Recently on TikTok, people have been filming themselves throwing their unused tampons straight into the trash or talking about abandoning the menstrual product. “I’m about to start my period in a couple of days and honestly I don’t know what to do,” one TikToker said. “I’m seeing more and more girlies saying that they’re free bleeding and I’m like, maybe that’s not such a bad idea if the other alternative is lead.”
The wave of panic stems from a recent study finding that some tampons contain toxic metals like lead and arsenic. Anti-tampon sentiments are also on the rise writ large; though tampons are still the most-used menstrual product, alternatives like period cups have been gaining popularity for years. But doctors and even the lead author of the study want people to know it’s still okay to use tampons—though many of them acknowledge a need for more research.
Despite concerns, the study didn’t actually find that tampons aren’t safe
The peer-reviewed study, which appears in this month’s issue of the journal Environment International, found levels of 16 different metals in a variety of tampon brands, including ones marketed as organic, sold in the U.S. and Europe. Some of the metals, like zinc, are typically considered safe. But others, like lead and arsenic, prompted widespread concern because they can be dangerous.
To everyone panicking, experts all say the same thing: don’t.
While the study found the presence of metals in tampons, it didn’t determine how much—if any—is released from the tampon and absorbed by the body, says Nathaniel DeNicola, an ob-gyn and the environmental health expert for the American College of Obstetricians and Gynecologists (who was not involved in the research).
“As far as what this study showed us, there’s nothing to say that you should stop using tampons,” DeNicola says. “I don’t tell my patients to stop using tampons based on this study. I do think that knowledge is empowering, so I mention it now if patients ask about it as something to think about.” Tampons go inside the body, and there could be a “cumulative risk” because people use the products repeatedly over many years, he says.
Doctors point out that many of the metals, including lead and arsenic, are in a lot of everyday products already. Because arsenic can be found naturally in soil, plants can absorb small amounts, which is why the heavy metal can be found in some foods like rice. The levels of the metals that were found in the tampons were also very low—though the U.S. Environmental Protection Agency has said that there’s no safe level of exposure to lead.
“You might as well tell people to stop eating all fruits and vegetables and stop drinking water if you want to eliminate all exposure to metals,” says Karen Tang, a gynecologist (who was not involved in the new research) and the author of It’s Not Hysteria, a book about reproductive health. (Tang has done some paid campaigns for Tampax in the past.) “If you’re not worried about just eating fruits and vegetables [and] drinking tap water, you definitely shouldn’t be concerned about the exposures in your tampons because it was much less.”
Tang also points out that the study conditions don’t mimic the situations for which tampons are used; the researchers used acid and heat on the tampon samples, which are not comparable to the environment inside the vagina. Jenni Shearston, lead author of the study and a postdoctoral scholar at the UC Berkeley School of Public Health, says that the study’s goal was not to mimic real-life environments, but to dissolve the tampon samples to figure out what’s inside them.
Shearston says she doesn’t want people to take away from this study that tampons aren’t safe to use, because the research wasn’t designed to answer that question. It just tested the chemicals inside the tampon products.
“I don’t want to be alarmist because we don’t know,” Shearston says. “And that’s a limitation that we need to address.”
The need for more research
This isn’t the first time people have raised concerns about what ingredients are in tampons. Past research has found the presence of chemicals, including phthalates, in some sanitary pads, panty liners, and tampons. Phthalates, which are chemicals often used to make soft and flexible plastics, can be found in other products like shampoo and makeup, and have been associated with reproductive health issues.
Read More: PFAS ‘Forever Chemicals’ Are Turning Up in Menstrual Products. Here’s What You Need to Know
But doctors say there’s little risk proven to be associated with tampons aside from toxic shock syndrome (TSS), a rare infection that could become fatal if left untreated.
Every so often, something sparks a new wave of panic over tampons. Previously, people posted videos on TikTok expressing concern that a tampon brand listed titanium dioxide, which they claimed could cause cancer, as an ingredient in the menstrual product. Ob-gyns tried to quell the fear: those worries stemmed from research that showed that rats, not humans, developed cancer after inhaling large amounts of titanium dioxide. Titanium dioxide is also used in other personal care products like sunscreen.
Part of the problem, experts say, is a lack of research.
“There is so much confusion about women’s health in general; there’s not enough research and people sort of fill that absence with question marks and fears,” Tang says.
Shearston, who conducted the research for the study, says that she and her colleagues are now working on a study to determine whether the metals can come out of tampons. Future areas of research could then determine if the vagina absorbs those metals, and, if so, what the potential health impacts of that are.
“What I think this study really shows is that we need to know a lot more about what is present in these menstrual products,” Shearston says. “We should be testing for that, and we need to understand if there are things that could be impacting our health.”
How tampons are regulated
Tampons and other menstrual products are regulated as medical devices by the U.S. Food and Drug Administration (FDA). FDA spokesperson Amanda Hils said in an email that the administration “is reviewing the study,” and that “all studies have limitations.” She too pointed out that the study doesn’t indicate whether any metals are released from tampons when inserted into the body, or whether the body absorbs any of those metals.
“We plan to evaluate the study closely, and take any action warranted to safeguard the health of consumers who use these products,” Hils said. “Overall, the FDA has not identified significant safety or effectiveness issues related to tampons based on our premarket, compliance, and postmarket oversight of these products.”
While the FDA doesn’t test tampons as part of the administration’s required premarket review, it expects manufacturers to “conduct the testing necessary to demonstrate the safety and performance” of their products, Hils said. The FDA expects to receive a list of the component materials in the tampon as part of its premarket review, among other safety information about the product. The FDA also provides recommendations to manufacturers, including that tampons be free of dioxins, pesticide, and herbicide residue.
“The FDA carefully reviews the testing results in premarket submissions to assure the devices are safe and effective for their intended use,” Hils said.
Hils said the FDA doesn’t require manufacturers of medical devices to list the materials in their product labeling—a rule that continues to cause controversy, particularly regarding menstrual products. Some states, including New York and California, have passed laws aimed at increasing transparency and requiring menstrual product manufacturers to publicly disclose more ingredients.
So are tampons safe or not?
Shearston says she knows it’s “frustrating” that the study leaves people with questions, but urges people to remain calm.
“I do try to encourage people not to panic—to recognize that we’re exposed to metals all the time, all around us in our environment, and we don’t know yet whether or not this is a source of any health problems,” Shearston says. “We’ll just have to wait to learn more.”
DeNicola draws an analogy—when you’re on a plane and there’s some turbulence, look at the flight crew. “If they’re not panicking, then you kind of feel better because you’re like, the people who do this all the time, every day, this is their profession—if they’re not panicked, then maybe there’s reassurance here, even if it feels scary to me.”
“The experts are not seeing this as a reason to panic,” he adds.
