Could Toxic Tampons Be Contributing to Urinary Incontinence In Women?

Tampons have been shown to contain "forever chemicals" called polyfluoroalkyl substances (PFAS), and new studies are showing that some organic and non-organic tampons also contain arsenic, lead, and other heavy metals and toxic metals.

While this is an alarming finding that potentially puts women's health at risk, it's yet to be determined whether these toxins can leach from tampons into the vagina.

However, according to the Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO), and the Environmental Protection Agency (EPA), there is no safe level of exposure to these chemicals that is known to be without harmful effects.

The vagina is considered a mucous membrane and has a high potential for absorption systemically into the body. The vaginal mucosa is highly vascularized, containing a rich supply of blood vessels, allowing for quick and effective absorption with any products that come in contact with it.

While the recent study that found lead and arsenic in tampons couldn't conclude whether or not the toxins could leach from tampons into vaginas, it's a possibility.

"Vaginally-absorbed products also do not undergo first-pass metabolism and detoxification through the liver, meaning that they can directly enter systemic vascular circulation," says Board-Certified Physician Assistant Aleece Fosnight.

Chronic exposure to both lead and arsenic can cause neurotoxicity in the body. Neurotoxicity can cause oxidative stress, inflammation, and hormonal disruption as specific mechanisms that can be affected. 

Consuming heavy metals in products can lead to systemic broad concerns, specifically in the central nervous system (CNS). However, local absorption through vaginal tissues can lead to more isolated organ damage, particularly in the organ systems nearby, including the genitourinary system and anorectal systems.

It is also probable that vaginal absorption can lead to higher bioavailability and higher concentrations of metal versus oral consumption.

"I think that these recent studies will lead to further research of absorption routes and higher concentrations," says Fosnight.

More research needs to be done to say if toxic chemicals in tampons can cause UI in women, but there is supporting evidence that toxins may cause UI. 

The development of UI from lead / arsenic exposure is linked to the neurotoxicity and damage of pelvic and sacral nerves that are essential in the functionality of the bladder and urethra. Nephrotoxicity is another concern for UI, according to Fosnight. The chemicals found in tampons have also been linked to bladder cancer. Studies have shown that polyfluoroalkyl chemicals (PFCs) are also linked to urge incontinence in women.

Signs that your tampons may be causing UI may be similar to the typical UI symptoms, like loss of sensation that you need to void your bladder, leading to leakage, needing to void your bladder more frequently than usual, and leaking urine when coughing, laughing, or sneezing.

"If you're experiencing UI and suspect it may be related to toxin exposure, you should stop using your products immediately and seek medical attention," says Fosnight. 

Your healthcare provider may draw serum blood levels to test your body's chemical levels. They may also suggest chelation therapy to decrease the level of metals in your body.

Discontinue the use of your tampons as soon as possible if you suspect they're causing UI, and use alternative menstrual products, such as menstrual cups or a progestin-containing IUD.

Women with heavier menstrual cycles (endometriosis, menorrhagia, etc.) may be more vulnerable to developing UI due to exposure to toxins in tampons.

This is because women with heavier cycles may have used more tampons than the average female for a more extended period, as well as pads in combination as a safeguard should the tampon overflow.

While many products we are exposed to everyday contain chemicals that can lead to decreased health, anything you can do to limit your exposure is best to protect yourself from tampon toxins. Fosnight recommends avoiding products with fragrances, Rayon, or plastic applicators. 

Some possible safe brands of menstrual products include Seventh Generation, Viv, or Cora. However, it's still not 100% certain that these products won't cause any concerns, especially since the recent study found toxins in organic and non-organic tampons.

"Unfortunately, the bigger picture is that using tampons and other menstrual products that are organic or considered 'safe' can be more costly and not feasible to everyone," Fosnight says. "However, thinking about your overall health and longevity should be top of mind."

Healthcare providers should ask their patients what products they use for menstrual management. If tampons (and even other products) come up in the conversation, they should discuss the safety of using tampons and encourage their patients to avoid products with fragrance, plastic applicators, and Rayon. 

The U.S. Food and Drug Administration (FDA) considers menstrual products a Class II medical device, so they are already subject to special controls, such as performance standards, specific labeling requirements, and post-market surveillance. 

Public policy can more strictly regulate products and enforce safety standards that limit the presence of harmful chemicals, similar to the European Union's REACH regulations. Banning harmful substances, policies that reduce cost and increase the availability of safe products, consumer education and awareness campaigns, and allocating funds for research and data collection to develop safer alternatives to menstrual products would be significant steps toward public health policies requiring safer consumer options.

There needs to be more research to show the link between tampon toxins and UI or genitourinary symptoms and even bladder cancer. Oral ingestion of these chemicals shows a direct link to these conditions. However, products containing chemicals in the body's local area need to be studied. 

This is a systems issue, and until we show more equitable value for vulva owners in quality menstrual products, pregnancy care, and childcare and get rid of the pink tax, women will continue to struggle with day-to-day costs of living.

References

Upson, K., Shearston, J. A., & Kioumourtzoglou, M.-A. (2022). Menstrual Products as a Source of Environmental Chemical Exposure: A Review from the Epidemiologic Perspective. Current Environmental Health Reports, 9(1). https://doi.org/10.1007/s40572-022-00331-1

‌Shearston, J. A., Upson, K., Gordon, M., Do, V., Olgica Balac, Nguyen, K., Yan, B., Marianthi-Anna Kioumourtzoglou, & Schilling, K. (2024). Tampons as a source of exposure to metal(loid)s. Environment International, 108849–108849. https://doi.org/10.1016/j.envint.2024.108849

‌Cui, S., Zhao, X., Chu, X., Zhang, S., Gu, Q., & Xu, C. (2021). Effect of polyfluoroalkyl chemicals on the occurrence of urge urinary incontinence: a population-based study. Therapeutic Advances in Urology, 13, 175628722110297. https://doi.org/10.1177/17562872211029799

‌U.S.: usage of tampons 2020. (n.d.). Statista. https://www.statista.com/statistics/278085/us-households-usage-of-tampons/#:~:text=The%20data%20has%20been%20calculated

Disclaimer

Information provided on the Aeroflow Urology blog is not intended as a substitute for medical advice or care from a healthcare professional. Aeroflow recommends consulting your healthcare provider if you are experiencing medical issues relating to incontinence.