Reusable Menstrual Products
Danielle M Higbee
Before continuing, the author would like to acknowledge that while many of the videos and other quoted materials mention binary terms such as "women" & "girls," that not all women menstruate and not all people who menstruate are women. The term "menstruator" refers to any person who experiences a monthly menstrual cycle and will be used when possible.
The Menstrual Taboo
"Menstrual hygiene practices [are] affected by cultural norms, parental influence, personal preferences, economic status, and socioeconomic pressures"
(Kaur, et. al., 2017)
Across the globe, there are people menstruating at all different times. However, there continues to be a stigma around the natural, life-giving process. Menstruators around the world endure restrictive practices rooted in religious and cultural beliefs. Some of the most common practices include "prohibition [from entering] the prayer room or the kitchen, looking into a mirror, attending to guests, offering prayers, and touching holy books" (Ranabaht, et al., 2015). As a result, inequities continue around access to products and knowledge of bodily autonomy related to menstruation. Breaking down this taboo is an essential step to creating a safer environment for menstruators.
A Brief History of Menstrual Products
This timeline begins in the late 19th century and focuses on the United States context. While these products may be modern, menstruation is not. People have been menstruating for much longer and finding many ways to manage (Vostral, 2008).
"Menstrual hygiene technologies are hidden artifacts that have enabled women to pass, to overcome prejudice leveled against a bleeding body" (Vostral, 2008).
This timeline may end in the early 2000's, but menstrual technology innovation is continuing. While there are many different products used and available globally, this page will mainly focus on environmental and human concerns of commercially available tampons and menstrual cups.
Tampons
There are many different companies with these products on the market. Each company or brand has their own unique combination and quantity of the materials to create the product (Hait & Powers, 2020). The usual products making up traditional absorbent material in tampons and pads are rayon and/or cotton. Tampons often come inside an applicator, individually packaged in plastic, inside a cardboard box. The applicators are made of either cardboard or plastic. Similarly, pads come individually wrapped in plastic within a larger cardboard box. These products are both single-use meaning that after each use they are thrown away.
Rayon
A semi-synthetic fabric made from cellulose or wood pulp that undergoes an intensive manufacturing process such as bleaching (Hait & Power, 2020).
Photo by Asif Ahmed Safwan
Cotton
A leading agricultural crop that is both economical and comfortable. For disposable material, it is unwoven and the fibres are fused together (Weigmann, 2021).
Photo by Tijana Drndarski from Pexels
Photo by The Period Blog
Over 20,000 tampon applicators were collected by the Ocean Conservancy's International Coastal Cleanup project in 2009 (Okamoto, 2018).
Tampons come both with and without applicators. Most common materials for an applicator are cardboard and plastic.
Plastic is a petroleum product, while cardboard is paper. Additionally, multiple companies now sell a reusable tampon applicator.
Menstrual Cups
Over the past decade, there has been a large increase in the amount of reusable menstrual products available on the market. Options include menstrual cups, reusable pads, period underwear, menstrual disc, reusable tampon applicator, just to name a few. In particular, menstrual cups have seen a large increase in popularity. According to van Eijk (2019), there are currently 199 brands of menstrual cups available on the market in 99 countries. Menstrual cups are commonly made out of medical-grade silicone, rubber, elastomer, or latex. On average, they can be worn for about 6-12 hours, collect between 10-38 mL of blood, and can be continually used for up to 10 years (van Eijk, et al., 2019). The following section briefly describes the most common ingredients used to make menstrual cups.
Silicone
Medical-grade silicone is the norm for most menstrual cup these days since WWII (Vostral, 2008).
Rubber
Pre-WWII rubber shortage, menstrual cups were made from rubber (Vostral, 2008).
Photo by San Jose Recycles
Looking to try a Menstrual Cup?
The following button will take you to a website that provides in depth information and videos about brands, sizes, how to insert the menstrual cup, and much more.
The following highlighted brands either donate a portion of their profit to a non-profit that focuses on menstrual health management or period poverty or they have a one to one donation program for menstrual cups.
Disposal Differences
Menstrual cups can be used multiple times for up to 10 years (van Eijk, et al., 2019). While there is not specific data on the breakdown of menstrual cups, there has been ways to make them be part of a circular economy. (see Ray of Light at the end)
A study conducted in Tasmania, compared the breakdown of different paper products such as toilet paper, facial tissues, and tampons in natural environments. Specifically, they wanted to assess the environmentally friendliness of current standing guidelines for disposal when backpacking or camping in National Parks. Out of the three, tampons were the most resistant to decay. In some cases, a tampon took up to two years to decay (Bridle & Kirkpatrick, 2015).
Thank you for not flushing your tampons!
Tampons are made out of extremely absorbent material and as a result, they expand in water. This can wreak havoc on water pipes as well as water treatment systems. Kaur, et al. (2018) explains flushing these products can cause sewage blockage. This is a serious health hazard for water quality and especially for the water system workers who have to clean these out by hand.
Why should we care?
"Despite the widespread use of these products, little is understood about women's exposure to various materials compromising products that are used to intimately by about 8 million women in the U.S. (~28% of the population)" (Hait & Powers,)
Menstrual products are placed near or inserted inside the vagina for multiple hours during menstruation over decades. The vaginal tissue consists of highly permeable tissue. Additionally, many blood vessels and lymphatic vessels reside within the vaginal wall. As a result, any chemicals entering through the vagina are up-taken quickly into the bloodstream and from there, the rest of the body (Lin, et. al., 2020).
What harmful chemicals are in tampons and pads anyway?
Because menstrual products are listed as medical devices, disclosure of ingredients is not required (Hait & Power, 2019). Even labels indicating "organic" or "for sensitive skin" did not give any good indication of their definition of products they contain. Environmental and human health impacts cannot be properly assessed because the products vary so much by the companies that product them (Hait & Power, 2019).
However, multiple studies have cited different chemicals, such as VOCs and dioxins, found in tampons and/or pads:
Volatile Organic Compounds (VOCs): A study done by Lin, et al. (2020) looked into VOCs concentration in menstrual products commercially available in the US. Their results indicated that all the menstrual products tested contained a small amount of VOCs, like most other consumer products. It was unclear from this study whether or not the VOCs were residual contaminants from the manufacturing processes. In particular, products that contain any sort of added scent or fragrance as well as sprays, wipes, and douches (Lin, et al., 2020).
Dioxins: Tampons and pad do have natural origins since they are made of wood. But the chlorine bleaching process causes rayon to have harmful human health impacts (Hait & Powers, 2020) including the creation of dioxins. According to Scranton (2013), dioxin has been found in tampons and pads. "Exposure to dioxins and furans has been linked to cancer, reproductive harm and endocrine disruption" (Scranton, 2013).
Toxic Shock Syndrome
It's hard to talk about menstrual products and their history without mentioning Toxic Shock Syndrome (TSS).
On September 22, 1980, Procter & Gamble removed Rely, their brand of high-absorbent tampons from the market after they were linked to TSS caused by Staphylococcus aureus growth. In that year, TSS cases peaked with 814 clinical cases and 38 reported deaths. There were likely many more cases during that year, but they may not have fit the disease criteria outlined by the CDC (Vostral, 2008).
There have only been 5 reported cases globally of TSS associated with the use of a menstrual cup (van Eijk, 2019).
While chances of TSS is very unlikely with a menstrual cup, it is still possible.
Terms to know
Menstrual Health Management (MHM)
"Menstrual health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity, in relation to the menstrual cycle.
Achieving menstrual health implies that women, girls, and all other people who experience a menstrual cycle, throughout their life-course, are able to:
access accurate, timely, age-appropriate information about the menstrual cycle, menstruation, and changes experienced throughout the life-course, as well as related self-care and hygiene practices.
care for their bodies during menstruation such that their preferences, hygiene, comfort, privacy, and safety are supported. This includes accessing and using effective and affordable menstrual materials and having supportive facilities and services, including water, sanitation and hygiene services, for washing the body and hands, changing menstrual materials, and cleaning and/or disposing of used materials.
access timely diagnosis, treatment and care for menstrual cycle-related discomforts and disorders, including access to appropriate health services and resources, pain relief, and strategies for self-care.
experience a positive and respectful environment in relation to the menstrual cycle, free from stigma and psychological distress, including the resources and support they need to confidently care for their bodies and make informed decisions about self-care throughout their menstrual cycle.
decide whether and how to participate in all spheres of life, including civil, cultural, economic, social, and political, during all phases of the menstrual cycle, free from menstrual-related exclusion, restriction, discrimination, coercion, and/or violence." (Hennegan, et al., 2021).
Period Poverty
“state of being unable to afford period products" (Okamoto, 2018)
Menstrual Health Management is a Public Health Issue
"50% of schools across the low-income world lacking adequate water and sanitation, and an as yet unquantified number of girls lacking guidance before the onset of menstruation" (Sommer, et al., 2015).
Previously, anything related to menstruation was seen as a private matter or one that was covered by the family. However, multiple studies have found there is a lack of knowledge around sexual and reproductive health as a result of the menstrual taboo.
An article by Sommer, et al. (2021) hashes out how menstrual health is a main part of the United Nations' Sustainable Development Goals (SDGs). The 17 SDGs can be described as "a collective agenda that identifies how the global society can enable sustainable economic, social, and environmental development for all, with an emphasis in the preamble to the SDGs on the need ‘to achieve gender equality and the empowerment of all women and girls" (Sommer, et al., 2021). Despite mentioning empowerment of women and girls, there is no explicit mention of MHM. However, including this is a necessary action to help with bodily autonomy and thus sustainable development. For example, in a study from Bangladesh, Jahan, et al. (2020) states that 40% of school girls were absent from school because of their period an average of 2-3 days per month. Additionally, of these girls, 86% reported that due to lack of private and clean spaces, they did not change their menstrual products at school.
The increase in studies on the need for MHM was lead mainly by the Water, Sanitation, and Hygiene (WASH) sector. "[T]hey have advocated the engagement of the education, gender, and sexual and reproductive health sectors, arguing that WASH cannot alone address all the needs of pubescent girls around menstruation" (Sommer, et al., 2015).
Primary prevention in public health is done by intervening to prevent the development of problems. Potential problems being prevented through the implementation of MHM programs include:
"school dropout
lower self-esteem
negative sexual or reproductive health outcomes" (Sommer, et al., 2015)
In a systemic review of the uptake of menstrual cups, van Ejik, et al. (2019) notes there were many reports of difficulty changing or emptying the cup in public restrooms. Many schools were constructed in a time period where girls were "not permitted or encouraged to attend school" (Sommer, et al., 2015). As a result, bathrooms were not designed with menstruators in mind. Many places in the world lack proper disposal facilities in addition to access to water (Kaur, et al., 2018).
van Eijk, et al. (2019) cites that sexually transmitted disease prevalence was lower among schoolgirls (ages 14-16) who were given a menstrual cup. They speculate that being providing a menstrual product lowered the need for transactional sex in order to obtain money to buy them.
While Toxic Shock Syndrome and the hazardous chemicals found in tampons do pose a concerning public health issue, this particular page is focusing on the waste aspect on menstrual health. Also there are many menstrual related disorders that are under researched and require adequate attention.
Menstruation in Alternate Contexts
Are Menstrual cups the Solution?
Menstrual cups have revolutionized modern period care and they have been used in menstrual health educational programs. Here are some potential avenues to consider before claiming that menstrual cups are a fix to period poverty and menstrual health management.
Menstrual cups have a large up front cost. The price ranges from US$0.72 to 46.72 with a median price of $23.30 (van Eijk, et al., 2019). This cost however, is a small fraction to the purchase of tampons or pads over a lifetime.
Access to clean water is necessary to keep them sanitary before reinsertion. Otherwise, there is risk of infection and other health issues. This can be a challenge for people experiencing homelessness, refugee situations, and other places with water scarcity.
Often require more in depth training about the human body in a sexual and reproductive health context.
Menstrual cups have been found to dislodge Intrauterine Devices (IUDs) (van Eijk, et al., 2019).
People in Refugee Settings
Kemigisha, et al. (2020) notes that problems normally demonstrated by menstruators are exasperated in refugee settings as exemplified in a refugee camp in Uganda. "Adolescent girls in a refugee setting offer a unique context and are more likely to have scarcity of essential needs, including menstrual hygiene materials, access to health facilities, reduced opportunities for self-sustenance and dependence on aid from NGOs" (Kemigisha, et al., 2020).
People experiencing Homelessness
Barriers to managing menstruation:
access to private, clean spaces to change menstrual products
access to both laundry and bathing facilities
ongoing menstrual stigma (Sommer, et al., 2020)
Ray of Light
Despite the controversies and dire need for more research, there is a lot happening in the menstrual health management world including recycling menstrual cups, policy changes, and many non-profits whose sole mission is to improve menstrual health management.
As of November, Ann Arbor Michigan became the first city in the United States to require free menstrual products in all public restrooms.
Divacup has partnered with Terracycle to start an experimental recycling program for their menstrual cups. They are ground into a powder to be used for athletic fields and playgrounds.
Have you ever heard of paid menstrual leave? This practice has recently gained popularity in Europe, but has been the norm in Asian countries for years. This article briefly discusses the push for this practice in India (Rodriquez, 2020).
Femme International is a non-governmental organization that "employs education, advocacy, distribution and research to address the unique needs of menstruators in low-income communities" (Femme International, 2020).
Based in Kampala, Uganda, WoMena has been a pioneer in menstrual health research and education. (WoMena, 2021)
Founded in 2014 in Portland, Oregon, Period, Inc. is a youth-led non-profit aiming to end period poverty through education and advocacy. There are hundreds of chapters across the United States to help achieve this common goal (Period, Inc., 2020).
Founded in sub-Saharan Africa in 2010, AFRIpads creates jobs and financial independence for women.
Topics for further research
Other reusable menstrual products
Accessibility
Environmental impact
Health impact
Menstrual-related disorders (e.g., polycystic ovarian syndrome (PCOS), endometriosis, etc.)
Menopause
Contraceptive methods
Contraceptive-induced Menstrual Bleeding Changes (CIMBCs)
Accessibility
Use with menstrual cups
Environmental impact
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