What's wrong with Tampons?
Besides the obvious, there are some perhaps not-so-obvious problems with tampons. They have to be bought over and over. They have to be changed often. They have to be packed along in sufficient quantities and varieties of sizes, on trips. And, of course, chlorine-bleached tampons made with synthetic fibers have been linked to Toxic Shock Syndrome. Conventional tampons may contain residues of dioxin, as well as chemicals to aid in absorbency. It has been estimated that an average woman may use up to 15,000 tampons in her lifetime. That's a lot of "waste for the environment."
According to the National Research Center for Women and Families, approximately 43 million women in the United States use tampons. These tampons are usually made of cotton and rayon or blends of cotton and rayon for absorbency. Rayon is a cellulose fiber made from wood pulp. During the bleaching process, a toxic byproduct known as dioxin is created. However, very small amounts of dioxin are in the rayon fiber. In addition, until the late 1990s, a chlorine bleaching process that also produces dioxin was used on both the rayon and the cotton used in tampons.
According to the FDA, state-of-the art testing of tampons and tampon materials has shown that dioxin levels are at or below the detectable limit. They state that no risk to health would be expected from these trace amounts: "At one time, bleaching the wood pulp was a potential source of trace amounts of dioxin in tampons, but that bleaching method is no longer used."
Now there are two methods of bleaching: elemental chlorine-free bleaching and totally chlorine-free bleaching. Elemental chlorine-free bleaching are methods that do not use elemental chlorine gas to purify the wood pulp. These methods include the use of chlorine dioxide as the bleaching agent as well as totally chlorine-free processes. "Some elemental chlorine-free bleaching processes can theoretically generate dioxins at extremely low levels, and dioxins are occasionally detected in trace amounts in mill effluents and pulp. In practice, however, this method is 'considered' to be dioxin free."
Totally chlorine-free bleaching refers to use of bleaching agents that contain no chlorine. These methods are also dioxin-free.
This information should put every woman's mind at ease, right? In 1994, the Environmental Protection Agency (EPA) issued a report that stated that dioxins are known to cause cancer in animals, and probably cause cancer in people. The EPA also has determined that people exposed to high levels of dioxins may be at risk for a damaged immune system, increased risk of pelvic inflammatory disease (PID), and reduced fertility. Recent research on monkeys has linked dioxin exposure with an increased risk to develop endometriosis, a painful disease in which uterine tissue is found outside the uterus, frequently leading to infertility.
One study found that 80 percent of the monkeys exposed to dioxin developed endometriosis, and that higher levels of exposure caused the development of more severe forms of the disease. Two of the monkeys in the study died due to endometriosis.
Tampons contain low levels of dioxins so the FDA says it is fine. But, according to the EPA, there really is no "acceptable" level of exposure to dioxin given that it is cumulative and slow to disintegrate. The real danger lies in repeated contact. So, would using about 4-5 tampons a day, 5-7 days a month, for about 40 years be considered repeated contact?
When fibers from the tampons are left behind in the vagina, it creates a breeding ground for the dioxin. But the tampon companies state that "Fibers can come off any tampon. The natural cleansing process of the vagina removes these fibers within a short time (a day or two)."
When questions about dioxin came up a few years ago, the FDA asked tampon manufacturers to provide information about their pulp purification processes and the potential for dioxin contamination. Manufacturers of rayon tampons are also asked to routinely monitor dioxin levels in the raw material used or the finished tampons. Manufacturers have provided the FDA with test results of studies conducted at independent laboratories. This means that the agency's reassurances are largely based upon data that was submitted by tampon manufacturers, but are not publicly available.
According to the results of studies conducted by tampon manufacturers submitted to the FDA, dioxin levels in the rayon raw materials range from undetectable to 1 part in 3 trillion. More recently, a study sponsored by the FDA Office of Women's Health was published in 2005, which found "detectable levels of dioxin in seven brands of tampons," including at least one 100 percent cotton brand.
TSS, a rare but potentially fatal disease caused by a bacterial toxin, has also been associated with tampon use. Although the exact connection remains unclear, use of high-absorbency tampons produced with rayon for an extended period of time seems to increase the risk. The disease, which was first found among teenage girls in 1978, primarily strikes tampon users under the age of 30. The TSS epidemic reached a peak in 1980 with a total of 813 cases, including 38 deaths reported to the Centers for Disease Control and Prevention (CDC).
According the to the FDA, the number of menstrual-related TSS cases has decreased significantly in recent years; there were only six confirmed cases in 1997 and three in 1998. Rana Hajjeh, M.D., a medical epidemiologist with CDC's division of bacterial and mycotic diseases, attributes the drop in TSS cases to the advances in the way the FDA regulates tampon materials and absorbency.
In 1982, the FDA required that all tampon labels advise women to use the lowest absorbency needed to control their flow as well as the TSS warning signs. The agency also standardized absorbency labeling in 1990 so that absorbency terms (e.g. regular, super, etc.) are consistent across brands. Philip Tierno Jr., M.D., chief of clinical microbiology and immunology at New York University Medical Center and a leading expert on the health risks of tampons, points out that the drop in the number of cases are only defined by a "strict-case" definition of TSS; the actual number of "clinical cases" has not really changed.
Another possible reason for this reported decrease is because tampon manufacturers have removed three of the four synthetic ingredients (polyester, Carboxymethylcellulose, and polyacrylate rayon) that were once commonly used in tampons to enhance absorbency. However, highly absorbent viscose rayon is still used.
The removal of the synthetic fibers by manufacturers was due in part to independent research that showed tampons containing synthetic additives increase production of the TSS toxin, and that all-cotton tampons do not. According to Tierno, this suggests that all-cotton tampons actually decrease the risk of TSS, and are thus safer than rayon and rayon-blend tampons.
Some European countries have demanded a switch to "safer" tampons. The makers of sanitary products in England (in response to a strong campaign) have in fact switched to oxygen bleaching, a "green" method of bleaching. Several alternatives to tampon use are available to women, including all-cotton tampons and pads that are unbleached or are whitened with hydrogen peroxide as well as reusable menstrual cups.