Toxic Tampons: Fact vs Fiction

Safety concerns connected to tampon use have been on the minds of women for many years. From toxic shock syndrome to questions about specific chemicals widely used in the menstrual products, some have turned to tampons marketed to be organic or “clean” and invested in reusable period products like a menstrual cup or period underwear, while others have continued regular tampon use despite concerns.

While previous research has been conducted evaluating the presence of chemicals in tampons — dioxins, furan congeners, polycyclic aromatic hydrocarbons, fragrances, phthalates, parabens, bisphenols, triclocarban, glyphosate, flame retardants, and volatile organic compounds — a new study is reportedly the first of its kind to measure metals in tampons.

And the study, which was recently published in Environment International, has added fuel to the fire when asking, are tampons actually safe?

Metals in tampons

Conducted by researchers from UC Berkely, Michigan State University, and Columbia University, the study evaluated the concentrations of 16 metal/metaloids in 30 tampons from 14 tampon brands and 18 product lines, then compared them by tampon characteristics.

The metals evaluated included:

They found that the tampons studied had measurable concentrations of all 16 metals, including concentrations of several toxic metals like lead, cadmium, and arsenic. The metal concentrations differed by the region in which the tampon was purchased — United States vs European United/United Kingdom, by organic vs non-organic material, and by store vs name brand product.

“Most metals differed by organic status; lead concentrations were higher in non-organic tampons while arsenic was higher in organic tampons,” the researchers wrote. “No category had consistently lower concentrations of all or most metals.”

The tampon brands evaluated in the study were not named.

But what does this all mean?

Metals can make their way into tampons through multiple avenues, according to the study.

One way they can arise is through contamination of the absorbent core materials found in tampons — cotton, rayon, viscose. These materials, in one way or another, come from natural resources. Cotton comes from cotton plants of the genus Gossypium in the mallow family Malvaceae. Rayon/viscose is a semi-synthetic fiber made from natural sources of regenerated cellulose, generally derived from wood pulp. Metals can leach out of contaminated soils and into plant species. Some metals, including lead, copper, zinc, and cadmium can bioaccumulate in plants used in tampons.

“Cotton plants readily take up metals from soil which can be contaminated by metals through atmospheric deposition, application of wastewater, and use of metal-containing pesticides and fertilizers (eg, arsenic in phosphate fertilizer),” according to the study.

Additionally, manufacturers may also add metals during tampon production for product whitening, antimicrobial purposes, odor reduction, lubrication, and as pigments for applicators.

The researchers confirmed the presence of several toxic metals in the tested tampons, including lead, cadmium, and arsenic, but didn’t find substantial presence of chromium or mercury.

“Although toxic metals are ubiquitous and we are exposed to low levels at any given time, our study clearly shows that metals are also present in menstrual products, and that women might be at higher risk for exposure using these products,” said study co-author Kathrin Schilling, assistant professor at Columbia University Mailman School of Public Health, in a Berkely press release.

Arsenic and cadmium are associated with numerous adverse health outcomes. Inorganic arsenic is a known carcinogen and associated with cardiovascular disease and dermatitis, along with respiratory and neurological disease. Cadmium targets the renal system and may cause kidney damage along with cardiovascular disease.

Additionally, some metals, like lead, have no safe exposure levels.

“Concerningly, we found [lead] in all the tested tampons,” researchers wrote. “There is no safe exposure level to [lead]; any proportion of [lead] that may leach out of a tampon and reach systemic circulation might contribute to negative health outcomes. [Lead] is stored in bones, where it replaces [calcium], and can be retained in the body for decades. [Lead] is associated with numerous adverse neurological, renal, cardiovascular, hematological, immunological, reproductive, and developmental effects. Of particular note, even low-level exposure to [lead] can result in neurobehavioral impacts in adults and children, including decreased cognitive function such as impaired attention, memory, and learning ability.”

Of note, researchers only studied the presence of metals in tampons, not whether those metals are absorbed into the body. “While the study found metals in some tampons, the study did not test whether metals are released from tampons when used,” FDA said in a statement. “It also did not test for metals being released, absorbed into the vaginal lining, and getting into the bloodstream during tampon use.”

Public reaction

Even with the caveat that the release of metals into the body wasn’t studied, the public’s reaction has been swift and harsh.

After the study identified tampon use as a potential source of metal exposure, the Democratic Women’s Caucus wrote an open letter to FDA – which regulates tampons as medical devices – urging the agency to investigate and review tampon requirements to ensure women are safe from harmful and toxic substances.

"It's unconscionable to think that women could be putting their health and lives at risk simply by using basic, essential hygiene products like tampons," said Congresswoman Ayanna Pressley, Democratic Women’s Caucus policy co-chair, in the letter. "In light of this alarming report, we're calling on the FDA to take urgent action to ensure the safety of these products, protect the health of those who depend on them, and give women the peace of mind that they can use them without putting themselves at risk."

The caucus said in the letter that FDA does not require “ingredients used in menstrual products like tampons to meet any kind of safety standard,” detailing individuals states that have passed legislation requiring manufacturers to disclose all intentionally added ingredients on packaging.

“In 2021, New York became the first state to enact a menstrual product disclosure law requiring companies to list all intentionally added ingredients on packaging,” according to the letter. “Last year, California passed a similar law, but it gives manufacturers trade secret protections, so not all ingredients are necessarily disclosed. At least six other states have introduced legislation to address safety and disclosure of ingredients in these products.”

Tampon users also seem to have a lot to say about the study and overall regulation of period products. In the Reddit thread r/TheGirlsSurvivalGuide, many users expressed their concern over the news.

One user said “I am extremely appalled and disturbed. I was already aware that tampons can be dangerous, and that some contained titanium dioxide, but this is just vile to me. When are we going to have stricter productions of menstrual products? When will we actually know for sure what is safe and what is not? Something clearly needs to change.”

Another commented, “We actually need strong regulations for tampons. It used to be impossible to find unscented by me, even tho [sic] it is now known the chemicals are not great. They are an internal product in a sensitive reproductive system. ‘Just use pads’ is also not a good solution because they are manufactured in the same conditions. Our bodies are simply not being given the respect they need, and we can't just bleed everywhere, so we keep having to use shoddy products.”

Commenting on the fact that the study found lead concentrations were higher in non-organic tampons, but arsenic was higher in organic tampons, one user said, “This was insane to me to read. I thought switching to organic would be safest and now it's just ‘pick your poison’.”

FDA steps to the plate

Now, FDA is fighting back against accusations that tampons are not being regulated appropriately.

The agency, in an announcement, reassured the public that tampons must meet FDA requirements for safety and effectiveness in order to be legally sold in the US. “Manufacturers must test the product and its component materials before, during, and after manufacturing. Before a product is allowed onto the market, biocompatibility testing is undertaken by the manufacturing company, which is part of safety testing, and is reviewed by the FDA prior to market authorization.”

Additionally, any tampon currently cleared by FDA, according to the agency, has been evaluated as described in the guidance document Menstrual Tampons and Pads: Information for Premarket Notification Submissions (510(k)s) and was determined to meet FDA premarket requirements.

The guidance document, however, has no specific reference to metals or systemic circulation, only covering adverse tissue reactions, vaginal injuries, vaginal infection, and toxic shock syndrome.

In the same announcement, FDA also said it has decided to commission an independent literature review and initiate an internal bench laboratory study to evaluate metals in tampons in other to have a “better understanding of the data currently available regarding the presence of chemicals in tampons, and, importantly, any associated health effects of those chemicals.”

The laboratory study will measure the amount of metals that come out of tampons under conditions that more closely mimic normal use, enabling FDA to complete a risk assessment to metals contained in tampons, based on a worst-case scenario of metal exposure. The agency said it will communicate the findings from both the literature review and laboratory testing to the public when they are available and have been peer reviewed.