Tampon use, environmental chemicals and oxidative stress in the BioCycle study

Chemical characterization of menstrual and intimate care products: An extractables & leachables investigation

BACKGROUND

Menstrual and intimate care products (MICPs) such as tampons, menstrual pads, menstrual cups, and adult novelties are widely used worldwide for women's menstrual comfort or pleasure, respectively. However, growing consumer concerns regarding the presence of hazardous chemicals in these products have been raised.

METHODS

The aim of this study was to obtain an accurate overview of potential hazardous chemicals (organic and inorganic) that are present in MICPs and to determine the quantities that might leach under typical in-use conditions. Hereto, we developed a workflow analogous to the biological evaluation of medical devices (ISO-10993), encompassing three steps: (1) Conducting extraction experiments under exaggerated conditions and developing analytical methods to identify all chemical constituents (extractables); (2) Prioritizing the extracted chemicals based on available regulatory hazard information, eventually supplemented with in silico toxicological data; (3) Performing migration studies using simulants of vaginal and menstrual fluids, followed by targeted quantification of the prioritized leachable chemicals using newly developed analytical methodologies. The established strategy was applied to 64 MICPs, including absorbent menstrual products (i.e. tampons (n = 9) and menstrual pads (n = 6)), adult novelties (n = 15), menstrual cups (n = 15), Kegel-exercise devices (n = 14) and menstrual sea sponges (n = 5), all products originating from EU, US and China.

RESULTS

(1) Extractables assessment revealed the presence of 55 unique chemicals, including phthalates, siloxanes, volatile organic compounds (VOCs), fragrances, and plastic additives. (2) A hazard-based prioritization step highlighted phthalates (DEHP, DiNP, DBP), styrene, and ethylbenzene as the top chemicals for further investigation. (3) The leaching simulation experiments revealed that 65 %, i.e. 36 of the 55 chemicals identified in the extractables assessment were not detected in the leachables assessment. The 19 leachable chemicals identified comprised 9 fragrances, 5 phthalates, 2 plastic additives and 3 VOCs. Their maximum levels quantified were 28.22 µg/g (heliotropine), 100 ppb (DEHP), 18 ppm (triethyl citrate), and 0.24 ppm (2-ethyl-1-hexanol), respectively. In addition to the analysis of organic chemicals, examination of metals and metalloids revealed that menstrual sea sponges had the highest levels of metals and metalloids leaching among all tested menstrual and intimate care product categories, with Nickel, Cadmium, Antimony, and Mercury reaching levels of 1850, 1.0, 0.3, and 0.6 ppm, respectively.

CONCLUSION

This study provides new insights into the chemical composition of MICPs. Furthermore, it demonstrates that the majority of hazardous chemicals present in the studied MICPs are not detected under realistic use conditions; however exposure to phthalates, fragrances and other chemical constituents remains possible.

Menstrual products: culprits or bystanders in endometriosis and adenomyosis pathogenesis?

Products that may reduce menstrual flow from the endometrial cavity to the vagina (i.e. tampons and menstrual cups) could facilitate retrograde menstruation and the spillage of blood into the myometrium, two mechanisms which could be major determinants in endometriosis and adenomyosis pathogenesis. The aim of this narrative review is to summarize the evidence regarding the mechanical role menstrual products may have in the pathogenesis of these two conditions. Evidence in this regard is inconclusive. While Darrow and colleagues observed that 14 or more years of tampon use were associated with endometriosis (OR 3.6; 95% CI, 1.04-13.5); in Meaddough and colleagues' retrospective study, the percentage of women using pads only was significantly higher among those with endometriosis than among those without the condition (31% vs 22%). Three further groups failed to find an association between endometriosis/adenomyosis and any type of menstrual product. The only case that may be considered as a sort of proof-of-concept of the association between products potentially reducing anterograde menstrual flow and endometriosis was reported by Spechler and colleagues, who described the case of a 41 year-old who developed endometriosis after having used a menstrual cup on a regular basis. However, the number of studies on the subject is scarce, study populations are exiguous and a greater attention to temporality of endometriosis onset in relation to when women started habitually using a specific menstrual product is needed. Confounding variables including type and quantity of endocrine disruptors contained in menstrual products should also be addressed. At the present moment, no recommendation can be provided on the safety of one type of menstrual product compared to another.

Examining differences in menstrual and intimate care product use by race/ethnicity and education among menstruating individuals

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.

The Effect and Activity of Free Radical Enzymes Due to Arsenic Exposure Through the Vulva and Vagina

BACKGROUND OF THE STUDY: Geogenic arsenic is ubiquitous, found in water and soil that is used daily, can be exposed to the female body through the genital organs. The vulva and vagina are open channels that allow toxic agents to enter the internal genitalia and distributed throughout the body. AIM OF THE STUDY: This study investigated the effects of vaginal arsenic exposure via vulvar immersion and vaginal douching in Rattus norvegicus on the damage of uterus and ovaries through oxidative mechanisms (MDA, SOD, and H₂O₂). METHODOLOGY: The experimental animals were divided into three treatment groups, i.e., K0 (control group), K1 (group treated with vulvar immersion in 0.8 mg/L arsenic solution), and K2 (group treated with vaginal douching using 0.5-mL of 0.8 mg/L arsenic solution). For each group, the treatment was repeated six times and carried out for fourteen days. Before the study, a seven-day acclimatization period was conducted for adaptation purposes. The experimental animals were euthanized using ketamine xylazine. The uterus and ovaries were collected for MDA, SOD, and H₂O analysis, as well as histopathology examination. RESULTS: The vaginal douching group had the highest MDA level both on the uterus (210.66±4.92μM) and the ovaries (214.67±2.50 μM). The immersion group also experienced an increase in MDA in the uterus (198.66±3.33μM) and ovaries (206.33± .21μM). However, a higher level of MDA was found in the ovaries. The highest H₂O₂ level was also found in the uterine and ovarian organs in the douching group. In contrast, the lowest SOD levels of uterine and ovarian were identified in the vaginal douching group. Arsenic exposure through vaginal immersion and douching affected the uterine MDA, SOD, and H₂O levels (Ρ<0.05). Arsenic exposure through vaginal douching also affected the ovarian MDA, SOD, and H₂O levels (Ρ<0.05). There was a significant difference in the mean of inflammatory cells (infiltrated neutrophils, macrophages, and lymphocytes) in the uterus and ovaries in the control, immersion, and vaginal douching groups (Ρ<0.05). CONCLUSION: Exposure to 0.8 mg/L arsenic solution through vulvar immersion and vaginal douching can cause oxidative stress and trigger inflammation of the uterine and ovarian tissue.

Menstrual Products as a Source of Environmental Chemical Exposure: A Review from the Epidemiologic Perspective

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.