Toxic Tampons, Teens and the Microbiome: What’s the Connection?

Measurable from a drastic increase in internet searches and social media posts, awareness of environmental pollutants and their effects on health are gaining more attention. A particularly harmful group of chemicals, known as endocrine-disrupting chemicals (EDCs), are ubiquitous and have significant health ramifications from their untoward effects, particularly on hormone action. This group of chemicals can:

• Mimic hormones

• Disrupt hormone synthesis

• Breakdown or alter hormone receptors (binding sites) 

• Act as hormone antagonists

Environmental EDCs stem from a variety of sources including plastics and plasticizers, electronic waste, flame retardants, food additives, personal care products, and pesticides. From a pediatric viewpoint, one of the biggest concerns is their effects on children. Some of these chemicals were designed to have a long half-life and are thus labeled “persistent organic pollutants (POPs), which are lipophilic (love fats) and accumulate in fatty (adipose) tissue. Exposure routes such as ingestion (food and water), inhalation, skin contact (think hand-to-mouth behaviors), trans-placental route and through breast milk have a greater impact on children than adults.

What about female puberty?

Early-onset of puberty has now been noted globally and EDCs have been implicated including, but not limited to BPA, phthalates and organohalogens (pesticides).  50% of girls have breast development at 9 ½ years old, which is younger than previously thought.  The same trends are appearing in male puberty, but the focus of this article is specifically on female menstruation, the usage of menstrual products and their effects on the microbiota. 

Early puberty means the introduction of menstrual products at an ever earlier age with longer exposures to both tampons, pads and other products.  Girls commonly use tampons, especially those engaged in sports and other physical activities.  However, it does appear that there is a trend for more women choosing pads over tampons over the fear of leaving them in too long (toxic shock syndrome or TSS).  Whether this is also happening in our teens is unclear.  Should we be concerned about tampon usage in young women?

There are many concerning chemicals in menstruation care products, especially but not solely due to tampons.  In a study from the University of La Plata in Argentina, glyphosate (the main herbicide in Roundup®) was found as a contaminant residue in 85% of the tampons tested from GMO/pesticide-laden cotton.  There is little data available on the actual amounts of overall pesticide residues in tampons.  However, one study in 2013 found 9 pesticides, which goes against the FDA recommendation that tampons be “free of pesticide residue”. 

Other hazardous ingredients found in menstrual products included dioxins, toxic dyes, solvents, and formaldehyde-releasing preservatives (such as quaternium ingredients, covered in other Better Biome Collective articles); all noted to be potential carcinogens. A host of other pernicious products that are used by teens are also toxicant-containing, including pads, wipes, washes, douches, anti-itch creams and deodorants.  There is a big price tag earned by the ‘feminine products’ industry exceeding $3 billion dollars, and 70-85% of women use these products.  Of additional concern, regulatory agencies (such as the FDA) do not require companies to ensure the safety of their products nor share their information with the FDA/ Therefore, there is essentially no safety oversight of these products.  (For an in-depth overview of the Chem-Fatale report and the health effects of toxic chemicals in menstrual care products, go here.)

A look at the biology of the vagina is worth a quick review in order to understand the magnitude of the potential toxicity from chemicals, narrowing our focus on the microbiome.  Vulvar and vaginal tissue are more hydrated and permeable than other skin.  There are rich blood and lymphatic supplies, which allow direct transfer of chemicals into the circulatory system, without being metabolized first. Of major significance is the robust and complex vaginal microbiota which can be affected by the toxic onslaught.

There are published studies that have shown that the gut microbiota can metabolize EDCs which can lead to dysbiosis as well as an alteration in bacterial genes. The chemical-induced dysbiosis of the gut microbiota can lead to disruptions in various host systems.  However, the role of EDCs on the vaginal microbiome, in particular with an in-place delivery system of toxicants in tampons, is now just starting to be addressed in the literature, but not quite making its way routinely into clinical practice.  What we have learned from the research includes the following:

• Vaginal bacterial counts were lower in women that used tampons over pads.

• Tampon type had little effect on the qualitative and quantitative composition of the vaginal microflora during menstruation.

• In a study of tampon versus napkin usage, tampons resulted in alteration in the vaginal microflora.

• The vagina is a niche of S. aureus in tampon users ,and there are complex interactions in virulence including inhibition by lactic acid-producing bacterial species.

• Tampons should be reclassified from a Class II Medical Device to a Class III Device, where pre-market testing is mandatory. This paper was based on the appearance of TSS from tampons.  It was written in 1981, however, no changes were made or recommendations followed in reclassifying tampons.

From a review of approximately 100 articles on the subject of the vaginal microbiota ,  few focused on teens and vaginal microbial changes from menstrual products.  There were some studies on tampons, but very few on the many other products available for ‘menstrual hygiene’.  Additionally, little to no information was available regarding the effects of EDCs overall on vaginal microbial welfare.  Considering the fact that the microbial ecology of the vagina is an integral part of health, including sexual life and child-bearing, there is a dearth of information on girls and teens, especially those with precocious puberty.   

From our understanding of the effects of EDCs on the gut microbiota, it stands to reason that the vaginal microbiome is equally affected.  There needs to be a restructuring of the oversight of products geared towards women’s reproductive health including all ages.  Other important reasons to understand the vaginal microbiota and its makeup has to do with vaginal complaints such as vaginitis and vaginal discharges which are common ailments in teens.  These issues are often ascribed to ‘hygiene’ or ‘physiologic’, without really delving into the individual’s menstrual habits, bathing, underwear materials (synthetics), etc., which can all affect the microbiota.  In general, it appears that the vaginal microbiota of adolescents resemble those of older women, but bacterial loads may increase later when reaching adulthood.

What is clear is that products designed and targeted for young women (often with aggressive marketing), are toxicants and are able to be easily systemically absorbed as well as have local effects on the vaginal microbial ecology.  In order to create healthy teens that become healthy young women, different methods of menstrual care should be discussed and explored.  There are now safe menstrual care products made from organic cotton (tampons, pads and specially designed underwear) as well as medical- grade silicone devices for menstruation such as menstrual cups. Parents of girls/teens can become informed consumers concerning chemicals here. 

Voting with our dollars sends a loud message to industry that we care about product safety for our teens: #DetoxTheBox: https://www.womensvoices.org/menstrual-care-products/.