It’s 2019, And I Still Don’t Know What’s In My Menstrual Products

I was eleven when I got my first period. Panicked, I called my mom to say my farewells, convinced I was bleeding to death.

She calmly told me I was fine and instructed me to find a bright-pink box of tampons under her sink. I inserted the tampon — applicator and all –– and uncomfortably awaited my mother’s return from the grocery store to explain why I did not have a terminal illness.

From that day on, until the age of age 27, I used that same name brand tampon my mother bought in bulk from Costco. It wasn’t until the recent surge of small companies in the menstrual product world were promoting all organic, chemical-free tampons and pads that I began to question what was in the tampons I had been using.

Was there any science to support the switch to organic? What are current regulations on our menstrual products?

The FDA Classifies Menstrual Products As Medical Devices

There’s a misconception that there is no Federal Drug Administration [FDA] regulation of menstrual products, but the FDA classifies tampons as medical devices and pads as “low risk” medical devices. The decision was made after 814 cases of Toxic Shock Syndrome were linked to a brand of high absorbency tampons in 1980. After tampons were classified as a medical device, manufacturers were required to place warning labels on their products.

In addition to warning labels, companies are required to submit “the results of testing to evaluate the safety of the materials used to make tampons and applicators (if present); tampons’ absorbency, strength, and integrity; and whether tampons enhance the growth of certain harmful bacteria or alter normal bacterial growth in the vagina.”

It’s All About the Bleaching Process

While tampons may start out free of chemical residue, a lot of problems can occur in the fiber bleaching process. Historically, tampon manufacturers would use chlorine gas to bleach the cotton and rayon fibers. This method was abandoned when it was discovered that the process produced dioxin compounds, a toxic byproduct that can cause reproductive and developmental issues, damage the immune system, interfere with hormones and, in some cases, cause cancer.

The FDA now has regulations in place that recommend tampons be free of dioxins and any pesticide and herbicide residues; manufacturers should disclose what bleaching process is used (Elemental Chlorine Free [ECF] or Totally Chlorine free). The FDA also requires proof that no chemical residues are present and IF they are present, what levels they are present at.

If you think the language used here leaves a lot of room for misinterpretation, that’s because it does. The regulations for pads get even more vague because of their classification as a low-risk medical device. Manufacturers don’t have to prove the non-existence of dioxins because they are used intra-labially and are outside the scope of intravaginal devices.

What Is Actually in Our Menstrual Products?

Generally speaking, tampons and pads are made out of a mixture of cotton, rayon and synthetic fibers.

HOWEVER — and it’s a big however — the exact ingredients for each manufacturer remain a mystery due to their “proprietary” nature.

We Need to Talk About TSS

If we don’t know what exactly is in our tampons, should I be worried about TSS?

Toxic shock syndrome (TSS) is the nightmare that haunts every prepubescent girls’ health education class. It is caused by the bacterium Staphylococcus aureus (S. aureus) and can result in high fever, nausea, vomiting, diarrhea, low blood pressure and skin rash. The reaction most commonly occurs in menstruators with the prolonged use of tampons in the presence of S. aureus –– which secretes toxins that enter the bloodstream through the uterus or tiny cuts within the vaginal lining.

There is little funding dedicated to research on the long-term side effects of synthetic fibers, trace amounts of dioxins and chemical fragrances. What we do know is you can still get TSS using organic tampons, because the most frequent causes are prolonged usage and choosing the wrong absorbency.

I know it’s tempting to put one super-jumbo tampon in for 12 hours and just change it at the end of the day, but choosing the appropriate tampon absorbency for your flow and changing your tampon every 4-8 hours is the best way to mitigate the risks of TSS.

While TSS is not a concern with pads, changing a pad frequently is also important to avoid any extra moisture that can make you prone to yeast or bacterial infections.

Menstrual Product Recalls

In December of this year, consumers reported “the U by Kotex® Sleek® Tampons, Regular Absorbency, unraveling and/or coming apart upon removal, and in some cases causing users to seek medical attention to remove tampon pieces left in the body. There also have been a small number of reports of infections, vaginal irritation, localized vaginal injury, and other symptoms.” Kimberly-Clark voluntarily recalled the tampon brand in particular, but not without calling into question whether or not the FDA guidelines are enforced or merely a suggestion.

There Isn’t Any Legislation to Make Menstrual Product Ingredients Transparent?

Unsurprisingly, transparency in menstrual products and agency over women’s reproductive health isn’t a top priority for a lot of our legislators.

There have been pushes to make manufacturers more transparent about their ingredients. Rep. Carolyn Maloney of New York has repeatedly brought the Feminine Hygiene Safety Act, a bill that would force companies to disclose the ingredients of their menstrual hygiene products to consumers, before congress numerous times without success. The act would also establish a program of research to study the effects of dioxin, synthetic fibers and chemical fragrances found in menstrual hygiene products.

Rep. Grace Meng of New York is also sponsoring the Menstrual Product Right to Know Act, which would require manufacturers to list the ingredients of their products on the packaging.

What Should I Be Looking For in Tampons or Pads?

With all of the regulations, lack of information and product recalls, it can be overwhelming to find a tampon or pad that works for you. Here are some factors to consider when you’re deciding:

1. Make sure your menstrual product of choice hasn’t recently had a recall (because if having a vagina wasn’t hard enough, we now have to worry about tampons falling apart inside of us)
2. If you are prone to irritation, avoid products with any synthetic fragrances or chemicals (which might be easier to do if your brand of choice fully discloses their ingredients)
3. If you’re looking for something more eco-friendly and sustainable, try applicator-free tampons and products made with biodegradable materials like compostable cotton, or plant based fibers from bamboo, corn or banana leaves

If you want products that meet this criteria, try Public Goods’ line of sustainable menstrual care:

• bamboo regular pad
• bamboo super pad
• bamboo overnight pad
• bamboo panty liner

Bio: Courtney Snavely is the co-founder of Ovee, an inclusive sexual and reproductive health platform for people with vaginas. Check it out for everything related to pelvic health and wellness, from treating chronic yeast infections and testing positive for HPV to extremely in-depth product reviews.