Tampons Have Traces of Lead: Does it Matter?

For the past year, Kathrin Schilling, PhD, has been trying to answer a question with major implications for public health: Does lead contained in tampons cross the vaginal lining and enter the bloodstream? If yes, millions of women a year in the US alone may be at risk for infertility and cancer.Schilling and her colleagues created a 3D model of vaginal tissue and applied the neurotoxic metal, measuring penetration into underlying layers. They do not yet have definitive results. The research was sparked by recent studies that found traces of lead and other heavy metals in widely available tampons.There is “a key gap between finding a chemical in a product and understanding whether someone is actually exposed to it,” said Schilling, an assistant professor of environmental health sciences at the Columbia University Mailman School of Public Health in New York City.It will be years before longitudinal studies determine the effect of using these tampons, said Marya Zlatnik, MD, a professor of ob/gyn and reproductive sciences at the University of California, San Francisco.If even a tiny amount of lead is added to the body’s total concentration, “is there potentially any harm?” she said. And what if that exposure occurs over several days every month, for decades? FDA’s Toxicologic Risk AssessmentThis year, the FDA published findings from tests on 11 retail products. Twenty-one metals were extracted under conditions that mimicked 24 hours of use, rather than the maximum 8 hours recommended in the FDA guidance. The amount of lead extracted was 3.5 ng/g (or 3.5 µg/kg) of tampon sample.All the metals had tolerable intake levels indicating “negligible toxicological concern,” assuming 100% absorption through the vaginal mucosa.“These numbers are not anywhere near what we would worry about in humans, with the caveat that we don’t have in vivo data of how much lead actually may enter the body,” said Mehruba Anwar Parris, MD, an associate professor of emergency medicine at Rutgers New Jersey Medical School in Newark and a medical toxicologist with the New Jersey Poison Information and Education System.Following the FDA report, other researchers tested eight tampon products. Conventional, nonorganic products had between 0.121 and 0.141 parts per million (ppm) of lead. Organic products clustered between the lowest concentration that can be detected and 0.020 ppm. The Environmental Protection Agency requires water systems to take action if more than 10% of water samples exceed 15 parts per billion.The findings showed no clinical threat, said Jacob Hands, MD, head of the Science Department at Oasishealth.app, a firm that runs lab testing on commercial products, in Venice Beach, California, who helped lead the research.“Because vaginal ingestion [absorption] of metals and the uptake from that specific tissue is so variable, it is not possible to definitively render a conclusion,” Hands said.Unanswered QuestionsThe FDA’s finding that the amount of lead that could be absorbed from tampons is likely very low was encouraging to Jenni Shearston, PhD, MPH, an assistant professor of integrative physiology at the University of Colorado Boulder and lead author of the 2024 study that led to FDA’s analysis.“However, just because it’s very low doesn’t mean that there could be no effect,” she said.Manufacturers should be required to test for lead and include the levels, as well as arsenic, mercury, and cadmium, on product labels, said Jeanne Conry, MD, PhD, president of the Environmental Health Leadership Foundation in Granite Bay, California, and a past-president of the American College of Obstetricians and Gynecologists.“But how low is low? Who sets those parameters? And how are they determined?” she said.California passed legislation last year requiring manufacturers of tampons and pads report concentrations of toxic metals in their products by the end of 2026.Research has shown the existence of lead in women’s bodies is associated with various adverse outcomes, including diminished ovarian reserves.The conclusion in one study: “Our study revealed that avoiding heavy metallic elements and properly supplementing trace essential elements are conducive to ovarian function.”Shearston is soon launching an epidemiologic study that will record participants’ use of menstrual products and will collect and analyze samples of their menstrual blood in the following cycle. She hopes to begin recruitment in November.Conry said that while she has not advised patients to stop using tampons, she tells them about studies showing organic tampons have lower levels of lead. Menstrual cups, if patients want to stay away from tampons, are a great alternative. “I think tampons are fabulous, and they’re convenient,” Conry said.Schilling reported receiving funding from the National Institute of Environmental Health Sciences for her research. Conry reported giving lectures for Hologic and Well Women Health Care and working with the nonprofit Preconception to Infancy. Shearston reported receiving funding from the National Institutes of Health. Parris reported participation in a working group funded by Procter & Gamble. Zlatnik reported receiving federal grant funding for environmental health education.Brenda Sandburg is a freelance journalist and has written about the biopharmaceutical industry and legal issues for the Pink Sheet.