Choosing Safe Menstrual Products
The only obligations required of menstrual product manufacturers are that they provide basic instructional labeling on their packaging and keep records of adverse events caused by their product.
There is still no requirement for testing or for labeling and detailed disclosure of product ingredients on packaging.
History
The U.S. Food and Drug Administration is responsible for approving and disclosing the ingredients in menstrual products. Originally classified as cosmetics with little to no labeling, this changed in 1976 with the Medical Device Amendments
It was at this time that tampons (and now also, menstrual cups) were considered Class II medical devices, and Pads Class I
Because tampons had already been sold on the market at the time of this classification, they were “grandfathered” in without performing safety testing. Companies were also welcome to establish “substantial equivalence” for new products, bypassing premarket approval processes
In the 1960’s tampon manufacturers started using semi/synthetic ingredients that were cheaper than cotton. These were able to bypass the preapproval process
In the 1970’s Procter & Gamble created an entirely synthetic tampon called Rely, which caused a deadly condition called Toxic Shock Syndrome (caused by the bacterium Staphylococcus aureus). In September 1980, Rely was withdrawn from the market
Pads
Pads are a menstrual collection device used to absorb blood flow. They are typically worn in the underwear.
Pros
Various absorbency levels
No risk of toxic shock syndrome
Users report less cramping than internal products
Some reusable options available, some organic disposable options available
Safety
Brands cannot be trusted to conduct their own safety profiles, even if they contain the label organic
Conventional bleaching methods are used in conventional pads and liners. Dioxins and furans are common byproducts of the bleaching process. They are linked to cancer, endocrine disruption, and reproductive toxicity.
Some pads emit toxic chemicals, including chemicals identified by the U.S. Department of Health and Human Services National Toxicology Program, the Agency for Toxic Substances and Disease Registry, and the State of California Environmental Protection Agency as carcinogens, and reproductive and developmental toxins.
See this guide for a deeper breakdown of the chemicals contained within pads. Their study found that the highest concentration of phthalates detected were both found in organic pads.
This organization tested Always brand pads finding carcinogens and endocrine disrupting chemicals
Cons
Bulky and uncomfortable fit
Not biodegradable
Contain microplastics
Are often scented with undisclosed chemicals in the fibers
Costly over time (average: $168 per year)
Restrictive for certain activities
Safety issues
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Polyacrylate Foam, Polypropylene, Polyethylene, Calcium Chloride, Ethylene/propylene copolymer, Hot Melt Adhesive, Styrene Block Copolymer, (Styrene Isoprene Co-Polyme), Vinyl acetate, Ethylene Hydrocarbon Resin, Napthenic oil, Thermoplastic adhesives, Acetate/ethylene/hydroxymethylacrylamide/ acrylamide copolymer, Styrene/butadiene copolymer, Tris (2,4-ditert-butylphenyl) phosphite , Methyl lactate, Synthetic beeswax, Potassium Polyoxyethyylene, Lauryl Ether Phosphate, Polyethylene Glycol Monolaurate, Glycerin, Dioctyl sodium sulfosuccinate, Peg-15 cocoate, Peg-10 castor oil, Deceth-4 phosphate, Stearamide DEA, Diethylhexyl sodium sulfosuccinate, c12-14 sec-pareth-3, Peg-10 dimethicone, Peg-10 laurate, Peg-10 oleate, Polyoxyethylene lauryl ether, phosphate potassium salt, Laureth-10, Potassium octadecyl phosphate, Ceteareth-10, Ethylene vinyl acetate copolymer, Polyoxyethylene monoallyl ether, Polyethylene glycol monolaurate, Ditallowethyl hydroxyethylmonium methosulfate, PEG- 11 Castor oil, Calcium Salts of Fatty Acids, Titanium Dioxide, Pigment Blue 15, Pigment Yellow 83, Pigment Red 48:2, Black 2, Pigment red 57:2, Pigment White 6, Pigment Violet 23, Pigment white 21, Solvent blue 104, Polyoxyalkylene substituted chromophore (blue), Pigment red 52:1 Lavandula Angustifolia Flower Oil Aloe barbadensis Leaf Juice, Rosa Damascena Flower Water, Houttuynia Cordata oil, Borneol, Menthol, Cornmint oil, Ethylene Brassylate, Triethyl Citrate, Extract of Chamomile, Petrolatum, Behenyl Alcohol, Aloe vera, Vitamin E
Tampons
A cylindrical shaped menstrual collection device made to absorb menstrual blood when inserted into the vaginal canal
Pros
More comfortable fit than pads
Useful for water activities
Comes in a variety of flow sizes
Sometimes preferred for athletics
Minimally obtrusive when wearing clothing
Cons
Sometimes difficult or uncomfortable to insert
May cause vaginal irritation, microbiome issues, and dryness
Have to change frequently
Not recommended for bedtime
Large environmental impact
Exposure to fragrances and other toxins through vaginal mucosa and lack of transparency
Safety issues and risk of TSS
Safety
Can lead to urinary tract infections and bacterial vaginosis
Most tampons contain very low levels of dioxin, a known carcinogen
They become less safe to use if you don’t change tampons after defecating
Using too large of a tampon for your flow can dry out the natural mucosa of the vaginal canal
Because tampons are considered medical devices, there’s no labeling requirement for ingredients
In one study 22% were found to have PFAS “forever chemicals” and some were organic brands
Tampon ingredient disclosure generally included only eight common ingredients: rayon, cotton, polyethylene, polypropylene, polyester, wax, fragrance, fiber finishes
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More recent ingredient disclosures included: PEG Castor Oil, PEG Cocoate, Dialkyl sulfosuccinate, Glycerin, Ethoxylated Fatty Acid Esters, PEG-100 Stearate, Fatty Acid Polyglycol Ester, Plant Derived Oil, Cetearyl Alcohol, Oleyl Alcohol, Ceteareth-20, Ether & Ester based oil, Titanium Dioxide, Pigment White 6, C.I. Disperse Blue 60 (string), Disperse Yellow 235 (string) Dihexyl fumarate, Ethyl Undecylenate, Isobornyl Cyclohexanol, Phenoxy Ethyl Alcohol, Polysorbate 20, 4-tert-butylcyclohexyl acetate, alpha-isomethyl ionone, dipropylene glycol, ethylene brassylate, geraniol, hexyl cinnamal, isobutyl methyl tetrahydropyranol, limonene, linalool, methyl hydrogenated rosinate, methyldihydrojasmonate, pentadecalactone, tetramethyl acetyloctahydronaphthalenes (OTNE) Paraffin, Butyl Stearate, Carnauba Wax, Polymer Wax Dispersion
Cups
A U-shaped menstrual collection cup which is inserted in the vagina to collect blood flow
Pros
Lasts for about 10 years
Can be worn for many hours depending on flow
Minimal to no awareness once inserted properly
Produces less plastic waste
More ecological, contents can be composted
Cost effective
Can be boiled to sterilize
Healthier for vaginal canal
Sometimes preferred for athletics and travel
Safety
Less likely to contribute to yeast infections and bacterial vaginosis, according to some studies
Not recommended for everyone due to differences in anatomy, vaginal injuries, recently giving birth, or with conditions such as vaginismus or vulvodynia
Toxic Shock Syndrome risk is low but recent studies have confirmed it is still possible
Some evidence suggests that menstrual cups play a role in dislodging IUDs, however a study found no measurable difference comparing to other forms of internal menstrual products.
Almost all menstrual cups disclose just one ingredient: Medical grade silicone.
Cons
Insertion and removal can be difficult for some bodies
Sometimes cups exert pressure on the walls of the vaginal canal causing discomfort
Need to try different kinds to find the right fit, which can be costly
Can be prone to leakage
Cleaning the cup can be messy depending on the bathroom or facilities available
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Organopolysiloxane mixture, Silicon Dioxide, Silicon Oil, Hydroxyl-terminated.
Although many menstrual cups are colored, no dyes or colorants were ever disclosed for these products.
Discs
A menstrual collection device shaped as a shallow, circular disc that sits just below the cervix.to collect menstrual blood
Pros
Lasts for about 10 years
Can be worn for many hours depending on flow
Minimal to no awareness once inserted properly
Healthier for vaginal canal
Sometimes preferred for athletics and travel
Can be worn during insertion sex
Can be self-emptying (also known as “auto-dumping”) when the pelvic floor muscles contract while using the bathroom, causing the rim of the disc to momentarily move out of place and empty the disc.
Cons
May be reusable or disposable, which contributes to plastic waste
Costly
Insertion and removal can be difficult for some bodies
Sometimes discs exert pressure on the walls of the vaginal canal causing discomfort
Can be prone to leakage
Removing and cleaning the disc can be messy depending on the bathroom or facilities available
Safety
Menstrual discs are made from silicone or a combination of polymers of plastic and resins.
Not recommended for everyone due to differences in anatomy, vaginal injuries, recently giving birth, or with conditions such as vaginismus or vulvodynia
Menstrual discs largely disclose a single ingredient: Medical grade polymers. Other ingredients rarely disclosed included: Mineral oil Antioxidants, Natural carbon black
Absorbent Underwear and Clothing
Clothing that looks like typical underwear, but are designed to keep moisture away from your skin as they absorb menstrual blood
Pros
Lighter, more comfortable fit than pads
Can be worn for many hours
Useful for traveling and limited access to bathroom
Users report less cramping than internal products
Reusable
Cost Effective
Good for days leading up to or final days of menstruation when flow is low
Safety
In 2020, PFAS (chemicals with significant health impacts) were found in several brands of period underwear
Brands cannot be trusted to conduct their own safety profiles
See this guide for more brand information
The safest brands were The Period Company, Modibodi, Bambody, and Luna Pads
The worst brands were Thinx, Knix, Ruby Love, Saalt, and Sustain
Organic and non-toxic labels had no impact on the test results
Most period underwear products only disclosed ingredients on the product itself (in accordance with clothing labeling regulations), and not on the outer packaging as required by law. Ingredients commonly disclosed in period underwear included: Polyester, spandex, cotton, nylon
Cons
Requires washing and access to clean water and drying facilities
Can’t always handle very heavy flows
Limited brand choices
Safety issues
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Polyamide Elastane Lyocell Truetex Lycra Xtra Life Fresh Fix Technology Agion HANSA SP 1050 Lava-XL-N Colorant Carbon Polyurethane
Free Bleeding
The practice of intentionally menstruating without blocking or collecting the menstrual flow
Pros
Some people experience less menstrual pain and less cramping than with insertion products
Less susceptible of infection
Environmentally friendly
Fights social stigma of menstrual concealment
Less exposure to undisclosed chemicals
Encourages menstruating in a comfortable environment
Safety
Can increase the risk of spreading blood-borne diseases if blood is left in shared spaces. Don’t leave blood for someone else to clean up, there are ecological ways of disposing of menstrual blood such as diluting in water and watering the soil, burying it, or washing it off.
Cons
Not practical for public or shared spaces
Blood stains clothing and sheets so menstrual specific items may make the process more comfortable
Requires frequent access to water hygiene
Menstrual Collection Choice Is Personal
You don’t need a menstrual product if you don’t want one
Only you will know the right menstrual product for your needs
Preferences vary, even among the same person
Most people will try multiple products in their life or combine multiple products
Cost is the most influential factor in menstrual product access
There are pros and cons to every method of collection
Menstrual Collection Choice Is Political
discrimination via non-availability in public spaces
discrimination via tampon tax
discrimination via being refused school/work leave or retaliation
discrimination via lack of regulation to safe menstrual products
discrimination via stigma in advertising
discrimination during incarceration or homelessness
discrimination via religion or culture
What Can We Do?
Read ingredient listings on the product package and/or website.
Look for products that do not contain plastics (ingredients like polyester, polypropylene, or polyethylene).
If possible, select products that contain 100% cotton, without additional plastic layers.
Look for products made with simpler and fewer ingredients
Avoid fragranced products
Avoid products with colorants
Avoid products with additives like PEGs, which may be contaminated with ethylene oxide or 1,4 dioxane.
Pay attention to any symptoms that occur during the use of a product – and try another brand for a month to see if it makes a difference.
Use your voice to demand free, safer, and healthier products for ALL by engaging politically in a variety of ways
Set up menstrual routines, rituals, and practices that encourage you to have the best, most relaxing, and rejuvenating menstruation possible, and this includes your products of choice, or none at all!