|
Tampon Safety
By Susan Dudley and Salwa Nassar
A widely circulated rumor
spread over the Internet alleges that tampons are contaminated with asbestos
and dioxin, and that the rayon in some tampons causes toxic shock syndrome.
In response to the email rumor, the Food and Drug Administration (FDA), which
regulates the safety and effectiveness of medical devices, issued a statement
on its website that the available scientific evidence does not support the
rumors and provided information about tampon safety.
Unfortunately, the FDA's
statement also highlights the fact that certain important questions and concerns
regarding the safety of tampons have not been adequately addressed. Moreover,
the agency's reassurances are largely based on data that were submitted by
tampon manufacturers, but are not publicly available.
Dioxin
Tampons, used by approximately
43 million women in the United Stated today, are usually made of cotton
and rayon. Rayon is a synthetic fiber made from wood pulp. During that process,
a toxic byproduct known as dioxin is created. Very small amounts of dioxin
are in the rayon fiber. In addition, until the late 1990's a chlorine bleaching
process that also produces dioxin was used on both the rayon and the cotton
used in tampons.
In 1994, the Environmental
Protection Agency (EPA) issued a report that stated that dioxins are known
to cause cancer in animals, and probably cause cancer in people. The EPA
also has 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. Recent research on monkeys has linked
dioxin exposure with increased risks for developing endometriosis, a painful
disease in which uterine tissue is found outside the uterus, frequently
leading to infertility. One study found that 80 percent of the monkeys exposed
to dioxin developed endometriosis, and that higher levels of exposure caused
the development of more severe forms of the disease. Two of the monkeys
in the study died of endometriosis.
While the dioxin hazard
from bleaching has been reduced in recent years as a result 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, trace amounts of dioxin may be present
in the cotton or wood pulp raw materials used to make tampons. According
to the results of studies conducted by tampon manufacturers and submitted
to the FDA, dioxin levels in the rayon raw materials range from undetectable
to 1 part in 3 trillion. More recently, a study sponsored by the FDA Office
of Women's Health and published in 2005 found detectable levels of dioxin
in seven brands of tampons, including at least one 100% cotton brand. Although
the FDA currently requires tampon manufacturers to monitor dioxin levels
in their finished products, the results are not available to the public.
The FDA says that the
exposure to dioxin from tampons today "is many times less than normally
present in the body from other environmental sources, so small that any
risk of adverse health effects is considered negligible." However, according
to Dr. Phillip 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 some of the most absorbent
tissue in the body. In addition, the effects of dioxin are cumulative and
can be measured 20 to 30 years after exposure. That is particularly troubling
because tampons are used by up to 70 percent of menstruating women in the
U.S., and it has been estimated that the average woman may use as many as
16,800 tampons in her lifetime.
Toxic Shock Syndrome (TSS)
TSS, a rare but potentially
fatal disease caused by a bacterial toxin, has also been associated with tampon
use. Although the exact connection remains unclear, use of high-absorbency
tampons produced with rayon and leaving tampons in for an extended period
of time seem to increase the risk of TSS. The disease, which was first described
among teenage girls in 1978, primarily strikes tampon users under the age
of 30. The TSS epidemic reached a peak in 1980 with a total of 813 cases,
including 38 deaths, reported to the Centers for Disease Control and Prevention
(CDC).
According
the to the FDA, the number of menstrual-related TSS cases has decreased significantly
in recent years; there were only six confirmed cases in 1997 and three in
1998. Rana Hajjeh, M.D., a medical epidemiologist with CDC's division of bacterial
and mycotic diseases, attributes the drop in TSS cases to the advances in
the way FDA regulates tampon materials and absorbency. 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. The agency also standardized
absorbency labeling in 1990 so that absorbency terms (e.g. regular, super,
etc.) are consistent across brands.
But Tierno points out
that the drop in the total number of cases is only apparent when a "strict-case"
definition of TSS is used; the actual number of "clinical cases" has not really
changed. Another possible reason for this reported decrease is because tampon
manufacturers have removed three of the four synthetic ingredients (polyester,
carboxymethylcellulose, and polyacrylate rayon) once commonly used in tampons
to enhance absorbency. However, highly absorbent viscose rayon is still used.
The removal of the synthetic
fibers by manufacturers was due in part to independent research that showed
tampons containing synthetic additives increase production of the TSS toxin,
and that all-cotton tampons do not. According to Tierno, this suggests that
all-cotton tampons decrease the risk of TSS, and are thus safer than rayon
and rayon-blend tampons. Considering that a 1994 study found that up to 99
percent of menstruating women diagnosed with TSS were using tampons, and that
not enough is known about potential health risks associated with tampon additives,
it is clear that more accurate information is needed regarding the hazards
of tampons.
Asbestos
The asbestos allegation
contained in the Internet rumor has never been confirmed; however, there seems
to be a general consensus among health experts and scientists that the allegations
are unfounded. The email message claims that manufacturers add asbestos to
tampons to promote excessive bleeding in order to sell more of their product.
The FDA says it reviews the 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. Moreover, because tampon manufacturers
are subject to FDA inspection, the agency assures women that "these inspections
would likely identify any procedures that would expose tampon products to
asbestos." Although the FDA states that it has no evidence of asbestos in
tampons, the reliability of this claim is uncertain because the agency has
historically relied on data provided by manufacturers in determining product
safety.
Legislation in Congress
U.S. Representative
Carolyn Maloney of New York recently introduced an important piece of legislation
that attempts to address the unresolved health concerns surrounding tampon
safety. The Robin Danielson Act (H.R. 360) directs the CDC to collect and
report information on toxic shock syndrome. Reporting of TSS to the CDC is
currently optional and uneven, and the number of TSS cases and deaths is unknown.
The collection and reporting of TSS cases would help increase awareness of
the continued risk of contracting the disease. H.R. 360 also requires the
National Institutes of Health (NIH) to conduct research to determine the extent
to which the presence of dioxin, synthetic fibers, and other additives in
tampons and related products pose any health risks to women.
Alternatives
Several alternatives to
tampon use are available to women, including all-cotton tampons and pads that
are unbleached or are whitened with hydrogen peroxide and reusable menstrual
cups. The use of pads also reduces the risk of TSS. Alternative menstrual
products can be found at natural food stores or ordered directly from individual
companies. All-cotton sanitary products, however, may contain pesticide residues
that could be absorbed in the same way as dioxin. No research has been conducted
to determine whether all-cotton tampons and pads are safer than the more commonly
available tampons and pads.
Links
To separate
fact from fiction on other Internet Health info, click here.
|
