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ATLANTA — The average menstruating woman will spend about five years of her total reproductive lifespan using an estimated 11,000 tampons, sanitary pads, panty liners and other menstrual products, experts say.
Past research has found tampons and other menstrual products may contain chemicals such as perfluoroalkyl and polyfluoroalkyl substances, or PFAS; plasticizers, also known as phthalates; and volatile organic compounds, emitted as gas or fragrances from many consumer products.
All these chemical groups have been shown to disrupt the body's endocrine system, which regulates sexual development, metabolism, blood sugar, mood, sleep and more.
Recently, a small pilot study found arsenic and lead in organic and nonorganic tampons — and while the levels were small, there is no safe level of exposure to lead, according to the U.S. Environmental Protection Agency.
However, that study was unable to determine whether heavy metals might leach from tampons into the body, thus making any potential health impact unknown, said senior study author Kathrin Schilling, assistant professor of environmental health sciences at Columbia University's Mailman School of Public Health in New York City.
"I do not want people to panic but to be aware that heavy metals have been found in these menstrual products," Schilling said. "Obviously, the next step is to do research that would show if the metals leach from the tampon into the body."
The study was also unable to determine whether any metal, even if released into the body, can be absorbed into the vaginal lining and subsequently into the bloodstream, said Amanda Hils, a spokeswoman for the Food and Drug Administration, which regulates tampons and other menstrual products as medical devices.
"We plan to evaluate the study closely and take any action warranted to safeguard the health of consumers who use these products," Hils said in an email.
Vaginal tissue is more permeable than other parts of the body, so if studies were to find that heavy metals — or worrisome chemicals — do leach from menstrual products into the body, it could be a significant problem, said Anna Pollack, associate professor of global and community health at George Mason University in Fairfax, Virginia. She was not involved in the pilot study.
"I am most concerned with menstrual products that are used inside the body," said Pollack, who coauthored a review of 10 years of studies on contaminants in tampons, sanitary pads, menstrual cups and other products.
"However, there is no reason for people to be afraid to use menstrual products at this time," she added. "I would just be aware of the issue and monitor any research that develops."
Heavy metals in tampons
Schilling and her team tested 30 tampons from 14 brands purchased from major online retailers and stores in the United States, United Kingdom and Greece. The researchers conducted a blinded study, so they did not know the brands.
The team ran tests for 16 heavy metals: arsenic, barium, calcium, cadmium, cobalt, chromium, copper, iron, manganese, mercury, nickel, lead, selenium, strontium, vanadium and zinc.
"We found an average of 100 nanograms per gram of lead, and two nanograms per gram of arsenic in the tampons," Schilling said, "but there was no detectable level of chromium and no detectable level of mercury, which is very good."
Organic tampons contained higher levels of arsenic, while nonorganic tampons had higher levels of lead, the study found.
"The average lead concentration in tampons was about 10 times higher than the maximum levels currently allowed in drinking water," Schilling said, adding that arsenic levels were five times lower than current limits for drinking water.
"It's important to note that arsenic shouldn't be present in tampons at all, and we don't yet understand the effects of vaginal exposure since it hasn't been studied," she said. "There is no safe level of lead exposure, and it has been shown to cause reproductive health issues in women."
Most tampons are made of cotton or a mixture of cotton and rayon, a semi-synthetic fiber made from wood pulp. Arsenic is a natural element found in soil, water and air, while lead and other heavy metals are a natural part of Earth's crust — so plants can easily absorb metals as they develop.
"As the Centers for Disease Control and Prevention emphasizes, 'The measurement of an environmental chemical in a person's blood or urine is a measure of exposure; it does not by itself mean that the chemical causes disease or an adverse effect,'" a spokesperson for the council told CNN.
How to protect yourself
Tampon makers and the FDA recommend that tampons not be used at night or for longer than eight hours due to a greater risk of toxic shock syndrome, a deadly bacterial infection that can cause organ failure and death if not treated.
That advice also applies to anyone concerned about heavy metals or chemicals in their menstrual products, said Nancy King Reame, professor emerita of health promotion and risk reduction at the School of Nursing at Columbia University Medical Center.
"But because the vaginal microbiome, including menstrual fluid, is the least understood organ system in the body, real world advice on the use of period products based on these findings is premature to say the least," said Reame, who assisted on the tampon study.
Other recommendations include washing your hands before and after inserting or removing a tampon to reduce bacterial spread, changing tampons every four to eight hours and using the lowest absorbency possible.
"If you can wear one tampon up to eight hours without changing it, the absorbency may be too high," the FDA noted on its website.
Signs of toxic shock, which include a sudden high fever, diarrhea, dizziness, vomiting or a rash that looks like a sunburn, need immediate medical attention.
In addition, "if you have discomfort, pain or other unexpected symptoms like unusual discharge when trying to insert or wear a tampon, or if you have an allergic reaction, stop using tampons and contact your provider," the FDA said.
