Tampon Safety

Farmin Shahabuddin MPH, Winnie Zhao , National Center for Health Research

A rumor on the Internet alleges that tampons are contaminated with asbestos and dioxin, and that the rayon in some tampons causes toxic shock syndrome. What are the facts?

Tampons are big business. Approximately 50% of non-Hispanic White females use tampons, compared to 39% of Hispanic, 37% of Asian, and 31% of non-Hispanic Blacks. 2 Consumers deserve clear and trustworthy information about potential health risks.

Tampons are regulated by the FDA as Class II (moderate risk) medical devices. This classification does not require clinical trials or pre-market ingredient disclosure or comprehensive chemical testing. In 2024, the FDA launched an independent literature review of existing studies on tampon contaminants and an internal laboratory study simulating real-world use to measure potential metal release and absorption. As of December 2024, the FDA’s literature review found no clear evidence of health risks but highlighted major gaps in existing research. As of 2025, its laboratory testing continues. 3

Dioxin and Rayon

Dioxin is a byproduct when wood pulp is converted into a synthetic fiber called Rayon, which is often used for fabric. Dioxin is a known carcinogen, made infamous because of its use by U.S. soldiers as herbicide in the Vietnam War. Tampons are usually made of cotton and rayon. Up until the late 1990s, bleaching the wood pulp resulted in traces of dioxin in tampons, but that method has been replaced with a chlorine-free bleaching process. 4

While the dioxin hazard has been reduced because of new bleaching methods, dioxin is still detected in tampons — even those made of 100% cotton. The EPA states that, due to decades of pollution, dioxin can be found in the air, water, and ground; thus, small amounts of dioxin may be present in the cotton or wood pulp raw materials used to make tampons. The FDA website reports that tampon manufacturers have provided the agency with results from studies conducted at independent laboratories, which concluded that the dioxin in the rayon raw materials ranges from undetectable 0.1 to 1 parts per trillion. Although the FDA currently requires tampon manufacturers to monitor dioxin levels in their finished products, the results are not available to the public. 5

It was not until 1994 that the Environmental Protection Agency (EPA) issued a report stating that dioxins are known to cause cancer in animals and probably cause cancer in people. The EPA has also determined that people exposed to high levels of dioxins may be at risk for a damaged immune system, increased risk of pelvic inflammatory disease (PID), and reduced fertility. The U.S. Department of Health and Human Services now classifies 2,3,7,8-TCDD, the most toxic dioxin, as a known human carcinogen. 6 A 2022 critical review funded by the National Natural Science Foundation of China found that 80% of monkeys exposed to dioxin developed endometriosis, a painful disease in which uterine tissue is found outside the uterus, frequently leading to infertility. This means that animal evidence of harm remains strong, but human data remain limited and inconclusive. 7

A landmark 2002 study concluded that exposure to dioxin from tampons is thousands of times lower than exposure through food. In fact, according to the EPA, over 90% of typical human dioxin exposure originates from animal fats, meat, dairy products, and fish. 8 The FDA also mentions that the exposure to dioxin from tampons today “is many times less than normally present in the body from other environmental sources.”

However, according to Dr. Philip Tierno, director of clinical microbiology and diagnostic immunology at the New York University Medical Center and a leading expert on the health risks of tampons, even trace amounts of dioxin are cause for concern because tampons come in contact with vaginal tissue, which is covered in permeable, mucous membranes leading directly to the reproductive organs. In addition, based on an average woman’s menstrual cycles, about 12,000 tampons per lifetime is possible. The cumulative effects would therefore be considerable and possibly measurable for many years. 9

Heavy Metals

In 2024, researchers from the University of California, Berkeley, and Columbia University conducted the first study measuring 16 metals in 30 tampon brands sold in the U.S. and Europe. They found detectable levels of lead, arsenic, and cadmium in every product, although concentrations varied widely among brands and materials. 10

The study did not determine whether these levels are high enough to harm health, but it raised concerns because vaginal tissue is highly permeable, and regulatory limits for metals in menstrual products do not exist. Following these findings, the FDA announced a review of heavy metals in menstrual products and related medical devices. 11 Until more data are released, experts recommend choosing tampons from companies that publish independent laboratory results and avoiding fragranced products, which may contain additional chemicals.

PFAS

Recent research has also detected PFAS (per-and polyfluoroalkyl substances) – chemicals used for water and stain resistance in carpeting, upholstery, and clothing- in some menstrual products. These “forever chemicals” can build up in the body and are linked to cancer, immune suppression, hormonal disruption, and reproductive harm. 12

In 2025, scientists tested over 100 menstrual products, including pads, tampons, and period underwear. They found fluorine, which is a PFAS indicator, in several items; however, most tampon cores had very low or undetectable levels. 13 Fluorine is used as a PFAS indicator because every PFAS molecule contains fluorine atoms, and fluorine does not appear naturally in cotton or most menstrual-product materials. So, when fluorine is detected, it signals that PFAS are likely present, even if laboratory testing has not measured each PFAS compound individually.

Another 2025 study reported that all reusable menstrual cups, pads, and underwear tested contained PFAS, with intentional use suspected in about one-third of samples. 14 “Intentional use” means the PFAS were added on purpose during manufacturing, for example, to make the material more water or stain-resistant rather than showing up accidentally from the environment or machinery.

Currently, there is no federal limit for PFAS in menstrual products. The FDA is expected to publish a safety assessment of PFAS by December 2025, but menstrual products are currently unregulated for PFAS content. 15 Because PFAS are highly persistent, experts suggest consumers look for “PFAS-free” or uncoated products and contact manufacturers for transparency about materials and testing.

While there is no federal regulation on PFAS in menstrual products, at least nine U.S. states – including California, Minnesota, Maine, Colorado, Vermont, Rhode Island, Connecticut, New Mexico, and New York – have now passed or are finalizing bans or restrictions that will take effect between 2025 and 2028. Several additional states, such as New Jersey, have introduced similar bills. These efforts mark a state-led movement to protect consumers while federal regulations are lagging behind.

Toxic Shock Syndrome (TSS)

Toxic Shock Syndrome (TSS) is a rare but potentially fatal disease caused by bacterial toxins, often caused by prolonged use of high-absorbency tampons.16 The condition, first identified among teenage girls in 1978, primarily affects tampon users under age 30. While TSS is rare, early recognition of symptoms, such as fever, vomiting, rash, or dizziness, is critical because the condition can be fatal if untreated.

Research in the 1980s found that certain fibers reduced magnesium in the vaginal environment, which caused the Staphylococcus aureus bacteria to make much more of the toxin that leads to TSS. 18 The TSS epidemic reached its peak in 1980, with 814 cases and 38 deaths reported to the Centers for Disease Control and Prevention (CDC). 17 After public awareness campaigns, the most absorbent tampons were withdrawn from the market, and the number of cases decreased sharply between 1980 and 1990.

In 1982, the FDA required that all tampon labels advise women to use the lowest absorbency needed to control their flow and include TSS warning signs. In 1990, the FDA standardized tampon absorbency labeling to help consumers select the lowest absorbency necessary for their flow and reduce the likelihood of getting TSS.19 A possible reason for the decrease in TSS cases is that manufacturers removed synthetic ingredients such as polyester, carboxymethylcellulose, and polyacrylate rayon, which helped create conditions that made it easier for the bacteria to produce the TSS toxin. 20

Today, viscose rayon, a different absorbent fiber, is still used but is considered safe. 21 TSS now occurs at an annual rate of about 0.07 cases per 100,000 females in the U.S., according to the CDC. 22

Asbestos Rumor

The asbestos alleged in the Internet rumor has never been confirmed. The email message claims that manufacturers add asbestos to tampons to promote excessive bleeding to sell more of their product. The FDA says they review all industry-supplied data on the design and materials of all tampons before they are marketed in the U.S., and that asbestos is not an ingredient in any tampon brand.

Legislation in Congress

Starting in 2008, U.S. Representative Carolyn Maloney of New York introduced legislation to require studies of tampon safety. The most recent version of the bill, now called the Robin Danielson Feminine Hygiene Product Safety of 2023 (H.R. 5957), was also introduced by Rep. Carolyn Maloney and required NIH to “study the contaminants and substances used, such as dioxin, synthetic fibers, fragrances, dyes, and preservatives in feminine hygiene products pose health risks to women who use the products.” The bill did not advance in Congress despite broad support from public health advocates, 23 and Rep. Maloney has since retired from Congress.

Alternatives and Recommendations

Using menstrual pads can reduce the risk of TSS, and consumers should follow FDA guidance as follows:

  • Use tampons only during active menstruation.
  • Select the lowest absorbency needed.
  • Changing tampons every 4–8 hours.

Several other alternatives to tampons exist, including all-cotton tampons, hydrogen-peroxide-whitened pads, and reusable menstrual cups. However, there is no evidence that these are inherently safer than tampons.

In addition, consumers concerned about chemical exposure can look for menstrual products that are labeled as PFAS-free or that publish independent laboratory testing results. These labels indicate that the manufacturer has taken extra steps to verify product safety, although no federal standard yet requires such testing.

References

  1. Credence Research. (2023). U.S. feminine hygiene products market report. https://www.credenceresearch.com/report/us-feminine-hygiene-products-market
  2. American Journal of Obstetrics and Gynecology. (2025). Menstrual product use by race and ethnicity. https://www.ajog.org/article/S0002-9378(25)00145-0/fulltext
  3. U.S. Food and Drug Administration. (2024). Biocompatibility and toxicology program: Research on medical devices. https://www.fda.gov/medical-devices/medical-device-regulatory-science-research-programs-conducted-osel/biocompatibility-and-toxicology-program-research-medical-devices-biocompatibility-and-toxicology
  4. U.S. Food and Drug Administration. (2015). Tampons and asbestos, dioxin, & toxic shock syndrome. http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/PatientAlerts/ucm070003.htm
  5. U.S. Food and Drug Administration. (2024). Tampon manufacturing and safety monitoring update. https://www.fda.gov/media/184682/download
  6. U.S. Department of Health and Human Services. (2021). Report on carcinogens (15th ed.). https://ntp.niehs.nih.gov/sites/default/files/ntp/roc/content/profiles/tetrachlorodibenzodioxin.pdf
  7. Li, C., et al. (2022). Critical review of dioxin toxicity in humans and animals. Science of the Total Environment, 842, 156789. https://doi.org/10.1016/j.scitotenv.2022.15678
  8. U.S. Environmental Protection Agency. (2025). Dioxins and furans overview. https://www.epa.gov/dioxin
  9. Topping, A. (2016, March 21). Are tampons unsafe? What you need to know about toxic shock syndrome. The Guardian. https://www.theguardian.com/lifeandstyle/2016/mar/21/tampon-health-concerns-toxic-shock-syndrome-menstruation-women
  10. Wu, E., et al. (2024). Toxic metals in tampons: A cross-sectional analysis. Environmental International, 185, 108132. https://doi.org/10.1016/j.envint.2024.108132
  11. U.S. Food and Drug Administration. (2024). Response to toxic metals in tampons. https://www.fda.gov/news-events/press-announcements
  12. U.S. Environmental Protection Agency. (2025). Key EPA actions to address PFAS. https://www.epa.gov/pfas/key-epa-actions-address-pfas
  13. American Chemical Society. (2025). PFAS found in several period products. https://www.acs.org/pressroom/presspacs/2025/august/research-update-pfas-found-in-several-reusable-period-products.html
  14. Technology Networks. (2025). Toxic PFAS found in reusable menstrual products. https://www.technologynetworks.com/applied-sciences/news/toxic-pfas-found-in-reusable-menstrual-products-402586
  15. U.S. Food and Drug Administration. (2025, March 11). Per- and polyfluoroalkyl substances (PFAS) in cosmetics. U.S. Department of Health and Human Services. https://www.fda.gov/cosmetics/cosmetic-ingredients/and-polyfluoroalkyl-substances-pfas-cosmetics
  16. Centers for Disease Control and Prevention. (2024). Epidemiology of staphylococcal toxic shock syndrome. https://www.cdc.gov/mmwr/preview/mmwrhtml/00001651.htm
  17. Centers for Disease Control and Prevention. (1990). Reduced incidence of menstrual toxic-shock syndrome—United States. Morbidity and Mortality Weekly Report, 39(24), 421–422. https://www.cdc.gov/mmwr/preview/mmwrhtml/00001651.htm
  18. U.S. Food and Drug Administration. (2004, August 25). Medical devices; labeling for menstrual tampons; ranges of absorbency. Federal Register. https://www.federalregister.gov/documents/2004/08/25/04-19488/medical-devices-labeling-for-menstrual-tampons-ranges-of-absorbency-change-from-junior-to-light
  19. Centers for Disease Control and Prevention. (1990). Toxic shock syndrome and tampon material changes. https://www.cdc.gov/mmwr
  20. Schlievert, P. M., & Blomster, D. A. (1983). Effect of tampons on staphylococcal growth and toxic-shock-syndrome toxin-1 production. Journal of Infectious Diseases, 147(2), 236–242. https://doi.org/10.1093/infdis/147.2.23
  21. Vulvani. (2022, June 14). What is in tampons? And should we be worried? https://www.vulvani.com/en/what-is-in-tampons-and-should-we-be-worried/
  22. Atchade, E., De Tymowski, C., Grall, N., Tanaka, S., & Montravers, P. (2024). Toxic Shock Syndrome: A Literature Review. Antibiotics (Basel, Switzerland), 13(1), 96. https://doi.org/10.3390/antibiotics13010096
  23. H.R. 5957 – Robin Danielson Menstrual Product and Intimate Care Product Safety Act of 2023. (2023). Congress.gov. https://www.congress.gov/bill/118th-congress/house-bill/5957