticide and herbicide residues. The FDA also recommends that companies identify any bleaching processes used, such as Elemental Chlorine-Free (ECF) or Totally Chlorine-Free (TCF) bleaching practices. And, they advise companies to describe how their products in their final form avoid:
- enhancing the growth of Staphylococcus aureus
- increasing the production of Toxic Shock Syndrome Toxin-1 (TSST-1)
- altering the growth of normal vaginal microflora
The European approach to tampon safety
In Europe, tampons are not supposed to contain any traces of dioxins, and safety matters relating to menstrual products are covered by Directive 2001/95/EC on general product safety. This directive requires manufacturers to ensure that only safe products are placed on the market, and the REACH Regulation bans the use of certain toxic chemicals in these products.
The European Commission has also stated that it would consider extending restrictions under REACH if further health risks were demonstrated. So far, these regulations have not been broadened, despite the broadcast of a documentary in France in April 2017 that revealed that 20-30 potentially toxic chemical components were found in six of the biggest-selling tampon brands.
How common are dioxins in tampons?
Research carried out by the French magazine 60 Millions de Consommateurs revealed in 2016 that 5 of 11 products tested contained traces of dioxins, insecticides, or other undesirable chemicals. Traces of halogenated waste, a by-product of manufacturing, were found in Tampax Compak Active Regular Fresh tampons and residues of organochlorine pesticides and pyrethroid insecticides were found in some Always sanitary towels. These manufacturers said the results were a “mistake” and blamed the testing process itself. Traces of dioxins were found in o.b. and Nett brand products.
Surprisingly, the researchers also found traces of glyphosate (the chemical in Roundup weed killer) in organic cotton sanitary towels made by Organyc. The company, who noted that organic cotton should be free from this herbicide, confirmed the results through their own tests and chose to voluntarily recall a batch of 3,100 boxes of sanitary towels on sale in France and Canada. Organyc said they would initiate comprehensive testing of their raw materials from their cotton suppliers, who are primarily based in the U.S. and India.
Let’s take a closer look at synthetic materials in tampons and pads, followed by a discussion of dioxins and toxic shock syndrome.
Synthetic Materials in tampons and pads
Because they are not subject to significant regulation in the U.S., unlike most things we ingest or put in our body, most manufacturers are not upfront about the materials they use to make tampons and sanitary pads. Instead, companies rely on vague phrases such as ‘cotton like’, or ‘smooth as silk’, to conjure up a natural image that reassures customers.
Most tampons and pads are not made with cotton, however. Instead, synthetic fibers are used that feel like cotton but are much more absorbent. So absorbent, in fact, that they led to a huge increase in cases of toxic shock syndrome. In turn, this prompted the FDA to insist that companies such as Rely (who were sued by customers) used lower absorbency materials (more on this below).
Although it’s hard to find exact materials listings for tampons and pads, some of the likely ingredients in these products include:
- Low density, highly absorbent, open-celled foam
- Hydrogel (sodium polyacrylate or polyacrylate absorbents)
- Chlorine-bleached Rayon, made from wood pulp (of which dioxin is the by-product)
- Genetically modified cotton
Wood pulp and GM cotton aren’t necessarily toxic, but they may be treated with problematic chemicals (such as chlorine and glyphosate) that are present in the final product or that create toxic by-products during manufacturing. As for the other materials, these synthetic petrochemicals can cause skin irritation and discomfort and make it hard for skin to breathe, all of which raises your risk of bacterial growth, infection, irritation and other health problems.
The healthier, more eco-friendly option is to choose organic, unbleached or naturally bleached, 100 percent cotton products that do not contain traces of pesticides, herbicides, or other undesirable chemicals such as dioxins.
Toxic Shock Syndrome (TSS)
Toxic Shock Syndrome (TSS) is, perhaps, the best known problem with tampons. This potentially fatal illness is caused by a bacterial toxin, typically Staphylococcus aureus MN8 or Streptococcus. These bacteria are much more likely to grow in the presence of super absorbent synthetic tampons, meaning greater production of the toxin that causes TSS. This is because when synthetic fibers absorb more bodily fluids, they concentrate menstrual proteins to a greater degree than cotton, providing the ideal environment for toxin production (R).
Toxic shock syndrome is on the rise
After rates of TSS skyrocketed in the 1970s, the U.S. FDA recognized this problem with highly absorbent tampons and introduced regulations requiring that companies withdraw these products and replace them with less absorbent tampons. The FDA also requires that companies advise users to choose the lowest absorbency tampon for their needs, to not use tampons for more than 8 hours, and to avoid using tampons overnight.
Cases of TSS have fallen since the 1980s, so much so that the U.S. Centers for Disease Control no longer bother monitoring the condition. Still, TSS occurs at a rate of 1-2 in every 100,000 individuals likely to be menstruating, and TSS is thought to be fatal in around 50-70% of cases (R, R).
The main early symptom of TSS is fever, sometimes accompanied by a rash, vomiting, and diarrhea, and symptoms related to hypotension (low blood pressure) such as dizziness and unconsciousness. Multiple organ failure can occur very quickly, within hours of the onset of fever. As such, it is essential to seek medical help immediately if you suspect you might have TSS.
Look for 100% cotton tampons
One of the best ways to reduce your risk of TSS is to avoid using tampons altogether or, at the very least, switch to 100 percent cotton tampons. Researchers as far back as the 1990s showed that tampons made with rayon or a rayon/cotton mix promoted the growth of the main bacterial culprits behind TSS, as did a contraceptive sponge and diaphragms. All-cotton tampons from NatraCare and Terra Femme, as well as menstrual cups, did not appear to promote the growth of these bacteria, however. Indeed, one major researcher in this area considers cotton the best option to avoid TSS, having never seen a case with exclusive use of all-cotton tampons in several decades of research (R).
In summary, to reduce your risk of TSS from tampons, consider:
- Switching tampons for a menstrual cup or pads
- Choosing all-cotton, organic regular tampons
- Using only the minimal absorbency you need
- Changing tampons every 4-8 hours at least
- Not using tampons overnight
One company, Imse Vimse, currently sells reusable cloth tampons, but only in the UK. These tampons, which are used like regular tampons, have not been tested for their capacity to promote bacterial growth. But, given that they are made with 100 percent organic cotton, are meant to be changed as frequently as disposable tampons, and are meant to be washed and boiled between uses, chances are that they are comparable to NatraCare and Terra Femme all-cotton tampons.
In addition to concerns about dioxins, synthetic materials, and TSS, many researchers have connected vaginal and vulval irritation to the use of conventional sanitary products. Allergic contact dermatitis from sanitary pads has been associated with ingredients such as colophonium (resin) (R), perfumes (R), Always pads (R), and methyldibromo glutaronitrile (a preservative) (R).
What’s more, tampons also pose a risk due to the presence of endocrine disruptors such as parabens (preservatives) (R), perfumes such as diethyl phthalate (R) and Galaxolide® (R), and from plastic chemicals in applicators (R).
Questions to ask before buying tampons
Looking at the concerns laid out above, it makes sense to ask the following questions when choosing menstrual products:
- Does the product contain synthetic petrochemical materials that may have adverse effects on personal health and comfort?
- Does the product increase the risk of vaginal microflora imbalance and toxic shock syndrome?
- Are any toxic chemicals or undesirable practices (such as bleaching) used in the manufacture of the product which could lead to contamination of the product and/or detrimental effects on the environment?
- Has a company demonstrated a good faith effort to be transparent with customers about potentially harmful chemicals in their products?
By asking these questions, we can make better informed choices for ourselves and for the environment. And, if enough of us switch to eco-friendly menstrual management products, the impact would be significant.
Alternatives are available! Take a look at some of the following reviews for non-toxic period products that you may be interested in:
- Dame Reusable Tampon Applicator Review
- Organyc All Cotton Tampons Review
- The Honest Company Tampons Review
- Seventh Generation Organic Cotton Tampons Review
- Natracare Organic All Cotton Tampons Review
- Lunapads Reusable Period Pads and Liners Review
- GladRags Reusable Cotton Pads and Pantyliners Review
- Organyc Pads and Pantyliners Review
- Hesta Organic Reusable Menstrual Pads and Pantyliners Review
- The Honest Company Pads and Pantyliners Review
- Natracare Ultra, Ultra Extra, and Maxi Pads Review
- Lena Menstrual Cup Review
- SoftDisc® / SoftCup / FLEX Review
- Moon Cup Menstrual Cup Review
- The Keeper Menstrual Cup Review
- DivaCup Menstrual Cup Review