Delivered Directly: Tampons, Toxins, and the Diseases Medicine Cannot Explain

An Essay

By the time she reaches her mid-thirties, she has collected a small library of diagnoses. The painful periods that began in adolescence were eventually named endometriosis, after years of being dismissed as normal. The irregular cycles and unexplained weight gain became PCOS. The fatigue and widespread pain that no test could explain became fibromyalgia. The abnormal cells found during a routine Pap smear were attributed to a “virus” she may or may not have encountered years ago.

At each turn, she has been offered explanations: genetics, hormonal imbalance, an overactive immune system, a sexually transmitted infection. What she has never been offered is a common thread—some reason why her reproductive system seems to be failing in so many different ways at once.

What she has also never been told is this: from the age of twelve or thirteen, she has been inserting a small plug of processed cotton and synthetic fibers directly into her vaginal canal, several days each month, for decades. She has been doing this without any knowledge of what that plug contains, because no one has ever been required to tell her, and almost no one has ever thought to ask.

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The Delivery System

The vagina is not like skin. It is a highly vascularized mucosal membrane, rich with blood vessels and lymphatic channels, designed for absorption. Pharmaceutical companies use it as a drug delivery route precisely because vaginal administration of estradiol produces significantly higher blood serum levels than oral administration. Medications delivered vaginally bypass first-pass metabolism in the liver, entering systemic circulation directly.

This permeability is not theoretical. In the early 1980s, it was demonstrated with lethal clarity. The Rely tampon, designed with synthetic materials for extended wear, was associated with a wave of severe systemic illness—hypotensive shock, organ failure, death. Whatever the precise mechanism, the episode proved that something in or produced by the tampon was crossing the vaginal epithelium and reaching systemic circulation with devastating effect.

The toxic shock syndrome epidemic proved the delivery mechanism. The vaginal epithelium is not a barrier; it is a gateway. The question that should have followed—what else might be crossing that gateway?—was never systematically pursued.

This is the core of what follows: a chronic, direct, unmonitored exposure to known toxicants delivered to the most permeable tissue of the female body. And almost no one has studied what it does.

The Payload

In 2024, researchers at Columbia University, UC Berkeley, and Michigan State published the first study to measure metal concentrations in tampons. They tested 30 tampons from 14 brands and 18 product lines, analyzing for 16 metals: arsenic, barium, calcium, cadmium, cobalt, chromium, copper, iron, manganese, mercury, nickel, lead, selenium, strontium, vanadium, and zinc.

They found all 16 in at least one tampon tested.

Lead was present in every tampon. The geometric mean concentration was 120 nanograms per gram—approximately ten times higher than maximum levels allowed in drinking water. There is no safe level of lead exposure. The EPA has stated this explicitly. Lead accumulates in bone, replacing calcium, and can be retained in the body for decades.

Arsenic, a known carcinogen associated with cardiovascular disease and skin lesions, was found in 95% of samples. The researchers noted that “arsenic shouldn’t be present in tampons at all,” and that the effects of vaginal arsenic exposure have never been studied. Cadmium, which targets the kidneys and cardiovascular system, was found in 100% of samples.

Zinc and calcium appeared in concentrations thousands of times higher than the toxic metals—52,000 ng/g and 39,000 ng/g respectively. Patent filings confirm why: manufacturers intentionally add various metals to tampons. Calcium, strontium, and zinc as lubricants. Cobalt, chromium, copper, nickel, and zinc as antimicrobial agents. Barium, cadmium, cobalt, iron, manganese, and zinc as pigments.

This was the first study to measure metals in tampons. The first. Despite billions spent on women’s health research, despite the fact that 52–86% of menstruating women use tampons, despite decades of concern about what these products might contain—no one had measured metals until 2024.

How did the metals get there? Cotton plants readily bioaccumulate metals from soil. Agricultural soils are contaminated through atmospheric deposition from industrial activity, wastewater application, and metal-containing fertilizers and pesticides. The water used in manufacturing may contain metals. And as the patents indicate, some are added deliberately.

But metals are not the only payload.

A 2023 systematic review in BJOG—the British Journal of Obstetrics and Gynaecology—examined the prior decade of research on chemicals in menstrual products. The researchers identified 15 studies that had measured chemicals in tampons, pads, and other menstrual products across the US, Europe, Japan, South Korea, and China. The findings constitute a catalog of concerning exposures:

Phthalates—plasticizers and known endocrine disruptors—were detected across multiple studies. Di(2-ethylhexyl) phthalate (DEHP), classified by the International Agency for Research on Cancer as a possible human carcinogen, was found in tampons at median concentrations of 0.267 μg/g. Dibutyl phthalate (DBP), which the EU has restricted due to reproductive toxicity concerns, was found in pads at levels up to 7.82 μg/g. Phthalate exposure has been associated with reduced fertility, endometriosis, and disrupted hormonal signaling.

Volatile organic compounds including toluene, xylene, and methylene chloride were detected. A 2018 analysis found carbon disulfide in all rayon-containing tampons tested. Carbon disulfide is a reproductive toxicant; studies of female workers in rayon manufacturing have documented increased risk of menstrual disorders, early menopause, and hormonal disturbances.

Dioxins and furans—persistent organic pollutants classified as known human carcinogens—were detected in tampons at levels ranging from 0.2 to 20.7 pg/g. These are byproducts of the chlorine bleaching process. While manufacturers have largely switched from elemental chlorine to chlorine dioxide bleaching, detectable concentrations remain. No safety threshold exists for vaginal dioxin exposure—the route has never been studied.

Bisphenols and parabens—endocrine-disrupting compounds with estrogenic activity—were found throughout. Bisphenol A (BPA) was detected in 92% of tampons tested in one US study. These compounds can interfere with hormonal signaling at very low concentrations.

PFAS—per- and polyfluoroalkyl substances, the “forever chemicals”—were found in 22% of tampons, 48% of pads, and 65% of period underwear tested by advocacy organizations in collaboration with university laboratories. These compounds do not break down in the environment or the body. They have been associated with immune dysfunction, hormonal disruption, decreased fertility, and increased cancer risk. Testing found PFAS even in products marketed as “organic,” “natural,” or “free of harmful chemicals.”

The review’s authors noted that vaginal and vulvar tissue is “highly vascular and permeable,” and that chemicals absorbed through this route reach reproductive organs at higher concentrations than systemic circulation via the “uterine first-pass effect.”

Then they noted the most damning finding: “There are no large, prospective cohorts that quantify cumulative tampon use and relate it to cancer, fertility, autoimmune or endocrine outcomes.”

The Void

The average woman who menstruates will use approximately 11,000 tampons over her reproductive lifetime. Each remains in contact with vaginal mucosa for several hours. This represents roughly five cumulative years of exposure to whatever those tampons contain—delivered directly to highly permeable tissue, bypassing the liver’s detoxification, reaching reproductive organs at concentrated levels.

Five years. To products containing lead, arsenic, cadmium, phthalates, dioxins, PFAS, and dozens of other compounds. Via a route that pharmaceutical companies use specifically because it delivers drugs to the body more effectively than swallowing them.

The research that should exist:

Long-term epidemiological studies examining tampon use as an exposure variable for reproductive cancers. Never designed.

Dose-response relationships for vaginal absorption of metals or endocrine disruptors from menstrual products. Never established.

Studies comparing health outcomes in tampon users versus non-users, stratified by years of use. Never conducted.

Studies examining whether women with endometriosis, PCOS, or fibroids have different tampon usage patterns than women without these conditions. Never funded.

Regulatory requirements for manufacturers to test tampons for metals, PFAS, pesticides, or most chemical contaminants. Never enacted.

The FDA classifies tampons as “medical devices” but only recommends—does not require—that they not contain dioxins or pesticide residues. There is no FDA standard for lead in tampons, despite lead being present in every tampon tested. The European Union regulates tampons under general product safety directives that limit lead in textiles to less than 1 mg/kg—but these limits were designed for skin contact, not mucosal absorption. The UK requires products to be “safe” without specifying what that means or how it should be verified.

Consider the contrast: a pharmaceutical drug delivered vaginally would require extensive safety testing, clinical trials, post-market surveillance. A tampon—also delivered vaginally, also absorbed systemically—requires none of this.

The research void is not an oversight. It is a policy.

One Study That Looked

The 2019 BioCycle study, published in Environmental Health, examined tampon use in relation to metal concentrations and oxidative stress biomarkers in 259 regularly menstruating women—one of the only studies to attempt this connection.

The researchers measured blood levels of cadmium, lead, and mercury at enrollment, then tracked oxidative stress and inflammation biomarkers at up to eight clinic visits across two menstrual cycles. They assessed tampon use through daily diaries.

The findings moved in exactly the direction the chemical evidence would predict:

Tampon users had 25% higher blood mercury levels than non-users. When the researchers used an alternative statistical transformation that allowed them to include all participants, this association became statistically significant.

Tampon users had consistently elevated isoprostane—a biomarker of lipid peroxidation and oxidative stress—throughout the menstrual cycle, with the elevation most pronounced during the menstruating week when tampons were in use.

Tampon users had higher levels of TBARS, another marker of lipid peroxidation.

Tampon users had lower levels of PON1P—an antioxidant enzyme that hydrolyzes organophosphate compounds. Reduced PON1P suggests decreased capacity to combat oxidative stress.

None reached conventional statistical significance. The researchers explained: the study was not designed for this question. Metals were measured from a single blood sample collected approximately 16 days before the first menstrual cycle, not during active tampon use. Sample size was small. No pesticides were measured, though these are also plausible tampon contaminants. And crucially: “Since there is no reason to believe that any error is related to tampon use, any bias would be towards the null, which may explain our null findings.”

When researchers finally looked—using a study not designed for the question, with inadequate power and imperfect timing—they found the signal through the noise. Elevated mercury. Elevated oxidative stress. Reduced antioxidant capacity. The biological fingerprints of chemical insult.

Then they noted that “the vaginal exposure route has been so far overlooked” and called for “larger and sufficiently-powered biomarker studies of tampon users to assess the importance of tampon use as a chemical exposure pathway.”

Those studies have not been conducted.

The Constellation

If tampons were delivering toxins to the reproductive system for decades, what would we expect to see?

Conditions affecting the organs and tissues exposed: the vagina, cervix, uterus, ovaries. Emerging during the reproductive years, when exposure is occurring. Rising in prevalence over recent decades—a pattern environmental exposure can explain but heredity cannot. Involving inflammation, oxidative stress, hormonal disruption, tissue damage—the known effects of the chemicals documented in tampons.

We would expect exactly what we see.

Endometriosis affects 10% of reproductive-age women—190 million worldwide. It involves endometrial-like tissue growing outside the uterus, causing chronic pain, inflammation, adhesions, and often infertility. Its cause is officially unknown, though genetic factors, retrograde menstruation, and immune dysfunction are invoked.

What is documented: dioxin exposure causes endometriosis in laboratory animals. Rhesus monkeys chronically exposed to TCDD—the most toxic dioxin compound—developed endometriosis at rates directly correlated with exposure levels. The association was strong enough that researchers in the 1990s called endometriosis “the environmental disease of the nineties.” Subsequent research has confirmed that dioxins can promote inflammation-related development of endometriosis through effects on immune function and hormonal signaling.

Dioxins have been found in tampons. The pelvic cavity—where endometrial implants most commonly occur—is directly accessible from the vaginal route. The uterine first-pass effect means dioxins absorbed vaginally would reach these tissues at concentrated levels. A chemical delivered vaginally is not diluted by five liters of blood and processed by the liver; it arrives at reproductive organs in high concentration.

What has never been studied: whether tampon users have higher rates of endometriosis than non-users. Whether duration or intensity of use correlates with severity. Whether women who started using tampons earlier develop endometriosis at higher rates. Whether the documented chemical pathway explains the documented disease.

The same pattern repeats across the constellation of “unexplained” female conditions:

Polycystic ovary syndrome affects 6–12% of reproductive-age women, making it one of the most common endocrine disorders. It involves hormonal imbalance, irregular ovulation, and metabolic dysfunction. Cause: officially unknown.

What is documented: endocrine-disrupting chemicals, including phthalates and bisphenols, interfere with hormonal signaling. Phthalate metabolites have been found at elevated levels in women with PCOS compared to controls. BPA exposure has been associated with hyperandrogenism.

What is present in tampons: phthalates and bisphenols.

What has never been studied: whether tampon users have higher rates of PCOS. Whether the rising prevalence of PCOS correlates with menstrual product use patterns.

Uterine fibroids affect up to 80% of women by age 50, with substantially higher rates in Black women—a disparity that remains unexplained. These benign tumors cause heavy bleeding, pelvic pain, and are the leading indication for hysterectomy in the United States. Cause: officially unknown.

What is documented: fibroids are estrogen-dependent. Endocrine disruptors with estrogenic activity have been implicated in fibroid development.

What is present in tampons: compounds with estrogenic activity, delivered via a route that provides direct uterine exposure.

What has never been studied: whether tampon use patterns correlate with fibroid prevalence. Whether the racial disparity in fibroids correlates with differences in menstrual product use—a hypothesis that is plausible and testable.

Adenomyosis, vulvodynia, vestibulodynia, lichen sclerosus, primary ovarian insufficiency—each affects tissue exposed to menstrual products, emerges during reproductive years, involves plausible chemical mechanisms, and remains officially unexplained. None has been studied in relation to tampon use.

The pattern is consistent across all these conditions. They affect the delivery site. They are rising in prevalence. They are attributed to genetics, hormones, immune dysfunction, or bad luck. They have never been examined in relation to the chemical payload being delivered month after month, year after year, decade after decade.

The Organic Question

The health-conscious consumer may have a ready solution: switch to organic tampons. The marketing encourages this response. Organic tampons are positioned as the clean alternative—made from cotton grown without synthetic pesticides, free from industrial contamination.

The 2024 metals study addressed this assumption directly. The researchers compared metal concentrations in organic versus non-organic tampons, expecting—as consumers would—that organic products would be cleaner.

What they found was more complicated.

Organic tampons had higher arsenic concentrations than non-organic tampons. Non-organic had higher lead. For cadmium, cobalt, and zinc, non-organic tampons had higher levels. For calcium, chromium, iron, manganese, strontium, and vanadium, organic tampons had higher levels. For copper, mercury, nickel, and selenium, there was no significant difference.

The researchers’ conclusion: “No category had consistently lower concentrations of all or most metals.”

Why would organic tampons have higher arsenic? The researchers hypothesized that natural fertilizers used in organic farming—animal waste, plant-based compost—may alter soil chemistry in ways that increase arsenic bioavailability. Arsenic is a naturally occurring element; its uptake by plants depends on soil conditions, not just on whether synthetic pesticides were applied. The cotton plant bioaccumulates whatever is in the soil. “Organic” certifies how the cotton was cultivated; it does not certify what the soil contained.

The organic label addresses one potential source of contamination while ignoring others. It does not address metals in soil. It does not address contaminants introduced during manufacturing. It does not address what might be added intentionally. It does not require comprehensive testing of the finished product.

A woman who switches from conventional to organic tampons may reduce exposure to some compounds while increasing exposure to others. She cannot know the net effect, because comprehensive comparative data does not exist.

The problem is not which brand to choose. The problem is that no brand has been adequately studied for long-term safety, and no regulatory body requires such study.

The Streetlight

There is a parable about a man searching for his keys under a streetlight. A passerby asks where he lost them. “Over there,” the man says, pointing to a dark area across the street. “Then why are you looking here?” “Because the light is better here.”

This is how research funding works. This is how scientific careers are built. This is how regulatory frameworks are constructed. You look where the light is—where the methods are established, where the grants are available, where the pharmaceutical industry has invested billions and needs returns.

For cervical cancer, the light has been shined almost exclusively on a “virus.”

The Human Papillomavirus has dominated cervical cancer research for decades. The Nobel Prize in Physiology or Medicine was awarded in 2008 for discovering HPV’s purported role in cervical cancer. Billions have been spent developing vaccines against HPV strains considered high-risk. Screening programs worldwide have been redesigned around HPV testing. Young women and now young men are routinely vaccinated against a “virus” that, according to mainstream medicine, is responsible for virtually all cervical cancer.

The research infrastructure, the funding streams, the career incentives, the pharmaceutical investments, the public health messaging—everything points toward the “virus.” The light is very bright in this spot.

Meanwhile, in the darkness:

The cervix sits at the internal end of the vaginal canal. The tampon sits against it, or near it, for hours at a time, days each month, decades across a lifetime. The tampon contains documented carcinogens: arsenic, dioxins, some phthalates. It contains documented endocrine disruptors. It contains heavy metals for which no safe exposure level exists.

The cervix is not merely adjacent to this chemical exposure; it is the tissue most directly exposed, cycle after cycle, from adolescence onward. The vaginal route delivers chemicals to the cervix without the dilution and detoxification of oral exposure. The uterine first-pass effect means concentrations at the cervix may be higher than concentrations measured anywhere else in the body.

We have tens of thousands of papers examining HPV and cervical cancer.

We have almost none examining chemical exposure through menstrual products and cervical cancer.

Whether tampon use is associated with cervical cancer. Whether rates of cervical abnormalities differ between tampon users and non-users. Whether duration of use, age at first use, or frequency correlates with cervical disease. Whether the chemicals documented in tampons can produce the cellular changes attributed to HPV.

These questions have never been asked. The studies have never been funded. The hypotheses have never been tested.

Dawn Lester and David Parker, in their examination of disease causation, put it directly: the chemicals in tampons and sanitary products “are far more plausible as factors that contribute to cervical cancer than the non-living particles that have been called ‘viruses.’”

This is not a claim that requires a controlled trial to evaluate. First principles are sufficient: documented carcinogens and endocrine disruptors, delivered directly to cervical tissue, via a route that bypasses hepatic metabolism, for decades. The chemical hypothesis is not speculative—it is the straightforward application of known toxicology to a documented exposure.

We have decades of research examining a “virus.” We have almost nothing examining the chemicals being deposited on cervical tissue during the same decades when cervical disease develops. This asymmetry is not evidence that the viral hypothesis is correct and the chemical hypothesis is wrong. The asymmetry is evidence of where the light has been directed—and who controls the lamp.

The Legal Reckoning

The scientific establishment may not have connected these dots, but the legal system is beginning to.

In 2024, a lawsuit was filed against Procter & Gamble alleging that Tampax tampons contained unsafe levels of lead. The lawsuit emerged in the wake of the Shearston study, which had documented lead in all tested tampons but had not named specific brands.

In October 2025, Kimberly-Clark faced a class action alleging that its U by Kotex Click tampons contain undisclosed lead. According to the complaint, independent scientific testing commissioned by the plaintiffs’ attorneys found “substantial” lead in all sizes and configurations of the product. The lawsuit notes that Kimberly-Clark markets these tampons as containing “no harsh ingredients” and being “pesticide free”—claims that lead consumers to believe the products are free from harmful contaminants. Lead is not listed on the label. Lead is not disclosed to consumers. Yet lead, according to the testing, is present.

These lawsuits follow the 2022 settlement by Thinx, the period underwear company, over PFAS found in products marketed as “sustainable” and “free of harmful chemicals.” Testing had found fluorine—an indicator of PFAS—in Thinx products despite the company’s marketing claims.

The legal claims are narrow: failure to disclose, deceptive marketing, breach of implied warranty. They do not allege that the chemicals caused specific diseases. They do not require proof of harm to any individual plaintiff. But they signal something broader than their immediate scope.

The testing that regulators never required is now being done by plaintiffs’ attorneys. The questions that researchers never asked are now being posed in discovery. The information that companies never disclosed is now being extracted through litigation.

The dam is not breaking because scientists finally demanded answers. It is breaking because women started suing.

A Different Framework

Menstrual cups, made of medical-grade silicone, showed lower PFAS contamination in testing than tampons or pads. They collect rather than absorb. They are reusable, meaning less ongoing exposure to manufacturing contaminants. They are not a perfect solution—they have their own unstudied profile—but they represent a different category of product.

Yet this is not primarily about consumer choice. The problem is not which product a woman selects. The problem is that products inserted into her body for decades have never been subjected to long-term safety testing. The problem is that when she develops endometriosis, or PCOS, or cervical dysplasia, she will be offered explanations that exclude the one variable that has never been investigated.

The problem is regulatory and scientific failure. The problem is the streetlight.

The Question She Was Never Given

She is in her mid-thirties now, with her library of diagnoses, her collection of explanations that never quite explain. Genetics. Hormones. An immune system that attacks itself for unknown reasons. A “virus” she may have encountered once, blamed for changes in her cervical cells.

She has been told what is wrong with her. She has never been told what has been delivered directly to her reproductive tissues, month after month, since before her body was fully developed. She has never been told because no one measured it until 2024, and even now, no one has asked whether it matters.

The next time she is told her endometriosis is genetic, her PCOS is hormonal, her cervical cells are abnormal because of a “virus”—she might ask a different question.

She might ask what has been delivered directly to those tissues, for years, that no one ever thought to measure.

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References

Angelova, V., Ivanova, R., Delibaltova, V., & Ivanov, K. (2004). Bio-accumulation and distribution of heavy metals in fibre crops (flax, cotton and hemp). Industrial Crops and Products, 19(3), 197–205.

DeVito, M. J., & Schecter, A. (2002). Exposure assessment to dioxins from the use of tampons and diapers. Environmental Health Perspectives, 110(1), 23–28.

Foster v. Kimberly-Clark Corp., Case No. 1:25-cv-09736 (N.D. Ill. 2025).

Hussain, A., & Ahsan, F. (2005). The vagina as a route for systemic drug delivery. Journal of Controlled Release, 103(2), 301–313.

Lester, D., & Parker, D. (2019). What Really Makes You Ill?: Why Everything You Thought You Knew About Disease Is Wrong.

Marroquin, J., Kiomourtzoglou, M. A., Scranton, A., & Pollack, A. Z. (2024). Chemicals in menstrual products: A systematic review. BJOG: An International Journal of Obstetrics and Gynaecology, 131(5), 655–664.

Rier, S. E., Martin, D. C., Bowman, R. E., Dmowski, W. P., & Becker, J. L. (1993). Endometriosis in rhesus monkeys (Macaca mulatta) following chronic exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin. Fundamental and Applied Toxicology, 21(4), 433–441.

Shearston, J. A., Upson, K., Gordon, M., Do, V., Balac, O., Nguyen, K., Yan, B., Kioumourtzoglou, M. A., & Schilling, K. (2024). Tampons as a source of exposure to metal(loid)s. Environment International, 190, 108849.

Singh, J., Mumford, S. L., Pollack, A. Z., Schisterman, E. F., Weisskopf, M. G., Navas-Acien, A., & Kioumourtzoglou, M. A. (2019). Tampon use, environmental chemicals and oxidative stress in the BioCycle study. Environmental Health, 18(1), 11.

Upson, K., Shearston, J. A., & Kioumourtzoglou, M. A. (2022). Menstrual products as a source of environmental chemical exposure: A review from the epidemiologic perspective. Current Environmental Health Reports, 9(1), 38–52.

Vostral, S. L. (2011). Rely and toxic shock syndrome: A technological health crisis. Yale Journal of Biology and Medicine, 84(4), 447–459.

Women’s Voices for the Earth. (2018). What’s in your tampon? 2018 Tampon Testing Results.

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