The monthly dilemma


Are tampons hazardous to your health?

After toxic shock syndrome (TSS) affected 15,000 U.S. women and was fatal to more than 2,000 in the years 1980-1984, there were a number of changes made in how tampons are manufactured. Instructions are now included in all packages for ways to best avoid TSS, and women have become more educated about the proper use of tampons. The FDA created a regulated system of absorbency strengths after the TSS scare, so we don’t have to worry about getting sick from using a tampon-true?

The answer may not be cut and dried, according to Annemarie Bossert, an adjunct professor in the biology department at the College of St. Catherine. Bossert has raised concerns about tampons in her Biology of Women class, and her classes have conducted lab experiments on tampons. “I think women should truly question what they are putting into their bodies,” Bossert said, “as a consumer, as a woman, as someone with common sense.”

“Natural” alternatives

Along with the growing trend of organic and natural foods, companies have developed feminine hygiene products that are marketed as natural alternatives. These products can reduce the irritation problems many women experience, and help them feel safer about what they are putting their bodies. With organic products, there is the added assurance that no pesticides and herbicides have been used.

Relatively few women are well informed about alternatives to tampons because they are not as readily available as other commercial products. All-cotton and organic products tend to cost 10 to 20 percent more than mainstream products. There are also reusable products that help reduce waste and therefore benefit the environment. These include reusable cups called the Keeper, Diva Cup and Moon Cup, washable pads called Glad Rags, and even sea sponges. Alternative products can be found at organic food stores and co-ops, as well as online.

The price of convenience

Tampons are a manufacturer’s dream product: Between 53 and 70 percent of American women use them, and the average woman uses as many as 12,000 in her lifetime. Most popular-brand feminine hygiene products are made from a blend of bleached cotton and/or synthetic ingredients such as rayon, viscose and plastic.

While the uproar about TSS died down when women became educated about how to prevent it -changing tampons at least every four hours, avoiding high absorbency tampons-women like Bossert are concerned about whether the chemicals women are putting into their bodies four times per day, five days per month, 12 months per year, for 30 or 40 years have long-term effects.

Manufacturers say they have turned to including synthetic materials in their tampons because consumers demand absorbency and small size. But the tissue and skin around the vulva is sensitive and delicate, and for some women these chemicals can cause irritation. Should the FDA ban synthetic ingredients-or at the very least, carry some sort of warning or list of ingredients?

The Food and Drug Administration (FDA), the government agency charged with regulating feminine hygiene products, seems to talk out of both sides of its mouth on the issue. While the agency’s Kris Mejia said, “To obtain FDA approval, companies must demonstrate a reasonable assurance of safety and effectiveness, ” FDA documents for the guidance of the industry and FDA staff include the words “contains nonbinding recommendations” on the top of each page. The guidelines document states: “FDA’s guidance documents, including this guidance, do not establish legally enforceable responsibilities. Instead, guidances describe the Agency’s current thinking on a topic and should be viewed only as recommendations, unless specific regulatory or statutory requirements are cited.” Clearly, the manufacturers of these products can use their own judgment when considering what materials to use. And the FDA only recommends that manufacturers list ingredients on their packaging. Terms like “cotton and/or rayon” and “fragrance” can be seen on tampon boxes.

Washington’s watching

Though there’s been no great outcry about their safety, Bossert’s not the only one concerned about tampons that include synthetic materials. According to Congresswoman Carolyn Maloney, D-NY, “reliable and independent studies have not been done” to test the safety of these products. In 1997, Maloney introduced in Congress the Tampon Safety and Research Act of 1997 (since renamed the Robin Danielson Act after a victim of TSS who died in 1998). The bill required the establishment of “a program of research regarding the risks posed by the presence of dioxin, synthetic fibers, and other additives in feminine hygiene and other related products that pose any health risks to women including endometriosis and breast, ovarian, and cervical cancers,” Maloney said. The legislation would establish a program for the collection and analysis of data on toxic shock syndrome.

“I introduced this legislation so that American women can make educated consumer decisions about a product that has the potential to endanger their health and their lives,” Maloney said in a press release in 2003. She plans to reintroduce the bill into the 110th Congress this fall.

Testing them out

Professors at the College of St. Catherine are hoping to raise awareness and encourage their students to think about women’s safety. Most of the college’s “Biology of Women” classes are participating in lab work involving tampons. “We thought it would be interesting for students to look at menstrual products and to question whether there are any things about them that are concerning,” Bossert said. The students have found that fibers fall off when you place a tampon in a jar of water, and that the scent of scented tampons remains strong in the jar long after you dump out the water and tampon. Bossert is quick to affirm that these are not conclusive research experiments, but rather are designed to make the students think. “I’ve been doing this for a long time and I would not make any claims at all, I would never say ‘Oh these are harmful,’ but I certainly would never say ‘Hey, these are safe,'” she said.

How much dioxin is safe?

One of the big questions for advocates, such as Bossert and Maloney: Can the chlorine used in the bleaching process of production release dioxin, a known carcinogen, into a woman’s vagina and uterus? According to the FDA, major tampon manufacturers have tested their products for dioxin. Data show that dioxin levels in tampons range from undetectable to 1 part in 3 trillion. This is believed to be far below any risk level. But some people are still skeptical.

According to the Environmental Protection Agency, “One of the main concerns over health effects for dioxins is the risk of cancer in adults. Several studies suggest that workers exposed to high levels of dioxins at their workplace over many years have an increased risk of cancer. Animal studies have also shown an increased risk of cancer from long-term exposure to dioxins.”

Based on data from animal studies, “There is some concern that exposure to low levels of dioxins over long periods (or high level exposures at sensitive times) might result in reproductive or developmental effects.”

Does 12,000 tampons qualify as repeated exposure? No research has been done to answer that question. Want to learn more?

For more information about Carolyn Maloney’s legislation, go to and click on “My Work in Congress” and then scroll down to “Women’s issues” and select “Tampon Safety.”