Reassuring Info About Lead and Tampons THEY Didn't Want You to Know

Two studies show no increased levels of lead with tampon use

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I am not burying the lede or the lead–two studies show similar levels of lead (and arsenic and cadmium) in the blood among those who use tampons and those who do not. And no, I am not shocked that neither of these studies has ever made headlines. Or at least, not that I’ve seen.

Scaring women about their bodies is profitable and allows influencers to hide behind a veneer of caring. Reassurance? Not so good for page clicks.   

The past 72 hours have been filled with sensational headlines about a study that found minute amounts of lead, arsenic, and cadmium in tampons. I wrote about the study here. Despite the lack of any evidence for concern, many of the headlines insinuated that tampons are toxic death sticks. And on social media, naturopaths, functional medicine doctors, chiropractors, and influencers have gleefully joined in, practically celebrating Big Tampon's supposed misdeeds. These providers and influencers likely believed the study validated their supplement-filled, 'natural' recommendations that provide the ultimate currency–page views. 

Unfortunately, this kind of misleading propaganda is highly effective. First, we tend to mistake repetition for truth, and there has been A LOT of repetition. Like, a lot. This is why balanced reporting, including appropriate headlines, is crucial to prevent sensationalism and misinformation in the first place.    

But sadly, the truth is never as exciting as propaganda because the latter is so sure of itself, and science can rarely be absolute because it constantly evolves. This means a fact-filled video is less likely to go viral. In addition, regarding the data at hand, very few of us deal in parts per billion or nanograms, so the minuscule amounts of arsenic, cadmium, and lead found in tampons don't seem as intuitively reassuring as they actually are. Another issue is people often struggle to interpret risk (most of us are fear-motivated, something social media algorithms manipulate only too well), so only some of us are comforted by learning that all tampons tested had less lead than what is allowed in one 500 ml bottle of water. Never mind that while the method used to extract the metals is a valid way to tell us what is physically in a tampon, it can’t tell us what we really need to know–can these metals come out of a tampon that is in a vagina? This is because vaginas aren’t filled with nitric acid, and they can’t bake something at 180^o C for over 60 minutes. At least mine can’t. 

I knew that if I had information about the blood levels of metals, it would likely be more reassuring because that’s a concrete finding, as opposed to the more abstract idea about how much, or rather how little, were found in tampons. And so, after doing a little more research, I almost stumbled off my chair when I found a paper and a scientific abstract showing just that.

Let’s look at these studies. 

The first is from the BioCycle study (2019). This well-known study followed a group of women to learn about the relationship between reproductive hormones and oxidative stress. As part of the study, levels of various metals, including cadmium and lead, were measured from 255 women at a single point mid-cycle, and there was no difference between women who used tampons and those who did not. While a single measurement isn’t a definitive answer, and the study wasn’t designed to answer the question about metals and tampons, it’s reassuring, especially as lead takes a while to leave the body and would be expected to accumulate over time if there were regular exposure.  

The second study is a published abstract from the 34th Annual Conference of the International Society of Environmental Epidemiology (held in 2022). I don’t usually reference meeting abstracts because the methods and statistics aren't detailed, and the data hasn’t been submitted for peer review. It’s also possible the abstract would never become a paper for a myriad of reasons. However, as we have so little data and these results are from a larger study that has resulted in numerous publications vetted in peer-reviewed journals, including a paper that looked at risk factors for levels of metals in the blood, I feel it’s valid to include.

This second study analyzed data from 1,644 Black participants in the Study of Environment, Lifestyles and Fibroids (SELF) in Detroit, Michigan. Investigators measured blood levels of many metals, including arsenic, cadmium, lead, and zinc. They compared the findings from women who used tampons to those who did not. 

Reassuringly, the abstract showed no difference in arsenic, cadmium, or lead blood levels, whether tampons were used or not. In fact, of the metals tested, only three showed a difference between tampon users and non-users:

• Zinc levels in blood were slightly lower among tampon users. This is a reassuring finding because the investigators found higher zinc levels than expected in the tampons analyzed in the original study. 

• In a subgroup tested while using tampons, tampon use was only associated with elevated blood-chromium levels of 0.15 micrograms/liter (mcg/L). Chromium should be < 1.4 mcg/L, so this increase seems unlikely to have any biological significance. 

Interestingly, published data from the SELF study found that women who drank five or more glasses of water daily had 7.1% higher lead levels in their blood than women who drank two or fewer glasses of water daily. As lead is found in water, this isn’t surprising but is concerning. The influencers making videos blaming tampons for poisoning them somehow don’t seem invested in the identified risk factors for increased lead levels. 

Putting it All Together

• The levels of lead (and arsenic and cadmium) in tampons are exceedingly low and less than are found in many things people assume are healthy, such as bottled water, green tea, and supplements. This does not mean I think it’s “okay” to ingest lead, which several people accused me of on Instagram. This means we need to put exposure risk in perspective.

• Treating a tampon with nitric acid and baking it for over an hour at 180 C does not replicate what happens in the vagina, so we have no idea if any of these minute amounts of metal can get from a tampon into the vagina or if it can be absorbed into the blood.

• There are two studies, one unpublished, that tell us tampon use is not associated with increased levels of lead or cadmium, and one of these studies also found no increase in arsenic. These studies are not definitive, but they are reassuring, especially when put in context with the two points directly above. Studies that measure blood levels over a longer time are needed.

• We need more data to make sure that metals in tampons don’t negatively impact the vaginal microbiome; however, research to date has not found that tampons are associated with disturbances in the microbiome. Our ability to evaluate the vaginal microbiome has improved dramatically in the past ten or so years, so older studies should be replicated with newer technology.

More data here is important, and I applaud all the researchers working hard to fill the many data voids. It’s discouraging to see people cherry-pick parts of papers and take advantage of data voids to gin up concern to play vaginal fear factor for grifting. In fact, because it’s lying to women for personal gain, it’s misogynistic. As we wait for more data, know that medical professional societies often step up with statements if something genuinely concerning is found in a study.

For people who are worried about their cumulative burden of arsenic, cadmium, and lead, currently, there is no evidence that tampon use is a contributing factor. Could that change over time? Sure. What we know about any product or medication could change with new science. 

A single paper rarely means everything; instead, it’s a piece of a puzzle, and guessing the final picture without all of the pieces is wrong. Sadly, that message doesn’t work with social media and much of the press, so click-bait headlines and studies taken out of context or willfully misinterpreted will forever be fodder for TikTok videos and Instagram reels. So if you’ve seen people playing vaginal fear factor on social media, consider blocking them because your best defense is to curate your feeds to limit your exposure to known vectors of disinformation.

References

1. 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.

2. Geller RJ, Wesselink AK, Upson K, Claus Henn B, Schildroth S, Wright R, Coleman CM, Willis MD, Bethea TN, Williams PL, Harmon QE, Baird DD, Wegienka G, Wise LA. Correlates of whole blood metal concentrations among reproductive-aged black women. Journal of exposure science & environmental epidemiology. 2022. Epub 2022/09/15. doi: 10.1038/s41370-022-00477-y. PubMed PMID: 36104525.

3. Shearston J, Geller R, Harmon Q, et al. Tampons as a source of exposure to metals among reproductive-aged Black women. 34th Annual Conference of the International Society of Environmental Epidemiology 2022. ISEE Conference Abstracts Volume 2022, Issue 1 https://doi.org/10.1289/isee.2022.P-0375

4. Singh, J., Mumford, S.L., Pollack, A.Z. et al. Tampon use, environmental chemicals and oxidative stress in the BioCycle study.2019 Environ Health 18, 11. https://doi.org/10.1186/s12940-019-0452-z

5. Hochwalt AE, Abbinante-Nissen JM, Bohman LC, Hattersley AM, Hu P, Streicher-Scott JL, Teufel AG, Woeller KE. The safety assessment of tampons: illustration of a comprehensive approach for four different products. Front Reprod Health. 2023 Jun 20;5:1167868. doi: 10.3389/frph.2023.1167868. PMID: 37408999; PMCID: PMC10319135.