Feminine hygiene products: composition and toxic shock syndrome, our recommendations
Feminine hygiene products are consumer products used during periods to absorb menstrual flow. They are prompting many questions and women are increasingly concerned about the risks associated with their use. ANSES was asked to assess the safety of feminine hygiene products and concluded that there are low concentrations of chemicals in the composition of feminine hygiene products such as tampons, menstrual cups and sanitary towels. However, the Agency also reminds users of the importance of complying with the hygiene rules associated with the use of these products.
Feminine hygiene products
There are currently two categories of feminine hygiene products on the market. The first relates to internal sanitary products designed to be inserted into the vagina to absorb menstrual flow. The best known are tampons and menstrual cups (also called moon cups). Tampons are single-use while menstrual cups are reusable. The second category concerns external single-use or reusable sanitary products such as sanitary towels and panty liners.
ANSES received a formal request in 2018 to assess the safety of feminine hygiene products. The expert appraisal consisted in assessing the health risks associated with the possible presence of chemicals in these products, but also the risk of menstrual toxic shock syndrome (TSS). In late 2019, the Agency published results from additional tests on menstrual cups and tampons. The purpose of these additional tests was to better characterise the composition of the materials and estimate the risks in relation to Staphylococcus aureus, the bacterium responsible for TSS.
Menstrual toxic shock syndrome is an acute infectious disease. It is caused by the release into the bloodstream of a bacterial toxin, TSST-1, produced by a type of Staphylococcus aureus (also known as "golden staph").
Conclusions of the expert appraisal on the safety of feminine hygiene products
The tests revealed the presence of chemicals in tampons, menstrual cups, sanitary towels and/or panty liners, which did not however exceed the health thresholds. ANSES did not find any risk associated with the presence of these substances.
The Agency recommends that manufacturers improve the quality of the raw materials and revise certain manufacturing processes in order to eliminate or minimise the presence of chemicals.
ANSES found no direct link between the physico-chemical properties of the materials in these feminine hygiene products and an increased risk of TSS. The expert appraisal showed that menstrual TSS is more related to the conditions of use of feminine hygiene products. The risk of developing the disease increases with prolonged use of internal sanitary products and/or use of sanitary products with a higher than necessary absorption capacity.
ANSES's recommendations
- Follow each product’s specific recommendations for use, particularly concerning the length of time that tampons and cups can be worn.
- Remember to wash your hands before and after changing your feminine hygiene products.
- Use tampons only during menstruation.
- Take care to choose a tampon with an absorbency adapted to your menstrual flow, so that you can change it regularly.
In general, the Agency reminds users of the importance of complying with the hygiene rules associated with the use of feminine hygiene products. To limit the risks, ANSES also recommends that health professionals and women be better informed about menstrual toxic shock syndrome and its symptoms.
Lastly, it recommends that all manufacturers clearly indicate this risk on the packaging and instructions for use of internal sanitary products, particularly manufacturers of menstrual cups, which arrived on the market only relatively recently.
Going further
ANSES publishes the results of its additional assessment of menstrual cups and tampons
Following its 2018 expert appraisal on the safety of feminine hygiene products, ANSES is now publishing the results of its additional assessment. It confirms the need to provide better information to women and health professionals on the risk of menstrual toxic shock syndrome (TSS), which concerns all internal sanitary protection products (tampons, menstrual cups, etc.).