ANSES was asked by the Ministries of Health and the Economy to assess the safety of feminine hygiene products (tampons, sanitary towels, panty liners and menstrual cups). The expert appraisal consisted in identifying the regulated or non-regulated chemicals of concern liable to be present in these hygiene products, and then assessing the associated health risks. The expert appraisal also focused on an analysis of the microbiological risk associated with menstrual toxic shock syndrome (TSS).
Improve the manufacture of feminine hygiene products to reduce the presence of chemical substances
Laboratory tests revealed the presence of various chemicals at very low concentrations not exceeding health thresholds. ANSES did not find any risk associated with the presence of these substances, most of which seem to come from contamination of raw materials or manufacturing processes.
ANSES therefore recommends that manufacturers improve the quality of their raw materials and revise certain manufacturing processes in order to eliminate or reduce the presence of these substances as far as possible, particularly those with "carcinogenic, mutagenic or reprotoxic" (CMR), endocrine-disrupting or skin sensitising effects.
Furthermore, there are no specific regulations governing the composition, manufacture or use of feminine hygiene products. ANSES recommends establishing a more restrictive regulatory framework at European level to limit the presence of these chemicals and is supporting a project to restrict CMR substances in feminine hygiene products within the framework of the REACh Regulation.
Menstrual toxic shock syndrome: rare but potentially serious
Menstrual TSS is the main microbiological risk associated with the use of internal feminine hygiene products (tampons and menstrual cups). The bacterial toxin TSST-1 produced by Staphylococcus aureus can cause menstrual TSS, which although rare can have serious complications.
The expert appraisal showed that the risk of developing menstrual TSS increases with prolonged use of internal feminine hygiene products and/or use of internal feminine hygiene products with a higher than necessary absorption capacity.It should be noted that external feminine hygiene products (towels, panty liners) have never been involved in cases of menstrual TSS.
ANSES therefore recommends that health professionals and women be better informed about this disease and its symptoms. It further recommends that all manufacturers clearly indicate this risk on the packaging and instructions for use of internal feminine hygiene products.
In order to limit the risk of menstrual TSS, ANSES reminds women of the need to follow each product’s specific recommendations for use, particularly concerning the length of time that tampons and cups can be worn. They are also recommended to use a tampon only during menstruation and to choose one with an absorbency that suits their menstrual flow, in order to ensure that it is changed regularly.
More generally, ANSES reiterates the importance of respecting basic hygiene rules concerning the use of feminine hygiene products, and in particular the importance of washing hands before and after changing them.