Tampon Safety

Susan Dudley, PhD, Salwa Nassar, Emily Hartman, and Sandy Wang, National Center for Health Research

A widely circulated rumor on the Internet alleges that tampons are contaminated with asbestos and dioxin, and that the rayon in some tampons causes toxic shock syndrome. What are the facts?

U.S. women spend about $3 billion/year on sanitary protection.[1] Approximately 55% of white women of reproductive age, 31% of Black women, and 22% of Hispanic women report using tampons.[2] Women deserve to know if tampons have unnecessary risks, but the Food and Drug Administration (FDA), which regulates the safety and effectiveness of tampons as a medical device, merely issued a statement claiming that the available scientific evidence does not support the rumors. It does not adequately address women’s questions and concerns, and relied on data that were submitted by tampon manufacturers that are not publicly available.[3]

Dioxin and Rayon

Dioxin is the byproduct of the process from converting wood pulp into a synthetic fiber called Rayon, which is also used for fabric. Tampons are usually made of cotton and rayon. Up until the late 1990’s, bleaching the wood pulp resulted in traces of dioxin in tampons, but that method has been replaced with a chlorine-free bleaching process.[3]

In 1994, the Environmental Protection Agency (EPA) issued a report stating that dioxins are known to cause cancer in animals, and probably cause cancer in people. The EPA also has determined that people exposed to high levels of dioxins may be at risk for a damaged immune system, increased risk of pelvic inflammatory disease (PID), and reduced fertility. One study found that 80% of monkeys exposed to dioxin developed endometriosis, a painful disease in which uterine tissue is found outside the uterus, frequently leading to infertility.[4]

While the dioxin hazard has been reduced because of new bleaching methods, dioxin is still detected in tampons — even those made of 100% cotton. The EPA states that, due to decades of pollution, dioxin can be found in the air, water, and ground; thus, small amounts of dioxin may be present in the cotton or wood pulp raw materials used to make tampons. The FDA website reports that tampon manufacturers have provided the agency with results from studies conducted at independent laboratories, which concluded that the dioxin in the rayon raw materials range from undetectable 0.1 to 1 parts per trillion. Although the FDA currently requires tampon manufacturers to monitor dioxin levels in their finished products, the results are not available to the public.[3]

A study by Michel DeVito and Arnold Schecter, published in Environmental Health Perspectives in 2002, concluded that exposure to dioxin in tampons (and diapers) is thousands of times less than the dioxin people typically consume in the food they eat. There was no meaningful difference in dioxin exposure from 100% cotton tampons (or diapers) compared to cotton/pulp products. Tampons and diapers sold in health food stores or special ordered were not safer than brand name products. In fact, tampons ordered from a specialty company had much more dioxin than the other tampons. DeVito and Schecter suggest that women who want to reduce their exposure to dioxin, and policy makers with similar concerns, should focus on reducing dioxin in the food we eat, rather than tampons.[4]

The FDA says that the exposure to dioxin from tampons today “is many times less than normally present in the body from other environmental sources.”3 However, according to Dr. Philip Tierno, director of clinical microbiology and diagnostic immunology at the New York University Medical Center and a leading expert on the health risks of tampons, even trace amounts of dioxin are cause for concern because tampons come in contact with vaginal tissue, which is covered in permeable, mucous membranes leading directly to the reproductive organs. In addition, based on an average woman’s menstrual cycles, about 12,000 tampons per lifetime is possible. The cumulative effects would therefore be considerable and possibly measurable for many years.[5]

Toxic Shock Syndrome (TSS)

Toxic Shock Syndrome is a rare but potentially fatal disease caused by a bacterial toxin, has also been associated with tampon use. Although the exact connection remains unclear, use of high-absorbency tampons produced with rayon and leaving tampons in for an extended period of time seem to increase the risk of TSS. The disease, which was first described among teenage girls in 1978, primarily strikes tampon users under the age of 30.[3] The TSS epidemic reached a peak in 1980 with a total of 814 cases, including 38 deaths, reported to the Centers for Disease Control and Prevention (CDC). After publicity about TSS caused by tampons in 1980, the most absorbent tampons were taken off the market, and women and teenagers were warned about potential risks. The CDC noted that the number of menstrual-related TSS cases decreased significantly between 1980 and 1990, while the number of TSS from other causes has remained he same.[6]

Rana Hajjeh, M.D., a medical epidemiologist with CDC’s division of bacterial and mycotic diseases, attributes the drop in TSS cases to the advances in the way FDA regulates tampon materials and absorbency. In 1982, the FDA required that all tampon labels advise women to use the lowest absorbency needed to control their flow and include TSS warning signs. The agency also standardized absorbency labeling in 1990 so that absorbency terms (e.g. regular, super, etc.) are consistent across brands.3 Another possible reason for this reported decrease is because tampon manufacturers have removed three of the four synthetic ingredients (polyester, carboxymethylcellulose, and polyacrylate rayon), which were associated with the increase production of TSS toxin, and were previously used in tampons to enhance absorbency. However, highly absorbent viscose rayon, the fourth synthetic ingredient, is still used.[3]

Asbestos

The asbestos alleged in the Internet rumor has never been confirmed. The email message claims that manufacturers add asbestos to tampons to promote excessive bleeding in order to sell more of their product. The FDA says they review all industry-supplied data on the design and materials of all tampons before they are marketed in the U.S., and that asbestos is not an ingredient in any tampon brand. Moreover, because tampon manufacturers are subject to FDA inspection, the agency assures women that “these inspections would likely identify any procedures that would expose tampon products to asbestos.”[3]

Legislation in Congress

Starting in 2008, U.S. Representative Carolyn Maloney of New York introduced legislation to require studies of tampon safety. The most recent version of the bill, now called the Robin Danielson Feminine Hygiene Product Safety Act of 2017 (H.R. 2379), was also introduced by Rep. Carolyn Maloney and “requires NIH to study the contaminants and substances used, such as dioxin, synthetic fibers, fragrances, dyes, and preservatives in feminine hygiene products pose health risks to women who use the products or to the children of women who use the products during or before pregnancy.”[6]

Alternatives and Recommendations 

Several alternatives are available to women, including all-cotton tampons and pads that are unbleached or are whitened with hydrogen peroxide and reusable menstrual cups. As noted above, there is no scientific evidence that these products are safer. The use of any types of menstrual pads, however, can reduce the risk of TSS. The FDA recommends women use tampons only during active menstruation and use ones with the minimum absorbency necessary to control their menstrual flow. They also encourage women to speak with their doctor about TSS.[3]

To read more about the FDA’s recommendations, click here.

All articles on our website have been approved by Dr. Diana Zuckerman and other senior staff.

  1. Sanitary Protection in the US. (2015). Retrieved from http://www.euromonitor.com/sanitary-protection-in-the-us/report
  2. Branch, F., Woodruff, T. J., Mitro, S. D., & Zota, A. R. (2015). Vaginal douching and racial/ethnic disparities in phthalates exposures among reproductive-aged women: National Health and Nutrition Examination Survey 2001–2004. Environmental Health Environ Health, 14(1)
  3. S. Food and Drug Administration: Tampons and Asbestos, Dioxin, & Toxic Shock Syndrome. (2015). Retrieved from http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/PatientAlerts/ucm070003.htm
  4. De Vito, MJ and Schecter A. Exposure Assessment to Dioxins from the Use of Tampons and Diapers,Environmental Health Perspectives, Vol 110, January 2002, available at  http://www.ehponline.org/members/2002/110p23-28devito/EHP110p23PDF.PDF
  5.  Kounang, N. (2015). What’s in your pad or tampon? Retrieved from http://www.cnn.com/2015/11/13/health/whats-in-your-pad-or-tampon/
  6. H.R. 2379 Robin Danielson Feminine Hygiene Product Safety Act of 2017. (2017). Retrieved from https://www.congress.gov/bill/115th-congress/house-bill/2379/text