Your guide to what’s in tampons, pads and whether ‘organic’ is better than not

Your guide to what’s in tampons, pads and whether ‘organic’ is better than not
  • PublishedDecember 5, 2023

If you’re someone who has periods, on average you will use around 10,000 to 12,000 menstrual products over the course of your lifetime.

That’s around five years of cumulative exposure time.

But many of us haven’t ever looked at what’s actually in the tampons and pads we grab from our bathroom cupboards each month.

Organic tampons and pads are billed as the safer alternative but there’s never been research comparing them with their ‘regular’ counterparts.

However a recent pilot study by New Zealand researchers tried to get some answers.

It looked at four major brands of tampons sold in New Zealand.

One of the brands was a 100 per cent cotton tampon made by a NZ-based company selling organic products, which also commissioned the study.

The other three brands were not identified, but were described as “commercially available brands”. The make-up of these tampons was not specified. 

The researchers detected “measurable oestrogen activity” in one of the unnamed tampon brands and concluded it had “significant” endocrine-disrupting activity.

That’s when chemicals can mimic, block or interfere with the body’s hormones, which are part of the endocrine system.

The three other brands had no measurable oestrogen activity.

The paper was reported on by some mainstream media outlets but experts have slammed it, accusing it of causing unnecessary alarm.

University of Adelaide molecular pharmacologist Ian Musgrave said the study’s claims created “unreasonable fear and worry” among tampon-users while gynaecologist Alex Polyakov from the University of Melbourne said “no meaningful conclusions” could be drawn from the research.

The main issue with the study according to Dr Musgrave and Dr Polyakov was that it didn’t determine which chemicals in the tampon brand were actually being labelled as disruptive.

On top of this, they said the amount of oestrogen detected was too small to even matter.

“By my calculations at the highest level it is around 5 or so picomole. Even if all this ‘oestrogenic material’ was released at once, this would have no biological effect,” Dr Musgrave said.

When contacted by ABC’s Media Watch, the study’s lead author Alison Heather, a professor of physiology at the University of Otago, said “Our pilot study did not establish a direct link between tampons and an increased risk of cancer.”

But she did not respond to additional requests by the ABC to discuss the arguments put forward by Dr Musgrave and Dr Polyakov.

While further research is needed in this area, let’s look at what we do already know and whether there’s any merit to organic alternatives.

Inside the tampon

The most common type of non-organic tampon you will see on a supermarket shelf has a ‘core’ made out of rayon, a semi-synthetic fibre made from natural sources.

Two kinds of plastics (polypropylene or polyester) are then commonly used for the outer surface of the tampon to aid with insertion and removal.

And depending on the brand, polyester, cotton or rayon is used for the string (which in Australia must be no less than 80 millimetres long).

In the past, tampon companies bleached the rayon with chlorine gas (known as elemental chlorine) but now they use chlorine dioxide. This is why you might see the term “elemental-chlorine free” on some tampon packaging.

Bleaching is done to eliminate impurities and clean the fibres. It also gives that sparkling white finish.

A diagram points out the core, outer shell and string of a tampon
A diagram showing the parts of a tampon.(Supplied: AHPMA)

On the flip side, tampons marketed as organic are normally plastic-free and made from 100 per cent certified organic cotton that’s grown without pesticides.

Many don’t use chlorine to bleach the cotton, opting instead for hydrogen peroxide (a natural disinfectant) to ensure the product is sterile.

Organic tampons don’t use fragrances but by the same token, most non-organic brands have eliminated these too.

It’s important to note organic products in Australia don’t need to meet a particular standard to be labelled as such.

However if the product says it’s “certified organic” (through an organic certification body, for example) they must be able to prove that claim.

If, for example, a company describes it’s product as organic but the Australian Competition and Consumer Commission finds it has synthetic chemicals in it, an infringement notice can be issued to the company.

On top of this, there are also also tampons made out of 100 per cent cotton that don’t claim to be organic.

For example, any brand that uses Australian-grown cotton won’t be able to claim organic status as there are no organic cotton farms anywhere in Australia.

Let’s talk chemicals

A by-product of bleaching with chlorine is something called dioxins — an environmental pollutant which has been linked to cancer.

However since tampon brands swapped out chlorine gas for chlorine dioxide, only trivial amounts of dioxins can be detected.

One study found the concentration of dioxins in tampons and diapers in the US was  13,000 to 240,000 times less than in people’s diets and the US Food and Drugs Administration has called the risk of effects from dioxins in tampons “negligible”.

Other chemicals present in ‘regular’ tampons include phthalates and bisphenol A (more commonly known as BPA) and bisphenol F.

These are used to make plastic products; phthalates are commonly found in cosmetics, while BPA is often used to make hard plastic items like re-usable water bottles.

But, Dr Musgrave says, you would have to be exposed to high levels of these chemicals  for them to be a health risk.

He says they are “insanely weak” as oestrogenic compounds, meaning they have little ability to mimic the body’s natural production of oestrogen.

Man with beard smiles in the lab
Ian Musgrave says the likelihood of these chemicals having an effect is low.(Supplied: University of Adelaide)

“You would have to be exposed to concentrations tens of thousands times higher than what a human would be exposed to under any conceivable circumstances,” he says.

“For bisphenol to have an oestrogenic effect you’d basically have to fall into a vat of it.”

Volatile organic compounds (VOCs) have also been detected. These are a suite of more than 100 toxic air pollutants, released by common household products such as aerosol sprays.

But again we’re talking about very small quantities in tampons.

“It’s the dose that makes the poison and we don’t have the evidence to suggest a significant problem,” says Dr Musgrave, who specialises in the toxicological impacts of everyday items.

“The levels are far too low to have any physiological effect.”

Parabens are also found in tampons. These are preservatives that prevent the growth of harmful bacteria.

They possess only weak oestrogenic effects and no studies to date have have been able to confirm links to hormone disruption or cancer.

Finally, although most of the big brands have eliminated fragrances, there are still some available with scents which can contain VOCs and phthalates.

Absorption

So we know these chemicals have been detected in tampons but can they actually leach into our body?

A major US review of all research on this topic said a key concern was how the vagina absorbed chemicals.

Vaginal tissue is highly vascular and permeable which means it’s highly absorptive.

There’s also something called the first uterine pass effect.

It means when drugs are administered vaginally they are delivered directly to the uterus, therefore circumventing metabolism.

The researchers who conducted the review said this suggested greater concentrations of the chemicals in tampons could interact with uterine tissue. 

But Dr Musgrave disagrees.

He says vaginal fluid isn’t very good at extracting polymers  — a category of natural and synthetic substances including plastics.

“It’s unlikely that any oestrogenic material (should it be present) will be fully released by the normal vaginal fluid.

“And the whole purpose of the tampon is to absorb things, not release them.”

So are organic cotton tampons safer?

The experts aren’t convinced.

“Just because some tampons are made from synthetic compounds doesn’t mean they’re better or worse,” Dr Polyakov says.

“So what  if a tampon has a bit of oestrogen on it — does it matter? Does it actually change the level of oestrogen in the blood or around the ovaries or the uterus? Probably not.”

Dr Polyakov also says just because organic tampons may be made from 100 per cent cotton doesn’t mean they are “pure”.

Studies have shown cotton plants can accumulate various metals, including lead, copper and zinc in different parts of the plant.

On top of this, research has shown organic tampons don’t necessarily have fewer VOCs than regular brands.

Instead, just make sure you’re buying tampons that are fragrance free, Dr Polyakov advises.

Dr Musgrave says the fact that vaginal oestrogen (in the form of a cream or gel) is used as a safe hormone replacement therapy should dull any concerns as it contains far higher levels of oestrogen.

He says research has also convincingly established low levels of phthalates, like those found in tampons, don’t increase cancer risk.

“And here we’re talking about concentrations of micrograms which translates to very low exposure for humans.”

It’s also worth noting there’s no evidence organic tampons are less likely to cause toxic shock syndrome (TSS) — the very rare but potentially life-threatening illness that’s been associated with tampon use.

What about pads, menstrual cups and period pants?

Pads and panty liners use synthetic plastic materials to improve their functionality so generally contain the same chemicals as tampons.

The US review actually found panty liners had higher phthalate levels than pads and tampons.

Another study found the levels of VOCs and phthalates detected in pads were below the daily exposure limit, with the exception of toluene (used to make adhesive).

A hand holding a menstrual cup that's folded for insertion
We don’t know enough about the chemicals present in menstrual cups yet.(Flickr: Menstruationstasse)

More research is needed on newer products such as menstrual cups and underwear but UK consumer body Which? recently found “notable” levels of silver in seven different brands of period pants sold in the UK.

Silver is an antimicrobial agent and added to period pants to combat odour but Which? could not work out what kind of silver was present in some of the absorbent pants.

Dr Musgrave said even the highest amount of silver found in one particular brand’s pants (which was 126.7miligrams per kilograms) would likely “not be an issue”.

The exception might be if someone had a silver allergy but those are rare, he says.

Earlier this year US underwear brand Thinx settled a $US5 million ($7 million) class action over harmful chemical substances known as PFAS (per- and polyfluoroalkyl substances) found in their period underwear.

However major Australian period underwear brands all claim they are PFAS-free.

SOURCE: ABCNEWS

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