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What’s In Your Tampon, and Should You Care?
06.01.17
Collage by Maria Jia Ling Pitt. 

The first time I worried about the ingredients in my Tampax Pearls was after seeing an ad for the organic alternative. “Do you know what’s in your tampons?” it asked. My answer was no, and for a long time, I didn’t want to know. But that was a few years ago, and the conversation around responsible and ethical feminine care has become much louder. For tampons, it’s particularly pointed: What they’re made of, how they’re taxed, where they go after disposal and why that matters. It’s the kind of curtain-pulling we’re seeing across a lot of industries right now.

Do we really need to worry?

There are plenty of people who think we do. Take Lola, the organic tampon subscription service whose site assures women: “We’re changing your period for the better, with feminine care that’s simple, natural, and easy to feel good about.” Or Cora, a similar service that promises, “A safer tampon. A sophisticated experience. An empowering cause.” Or Sustain Natural, a new offering in the world of organic, ethically minded period kits from Meika Hollender and her father Jeffrey, the founder of Seventh Generation. “Our 100% organic cotton tampons are rayon, fragrance, and chlorine free, because we believe you should only put good stuff inside yourself.”

These kinds of industry disruptors are helmed largely by young, activist-minded women seeking to educate consumers and, I presume, take business away from big players like Tampax and Kotex. They emphasize health, safety and goodwill. Many have charitable business models: Cora donates a sustainable sanitary product to a woman in need for every tampon it sells; Sustain donates 10% of its pre-tax profits to women’s healthcare organizations. Most also have an education or community arm aimed at providing resources to women beyond the products they’re selling.

The charitable and sustainable efforts may be reason enough for you to make the switch from a big-box brand, but in terms of personal health, the science is mixed. Organic tampons, as a health-conscious alternative, ride largely on one claim that’s been tricky to substantiate: that mainstream tampons are dangerous.

In The Daily Beast’s Keli Goff’s reported piece on tampons, the first three cited sources regarding the dangers of tampons are founders of feminine-care disruptors who stand to benefit from such findings (Jade and Pearl, Cloth Pad Shop, The Period Store). The two doctors she eventually cites are Dr. Rebecca Brightman, an ob-gyn who “cautioned that such fears are overblown,” and Dr. Joseph Mercola, who likens feminine hygiene products to “a ticking time bomb.”

Mercola’s thoughts on tampons are cited again and again in media coverage: take this piece in the Huffington Post, this piece in Time, this one on Bustle. His website is home to several articles outlining the dangers of traditional hygiene products. Mercola is not an MD but rather an osteopathic physician, who’s been written up more than once by Quackwatch for unsubstantiated claims and has been warned by the FDA and FTC several times for making false medical claims.

He harbors a clear distrust for the current scientific research, a view I’ve heard before. His approach, which assumes the FDA’s findings aren’t the whole story, is mirrored in other doctor testimonies. For instance, in Goop’s coverage of the topic, Dr. Maggie Ney says that while the modern manufacturing process for tampons produces almost undetectable traces of the toxin dioxin, and is considered safe by the FDA, she still feels, “that tampon companies underestimate the effects of dioxin.”

So what’s the right answer? Who can we trust? I reached out to Dr. Anita Mitra. She’s a practicing gynecologist and researcher based in London and the founder of Gynae Geek, a blog aimed at combatting misinformation. “With the internet flooded by websites and blogs full of poor quality, confusing information…there is a need for reliable, evidence-based information about women’s health,” her site reads. Fun fact: She tells me her surname, Mitra, is Greek for uterus.

She has a lot of thoughts on tampons. First, she warns me not to rely on Google when it comes to these matters, as a particularly worded search will tell you whatever you want to hear. (I can vouch for that!) I ask her to start with the basics, then. What are the supposed risks and why? “The main diseases people are associating with tampons are cancer and endometriosis…Pesticides and dioxin seem to be the two major compounds of concern,” she says.

Dioxin is a toxic compound, and the one most often associated with non-organic tampons. As the National Center for Health Research puts it: “Dioxin is the byproduct of the process from converting wood pulp into a synthetic fiber called Rayon…Tampons are usually made of cotton and rayon.” Until the late ’90s, bleaching of wood pulp to create tampons resulted in traces of dioxin, but that method has since been changed to a chlorine-free bleaching process. Traces of dioxin still remain, however, but “range from undetectable 0.1 to 1 parts per trillion.”

Is a lot? Nope. A 2002 study published in Environmental Health Perspectives found that, “exposure to dioxin in tampons…is thousands of times less than the dioxin people typically consume in the food they eat.”

There are a few reasons people are concerned by these “trace findings,” though: vaginal walls are highly absorptive, for one, and women might use around 10,000 tampons in their lifetime — might it add up? “Lots of people are talking about the accumulation of these products over a menstrual lifetime, but there is absolutely NO evidence to suggest they accumulate,” says Dr. Mitra.

She says while some small studies have linked dioxin with cancer or endometriosis, “they are performed in vitro (i.e. in the lab in a petri dish) or in animals, so we don’t really know if this translates to humans.” Quite simply, there is a lack of data.

Dr. Mitra says it’s impossible to draw conclusions until larger scale studies are conducted. “One of the main problems is the funding of such research. Major scientific bodies (e.g NIH in the U.S.) don’t seem interested in funding this research, and a well-controlled, large-scale study of thousands of women followed over many years would be necessary to determine whether particular types of tampons really do pose a threat.” As for toxic shock syndrome, she says there is no evidence to suggest this is more common with certain kinds of tampons over others. (A Vice piece from 2015 did tie synthetic fibers in tampons and absorbency levels to TSS.)

Why the sudden concern? Dr. Mitra chalks it up to wellness hype. “I see a trend towards this phenomenon with a healthy lifestyle in general.”

Aside from cautioning her own patients against fragranced feminine care products — “which can kill the healthy bacteria and cause bacterial vaginosis” — she says there is no right or wrong answers, and that it’s up to personal preference. She believes there are far more important health considerations than tampon choice. “I would say it’s a low priority compared to things like having a healthy diet, exercising regularly, not smoking or drinking too much alcohol and keeping stress levels low. Those are the five big hitters when it comes to preventing cancer and most other chronic diseases which cause death and ill health.”

Not everyone is of Dr. Mitra’s opinion, though. Take Laura Strausford, an attorney and the co-founder of Period Equity, a “law and policy institute dedicated to advancing menstrual access, equity and safety in the U.S.” She is passionate about getting tampons the attention they deserve from researchers, policymakers and women alike. “We’ve been able to study the health risks associated with tobacco use, alcohol and many other exposures,” she tells me. “Why haven’t we ever included a question about tampon use in long-term studies of women’s health?” She explains that congresswomen Carolyn Maloney has been asking the NIH to fund such a study for 20 years.

“I think women should worry at least as much about what’s in their tampons as they do their food and cosmetics,” Laura says. “What little we know about tampon ingredients — which are legally, but wrongfully protected as trade secrets — is of huge concern.” She’s referring to tampon companies not being required to list the ingredients on the box the way food and beauty companies are. In a recent interview with The New York Times, she referred to this secrecy as “the other tampon tax.” As in: in addition to the fact that tampons are often taxed as luxury items, the industry’s lack of transparency is a tax on women’s safety.

“Earlier this month,” reports the Times, “Representative Grace Meng, Democrat of New York, introduced a bill called the Menstrual Products Right to Know Act, which would require menstrual hygiene products — including tampons, pads, and menstrual cups – to list their ingredients on the package.” If passed, it could mean tampon companies have to own up to any potentially harmful ingredients used.

Whether the tampon concern is overblown or not, such disclosures might change our behavior. “Would you put rayon in your mouth,” Laura asks me, “made from chemically-treated wood pulp, and conventionally-grown cotton doused in pesticides?”

All of this is to say: There are plenty of reasons to choose and engage with feminine care products thoughtfully. Current research shows that potentially harmful ingredients are present, though in nearly undetectable amounts. Time and further studies may lead to new reveals. In the meantime, forward-thinking companies like Lola, Cora and Sustain are offering consumers ease of mind and are forcing big-box brands to be more transparent and ethically minded. It certainly can’t hurt.

Get more Beauty ?
  • Vanessa

    Two words: Diva Cup

    • Meika Hollender

      Definitely the most sustainable option vanessa!

      • Julia

        Love my diva cup

  • Jennifer

    This is great. Thanks for this Hayley. I agree that this whole wellness hype of EVERYTHING can get to be a little too much at times, but it doesn’t hurt to urge big companies to share their ingredients list- if it’s not harmful, they should be good to go. Consumers should know what’s inside everything they consume-food, cosmetics, clothing, etc. Then with that info, they can make an informed decision that suits them.

    • Meika Hollender

      Hey Jennifer, I’m the founder of Sustain Natural, and I agree that our goal is to make sure that women have the INFORMATION they need to make these decisions. The issue is that currently the FDA doesn’t require tampon and pad manufacturers to disclose their ingredients, and there has been no long term research on how the chemicals like chlorine bleach used in these products impact women’s bodies over time.

  • Bethany

    I hated spending money on period stuff every month,(and always forgetting to put tampons in my purse) so I just got a period cup. My periods are a lot shorter now, but not sure if it’s just a coincidence

    • Meika Hollender

      That’s awesome Bethany. They are definitely the most sustainable option!

  • Willa Konefał Davis

    I switched to the Luna cup in the fall of 2016 after doing some reading and thinking- about the people behind the classic tampon brands; what they are made with. The Luna cup, and other cups, are made by women, for women. I don’t think there is anything inherently wrong with a tampon, but I don’t want bleach or drying GMO cotton inside me. The sustainability aspect of the cup appeals to me as well.

    I got an IUD in November (re: election) and my period disappeared by March, but we had a good run, my cup and I. I will return to it if I ever stop having an IUD.

    • _lauristia

      OMG OMG OMG OMG!

      Twiiiiiins!
      I also switched to a menstrual cup Me Luna, and got an IUD, best convo ever!

      On the other hand, my periods went heavier but healthier, no cramps at all.

      Now I don’t worry about getting pregnant and when my period comes I really enjoy being in contact with my own nature, I feel empowered!

  • heat11her

    Love this article. Hate that Cora and Sustain Natural don’t offer the option for “light” tampons. I never use regular-sized tampons anymore (I know, I should be counting my lucky stars). Lola is the only one that offers the lights; they also have wonderful customer service.

    • Meika Hollender

      Hey! We will definitely offer a light option later this year. I think you’ll also really love a few other things about Sustain: 1. We use a bioplastic applicator which means it’s biodegradable versus a petroleum based plastic (which creates a lot of waste!) and 2. You can customize your period kit more than a few of the other brands out there 🙂 Check it out!

      • heat11her

        GREAT to know, thank you, Meika!!

  • Pterodactyl111

    I got a diva cup and it’s the bomb diggity. I am never ever going back to tampons. I don’t care what they’re made of, but they always leaked like crazy for me and dried me out. Plus the cup is reusable, so it’s less waste and way cheaper in the long run. Plus it reduces your chances of TSS by like a lot. It’s a no-brainer.

    • Rahim Whitehead

      Although the cup may be a healthier alternative. There is still the risk of TSS with the cup as well…

      • Pterodactyl111

        Yes, but it’s much lower than with any kind of tampon.

        • Rahim Whitehead

          Im glad that you are aware because many women/girls are not. My NOW WE NO CAMPAIGN (nowweno.net)educates women and girls and also gives them the best solution.You can view the Cherish video at Nspirenetwork.com/rwhitehead Let me know what you think at cherishlyyours.com

  • Kay Nguyen

    I’m depo so I now I haven’t had any period for a long time, however, when I did have period, I often use pad… tampon feels weird inside me! I also feel like tampon is more likely to cause UTI than pad…

    https://www.myblackcloset.com/

    • Meika Hollender

      Hey Kay! I’m the founder of Sustain Natural. So with with pads it’s also good to know what they’re made of as most pads are made with synthetic fibers and fragrances and actually cause irritation for a lot of women. Our 100% organic cotton pads in a test showed to reduce irritation in 80% of women that experienced irritation from traditional brands.

  • Kat

    I’m also Team Mooncup (UK version I think?) – I’ve had it for 4 years now and it’s definitely one of the best decisions I’ve ever made. It’s easy to clean and empty, you’re not constantly wasting money on pads or tampons, plus it’s so comfortable! You don’t get dried out like with tampons. I find I can take it out and very comfortably have sex straight away 🙂
    I end up enthusing about it to strangers in toilets very frequently!

  • Jac

    I feel so torn about companies like this! I love that they’re fighting for more transparency and against the tampon tax, plus taking business away from giant companies that sell the narrative of periods being weird, gross and shameful.

    But as a health scientist I hate that they seem to prey on people’s health fears via the ~wellness bubble~ to spread misinformation for their own profit. As Dr. Mitra points out, without any studies we have no idea if traditional tampons are dangerous or if the organic ones are any safer. People like Dr. Mercola are the ones I find most questionable — people who paint the FDA as a big scary corporation that’s trying to trick consumers. The FDA is a not-for-profit government organization that regulates the for-profit pharmaceutical etc industries, just like the EPA regulates energy companies. I always get the vibe the sort of “health experts” who are super anti-FDA are somehow profiting from it.

    I agree with Laura Strausford — we NEED funding to study the effects of tampon usage, but it’s very unlikely in the current funding climate for the NIH to fund something like that. I would love to see these natural period companies direct some of their profits to funding research on making safer products, too.

    • Meika Hollender

      Hi Jac. As the Founder of Sustain I can assure you that my goal is only to bring more transparency to the industry. While as you said we do not know the long term health effects of the chemicals used in traditional brands, I think THAT we don’t know them is an issue in itself. Just as we demand transparency in food and cleaning products, femcare should be no different. Sustain is about educating consumers on their right to know what they’re putting inside their bodies and they can make the decision from there.

      • Nicole

        I’m sorry, I just need to tell you that it’s kind of weird that you’re trolling articles about feminine hygiene products to hype your product, especially when the whole point of this article is that we need to be wary of the hype from well meaning companies (like yours) trying to scare women into an expensive or sustainable product when it should be an actual choice.

        • Meika Hollender

          Hey Nicole – sorry if you feel weird about it. For me a big part of being a leader in this space is to understand the concerns and issues women have with menstrual hygiene products. When my brand is mentioned in an article I do tend to pay extra close attention to the comments, but I also think it would be irresponsible of me to not be part of these conversations. Sorry if you feel it’s just a ploy to push my brand, I assure you if you look into who I am and what Sustain stands for, that’s not the case. My family founded Seventh Generation over 30 years ago and we’ve been working in the natural products space solely with the goal of changing industries to be more transparent. Engaging in conversation with women is a part of that. Be wary of information always, but I think the author of this piece agrees that women have a right to know what’s in their products and from their every one is entitled to whatever choice they want to make.

          • Nicole

            The problem is that you have something to profit from in this conversation. The author presenting your company in the article as a positive mention is one thing, but it’s entirely different for you to choose the comments section to personally contact every person with something to say about feminine hygiene products with your company’s bio. I don’t care how well meaning the industry or how much I want to see other women succeed, Women CEOs are still CEOs. You’ve obviously seen articles exposing Miki Agrawal and heard chatter about Sophia Amoruso. I don’t doubt that you’re a kind, compassionate person with a vision. I don’t care that I would probably like your product. I don’t like to have brands interact with me in social forums where I am trying to discuss issues without being sold to. We already get promoted ads on every social media platform. Please leave the discourse to us consumers. We have enough of your voices already.

          • Meika Hollender

            Definitely hear where you are coming from and agree it’s not always my place to share my perspective. I don’t feel that clarifying information about Sustain’s product and mission is misguided, but I respect what you’re saying. Makes sense.

      • Jac

        I agree that the lack of information is a critical problem, and one we’d be very unlikely to see in a product that wasn’t considered “a woman thing” (obv, not all women have periods and not all people w periods are women).

        Does your company have longer-term plans for working toward resolving the issue of lack of information, either through campaigning for research funding or contributing part of your proceeds toward funding researchers who are interested in femcare but are unable to receive the nonexistent federal funding?

        • Meika Hollender

          Hey Jac, the answer is yes. We are partners with Women’s Voices for the Earth, which is leading the efforts with Congresswoman Mahloney in D.C. to get a bill passed to get government funding to research the long term effects of the ingredients used in these products. I was in D.C. two weeks ago with Congresswoman Meng and Congresswoman Mahloney lobbing for their two bills (more info on that here: https://www.nytimes.com/2017/05/24/well/live/period-activists-want-tampon-makers-to-disclose-ingredients.html?_r=0). Definitely check out women’s voices for the earth as they have done good research around the ingredients in vagina-related products, but there is still a lot more work to be done.

    • xtyb

      I don’t know what it means to be a ‘health scientist’ but if you think that the FDA is watching out for consumers you are not paying attention! You compare it to the EPA-uh yeah the org headed by Scott Pruitt who endorsed Trump exiting the Paris Accord.

      I’m so confused by people who talk about ‘wellness’ as a ‘fad’ as if trying to be healthy is a lame trend that is going to pass.

      Regardless of how dangerous chemicals are in tampons, they are definitely part of climate change when they are in crops.

      Who cares if it’s toxic to your body, it’s toxic to the planet. Wellness is part of our lifestyle and part of taking care of the Earth.

      • Jac

        sorry for the jargon. by health scientist, i meant that i work at a university doing research regarding health. I’m in the field of behavioral medicine, which essentially encompasses all aspects of health that people have control over— remembering to take medication and taking it properly, eating well, exercising, developing/using healthy coping strategies, etc.

        Essentially, my research is in the science of “wellness” and i didn’t mean to make it sound like i’m anti-wellness. look – i’m a vegan, i meditate (or try to…), i compost, i bike to work, i eat organic, i primarily shop secondhand, i own thinx! — i very likely agree with you on most things. The wellness “fad” in my mind refers more to things like “detox teas,” which are really just liquid laxatives. For-profit companies that prey on people’s legitimate health concerns to sell them bogus products (or in some cases, like those teas, dangerous products!). I think wellness is INCREDIBLY important, which is why i take issue with people using it as a marketing strategy.

        i 100% agree with your point that organic and fairly made products are good for the earth as a whole even if they don’t make a difference in individual health. i would love if more companies marketed these products as being green/lower waste rather than being healthier or safer. still, even if they 100% knew that the health claims are wrong and were intentionally lying (they’re not, without research we don’t know either way), it’s still a net good, which is why i still do shop companies like these.

        it’s also true that any governmental body is only as good at its members. the FDA very likely has employees who are corrupt, just as the EPA currently does. still, i wouldn’t say that the solution to having scott pruitt heading the EPA is to get rid of it entirely, and i have seen so many EPA employees quasi-legally sharing and protecting their data so that their true goal of protecting the environment can continue regardless of the current political climate (pun not intended/deeply regretted). i mainly meant that the mission of the FDA is to protect consumers from companies selling harmful products, and many of its failures (certainly not all) can be attributed to how big pharma exploits loopholes in its regulations rather than them actively seeking to do harm to the public, and the people who stand to benefit most from undermining faith in the FDA are people trying to sell things to you, which is why i am skeptical of them.

  • Jessica

    Diva cup has changed my period life. My only regret is that I discovered it in my mid-thirties and not sooner. Its an amazing, environmentally friendly and wallet friendly option. And as a scientist, I get a real kick out of being able to accurately measure my flow.

  • Sam

    Something I keep going back to with the tampon debate, and other natural products (cleaners, makeup). There isn’t hard evidence yet – which leaves me to believe that avoiding these products couldn’t hurt in the meantime since we haven’t really been able to measure long term effects like 75, or 100+ years of information.