Kate Braddom is a staff writer and a first-year MPP student.

Modern advertisements for menstrual products are filled with uplifting, empowering messages that target menstrual stigma and boast wellness and sustainability with slogans like “A Step Closer to Saving the Nature” and “Meet Your Vagina’s New Best Friend.” But it can be difficult for women to embrace companies’ positive messages as a variety of watchdog organizations and mainstream news outlets have begun to raise the alarm about the harm that many of these products may be causing. Many menstrual products have been found to contain a variety of harmful ingredients, most notably per- and polyfluoroalkyl substances (PFAS), or “forever chemicals,” a family of over 12,000 chemicals, including those known as PFOS and PFOA, that contain a carbon-fluorine bond. PFAS were created in the 1940s and originally became popular in the manufacture of Telfon. Because PFAS are waterproof, stain-resistant and heat-resistant, they quickly became common ingredients in all manner of products from textiles to food-packaging and nonstick cookware. But PFAS’s versatility comes at a price: because PFAS are based on an exceptionally strong carbon-fluorine bond, they do not break down easily, causing them to linger and accumulate in the environment for extended periods. PFAS have also been linked to a number of adverse health effects, including increased risk of some cancers, birth defects, endocrine disruption and decreased fertility.

In August, a team of New York Times reporters sent 44 period and incontinence products to be tested for forever chemicals, every one of which showed at least trace amounts of PFAS ranging from 26 parts per million (ppm) to over 23,000 ppm. For reference, in 2016, the Environmental Protection Agency (EPA) took steps to provide Americans with a “margin of protection” from forever chemicals by establishing a health advisory level of 70 parts per trillion (ppt) for PFAS in drinking water, meaning the combined concentrations of PFAS and PFOS in water should not exceed 70 ppt. The menstrual products tested in the New York Times study had levels of PFAS as many as a billion times higher than the EPA’s advisory for drinking water. In addition, marketing and packaging on products can be misleading; Time Magazine conducted its own tests of menstrual products and noted that of 22 products that tested positive for PFAS, 13 were advertised as “natural,” “organic,” “non-toxic,” “sustainable,” or as using “no harmful chemicals.”

In addition to the extreme levels of PFAS found in menstrual products, chemical exposure through these products is likely to be more acute than through other exposure pathways, including ingestion. Vaginal tissue can absorb chemicals rapidly and without metabolizing them, meaning chemicals enter into blood circulation without being filtered through the liver first. Several studies have shown that administering drugs vaginally results in higher concentrations of the given drug in a patient’s blood compared to drugs that are administered orally, suggesting that most women are likely to be exposed to PFAS at much higher levels than other populations who are exposed only through ingestion or skin contact.

Current Action and Regulations

Currently, menstrual products are regulated as medical devices, which means they are not subject to the same labeling requirements as other household products or at-home health devices, which can make it easier for harmful ingredients to go unnoticed. Some states have begun taking steps to remedy this gap by passing laws that require companies to list ingredients on their packaging. In 2019, New York passed a menstrual product disclosure law requiring companies to list all components that are intentionally added to a product, and several states, including California, New Jersey, West Virginia, and Massachusetts, have followed suit. Ingredient lists that have been added as a result of these laws have revealed a number of common ingredients containing carcinogens, reproductive toxicants and allergens. But even where labeling laws do exist, they often contain substantial gaps. California’s law, for instance, gives manufacturers trade secret protections which allow companies to keep details about fragrances confidential, despite the fact that substances containing hormone disruptors and allergens are commonly used as ingredients in fragrances.

Labeling laws that don’t include trade secret protections also don’t protect consumers from products that have been contaminated with PFAS unintentionally. PFAS are extremely pervasive and are used across a variety of industries, which means, even when PFAS are not added intentionally, they are often used in other parts of the manufacturing process and can be transferred to the final product unintentionally. Coatings and lubricants used to maintain equipment and machinery like conveyor belts, personal protective equipment (PPE) worn by assembly line workers who handle products throughout the manufacturing process, and packaging — especially if it is water-resistant — all can and often do contain PFAS. Many manufacturers also purchase raw materials from intermediaries who may or may not know of, or disclose, the use of PFAS in production processes.

Despite their limitations, however, labeling laws are still a step in the right direction, and they are aided by litigation and growing public attention to the dangers of PFAS. Since 2020, three class action suits have been filed against Thinx, a major manufacturer of period underwear, after testing indicated the presence of PFAS in their products. The company reached a settlement in which they agreed to ensure PFAS was not deliberately used in any stage of production and to have their suppliers of raw materials sign a code of conduct affirming that they are taking similar preventative measures. The Thinx settlements, like labeling laws, are a small victory, but they indicate growing public pressure that bodes well for future regulation.

Looking Ahead: Friends in State Legislatures

The federal government has been making some progress on PFAS regulation. The Department of Defense is phasing out PFAS in Meals Ready-to-Eat and firefighting foam, and the EPA is expanding efforts to regulate PFAS in drinking water and improve monitoring of PFAS. But progress has been slow, and stricter regulations or outright bans are likely to be a while down the road. Regulatory agencies including the EPA, the Food and Drug Administration (FDA) and the Agency for Toxic Substances and Disease Registry are still conducting research on the human health impacts of PFAS exposure, despite widespread scientific evidence that PFAS causes severe health issues. Attempts to restrict the use of PFAS by Congress have also been stalled by industry representatives who maintain that most forms of PFAS are safe, despite evidence to the contrary. Between 2019 and 2022, Congress introduced over 100 bills to address various aspects of PFAS contamination and regulation, but fewer than 10 of those bills actually became law. PFAS manufacturers and the American Chemistry Council combined spent over $100 million on lobbying to prevent federal PFAS regulation.

However, the most promising action has been on the part of states, which have begun taking steps to regulate the use of PFAS more directly. In 2021, Maine became the first state to enact a broad PFAS ban which will take effect in 2030 and prohibits the intentional addition of PFAS to products, with some exceptions. Ten states have set their own standards for PFAS in drinking water below the EPA’s 2016 guideline. Attorneys general in 17 states have filed lawsuits that would hold PFAS manufacturers accountable. In 2023 alone, 195 new bills were introduced in state legislatures across the country that would require a growing list of products to be PFAS-free. In a few states, that list includes menstrual products specifically. Vermont, for instance, is currently considering a bill that would eliminate the use of some toxic ingredients in menstrual products. Ultimately, action on PFAS — in menstrual products specifically — will be concentrated at the state level in the near future, and more states need to pursue comprehensive PFAS bans, or at least targeted product-by-product restrictions that include menstrual products. 

This piece was edited by Deputy Editor Kathleen Bever and Executive Editor Nathan Varnell.

Photo by Natracare on Unsplash.