Part 2: Health

There are several health concerns related to using tampons and pads that WEN has been instrumental in calling public attention to and holding company manufacturers accountable for. In this post we’ll look at some of the risks associated with using sanpro products, what’s been done to help combat them, and what more has to happen before women can manage their periods without putting themselves in danger.

1. The deal with dioxins

Dioxins are one of the more dangerous toxins out there. They come from the family of organochlorines which also includes Agent Orange, and have been variously linked to all manner of ailments -- notably endometriosis, liver disease and cancer. Often dioxins are present in the pesticides which spray cotton and rayon, and are created as a by-product of the process of bleaching pulp with chlorine: these are the ingredients which make up tampons. WEN campaigned tirelessly - and successfully - to force manufacturers to change their bleaching processes: most now use chlorine dioxide or hydrogen peroxide, which create less dioxins than previous methods.

However, tests that sanpro companies were legally obliged to carry out on their products show that they do in fact still contain trace levels of dioxins. The companies have called this amount ‘statistically negligible’, but they’re also allowed to hire their own independent researchers. Even if we suppose that multinationals with multi-million dollar stakes in the market can realistically carry out unbiased scientific tests on their own products, there is still little to no research on what harm even trace levels of dioxins in sanitary products can cause over a long period of time. (Imagine if we only tested the harm levels of smoking a single cigarette?) What we do have is well-documented research on long-term effects of dioxin exposure, which includes the impairment of the immune system, the nervous system and reproductive functions*. Seeing as women typically get through around 12,000 tampons over the course of a lifetime, trace levels of dioxins start sounding a bit less ‘statistically negligible’ and a bit more like an unacceptable industry get-out-of-jail-free-card.

2. What else is in there?

On top of the dioxins, sanpro has been linked to a smorgasbord of other chemicals. These include artificial colours and perfumes (which can imbalance users’ pH), polyethylene, polypropylene, and propylene glycol, potentially linked to everything from dryness and itching to infertility and cancers. Because sanpro falls under legislation covering ‘medical’ devices (although tampons are NOT sterile**), manufacturers are under no obligation to disclose these ingredients to consumers. Progress has been made; after a prolonged campaign spearheaded by Women’s Voices for the Earth (WVE), in 2015 some tampon and pad manufacturers like Procter & Gamble (makers of Always and Tampax) agreed to post ingredients lists on their websites, in addition to including this in the packaging.

However, WVE are still concerned about ‘trace ingredients’; chemicals used in elements simply referred to as ‘flex foam’, ‘adhesives’ and ‘fragrance’, as well as the chemicals used to treat materials such as cotton and rayon. Alexandra Scranton from the WVE has written that ‘because these are contaminants that might be found in a product as opposed to actual components, they are often termed “unintentional ingredients”. And currently there is little to no precedent in labelling laws that require unintentional ingredients to be disclosed. She also highlights the lack of research into the potential impact of these chemicals on women using tampons and said it is difficult to verify when companies claim their products are free of chemicals. The WVE is now pushing for full transparency with relation to everything that is used to make sanpro products.

Perhaps unsurprisingly, I find myself agreeing with Scranton and the WVE here. Where is the research? And why is user safety not the sanitary ‘protection’ industry’s priority?

WEN's 1989 publication 'The Sanitary Protection Scandal'

WEN's 1989 publication 'The Sanitary Protection Scandal'

3. TSS

I’m sure this blog won’t have been your introduction to TSS. You’ll have seen it on in the warnings printed on the sides of boxes of tampons, or maybe in a rare but frightening news story about the death of a teenage girl or a young woman. Maybe it’s caused you to fret a couple of times while you use your tampons, but for the most part, the worry passes. Well, so did I - in those carefree days before I started this research and could live a life unplagued by nightmares.

TSS was the focus of one of our proudest campaigns. WEN battled with industry titans to raise awareness about the potentially fatal disease, force companies to acknowledge the links between tampon usage and TSS, and provide guidelines for their safest use. In 1992 after three years, the Association of Sanitary Protection Manufacturers agreed to mandate their member companies – the biggest names in the industry – to put the TSS warnings on the boxes which you still see today***.

This was such an important victory for us because although TSS is rare, it is horrific. WEN has a folder of survivors’ accounts, including one written by a woman who I will call Ann. This particular testimony exerted such a morbid fascination over me that I (ill-advisedly) read it three times, and as a result, have made the strictest vow never to use a tampon again. I’ll walk you through the basics.

Ann had been using tampons for twenty years. One week, she had what seemed to be the flu. Her husband, woken by their young baby at 2am, noticed that she had a high fever, a bright red rash, an almost negligible blood-pressure reading, and was non-responsive. He called the doctor, Ann was rushed to hospital with what seemed to be septicaemia, and by 2.50am her husband was informed that she was dying. She was kept in intensive care as the doctors scrabbled to keep her alive while all her major organs failed, baffled by a rapidly deteriorating condition that they had never before encountered. She felt the agonising beginnings of necrosis in one hand, as her cells began to die: if it had continued, her right arm would have had to be amputated. Miraculously, Ann survived the ordeal, but it did not end there. She spent weeks in agony, and lasting side-effects included extreme PMT every period, as well as fertility and pregnancy concerns, chronic anxiety, post-natal depression, post-traumatic stress disorder, peeling skin and alopecia.

Worryingly, we still don’t know very much about TSS. We know that it is caused by very common and mainly harmless bacteria, Staphylococcus Aureus, and it seems that these bacteria are most numerous during menstruation. What we don’t know is exactly what causes them to mutate and create the violent toxin that causes TSS, or what tampons have to do with it. We know that younger women tend to be more at risk, perhaps because they have not yet built up the antibodies needed to repel the disease. It is thought that tampons contribute by creating microscopic tears in the vaginal wall that allow the perfect conditions for the bacteria to thrive, but no one is sure.

Now, I’m not trying to scare you into thinking that you’ll get TSS next time you use a tampon, or that every tampon is a dioxin overload. (Although always be on the look-out for a sudden high fever, a sunburn-like rash, particularly on your palms or the soles of your feet, as well as flu-like symptoms and dizziness or confusion). The infection rates are extremely low; just a few cases per year out of all thirty million menstruating women in the UK. It’s very easy, therefore, to be complacent, although some might say that even one case is too high. What we really need is more research carried out on the disease, more awareness about the symptoms, and more promotion of other forms of sanpro that don’t pose such a risk.

In our next blog post, we’ll be looking at the problem of sanpro waste, the taboos surrounding menstruation that make people more reluctant to address it, and the catastrophic effects this has on the environment.

With thanks to Emmett Roberts



** Wouldn’t you have thought tampons were sterile? Anything else that is for internal bodily use has to be. But a 2015 study found the possibly carcinogenic herbicide glyphosate in 85% of tampons and pads

***It’s worth noting that Natracare, makers of plastic-free, perfume-free, chlorine-free, organic sanpro, had put warnings there of their own accord a year earlier.



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