Menstrual Products As a Source of Environmental Chemical Exposure: A Review from the Epidemiologic Perspective

Overview

Journal Curr Environ Health Rep

Specialty Environmental Health

Date 2022 Mar 18

PMID 35302185

Authors

Kristen Upson

Jenni A Shearston

Marianthi-Anna Kioumourtzoglou

Affiliations

Soon will be listed here.

Abstract

Purpose Of Review: Menstrual bleeding is a regular, common occurrence in a substantial portion of the population. Menstruators may use more than 10,000 menstrual products over the lifetime. Given the potential for environmental chemicals in menstrual products to be absorbed by the vulvar and vaginal epithelium into systemic circulation, we reviewed the available data on menstrual products as a source of environmental chemical exposure.

Recent Findings: Nearly two dozen studies have been conducted measuring environmental contaminants in menstrual products; all have detected environmental chemicals but had discrepant conclusions on exposure risks. Only three human studies have investigated menstrual product use and environmental chemical concentrations and all observed associations. Detection of environmental chemicals in menstrual products, in combination with challenges of exposure assessment, scarcity of human studies, and the exceedingly common occurrence of menstrual bleeding, motivates the need for further research. We provide recommendations to move this field forward.

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References

van Eijk A, Zulaika G, Lenchner M, Mason L, Sivakami M, Nyothach E . Menstrual cup use, leakage, acceptability, safety, and availability: a systematic review and meta-analysis. Lancet Public Health. 2019; 4(8):e376-e393. PMC: 6669309. DOI: 10.1016/S2468-2667(19)30111-2. View

Oriba H, Bucks D, Maibach H . Percutaneous absorption of hydrocortisone and testosterone on the vulva and forearm: effect of the menopause and site. Br J Dermatol. 1996; 134(2):229-33. View

Lin N, Ding N, Meza-Wilson E, Devasurendra A, Godwin C, Park S . Volatile organic compounds in feminine hygiene products sold in the US market: A survey of products and health risks. Environ Int. 2020; 144:105740. PMC: 7958867. DOI: 10.1016/j.envint.2020.105740. View

Kim H, Lee J, Kim J, Lee J, Bae O, Choi Y . Risk assessment of volatile organic compounds (VOCs) detected in sanitary pads. J Toxicol Environ Health A. 2019; 82(11):678-695. DOI: 10.1080/15287394.2019.1642607. View

Munro M, Critchley H, Fraser I . The FIGO classification of causes of abnormal uterine bleeding in the reproductive years. Fertil Steril. 2011; 95(7):2204-8, 2208.e1-3. DOI: 10.1016/j.fertnstert.2011.03.079. View

Kuki A, Zelei G, Nagy L, Nagy T, Zsuga M, Keki S . Rapid mapping of various chemicals in personal care and healthcare products by direct analysis in real time mass spectrometry. Talanta. 2018; 192:241-247. DOI: 10.1016/j.talanta.2018.09.054. View

Hill D, Brunner M, Schmitz D, Davis C, Flood J, Schlievert P . In vivo assessment of human vaginal oxygen and carbon dioxide levels during and post menses. J Appl Physiol (1985). 2005; 99(4):1582-91. DOI: 10.1152/japplphysiol.01422.2004. View

Park C, Barakat R, Ulanov A, Li Z, Lin P, Chiu K . Sanitary pads and diapers contain higher phthalate contents than those in common commercial plastic products. Reprod Toxicol. 2019; 84:114-121. PMC: 6504186. DOI: 10.1016/j.reprotox.2019.01.005. View

Brotman R, Klebanoff M, Nansel T, Zhang J, Schwebke J, Yu K . Why do women douche? A longitudinal study with two analytic approaches. Ann Epidemiol. 2007; 18(1):65-73. DOI: 10.1016/j.annepidem.2007.05.015. View

10.

Farage M, Maibach H . The vulvar epithelium differs from the skin: implications for cutaneous testing to address topical vulvar exposures. Contact Dermatitis. 2004; 51(4):201-9. DOI: 10.1111/j.0105-1873.2004.00444.x. View

11.

Vostral S . Rely and Toxic Shock Syndrome: a technological health crisis. Yale J Biol Med. 2011; 84(4):447-59. PMC: 3238331. View

12.

Srikrishna S, Cardozo L . The vagina as a route for drug delivery: a review. Int Urogynecol J. 2012; 24(4):537-43. DOI: 10.1007/s00192-012-2009-3. View

13.

Berger K, Kogut K, Bradman A, She J, Gavin Q, Zahedi R . Personal care product use as a predictor of urinary concentrations of certain phthalates, parabens, and phenols in the HERMOSA study. J Expo Sci Environ Epidemiol. 2018; 29(1):21-32. PMC: 6037613. DOI: 10.1038/s41370-017-0003-z. View

14.

Devito M, Schecter A . Exposure assessment to dioxins from the use of tampons and diapers. Environ Health Perspect. 2002; 110(1):23-8. PMC: 1240689. DOI: 10.1289/ehp.0211023. View

15.

Epstein D, Lee N, Kang J, Agapie E, Schroeder J, Pina L . Examining Menstrual Tracking to Inform the Design of Personal Informatics Tools. Proc SIGCHI Conf Hum Factor Comput Syst. 2017; 2017:6876-6888. PMC: 5432133. DOI: 10.1145/3025453.3025635. View

16.

Ding N, Batterman S, Park S . Exposure to Volatile Organic Compounds and Use of Feminine Hygiene Products Among Reproductive-Aged Women in the United States. J Womens Health (Larchmt). 2019; 29(1):65-73. PMC: 6998054. DOI: 10.1089/jwh.2019.7785. View

17.

Tzeghai G, Ajayi F, Miller K, Imbescheid F, Sobel J, Farage M . A Feminine Care Clinical Research Program Transforms Women's Lives. Glob J Health Sci. 2015; 7(4):45-59. PMC: 4802086. DOI: 10.5539/gjhs.v7n4p45. View

18.

Gao C, Kannan K . Phthalates, bisphenols, parabens, and triclocarban in feminine hygiene products from the United States and their implications for human exposure. Environ Int. 2020; 136:105465. DOI: 10.1016/j.envint.2020.105465. View

19.

Schlievert P, Davis C . Device-Associated Menstrual Toxic Shock Syndrome. Clin Microbiol Rev. 2020; 33(3). PMC: 7254860. DOI: 10.1128/CMR.00032-19. View

20.

Wu T, Mendola P, Buck G . Ethnic differences in the presence of secondary sex characteristics and menarche among US girls: the Third National Health and Nutrition Examination Survey, 1988-1994. Pediatrics. 2002; 110(4):752-7. DOI: 10.1542/peds.110.4.752. View