Imagine a parent who feeds a child food laden with toxic metals like cadmium and lead. Then imagine a middle-aged woman who applies poisonous arsenic skin treatments to her face every month. Both of these scenarios are horrifying. Depending on the amounts of the dangerous metals involved, the one-time ingestion of a food item or use of a facial cream might not pose a danger to human health. Repeated over time, though, exposure to these chemicals poses a substantial health risk, potentially causing severe neurological, renal, cardiovascular, and reproductive health issues. For billions of girls, women, and other people who menstruate, using tampons may expose them to harmful levels of metals like lead, cadmium, and arsenic. In a first-of-its-kind study, a team of US-based researchers has brought to light the alarming levels of toxic metals found in tampons – raising important questions about tampon safety.
Tampons and Metal Contamination
In “Tampons as a Source of Exposure to Metal(loid)s” by Shearston et al., published in Environment International, researchers report striking findings: 16 metal(loid)s were found in 14 various tampon brands. All of the tampons tested had measurable concentrations of metals. Furthermore, all the tested products contained lead, cadmium, and arsenic at a level that could pose health risks. The researchers found lead, in particular, in all samples, which is particularly alarming because there is no safe level of lead exposure. Similarly, cadmium and arsenic, both known carcinogens, were detected in significant amounts.
Because vaginally absorbed chemicals directly enter systemic circulation throughout the body, the researchers explained that it is crucial to conduct further studies to “assess whether metals can leach out of tampons and become bioaccessible for vaginal absorption.” Given the presence of these toxic metals, the concern warrants immediate industry and regulatory attention.
Regulatory Gaps and Health Risks
Regulatory frameworks in the US, the EU, and the UK are notably insufficient in addressing the safety of menstrual products. In the US, the Food and Drug Administration (FDA) classifies tampons as Class II devices, meaning that manufacturers must register with the FDA and comply with specific regulations for performance standards, postmarket surveillance, patient registries, and special labeling requirements. But manufacturers are not required to disclose the complete list of ingredients or conduct long-term safety studies for chemical or metal contaminants in these products. Manufacturers are not required to affirmatively demonstrate that their products are safe, either. Similarly, regulations in the EU and UK are lax, relying on voluntary industry codes of practice that do not require comprehensive testing for harmful chemicals.
The consequences of the failure to protect the health of those who menstruate from potential toxic exposures could be severe. The detected levels of lead, cadmium, and arsenic in tampons exceed what is considered safe for textiles that one wears on the outside of the body.
It is simply not known how much more dangerous these metals are when used in products placed inside the body, let alone inside the body for several days every month, every year, for approximately 35 to 40 years. This tampon safety gap underscores the urgent need for manufacturers and regulators to cooperate to ensure the safety of menstrual products.
Recommendations for Reform
In our book “Menstruation Matters: Challenging the Law’s Silence on Periods,” we emphasize the need for comprehensive legal and regulatory frameworks to safeguard the health of those who menstruate. We also explain reasons that industry might choose to voluntarily adopt “clean and green” standards for contaminant-free menstrual products. Given the empirical evidence provided by Shearston et al. of the health risks posed by menstrual products, we urge governments to regulate menstrual products more stringently and incentivize companies to produce safe products. In particular, we recommend:
- Mandate Comprehensive Labeling: Federal laws should require manufacturers to disclose all ingredients and chemicals used in menstrual products, similar to the labeling requirements for food and clothing. Under New York’s 2019 Menstrual Product Right to Know Act, manufacturers must disclose a list of ingredients on the packaging of menstrual products sold in the state. However, because the law requires disclosure of only “intentionally added” ingredients, manufacturers are not required to disclose all chemical components of a product, particularly those that might be present as contaminants or byproducts. Such watered-down state legislation is not sufficient. On the federal level, the proposed Robin Danielson Menstrual Product and Intimate Care Product Safety Act would require the National Institutes of Health to study the health impacts of menstrual products; it has been introduced into the US Congress several times but never gained traction.
- Health and Environmental Impact Studies: Additional research on the health impacts of menstrual products is needed to replicate the findings of Shearston et.al., and on the potential for these metals to leach out of tampons into the bodies of tampon users. Congress should revive the Tampon Safety and Research Act, introduced in the House of Representatives multiple times since 1997, but never passed. Products that are unsafe for humans should not pollute our waterways and land either, and we need guidelines for sustainable manufacturing practices.
- Regular Testing and Certification: Implement mandatory testing of menstrual products for chemical contaminants, conducted by independent laboratories, and require manufacturers to certify the safety of their products.
- Enhanced Regulatory Oversight: Reclassify menstrual products as Class III medical devices, subjecting them to more stringent pre-market approvals and safety evaluations. To be sure, menstruation is not a “medical” event; it is an inevitable part of life for approximately half the population. For that reason, there could be stand-alone national legislation that sets strict limits on the level of chemicals posing a substantial health risk that can be used in menstrual products The government can and does regulate the presence of lead in products for children, for example. It should do so for menstrual products, too.
- Public Awareness Campaigns: Increase public awareness about the potential health risks associated with certain menstrual products and promote the use of safer alternatives through education and advocacy.
Potential Roadblocks to Regulating Tampon Safety
In the United States, the ability of the FDA to regulate products—menstrual and otherwise—will be complicated by the Supreme Court’s recent decision in Loper Bright Enterprises v. Raimondo. Previously, federal agencies received deference for reasonable interpretations of ambiguous statutes within their regulatory domain. Now that this doctrine has been overturned, all regulatory agencies’ power will be more limited.
In the case of menstrual products, the FDA’s capacity to enforce stringent safety standards on menstrual products is weakened after Loper Bright. The judicial shift places an even greater burden on Congress to take action to protect public health.
The presence of toxic metals and chemicals of concern in menstrual products is a public health issue that calls for decisive action. Since the 1970s, the public has been raising concerns about potentially dangerous materials in tampons and other menstrual products. Even before the publication of this work by Shearston et al., scientists have raised the alarm about rash-causing chemicals in scented menstrual pads, the presence of endocrine-disrupting volatile organic compounds in menstrual pads (as well as diapers), and toxic chemicals in period underwear. To the extent possible, regulatory bodies should mandate rigorous testing of menstrual products for metal and chemical contaminants and enforce strict limits on permissible levels. Manufacturers should voluntarily adopt policies that provide transparency in the sourcing and manufacturing processes of their products, decrease the level of metals and chemicals of concern, and fully inform customers of the health risks. The findings from “Tampons as a Source of Exposure to Metal(loid)s” provide a compelling impetus for this much-needed reform. The health and well-being of all who menstruate is at stake.
Bridget J. Crawford and Emily Gold Waldman are professors at the Elisabeth Haub School of Law at Pace University and the authors of Menstruation Matters: Challenging the Law’s Silence on Periods (NYU Press 2022)
Photo Credit: Istock.com/Hitra
