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Marroquin J, Kiomourtzoglou MA, Scranton A, Pollack AZ. Chemicals in menstrual products: A systematic review. BJOG 2024; 131:655-664. [PMID: 37743685 DOI: 10.1111/1471-0528.17668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/22/2023] [Accepted: 09/01/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND From 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. OBJECTIVES To conduct a review of the literature to determine exposure to environmental chemicals in menstrual products. SEARCH STRATEGY This review identified 15 papers over the past 10 years. SELECTION CRITERIA Papers 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 ANALYSIS Reviewers assessed the articles and data provided. Multiple chemical groups were found. MAIN RESULTS Phthalates, 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. CONCLUSION Menstrual 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.
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Affiliation(s)
- Joanna Marroquin
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, Virginia, USA
| | - Marianthi-Anna Kiomourtzoglou
- Environmental Health Sciences Department, Mailman School of Public Health, Columbia University, New York, New York, USA
| | | | - Anna Z Pollack
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, Virginia, USA
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Zota AR, Franklin ET, Weaver EB, Shamasunder B, Williams A, Siegel EL, Dodson RE. Examining differences in menstrual and intimate care product use by race/ethnicity and education among menstruating individuals. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1286920. [PMID: 38126001 PMCID: PMC10731462 DOI: 10.3389/frph.2023.1286920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/07/2023] [Indexed: 12/23/2023] Open
Abstract
Introduction United States consumers spend over two billion dollars a year on intimate care products. These products, along with scented menstrual products, are marketed for odor control, perceived "freshness," and vaginal/vulvar cleanliness. However, these scent-altering products may increase exposure to carcinogenic and endocrine-disrupting chemicals. Prior research has not adequately characterized demographic differences in product use. The objective of our study is to examine racial/ethnic and educational differences in menstrual and intimate care product use among people who menstruate. Methods We pooled data from two US-based cross sectional studies to examine demographic characteristics and product use in 661 participants aged 18-54 years. Participants reported use of scented and unscented menstrual products (tampons, sanitary pads, and menstrual cups) and intimate care products (vaginal douches, sprays, wipes, and powders). We examined differences by race/ethnicity and education using log-binomial regression and latent class analysis (LCA), which can identify groups based on product use patterns. Results Our sample was 33.4% Black, 30.9% Latina, 18.2% White, and 16.2% another identity. Approximately half the population had a bachelor's degree or more; 1.4% identified as transgender and 1.8% as non-binary. In adjusted models, scent-altering products (i.e., scented menstrual and intimate care products) were more likely to be used by those with less formal education (p < 0.05). Unscented menstrual products were more likely to be used by those with more formal education. Compared to Black participants, White participants were more likely to use unscented tampons and menstrual cups and less likely to use douches and wipes (p < 0.05). Using LCA we identified two groups: one more likely to use scent-altering products, and a second more likely to use unscented menstrual products. Less education and older age, but not race/ethnicity, was significantly associated with membership in the group more likely to use scent-altering products. While sex/gender composition did not statistically vary across groups, all non-binary participants fell in the unscented menstrual product group. Discussion Lower educational attainment was consistently associated with greater use of scent-altering menstrual and intimate care products. Future research should examine associations between body odor stigma, product use, and health risks at intersections of race, class, and gender.
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Affiliation(s)
- Ami R. Zota
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | | | - Emily B. Weaver
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Bhavna Shamasunder
- Departments of Urban and Environmental Policy and Public Health, Occidental College, Los Angeles, CA, United States
| | | | - Eva L. Siegel
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
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Liberty A, Samuelson Bannow B, Matteson K, Edelman A, Colwill A. Menstrual Technology Innovations and the Implications for Heavy Menstrual Bleeding. Obstet Gynecol 2023; 141:666-673. [PMID: 36791417 PMCID: PMC10026971 DOI: 10.1097/aog.0000000000005126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/20/2022] [Accepted: 01/05/2023] [Indexed: 02/17/2023]
Abstract
Menstruation is a personal and cultural experience with financial and health implications. Menstruation historically has been managed with disposable commodities, including tampons and pads. New technologies, including underwear and menstrual cups and discs, have emerged to address diverse menstrual needs such as prioritization of sustainability, discretion, and inclusivity. New technologies are not routinely integrated into history taking or validated questionnaires, which currently rely on traditional tampon and pad use for identifying individuals with heavy menstrual bleeding. Review of menstrual technologies and accessories provides insight to empower gynecologists and other clinicians to take comprehensive menstrual histories, including strategies for identification of heavy menstrual bleeding and troubleshooting menstrual disturbances, within the context of new menstrual technologies.
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Affiliation(s)
- Abigail Liberty
- Division of Family Planning, Department of Obstetrics and Gynecology, and the Division of Hematology/Medical Oncology, Department of Medicine, Oregon Health and Science University, Portland, Oregon; and the Department of Obstetrics and Gynecology, UMass Memorial Medical Center, Worcester, Massachusetts
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Menstrual Products as a Source of Environmental Chemical Exposure: A Review from the Epidemiologic Perspective. Curr Environ Health Rep 2022; 9:38-52. [PMID: 35302185 PMCID: PMC9876534 DOI: 10.1007/s40572-022-00331-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW Menstrual bleeding is a regular, common occurrence in a substantial portion of the population. Menstruators may use more than 10,000 menstrual products over the lifetime. Given the potential for environmental chemicals in menstrual products to be absorbed by the vulvar and vaginal epithelium into systemic circulation, we reviewed the available data on menstrual products as a source of environmental chemical exposure. RECENT FINDINGS Nearly two dozen studies have been conducted measuring environmental contaminants in menstrual products; all have detected environmental chemicals but had discrepant conclusions on exposure risks. Only three human studies have investigated menstrual product use and environmental chemical concentrations and all observed associations. Detection of environmental chemicals in menstrual products, in combination with challenges of exposure assessment, scarcity of human studies, and the exceedingly common occurrence of menstrual bleeding, motivates the need for further research. We provide recommendations to move this field forward.
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Choi H, Lim NK, Jung H, Kim O, Park HY. Use of Menstrual Sanitary Products in Women of Reproductive Age: Korea Nurses' Health Study. Osong Public Health Res Perspect 2021; 12:20-28. [PMID: 33659151 PMCID: PMC7899234 DOI: 10.24171/j.phrp.2021.12.1.04] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/25/2020] [Accepted: 01/05/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The use of menstrual hygiene products and its effect on women's health remains under studied. Patterns of menstrual hygiene product use and the rationale behind choices among Korean women aged 18-45 years were examined. METHODS This cross-sectional study was a part of the Korea Nurses' Health Study. A total of 20,613 nurses participated, and 8,658 nurses participated in Module 7 which included a menstrual hygiene products-related survey. The data were collected through the mobile survey using a self-reported questionnaire. Participants' use of menstrual hygiene products and related characteristics were analyzed using frequency (percentage) or mean (SD). RESULTS The most common types of menstrual hygiene products across all age groups were disposable menstrual pads (89.0%), followed by cloth menstrual pads (4.5%), tampons (4.2%), and only 1.6% used a menstrual cup. Disposable menstrual pads were the most common across all age groups, but in those aged under 30 years this was followed by tampon use (6%). The most important criteria when choosing a menstrual hygiene product was comfort for disposable menstrual pads (31.3%) and tampons (41.5%), natural ingredients or organic products for cloth menstrual pads (51.4%), and custom fit for the menstrual cup (50.7%). However, for all menstrual hygiene products (except cloth menstrual pads), there was a higher proportion of anxiety than perception of safety, and low awareness of toxic shock syndrome. CONCLUSION It is important for women to use menstrual hygiene products with confidence. More research is needed to better understand potential health effects of menstrual hygiene products.
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Affiliation(s)
- Hansol Choi
- Division of Population Research, Department of Precision Medicine, Korea National Institute of Health, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Nam-Kyoo Lim
- Division of Population Research, Department of Precision Medicine, Korea National Institute of Health, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Heeja Jung
- College of Nursing, Konyang University, Daejeon, Korea
| | - Oksoo Kim
- College of Nursing, Ewha Womans University, Seoul, Korea
| | - Hyun-Young Park
- Department of Precision Medicine, Korea National Institute of Health, Korea Disease Control and Prevention Agency, Cheongju, Korea
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Protocatechuic acid modulates reproductive dysfunction linked to furan exposure in rats. Toxicology 2020; 442:152556. [DOI: 10.1016/j.tox.2020.152556] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/28/2020] [Accepted: 07/31/2020] [Indexed: 12/20/2022]
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Kwon YS, Choi SG, Lee SM, Kim JH, Kim SG, Lee DY, Seo JS. Improved Method for the Determination of Polychlorinated Dibenzo-p-dioxins and Dibenzofurans (PCDD/Fs) in Sanitary Napkins. ANAL LETT 2019. [DOI: 10.1080/00032719.2019.1647226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Young Sang Kwon
- Environmental Chemistry Research Group, Gyeongnam Department of Environmental Toxicology and Chemistry, Korea Institute of Toxicology, Jinju, Republic of Korea
| | - Sung-Gil Choi
- Environmental Chemistry Research Group, Gyeongnam Department of Environmental Toxicology and Chemistry, Korea Institute of Toxicology, Jinju, Republic of Korea
| | - Seung-Min Lee
- Environmental Chemistry Research Group, Gyeongnam Department of Environmental Toxicology and Chemistry, Korea Institute of Toxicology, Jinju, Republic of Korea
| | - Jong-Hwan Kim
- Environmental Chemistry Research Group, Gyeongnam Department of Environmental Toxicology and Chemistry, Korea Institute of Toxicology, Jinju, Republic of Korea
| | - Sang Gon Kim
- Gyeongnam Oriental Anti-aging Institute, Sancheong, Republic of Korea
| | - Dong Yeol Lee
- Gyeongnam Oriental Anti-aging Institute, Sancheong, Republic of Korea
| | - Jong-Su Seo
- Environmental Chemistry Research Group, Gyeongnam Department of Environmental Toxicology and Chemistry, Korea Institute of Toxicology, Jinju, Republic of Korea
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Singh J, Mumford SL, Pollack AZ, Schisterman EF, Weisskopf MG, Navas-Acien A, Kioumourtzoglou MA. Tampon use, environmental chemicals and oxidative stress in the BioCycle study. Environ Health 2019; 18:11. [PMID: 30744632 PMCID: PMC6371574 DOI: 10.1186/s12940-019-0452-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 02/05/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Tampons are used by up to 86% of US women and are a rarely considered potential source of pesticide and metal exposure. Tampons may be of particular concern given the likely higher absorption that occurs in the vagina. Our objective was to examine the potential associations between tampon use and metal concentrations, and biomarkers of inflammation and oxidative stress among healthy women. METHODS We used information from a prospective cohort of 259 regularly menstruating women, aged 18-44, followed for two menstrual cycles. Tampon use was assessed using information provided in participant study diaries. Metal concentrations were measured from a blood sample collected at enrollment. Oxidative stress and inflammation biomarker concentrations were determined from blood samples collected at up to 8 clinic visits for each cycle. Linear regression models were used to estimate associations of tampon use with metal exposure, and linear mixed models to estimate associations of tampon use with inflammation and oxidative stress biomarkers at different times during the menstrual cycle. RESULTS We observed non-significantly higher mean levels of mercury for tampon users compared to non-tampon users (exp(β) = 1.25, 95% CI = 0.93, 1.68). We found no evidence of an association between tampon use and inflammation biomarkers. We observed consistently higher isoprostane levels, an oxidative stress biomarker, among tampon users compared to non-tampon users (e.g. exp.(β) = 1.05, 95%CI = 0.96, 1.16, for the average isoprostane during the menstruating week); however, these results were not statistically significant. CONCLUSIONS While our results are not statistically significant, we observed suggestive associations between tampon use and elevated levels of mercury and oxidative stress biomarkers. Although our finding should be interpreted in light of our limitations, they indicate that tampons may be a source of exposure to metals and chemicals that have been largely ignored, and any related health effects are an important public health concern.
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Affiliation(s)
- Jessica Singh
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Sunni L Mumford
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Epidemiology Branch, Bethesda, MD, USA
| | - Anna Z Pollack
- Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, Virginia, USA
| | - Enrique F Schisterman
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Epidemiology Branch, Bethesda, MD, USA
| | - Marc G Weisskopf
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
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9
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Kuki Á, Zelei G, Nagy L, Nagy T, Zsuga M, Kéki S. Rapid mapping of various chemicals in personal care and healthcare products by direct analysis in real time mass spectrometry. Talanta 2019; 192:241-247. [PMID: 30348385 DOI: 10.1016/j.talanta.2018.09.054] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 09/14/2018] [Accepted: 09/17/2018] [Indexed: 10/28/2022]
Abstract
Residual chemicals on personal care and healthcare products, such as sanitary articles, sterile gauze bandages, nappies, plasters, were studied by direct analysis in real time mass spectrometry (DART-MS). We have identified around 40 compounds in seventeen different commercially available items. The tentative identification was further supported for about half of the chemicals by tandem mass spectrometric experiments (DART MS/MS). The most notable hazardous substances were tributyl phosphate, tris(2,4-di-tert-butylphenyl) phosphite, phthalic acid esters, erucamide, and nonylphenol ethoxylates (NPEs). In addition, we developed an efficient DART-MS analysis to determine the concentration of NPE in a swab sample. The quantitative result obtained by DART-MS was confirmed by liquid chromatography with mass spectrometric detection (LC-MS).
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Affiliation(s)
- Ákos Kuki
- Department of Applied Chemistry, University of Debrecen, Egyetem tér 1, H-4032 Debrecen, Hungary
| | - Georgina Zelei
- Department of Applied Chemistry, University of Debrecen, Egyetem tér 1, H-4032 Debrecen, Hungary
| | - Lajos Nagy
- Department of Applied Chemistry, University of Debrecen, Egyetem tér 1, H-4032 Debrecen, Hungary
| | - Tibor Nagy
- Department of Applied Chemistry, University of Debrecen, Egyetem tér 1, H-4032 Debrecen, Hungary
| | - Miklós Zsuga
- Department of Applied Chemistry, University of Debrecen, Egyetem tér 1, H-4032 Debrecen, Hungary
| | - Sándor Kéki
- Department of Applied Chemistry, University of Debrecen, Egyetem tér 1, H-4032 Debrecen, Hungary.
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Albani PP, Patel J, Fleming RI. DNA on feminine sanitary products. Forensic Sci Int 2018; 293:24-26. [PMID: 30396148 DOI: 10.1016/j.forsciint.2018.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/26/2018] [Accepted: 10/14/2018] [Indexed: 11/20/2022]
Abstract
The use of feminine hygiene products is commonplace and chaperones many women for most of their reproductive years. Unless specifically labelled, products are usually not sterile. Any DNA present on their surface could potentially be transferred onto the wearer and subsequently be detected in samples taken from intimate areas during a medical examination. This study investigated whether unused feminine sanitary products normally carry detectable amounts of DNA. Altogether, 52 items of tampons, pads, liners, and wipes were tape lifted and subjected to total and male-specific DNA quantification and STR amplification. Nineteen of these returned quantification values greater than zero. However, only four (one tampon and three liners) displayed one or two Y-STRs, whereas one pad exhibited one autosomal allele and an amelogenin X allele. All peak heights were below 515 RFU. Two liners may have collected partner DNA post purchase since they were not individually wrapped. Thus, feminine sanitary products are normally not a source of DNA.
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Affiliation(s)
- Patricia P Albani
- Institute of Environmental Science and Research Limited, Auckland, New Zealand; School of Chemical Sciences, The University of Auckland, Auckland, New Zealand
| | - Jayshree Patel
- Institute of Environmental Science and Research Limited, Auckland, New Zealand
| | - Rachel I Fleming
- Institute of Environmental Science and Research Limited, Auckland, New Zealand.
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Treloar SA, Bell TA, Nagle CM, Purdie DM, Green AC. Early menstrual characteristics associated with subsequent diagnosis of endometriosis. Am J Obstet Gynecol 2010; 202:534.e1-6. [PMID: 20022587 DOI: 10.1016/j.ajog.2009.10.857] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Revised: 07/05/2009] [Accepted: 10/16/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the association between early menstrual characteristics, before symptom onset, and later diagnosis of endometriosis. STUDY DESIGN This was a case-control study of 268 Australian women with surgically confirmed moderate-to-severe endometriosis (cases) and 244 women without endometriosis (controls). Early menstrual cycle characteristics, before age at symptom onset, were analyzed. RESULTS Menarche after age 14 years was strongly and inversely associated with endometriosis (odds ratio, 0.3; 95% confidence interval, 0.1-0.6). A history of dysmenorrhea was associated with subsequent endometriosis (odds ratio, 2.6; 95% confidence interval, 1.1-6.2). Despite a suggestive trend, shorter menstrual cycle length was not associated with endometriosis. Duration of natural menstruation and heaviness of flow were not associated with subsequent risk of endometriosis; neither was the reported type of sanitary protection used nor history of sexual intercourse during menstruation. CONCLUSION There is a decreased risk of endometriosis with late age at menarche and an increased risk in women who report an early history of dysmenorrhea.
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Affiliation(s)
- Susan A Treloar
- Center for Military and Veterans' Health, The University of Queensland, Brisbane, Australia.
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Obias-Manno D, Scott PE, Kaczmarczyk J, Miller M, Pinnow E, Lee-Bishop L, Jones-London M, Chapman K, Kallgren D, Uhl K. The Food and Drug Administration Office of Women's Health: Impact of Science on Regulatory Policy. J Womens Health (Larchmt) 2007; 16:807-17. [PMID: 17678451 DOI: 10.1089/jwh.2006.0135] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In 1994, the Food and Drug Administration Office of Women's Health (FDA-OWH) was created to provide leadership and policy direction for the Agency regarding issues of women's health. Within its first year, the FDA-OWH established a science program for women's health research, promoting the development of sound policy and regulation. In a little over a decade, the program has provided approximately 14 million dollars to fund more than 100 women's health research studies covering a broad range of health topics affecting women across their lifespan. Some studies, such as those elucidating drug effects on QT prolongation in women and drug-dietary supplement interaction, have had significant influence on regulatory decisions. Other studies have provided sound scientific data on sex and gender differences supporting FDA guidelines to protect women's health. This paper describes the science program at the FDA-OWH, providing examples of how funded research impacts regulatory policy.
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Affiliation(s)
- Dulce Obias-Manno
- Food and Drug Administration, FDA/OC/Office of Women's Health, Rockville, Maryland 20857, USA
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