Chemicals in menstrual products: A systematic review

Abstract

BackgroundFrom menarche until menopause, the average menstruator will use over 11 000 tampons or sanitary pads. Vaginal and vulvar tissue is highly permeable, and chemicals are absorbed without undergoing first‐pass metabolism.ObjectivesTo conduct a review of the literature to determine exposure to environmental chemicals in menstrual products.Search strategyThis review identified 15 papers over the past 10 years.Selection criteriaPapers that measured chemicals in menstrual products and that measured human biomarkers of chemical exposure were included. Papers had to also be available in English.Data collection and analysisReviewers assessed the articles and data provided. Multiple chemical groups were found.Main resultsPhthalates, volatile organic compounds, parabens, environmental phenols, fragrance chemicals, dioxins and dioxin‐like compounds were detected in menstrual products. Research gaps were identified, including the lack of studies on newer products such as menstrual underwear and cups/discs. In addition to measuring chemicals in these products, future research should focus on clarifying the exposure per menstrual cycle to these chemicals to understand how menorrhagia and cycle length influence exposure from menstrual products.ConclusionMenstrual products contained measurable levels of a range of endocrine disrupting chemicals including phthalates, phenols and parabens. This reflects a potentially important route of exposure to chemicals that can impact women's reproductive health.

Per- and polyfluoroalkyl substances (PFAS) – unravelling exposure sources and demographical exposure patterns in a Swedish adolescent population

“…Yet, PFAS is not the only chemical group of concern for human health. Humans are exposed to a plethora of chemical compounds on a regular basis, including industrial chemicals and chemicals found in building materials, household products, cosmetics and hygiene products, to name a few (Panico et al 2019;Rousseau et al 2022;Marroquin et al 2023). There consequently exists a need to understand, not only the potential effects of PFAS exposure on human health but also of possible combined effects that chemical mixtures may have on human health.…”

Proposal for targeted, neo-evolutionary-oriented, secondary prevention of early-onset endometriosis and adenomyosis. Part I: pathogenic aspects

“…In addition, despite the above findings, it may still be difficult to disentangle the evolutionary issues from other epidemiological aspects ( Eaton et al , 2002 ), and since retrograde menstruation is reported to be a common phenomenon in most menstruators ( Halme et al , 1984 ; Liu and Hitchcock, 1986 ; Tang et al , 2022 ), multiple factors in addition to ROM are likely to play a role in the development of endometriosis and adenomyosis ( Shafrir et al , 2018 ; Zondervan et al , 2018 , 2020 ; Koninckx et al , 2019 ; Leonardi et al , 2020 ; Olšarová and Mishra, 2020 ; WaNg et al , 2020 ; Kuan et al , 2021 ; Salliss et al, 2021 ; Taylor et al , 2021 ; Horne and Missmer, 2022 ; Marroquin et al , 2023 ; Muraoka et al , 2023 ; Vallée et al , 2023 ; Yang et al , 2023 ). Even an increase in endocrine-disrupting chemicals due to air and water pollution and occupational hazards can potentially lead to the onset and progression of endometriosis ( Vallée et al , 2023 ).…”

“…(ii) Second, in addition to repetitious ovulatory cycles, several other factors appear to play a role in the pathogenesis of endometriosis and adenomyosis, including genetic predisposition, epigenetic profile, constitutional variables, immunological and hormonal factors, and individual lifestyle ( Shafrir et al , 2018 ; Zondervan et al , 2018 , 2020 ; Bulun et al , 2019 , 2021 , 2023 ; Guo, 2020 , 2023 ; WaNg et al , 2020 ; Taylor et al , 2021 ; Horne and Missmer, 2022 ; Vallée et al , 2023 ). Thus, even if there is an actual progressive increase in frequency, this could be explained by augmented exposure to toxic environmental chemicals and endocrine disruptors ( Sirohi et al , 2021 ; Matta et al , 2021 ; Vallée et al , 2023 ; Marroquin et al , 2023 ), high trans-unsaturated fat intake ( Missmer et al , 2010 ), altered microbiome ( Koninckx et al , 2019 ; Leonardi et al , 2020 ; Salliss et al, 2021 ; Muraoka et al , 2023 ; Yang et al , 2023 ), or other features of modern life that may influence the risk of these diseases ( Missmer and Cramer, 2003 ; Viganò et al , 2004 ; Ottolina et al , 2020 ; Sasamoto et al , 2020 ; Shafrir et al , 2018; Koninckx et al , 2021a ). More in general, since endometriosis and adenomyosis appear as multistep phenomena in which, after an establishment phase, a proliferation and invasion phase occurs, accompanied or followed by an inflammatory reaction phase, each phase may be subject to the influence of different contributing factors ( Parazzini et al , 2017 ).…”

“…A different epidemiological context is represented by the increasing use over the last century ( Barton, 1942 ; Bullough, 1985 ; Liberty et al , 2023 ) of thousands of menstrual pads and tampons per person, as these disposable products have been shown to contain and release several endocrine disruptors, such as phthalates, phenols, and parabens, which may promote the development of endometriosis and adenomyosis ( Marroquin et al , 2023 ). In this case, the causative factor would not be the recent increase in ROM per se, but the resulting contemporary increased exposure of the average menstruator to chemicals that can be absorbed by the vulvar and vaginal mucosa without undergoing first-pass metabolism ( Marroquin et al , 2023 ). In addition, heavy menstrual flow has been consistently associated with the risk of endometriosis ( Cramer et al , 1986 ; Parazzini et al , 1995 ; Matalliotakis et al , 2008 ).…”

“…In addition, heavy menstrual flow has been consistently associated with the risk of endometriosis ( Cramer et al , 1986 ; Parazzini et al , 1995 ; Matalliotakis et al , 2008 ). At the same time, women with menorrhagia tend to use higher absorbency products and more protective disposables per cycle, thus potentially increasing their exposure to endocrine-disrupting chemicals ( Marroquin et al , 2023 ).…”