{"url":"https://whatshealthyandwhy.com/menstrual-products/tampons-pads-cups-and-period-underwear","path":"/menstrual-products/tampons-pads-cups-and-period-underwear","alternates":{"json":"https://whatshealthyandwhy.com/api/articles/menstrual-products/tampons-pads-cups-and-period-underwear.json","markdown":"https://whatshealthyandwhy.com/menstrual-products/tampons-pads-cups-and-period-underwear.md"},"topic":{"slug":"menstrual-products","name":"Menstrual Products","url":"https://whatshealthyandwhy.com/menstrual-products"},"slug":"tampons-pads-cups-and-period-underwear","order":1,"title":"Tampons, Pads, Cups, and Period Underwear","question":"What's in tampons, pads, and period underwear, and what is safest?","answer":"Period products may pose little chemical risk at normal use; trace metals and plasticizers are detectable, and no type is clearly safest.","description":"What lab tests found in tampons, pads and period underwear, how much it matters for your health, and how to choose between them, including cups.","confidence":2,"confidenceNote":"Most evidence is laboratory measurement of contents and release; almost no human studies link period-product use to health outcomes, and the FDA, academic and manufacturer analyses differ in emphasis.","evidenceSummary":{"rctCount":0,"observationalCount":0,"metaAnalysisCount":1,"totalParticipants":"3,319 (cup studies); no cohort data on tampons, pads or underwear","replicated":true,"newestStudyYear":2026},"category":{"categoryTitle":"What's Harming You","categorySlug":"harming-you","subcategoryName":"Personal Care & Beauty","subcategorySlug":"personal-care","url":"https://whatshealthyandwhy.com/explore/harming-you/personal-care"},"actions":["Use the lowest absorbency that handles your flow, change tampons every 4 to 8 hours, and never wear one for more than 8 hours [1].","For an alternative, try a menstrual cup: a review of 43 studies found leakage similar to or lower than pads or tampons, and no adverse effect on vaginal flora [2].","Favor brands that list materials and publish test results. Phthalate levels in sanitary pads differed 130-fold between brands, so the brand may matter [3]."],"cautions":["Sudden fever, rash, dizziness, vomiting or diarrhea during or soon after your period can be toxic shock syndrome: remove any tampon or cup and get urgent care [4].","Toxic shock syndrome is rare (0.03 to 0.50 cases per 100,000) but about 8% fatal [4].","If you have an IUD, ask your clinician before using a menstrual cup. The cup review recorded 13 reports of IUD dislodgement [2]."],"simpleText":"Tampons, pads and period underwear all contain traces of things you would rather avoid: metals in tampons [5], plasticizers in pads [3], and, in some textiles, PFAS [6]. Finding a chemical is not the same as being harmed by it, and no study we found shows harm from normal use. The better-understood risk is toxic shock syndrome, which is rare; FDA advises the lowest absorbency you need and a change every 4 to 8 hours [1][4].","mediumText":"How it works\n\nTampons: metals\n\nIn 30 tampons from 14 brands, all 16 metals tested were detected in at least one, including lead (geometric mean 120 nanograms per gram), cadmium and arsenic. Non-organic tampons had more lead and organic ones more arsenic, so neither group was consistently cleaner [5]. The key question is how much leaves the tampon. In a lab test, 22 tampons soaked for 8 hours in simulated vaginal or menstrual fluid released measurable amounts of up to 14 metals, but release in a test tube is not absorption by the body [7]. FDA scientists tested 11 tampons under exaggerated conditions and found margins of safety for every metal, \"negligible toxicological concern\" [8]. FDA also says FDA-authorized tampons use a bleaching process free of elemental chlorine, which prevents dangerous dioxin levels [1]. For medicines, vaginal absorption varies with the formulation, the patient's age and the point in the menstrual cycle [9], so absorption of tampon contaminants can be neither assumed nor ruled out.\n\nPads\n\nSanitary pads varied 5,900-fold between brands in volatile organic compounds and 130-fold in phthalates, with phthalates higher than in common plastics [3]. In 29 pads, toluene was found in 28 and polypropylene microplastic fibers in all. The four pads whose extracts did not suppress cell metabolism all had organic cotton topsheets [10].\n\nPeriod underwear\n\nTextile impregnation is one of the best-known uses of PFAS [6]. We found no peer-reviewed measurement of PFAS in period underwear, and no data on how much would reach your body. In lab skin models, short-chain PFAS were absorbed, while long-chain ones stayed in the skin tissue [11].\n\nCups and toxic shock\n\nA cup collects blood instead of absorbing it, and a systematic review judged cups a safe option [2]. Toxic shock syndrome (TSS) was first tied to tampons and is now seen as an interplay of bacterial toxins, immunity and vaginal changes; a few cases have followed cup use [4][2].\n\nWhat to do\n\nChoose what is comfortable and change it on time; no type has been shown to be clearly safer. For PFAS more generally, see Avoiding PFAS.","deepText":"The evidence in detail\n\nMetals in tampons\n\nA US research team measured 16 metals by mass spectrometry in 60 samples from 30 tampons (14 brands, 18 product lines). Every metal appeared in at least one tampon. Geometric means were 120 ng/g for lead, 6.74 for cadmium and 2.56 for arsenic. Concentrations differed by region (US versus EU/UK), organic status and store versus name brand [5]. They called lead a metal with no \"safe\" exposure level, and noted that no study had yet shown whether the metals leach and cross vaginal tissue.\n\nFollow-up work started to answer that. In 22 products tested at pH 4.2 and 7.4 for 8 hours at body temperature, 14 metals leached into simulated vaginal fluid and 12 into menstrual fluid. Mean lead was 40.3 ng (95% CI 6.94 to 73.7) in vaginal fluid and 15.6 ng (6.91 to 24.3) in menstrual fluid. Leaching fractions, calculated against metal totals reported in a different study, were imprecise; copper's was 233% with an interval from -87% to 553% [7]. The authors stress that release in vitro does not equal absorption. FDA scientists tested 11 legally marketed tampons under exaggerated conditions (50 degrees Celsius, 24 hours, acidified water). They found 19 metals, including trace arsenic, cadmium and lead, and every metal had a margin of safety, which they read as negligible toxicological concern [8]. FDA's consumer page repeats that very small amounts of metals can be detected in conventional and organic tampons and that the amount likely released is too small to cause harm [1].\n\nA 2022 review found nearly two dozen studies measuring contaminants in menstrual products. All found chemicals, but conclusions about exposure risk were discrepant. Only three human studies related product use to chemical levels in the body, and all saw associations [12].\n\nPads\n\nOne analysis found 5,900-fold differences in VOCs and 130-fold differences in phthalates between pad brands; VOC levels were similar to residential air but phthalates were higher than in common commercial plastics [3]. A 2025 study of 29 pads found toluene in 97% (below 0.04 to 2.79 micrograms per pad) and 6 to 115 polypropylene fibers per pad. Pad extracts cut cell viability by a median 39% in culture. Modeled toluene exposure was below the California occupational limit, and the authors called for transparency and further testing [10]. Only four pads, all labeled organic, left cells unaffected, a hint rather than a conclusion.\n\nPeriod underwear and PFAS\n\nThe PFAS literature shows a wide range of uses, including textile impregnation [6]. In human skin equivalents, perfluoropentanoic acid had 58.9% of the dose absorbed, while longer-chain compounds remained in the skin tissue instead [11]. That is laboratory evidence about the compounds, not about period underwear.\n\nCups\n\nThe systematic review included 43 studies (3,319 participants), only three of moderate-to-high quality among the 22 analyzed. In four studies comparing cups with usual products (293 participants), leakage was similar or lower. About 73% (95% CI 59 to 84) of users wanted to continue. Four studies in 507 women showed no adverse effect on vaginal flora. Reported harms included severe pain or vaginal wounds (5), allergy or rash (6), urinary complaints (9, three with hydronephrosis), TSS (5) and IUD dislodgement (13) [2].\n\nToxic shock syndrome\n\nMenstrual TSS incidence ranges from 0.03 to 0.50 per 100,000, with mortality around 8%. Tampon use was once seen as the main risk factor; understanding has since broadened to include S. aureus toxins, host immunity and vaginal changes during menstruation [4].\n\nWhere the evidence disagrees\n\nThe team that first measured tampon metals stressed that lead has no safe exposure level [5], while FDA scientists found negligible toxicological concern after a risk assessment with exaggerated release conditions [8]. Both can be right: a metal being present is not the same as it being released, and release is not absorption [7]. \"Organic\" gave a mixed picture, too: organic tampons had less lead but more arsenic [5], while the only pads that left cells unaffected were labeled organic [10]. The cup safety review is reassuring but rests mostly on low-quality studies [2].\n\nBottom line\n\nConfidence 2 of 5. Metals, plasticizers and other chemicals are measurable in period products, and brands differ widely. FDA's own risk assessment of tampon metals sees negligible concern, while academic teams call for more work; human data are scarce, and PFAS in period underwear is unmeasured in the peer-reviewed literature.","deepTruncated":false,"references":[{"id":"1","title":"The Facts on Tampons and Tampon Safety","authors":"U.S. Food and Drug Administration","year":2026,"journal":"FDA Consumer Update","url":"https://www.fda.gov/consumers/consumer-updates/facts-tampons-and-tampon-safety"},{"id":"2","title":"Menstrual cup use, leakage, acceptability, safety, and availability: a systematic review and meta-analysis","authors":"van Eijk AM, Zulaika G, Lenchner M, et al.","year":2019,"journal":"Lancet Public Health","pmid":"31324419","url":"https://pubmed.ncbi.nlm.nih.gov/31324419/"},{"id":"3","title":"Sanitary pads and diapers contain higher phthalate contents than those in common commercial plastic products","authors":"Park CJ, Barakat R, Ulanov A, et al.","year":2019,"journal":"Reprod Toxicol","pmid":"30659930","url":"https://pubmed.ncbi.nlm.nih.gov/30659930/"},{"id":"4","title":"Menstrual toxic shock syndrome: case report and systematic review of the literature","authors":"Berger S, Kunerl A, Wasmuth S, et al.","year":2019,"journal":"Lancet Infect Dis","pmid":"31151811","url":"https://pubmed.ncbi.nlm.nih.gov/31151811/"},{"id":"5","title":"Tampons as a source of exposure to metal(loid)s","authors":"Shearston JA, Upson K, Gordon M, et al.","year":2024,"journal":"Environ Int","pmid":"38963987","url":"https://pubmed.ncbi.nlm.nih.gov/38963987/"},{"id":"6","title":"An overview of the uses of per- and polyfluoroalkyl substances (PFAS)","authors":"Glüge J , Scheringer M , Cousins IT , et al.","year":2020,"journal":"Environ Sci Process Impacts","pmid":"33125022","url":"https://pubmed.ncbi.nlm.nih.gov/33125022/"},{"id":"7","title":"In vitro metal leaching from tampons under simulated vaginal and menstrual pH conditions","authors":"Kaneshiro GS, Martinez D, Hannoush H, et al.","year":2026,"journal":"AJOG Glob Rep","pmid":"42828226","url":"https://pubmed.ncbi.nlm.nih.gov/42828226/"},{"id":"8","title":"Do metals in tampons pose a health risk? A toxicological risk assessment study","authors":"Jin Y, Eppihimer M, Alam MS, et al.","year":2026,"journal":"Toxicol Sci","pmid":"42218823","url":"https://pubmed.ncbi.nlm.nih.gov/42218823/"},{"id":"9","title":"The vagina as a route for systemic drug delivery","authors":"Hussain A, Ahsan F","year":2005,"journal":"J Control Release","pmid":"15763615","url":"https://pubmed.ncbi.nlm.nih.gov/15763615/"},{"id":"10","title":"Safety assessment of commercial sanitary pads: Cytotoxicity, volatile organic compounds, and microplastics release","authors":"Germolus NP, Kim SN, Kim J, et al.","year":2025,"journal":"J Hazard Mater","pmid":"40886531","url":"https://pubmed.ncbi.nlm.nih.gov/40886531/"},{"id":"11","title":"Dermal bioavailability of perfluoroalkyl substances using in vitro 3D human skin equivalent models","authors":"Ragnarsdóttir O, Abou-Elwafa Abdallah M, Harrad S","year":2024,"journal":"Environ Int","pmid":"38810496","url":"https://pubmed.ncbi.nlm.nih.gov/38810496/"},{"id":"12","title":"Menstrual Products as a Source of Environmental Chemical Exposure: A Review from the Epidemiologic Perspective","authors":"Upson K, Shearston JA, Kioumourtzoglou MA","year":2022,"journal":"Curr Environ Health Rep","pmid":"35302185","url":"https://pubmed.ncbi.nlm.nih.gov/35302185/"}],"wordCount":1151,"source":{"path":"src/content/topics/menstrual-products/tampons-pads-cups-and-period-underwear.md"},"citeAs":"“What's in tampons, pads, and period underwear, and what is safest?.” What's Healthy and Why. https://whatshealthyandwhy.com/menstrual-products/tampons-pads-cups-and-period-underwear","notice":"General information backed by peer-reviewed research, not medical advice."}