Your tampons may contain toxic metals and forever chemicals

Health professionals are raising the alarm about contaminants discovered in menstrual products used monthly by a majority of American women for about 40 years of their lives.

Several studies found forever chemicals, or per- and polyfluoroalkyl substances, in some tampons, pads and other products used to manage menstrual bleeding, along with other contaminants such as heavy metals and pesticides.

Maine and other states are stepping up consumer protections with laws to limit sales of products with added forever chemicals, known as PFAS, and to require ingredients to be fully listed on labels. But many of those measures don’t take effect for a few years, leaving consumers to make a best guess at the safest products.

One study commissioned by consumer watchdog website Mamavation and green group Environmental Health News found that 22 percent of the 23 different tampons tested found organic fluorine, a marker that forever chemicals are present, with two of the products being advertised as “organic.” Another study in the journal Environment International led by researchers at the University of California Berkeley found lead, arsenic and other toxic metals in 24 different types of tampons.

The Berkeley study estimated that 52 percent to 86 percent of women who menstruate in the United States use tampons to manage their periods. An average woman may use more than 7,400 tampons over her reproductive years, with each tampon retained in the vagina for several hours.

“Despite this large potential for public health concern, very little research has been done to measure chemicals in tampons,” said Jenni Shearston, lead author of the Environment International study and a postdoctoral scholar at the UC Berkeley School of Public Health and UC Berkeley’s Department of Environmental Science, Policy, and Management. “To our knowledge, this is the first paper to measure metals in tampons. Concerningly, we found concentrations of all metals we tested for.”

Tampons are made of a cotton or rayon absorbent core, an outer non-woven covering, a string for withdrawal, a cardboard or plastic applicator for insertion and an external wrapper. One of the largest tampon makers, Procter & Gamble Tambrands, makes Tampax tampons for the entire United States and Canada at its factory in Auburn, where it produces 6,000 per minute or as many as 11 million per day, according to information released earlier by the company.

Procter & Gamble did not respond to several requests from the Bangor Daily News to answer questions about chemicals in tampons and whether it is trying to better identify and reduce them. It also did not respond to emailed questions about a lawsuit filed in July in California alleging deceptive marketing practices for not disclosing that its Tampax Pearl tampons contain a purportedly unsafe amount of lead that exceeds California’s Proposition 65 levels for reproductive toxicity. Procter & Gamble has until Sept. 20 to file its response.

The same plaintiff, Allison Barton, also is suing Kimberly-Clark Corp. , which makes Kotex tampons, for the same reason. That company has until Sept. 23 to respond to the complaint. It did not respond to questions from the BDN about the lawsuit and test results.

Few studies so far

Despite half of the world’s population experiencing menstruation and using products to manage it, the health effects of tampons have not been widely studied. In Maine, about 52 percent of the female population is within the average menstruation ages of 12 to 51 years old, according to U.S. Census Bureau data.

But tampons are of particular concern as a potential source of exposure to metals, PFAS and other chemicals, the UC Berkeley researchers said in their study, because the skin of the vagina has more blood vessels than skin elsewhere in the body and thus more of a possibility to absorb the contaminants.

Shearston said she could not disclose the tampon brands that were tested for the 16 metals. The researchers used 14 tampon brands, 18 product lines and five absorbances for a total combination of 24 tested products.

Metals can cause infertility, affect a baby’s developing brain and damage the liver and kidneys, according to the U.S. Centers for Disease Control and Prevention . PFAS chemicals have water-, heat- and grease-resistant properties. They break down slowly in the environment and are linked to health issues including kidney cancer and rises in cholesterol levels, the CDC noted.

Most chemicals get into the human body by ingestion or through the skin, according to the UC Berkeley researchers. Because of the limited research on vaginal products, theories vary on whether and to what degree PFAS and other substances can be absorbed into the bloodstream through the vaginal wall.

Earlier research by Canadian researchers on toxic shock syndrome, a bacterial infection in the vagina that can cause rashes, multiple organ failure and death, may shed some light on possible absorption. A study in the Canadian Medical Association Journal found that the infection could enter the body through tiny tears in the vagina caused by tampon use.

Some people believe PFAS may not get through the vaginal wall because menstrual blood may flush the chemicals out. But others think that the high number of blood vessels in the vagina, along with the possibility of vaginal tears, make it likely that the chemicals are absorbed into the body.

The vaginal canal is a mucous membrane that is thin and very absorbent, said Dr. Rachel Griswell, who specializes in toxic substances in the environment, including PFAS, at Redington-Fairview General Hospital in Skowhegan. Some drugs, including labor-inducing Mesoprostol, are administered through the vagina.

There is very little information about how much PFAS would be transferred from tampons, but “it’s unlikely to be nothing,” said Pete Myers, founder and chief scientist for Environmental Health Sciences, which publishes Environmental Health News, when the Mamavation study was released.

“It’s unacceptable for a product potentially used by half the population and marketed for decades to have never provided relatively basic science that can tell us about the absorption of chemicals they use through this vaginal route of exposure,” Myers said.

The study by Environmental Health News and Mamavation sent 23 different tampons to a laboratory certified by the U.S. Environmental Protection Agency to look for organic fluorine, which creates PFAS when it binds with carbon. The tests cannot identify specific PFAS chemicals, of which there are several thousand. Results showed that the amount of organic fluorine varied from 19 parts per million to 28 parts per million.

The low amount of organic fluorine found in the tampons could mean it was not intentionally added, but got into them from cleaning products used on manufacturing machines or from pieces of the tampons passing through the supply chain, according to the findings by Mamavation.

The study was reviewed by Terrence Collins, director of the Institute for Green Sciences at Carnegie Mellon University; Linda Birnbaum, former director of the National Institute of Environmental Health Sciences; Myers of Environmental Health Sciences; and Scott Belcher, professor with the Center for Environmental and Health Effects of PFAS at North Carolina State University.

If the chemicals were not intentionally added, they would not need to be reported to state regulators under a new Maine law being rolled out over the next few years.

The portion of the law covering menstruation products does not take effect for another year. But certain medical devices, which tampons are considered to be by the U.S. Food and Drug Administration, are currently exempt from the law. Maine plans to resolve the “apparent conflict” before the law takes effect in January 2026, David Madore, a spokesperson for the Maine Department of Environmental Protection, said.

Lawmakers in Rhode Island , Connecticut and Vermont have laws or bills under consideration that would prohibit sales of products with intentionally added PFAS.

What we know

PFAS, metals and pesticides could get into tampons a number of ways, including from the environment, during manufacturing or in the supply chain. The cotton material could have absorbed the chemicals from water, air, soil or from a nearby contaminant, for example, if a cotton field was near a lead smelter, according to the UC Berkeley researchers. Some chemicals could be added intentionally during manufacturing as part of a pigment, whitener, antibacterial agent or some other process in the factory, the study hypothesized.

Generally, it is not possible to determine the source of PFAS or any other chemical that may be present in a product, said Amanda Hills, a spokesperson for the FDA. The FDA cannot speculate on the presence or potential source of any PFAS in the tampon products, she said.

“Chemicals may be present owing to inclusion as a part of the manufacturing process, and residual levels may carry through to a final product,” she said. “Many products are also manufactured from component materials from subcontractors where the precise additives may not be known.”

The FDA’s safety instructions to tampon and menstrual pad manufacturers date back to July 2005 , before forever chemicals were known to be a widespread problem. Hills said the agency is currently reviewing that document and plans to update it as soon as possible, but she did not have a target date.

PFAS are so pervasive, including in surprising places, that they are hard to trace, said Belcher, with North Carolina State University. He said the federal government has not focused enough on the health effects of PFAS, so consumers have to demand that the chemicals be removed from products.

He said companies and manufacturers face challenges in identifying the sources of PFAS that they did not add into products.

“A lot of these companies and manufacturers are often working in good faith,” he said. “They’re just as surprised. It is extremely difficult to isolate PFAS where it gets into products on manufacturing lines that change.”

Testing for PFAS also is expensive, with a basic test running from $300 to $1,300 or more per sample, said Jeff Gearhart, research director at the Ecology Center, an Ann Arbor, Michigan-based environmental advocacy and education nonprofit. The less expensive test, which burns the product to extract the chemical, only indicates that organic fluorine is present. It is a common method that was used in the Mamavation study. The more expensive one uses liquid chromatography-mass spectrometry instruments to identify the type of PFAS present.

“But none of the products should have PFAS in them, period,” he said. “We really want products that come into intimate contact with our skin and our bodies to eliminate PFAS exposures wherever we can.”

Gail Carlson, assistant professor of environmental studies at Colby College in Waterville, agreed. She said eliminating PFAS from products is a bigger issue than teaching consumers which tampon brands to avoid.

“Testing more of them isn’t necessary to conclude that this could be a risk, and action is needed to reduce that risk,” she said.

Information for consumers has been lacking, despite the first modern tampon having been patented in 1931 and popularized during World War II as more women entered the workforce. It has only been in the past few decades that tampon manufacturers started to list more detailed ingredients on box labels, although many of those lists still are not extensive.

Some ingredients have surprised consumer health advocates, including titanium oxide, which is used to whiten tampon strings. It also is used in pharmaceutical, food and cosmetic products. But while it can irritate the lungs if inhaled, there have been no studies linking it to harmful health effects from tampons, said Alexandra Scranton, director of science and research at Women’s Voices for the Earth, a Cheyenne, Wyoming, nonprofit advocating for toxic-free household products.

With the scarcity of testing for feminine products, Scranton encouraged women to try a different product or brand if they think their current tampon is harming their health.

“There’s no perfect way to know what’s going to work best for your body,” she said. “There are lots of examples of people having less cramps, shorter periods or no rashes when they switch. But there’s not hard clinical research on that.”

That is one reason Leah Segedie founded the consumer health watchdog website Mamavation in 2009. Segedie has an autoimmune disorder that has made it difficult to walk without a crutch. She avoids hormone-disrupting chemicals, including those that contain PFAS, in her lifestyle while investigating them through the website. Other Mamavation studies have tested for organic fluorine in condoms and lubricants, clothing and other consumer products. The website’s studies are funded by partners such as Environmental Health News, donors and affiliated ad revenue.

“We are constantly surprised by the amount of hormone-disrupting contaminants found within ‘natural’ or ‘organic’ brands,” she said. “We find these contaminants because they are exactly the products our community is purchasing and bringing into their homes. And because of this, we don’t take anything for granted anymore.”

Lori Valigra is an investigative environment reporter for the BDN’s Maine Focus team. She may be reached at lvaligra@bangordailynews.com. Support for this reporting is provided by the Unity Foundation and donations by BDN readers.