(No) reason to see red

Heavy metals and pesticides in tampons

In 2024, American researchers detected traces of 16 metals – including heavy metals such as arsenic, lead, and cadmium – in tampons from various manufacturers, including those from the EU. Furthermore, in 2015 and 2016, small amounts of pesticide residues were detected in different hygiene products made of cotton. “Because tampons consist primarily of cotton, this possibility cannot be entirely excluded,” explains Suna Nicolai, whose work at the German Federal Institute for Risk Assessment (BfRshort forGerman Federal Institute for Risk Assessment) concerns the safety of consumer products. The rayon staple and cotton used in tampons should comply with the purity requirements of the European Pharmacopoeia for nonsterile sanitary cotton made from cotton and viscose. These requirements mandate that pesticide residues should be limited to a technically unavoidable minimum level. “In the view of the BfRshort forGerman Federal Institute for Risk Assessment, health impairments from pesticide residues and heavy metals in tampons are not to be expected, even in case of complete uptake via the mucous membranes,” Nicolai says in conclusion.

Alternatives - limited data

Today, reusable alternatives are commonly used among the available period products. These alternatives include menstrual cups which are typically made of medical grade silicone. Thermoplastic elastomers (rubber-like plastics) or natural rubber are also used. Depending on the material, different residues may be present in the menstrual cups. The available data on potential health risks is limited. However, initial data gathered by consumer protection authorities do not suggest that health impairments are to be expected. 

Menstrual sponges, including those made from sea sponges, are considered another sustainable alternative. The BfRshort forGerman Federal Institute for Risk Assessment has not yet conducted a health risk assessment for menstrual sponges. However, there are concerns regarding exposure to bacteria, mould, and residues for example from clams.

Hygiene matters

Hygiene should be particularly prioritised in relation to period products which are inserted into the body (tampons, menstrual cups, and menstrual sponges). Measures include thorough hand washing, cleaning of reusable products, and regular changing of inserted products. This reduces the risk of toxic shock syndrome (TSS). TSS is a rare, sudden-onset illness caused by bacteria. It can result in fever, headache or rash. Severe cases can lead to life-threatening conditions such as multiple organ or heart failure. 

For many women, period underwear is a welcome alternative. Blood is absorbed by a multi-layer insert integrated into the underwear. In order to combat bacterial growth and unpleasant odours, some manufacturers include biocides such as silver chloride in these products.

Biocides - missing approval

“Biocides must be approved before use. For many so-called old active substances which were already in use prior to May 2000, European approval processes are still ongoing. These substances can be used in period underwear until the processes have concluded,” explains Dr Vera Ritz, who oversees the health assessment of biocides at the BfRshort forGerman Federal Institute for Risk Assessment. Until then, however, the manufacturers are required to provide a safe and effective product and fulfil their labelling and information obligations. 

“Depending on the substance characteristics and on the concentration, biocides may have health effects, including allergic reactions or disturbances of the skin’s bacterial flora,” says Ritz. When in doubt, the BfRshort forGerman Federal Institute for Risk Assessment recommends using other products until the approval process has concluded.