Don't Panic about Lead in Tampons

And do you know how much is in supplements, kale, or tea (to name just a few)

Corina Ciocirlan / 500px/Getty Images

My Instagram has been abuzz with people asking questions about a new study that found metals in tampons, some of which are harmful to human health. This spawned numerous click-bait headlines because scaring women about their bodies is profitable. And, of course, as if on cue, self-styled alternative medicine doctors, naturopaths, and menstrual influencers are claiming this is proof that women should stuff moss in their vaginas instead (I am only half joking here). The massive irony is that many push unregulated supplements  (you will see the special relevance here in a minute). 

Okay, off the soapbox and back to the study.

Investigators evaluated 24 unique types of tampons from 14 brands with a range of absorbency (regular, super, super plus, and ultra). Seven of the products were labeled as organic. A total of 30 tampons were sampled (two lots were purchased for several of the products; hence, there were 30 tampons tested but 24 unique types). Each tampon was tested twice, for a total of 60 tests. 

I would like to point out that this can only be considered an exploratory study since one to two tampons of each type represents a small sampling and is not representative of the likely millions of tampons used every year.

The investigators sampled the absorbent part of the tampon, meaning the core (the cotton-looking fluffy stuff), and the woven cover, if one existed, looking for 16 different metals/metalloids. Twenty-six tampons were purchased in the US and four in the EU or UK. The country of purchase does not tell us where the product was made or where the cotton or wood pulp originated. 

The results do not tell us which tampon brand tested positive for which metal/metalloid. Very little chromium or mercury was found, so we won’t discuss those results further. 

I am not an expert in the methodology used in this study, so I asked Dr. Andrea Love, a biomedical scientist who does a lot of fact-checking. FYI, Dr. Love will also be writing more about this, so do check out her Substack, ImmunoLogic, here. 

Dr. Love emailed me a few concerns. She told me that in the “processing of the tampon samples, they use a cotton reference material only, not accounting for the other materials that tampons might contain.” Some of the tampons have rayon, polyester, or polypropylene, and, according to Dr. Love, “these non-cotton materials could impact the results” if they aren’t accounted for in the reference material.  

Dr. Love also pointed out that the results from the control material used for the lead testing were highly variable. There is normally a swing, meaning you expect some variation in test results day-to-day, but she felt the variation was greater than should occur. 

None of this means the study is bad; it just means that the results should be interpreted with these limitations in mind. 

What Was Found?

The metals that pose a hazard to human health that were found in the tampons are arsenic, cadmium, and lead. Every type of tampon had these metals. Organic tampons had more arsenic than conventional ones, and conventional ones had more lead than organic tampons. Tampons purchased in the UK/EU had less cadmium and lead than those purchased in the United States. We don’t know which brands were used, and we can’t assign a test result to a specific brand, and this is a good thing because testing one or two tampons from one or two lots doesn’t reflect an entire product line. 

To try to make the results a bit more digestible, I’ve focused on two specific results: the geometric mean and the maximum concentration, which you could think of as the “worst-case scenario.” 

What do these numbers mean?

For that, we need some context. 

Let’s start with safety standards for human consumption. The Environmental Protection Agency (EPA) has standards for exposure, and California has its own set of limits, known as Prop 65, which is typically stricter. This is why in California, it seems as if every single building has a sign that tells you there are cancer-causing chemicals in it, so enter at your own risk. 

To put a real number on this, we’ll compare what was found in tampons with something many people drink and think is safe: bottled water (thanks to Jennifer Lincoln, MD, whose video using bottled water as a reference for lead prompted me to take this deep dive). In the United States, bottled water can have up to 5 PPB (parts per billion) of lead, 10 PPB of arsenic, and 5 PPB of cadmium. Let’s make it easy by saying 5 PPB across the board. 

I don't regularly use parts per billion in my everyday life, and I bet you don’t either, so let’s convert that to a more understandable number. One part per billion is 0.001 mg/L, so five PPB is 0.005 mg/L, or 5,000 ng (nanogram) per liter. If a standard water bottle has 500 ml, a bottle of water can have up to 2,500 ng each of lead, cadmium, and arsenic and be within the EPA’s limits. Obviously, less is better, but it’s important to have a benchmark for perspective. 

Let’s also look at Prop 65 in California. For arsenic, the limit in supplements is ten mcg/day (10,000 ng); for cadmium, it is 4.1 mcg/day (4,100 ng); and for lead, it’s 0.5 mcg/day (500 ng).  And we should also look at what might be in some food. Tea can be contaminated with arsenic, cadmium, and lead, so I used data from a study that looked at the amount of contamination based on how long the tea was brewed and selected one brand of organic green tea and one of conventional black tea. FYI, I found several studies identifying higher amounts of lead in green tea than in black tea, yet I’ve never heard the press report on it. Oh, right. Scaring people about tea doesn’t get page clicks. 

To compare what is allowed in supplements, water, and what had been found in tea to what was found in tampons in this study, we need to know the actual weight of the tampon, so I bought a multipack of Tampax Pearl and weighed them on my kitchen scale (I know, not the most accurate). A super weighed 2 g (I cut off the tail, so it was just the weight of the absorbent material). Now, let’s return to our chart and add a couple of columns…

Now, you can see that a human could never use enough tampons in a day to get anywhere near the amount of arsenic or cadmium the EPA allows in a single bottle of water or what California allows in supplements. Also, green tea and black tea have more arsenic than a super tampon.  

So what about lead? One super tampon could have more lead than California allows in supplements, but the amount is still less than the EPA allows in a bottle of water. If someone uses three super tampons a day, using the tampon with the highest levels, then they would be just over the lead allowed in a single 500 ml bottle of water. As an important reminder, most tampons had much less lead. In fact, 75% of tampons had 215 ng/g of lead or less.

Do Tampons Deliver the Metals?

This is really the question. 

It’s fine to say that tampons have these chemicals, but we have no idea if these ions can even leave the cotton and enter the vagina, and then, if they do leave, can they enter the blood? We can’t compare exposing a tampon to nitric acid and then heating the sample to 180C (356 F) for over an hour, the method of extracting the metals, to putting a tampon in the vagina. Dr. Kevin Folta, PhD, an expert in horticultural science, told me via email that “the ions in cotton are not very mobile. Even if saturated, only a subset of them would move.” But even if some of the metals did come off the tampon and make it into the vagina, it would be nowhere near 100%, and even if some were absorbed into the blood through the vaginal walls, it would not be 100% of what managed to leave the tampon. 

Might the arsenic, cadmium, or lead get in the vagina and harm the ecosystem? Tampons haven’t been associated with infections (outside of the rare menstrual toxic shock syndrome) or cervical cancers, so that seems unlikely, although, admittedly, it’s understudied. 

How do these Metals get in Tampons?

Dr. Folta told me, “Plants uptake micronutrients, some of which are heavy metals. If the same work were done on kale, they’d get similar levels, as Brassicas are fairly good at heavy metal uptake, to the point some consider them for remediation of spills. It’s hard to say why conventional or organic would be different, other than they came from two different places where the soil contained more of those individual metal ions to sequester. These were retail products tested, and I don’t know that they know the source of the materials. It also depends on heavy metals in fertilizers, etc.   Phosphorous (the middle number in the N-P-K designation) frequently travels with heavy metal contamination. Bat Guano is probably the highest and is used in organic ag.”

I asked Dr. Folta if it was fair to compare what was found in the tampons to what is found in bottled water, and he replied, “Absolutely. Or compare it to kale, brussels sprouts, microgreens, or cannabis. The last one would raise some eyebrows.” Yes, cannabis is a hyperaccumulator of metals, which is why California and many other states require that cannabis be tested for lead and set limits. 

What About the Other Findings

Other metals were identified that may have been part of the manufacturing process but are unlikely to be significant. However, the investigators found a lot more zinc than expected, and given the amount, the logical conclusion is it was added on purpose. The authors point out that zinc wasn’t in the ingredient list, even for tampons purchased in New York, where that is law, so this is something to understand. If manufacturers are adding zinc, this needs to be evaluated. 

Perspective

Lead contamination in supplements is a big issue, and so the irony of people who profit from supplements jumping on the tampons-are-toxic train is not lost on me. In one study, over 220 prenatal vitamins were tested for lead, and 25 exceeded the 0.5 mcg/day Prop 65 limit. In another study in 2018, 20 prenatal vitamins (40% of products tested) exceeded the Prop 65 threshold for lead. One had four mcg! Also, lead contamination in Ayurvedic medication is a huge concern. So, if you are concerned about this tampon study, then you should be furious about supplements.

Could you sum it all up for Me? Please!

Nothing here is panic-worthy. 

Here are the key takeaways:

• The arsenic, cadmium, and lead levels in this small sample cannot reflect what is found in all tampons.

• The source of the arsenic, cadmium, and lead is almost certainly the soil. 

• It’s possible that the non-cotton components of the tampons could interfere with the testing, so there are some unknowns. 

• Extracting metals with nitric acid and then baking them for over an hour at 180 C is not reflective of what will happen in the vagina.

• Even if the results are correct and reflective of what is in tampons, if all the arsenic, cadmium, and lead made it into the vagina (highly improbable, like very highly improbable), the levels are still within safety standards.

It’s good to have transparency, but when you see the amounts of lead, arsenic, and cadmium in context, it changes things. And it’s important to emphasize that no medical condition, outside of toxic shock syndrome, is caused by tampons. 

Ideally, we want no arsenic, cadmium, or lead, but the reality is that they’re in the soil and will ultimately creep into all kinds of products. This is one reason we need regulation: so people can understand their cumulative risks. It’s good to test tampons and hopefully come up with standards, but it’s wrong to fearmonger and generate clickbait about this study. 

The FDA needs to step up tampon regulation because if there are limits for metal contamination in water or supplements, we should know if we need limits for menstrual products and, if we do, what those limits should be. This is especially important with lead, as people can have cumulative exposure from many sources. We should also know if the arsenic, cadmium, or lead in tampons could affect the vaginal ecosystem.

But the FDA also needs to step up with regulations to help stop the menstrual product scares. Every year, some new menstrual product concern that probably isn’t an actual concern causes people to get scared, and then a subsequent rogue’s gallery of social media influencers and Big Natural profiteers turns that panic into attention, clicks, and profit. They are able to do this because the rules around tampons with the FDA are rather lax.

And finally, if you are in the United States and Trump gets elected, you need to know that Trump’s Project 2025 will gut the FDA and the EPA. If you want to know what is in your tampons…or food or tea or water, and you want regulations so corporations can’t pump factory effluent into the water table, that will be a pipe dream under Trump. His team has put this down in black and white.  If you are someone who lost any sleep or wondered about the tampon scare, then a vote for Trump is a vote against your self-interests. 

And for those who don’t like when I get political. I’ve always been because health is inherently political, and women have always born an unequal burden compared to men. 

Lastly, if anyone scares you about tampons and they also sell supplements, they are selling something that presents a significantly greater potential for exposure to metals, which just makes them a big fucking hypocrite, and you should probably block them. 

As always, posts are not individual medial advice.

References

Shearston JA, Upson K, Gordon M, et al. Tampons as a source of exposure to metal(loid)s, Environment International. 2024; 190: 108849. ISSN 0160-4120,

https://doi.org/10.1016/j.envint.2024.108849.

FIGO Toxic Chemicals and Environmental Contaminants in Prenatal Vitamins. https://www.figo.org/resources/figo-statements/toxic-chemicals-and-environmental-contaminants-prenatal-vitamins

Prenatal Supplements: Amount of Some Key Nutrients Different from Product Labels. GAO-24-106689  Q&A Report to the Chair, Subcommittee on Human Rights and the Law, Committee on the Judiciary, U.S.Senate. Dec 12, 2023. https://www.gao.gov/assets/d24106689.pdf

Schwalfenberg G, Rodushkin I, Genuis SJ. Heavy metal contamination of prenatal vitamins. Toxicol Rep. 2018 Mar 6;5:390-395. doi: 10.1016/j.toxrep.2018.02.015.

Seltenrich N. Untested, Unsafe? Cannabis Users Show Higher Lead and Cadmium Levels. Environ Health Perspect. 2023 Sep;131(9):94001. doi: 10.1289/EHP13519. Epub 2023 Sep 25. PMID: 37747406; PMCID: PMC10519194.

Schwalfenberg G, Genuis SJ, Rodushkin I. The benefits and risks of consuming brewed tea: beware of toxic element contamination. J Toxicol. 2013;2013:370460. doi: 10.1155/2013/370460. Epub 2013 Oct 23. PMID: 24260033; PMCID: PMC3821942.