Approximately 26% of the total global population is of reproductive age and experiences a menstrual cycle, which equates to about half of the global population who are women (House et al. 2012; Kim 2021). During menstruation, menstrual products are used to collect blood and other vaginal discharge from the vaginal opening. Menstrual products include sanitary pads, tampons, cups, panty liners, and sponges. The most frequently used menstrual hygiene products in the United States are sanitary pads and tampons (UT Health Austin 2020). Menstrual product use may increase the exposure risk to certain hazardous chemicals. Further, several risk factors may contribute to exposure including frequency, duration of use of menstrual products, and enhanced permeability of the vulvar and vaginal tissues. In particular, this permeability allows water, soluble proteins, and certain chemicals to pass through the vaginal and vulvar epithelium at an increased rate compared to the epithelium covering the rest of the body(Anderson et al. 2014).
This paper focuses on dioxins, furans, and phthalates due to public concern, chemical persistence, and historical detection of these compounds in sanitary pads and tampons. Dioxins and furans are byproducts of the bleaching process with varied toxicities based on their binding affinities to the aryl hydrocarbon receptor and are persistent organic pollutants. Dioxins and furans are associated with carcinogenicity and reproductive and developmental toxicity. Phthalates are plasticizers, that can be of low or high molecular weight. Higher molecular weight phthalates can potentially bioaccumulate and are often more toxic compared to low molecular weight phthalates. Phthalates are known endocrine disrupters.
Current literature was reviewed to evaluate the hazard traits and exposure of dioxins, furans, and phthalates from menstrual product use. The evaluation criteria outlined in the California Departments of Toxic Substances Control (DTSC) Safer Consumer products (SCP) regulations were used to evaluate whether there is exposure to these chemicals in sanitary pads and tampons and whether this exposure can cause or contribute to significant or widespread adverse impacts.
The concentration of chemicals in sanitary pads and tampons reported in the literature varied. Polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans were typically below or at detectable limits or typical environmental background levels. Dioxin and furan exposure is not considered to be significant in tampons and sanitary pads.
Phthalates were above the limits of detection, ranging from 0.205-11.942 µg/g with tampons accounting for 15.2% and pads 2.9% of total phthalate exposure. This level of exposure from phthalates from tampons and sanitary pads indicates a potential increased risk of reproductive, developmental, and endocrine disrupting health concerns. Di(2-ethylhexyl) phthalate (DEHP) was detected in all sanitary products in the studies evaluated, with concentrations highest in tampons versus sanitary pads. This evidence suggests that exposure to phthalates in tampons and sanitary pads is of concern.