Marroquin et al. 2024 - menstrual-product chemical review

Marroquin et al. systematically reviewed studies that measured environmental chemicals in menstrual products or in biospecimens linked to menstrual-product use. The review is secondary evidence and does not perform new laboratory testing. It is routeable as menstrual-pad and menstrual-tampon occurrence context for non-metal chemicals, but it reports no Pb, Cd, As, Hg, Ni, Al, Cr, Sn, Sb, U, organotin, or other heavy-metal analyte values.

Key numbers

The review states that an average menstruator will use over 11 000 tampons or sanitary pads from menarche until menopause, corresponding to about 1800 days of menstrual-product exposure. The literature search identified 71 PubMed studies from 2000 through 2021; EBSCO, Web of Science, and Compendex added 1 additional article. Title/abstract review excluded 56 studies, leaving 15 included papers.

The included evidence set comprised 12 peer-reviewed studies measuring chemicals directly in menstrual products and 3 biospecimen studies. Products from the USA were measured in 7 studies, and 4 studies tested products from Japan and South Korea. The source identifies data gaps for menstrual cups, menstrual discs, period underwear, South/Central America, and Africa; these product forms and regions had no included peer-reviewed occurrence studies.

Table 1 maps the product-occurrence studies by product type and chemical group:

Table 2 reports phthalate concentrations as median and range values in μg/g. For sanitary pads, DEHP medians ranged from 0.0377 to 1.440 μg/g, with the largest DEHP range shown as 0.233-7.152 μg/g for the Tang et al. 2019 multi-country pad set. Gao and Kannan’s U.S. tampon row reports DEHP 0.267 (0.0641-4.680) μg/g, total phthalate 1.13 (0.621-6.160) μg/g, and DBP 0.125 (0.072-2.24) μg/g. The U.S. panty-liner row reports total phthalate 1.83 (0.168-34.5) μg/g and DBP 0.393 (0.0213-6.07) μg/g.

For dioxins and furans, the review reports that PCDD/PCDF compounds were detected in pads and tampons. Table 3 reports OCDD ranges of 0.3-7.1 pg/g in regular-absorbency tampons and 0.9-2.6 pg/g in super-plus tampons from Archer et al. 2005, a DeVito and Scherer 2002 tampon OCDD median/range of 3.70 (0.9-20.7) pg/g, and Shin et al. 2007 sanitary-pad OCDD values of 1.099-8.854 pg/g. The same table reports sanitary-pad OCDF 1.459-14.295 pg/g and tampon OCDF ND-3.377 pg/g in Shin et al. 2007.

For VOCs and fragrance chemicals, Table 4 reports Lin et al. 2020 TTVOC ranges of 47-2472 ng/g in tampons and 20-75 322 ng/g in pads. Park et al. 2019 pad-package-air measurements report p-xylene 0.001-0.278 ppb and toluene 0.005-5.471 ppb; the narrative states that toluene was detected in 9 of 11 brands and that pad use could account for 38.4% of a 20 μg/kg/day toluene reference dose in that source’s risk assessment. Kim et al. 2019 measured 504 sanitary pads and detected 50 of 74 VOCs, with concentrations ranging from 1,1,2-trichloroethane 0.025 μg/pad to ethanol 3548.086 μg/pad.

For fragrances, Desmedt et al. evaluated scented products including 4 tampons, 3 sanitary pads, and 3 panty liners for 24 sensitising allergens. Table 4 reports hexyl-cinnamal 12.03-22.57 μg/g in tampons and 82.69-95.85 μg/g in pad/panty-liner material, alpha-isomethylionone 12.55-19.12 μg/g in tampons, and benzyl salicylate 38.26-73.25 μg/g in pad/panty-liner material. The narrative reports R-(+)-limonene 0.174-199.032 μg/pad in sanitary pads.

Table 5 reports environmental phenols, bisphenols, and triclocarban for Gao and Kannan’s U.S. pads, panty liners, and tampons in ng/g. Total bisphenol medians/ranges were 5.59 (<LOD-55.9) ng/g for pads, 21.1 (<LOD-160) ng/g for panty liners, and 5.56 (<LOD-15.6) ng/g for tampons. BPA medians/ranges were 2.77 (<LOD-55.9) ng/g for pads, 5.12 (<LOD-157) ng/g for panty liners, and 0.70 (<LOD-2.46) ng/g for tampons. TCC medians were <LOD in pads, panty liners, and tampons.

Methods (brief)

The authors followed PRISMA guidelines and searched PubMed, EBSCO, Web of Science, and Engineering Compendex for English-language full-text studies published between 2000 and 2021. Eligible papers measured chemicals in menstrual hygiene products directly or measured biomarkers where the exposure of interest was menstrual-product use. National and international government reports were considered if available because the literature base was small. Because measurement methods varied widely, the review reported individual study medians and ranges rather than pooling values across studies.

Implications

Certification: This source contributes no heavy-metal occurrence values and should not move any HMTc metals threshold. It is useful menstrual-product context for non-metal contaminants and for documenting that the peer-reviewed menstrual-product literature through 2021 had not yet produced a heavy-metal occurrence study in this review’s included set.

Courses: The paper is a useful example of evidence-boundary discipline. A systematic review may be high-tier secondary evidence for the state of the literature while still being unsuitable for metals pooling when it contains no metal measurements.

App: The source can support a menstrual-product context card describing non-metal chemical groups and literature gaps. It should not be presented to users as evidence of heavy-metal contamination.

Microbiome: Not directly addressed. The review discusses vaginal/vulvar absorption and gynecological exposure relevance, but it does not measure vaginal microbiome endpoints.

Wiki pages this source may touch

• menstrual-pads
• menstrual-tampons

Verification notes

Identity checks before drafting found no existing wiki/sources/ hit for DOI 10.1111/1471-0528.17668, raw handle MFK_paper-22-marroquin-2024-systematic-review, cite key marroquin2024-menstrual-products-chemicals, or the exact title. The DOI, title, byline, publication year, journal, and CC BY-NC license were checked against the first page of /tmp/hmi-fem-014.txt. Tables 1-5 and Sections 2-4 were re-opened from the extracted text; values above preserve the source’s displayed units and no unit conversions were made. Table 2 labels phthalates as μg/g while the narrative around some of the same values uses mg/g; this page follows the table header and records the inconsistency rather than harmonizing it. Kim et al. fragrance/VOC pad units are taken from narrative text (μg/pad) where the table-unit line is hard to read in extracted text. metals: [] is intentional: the review reports no heavy-metal, total-arsenic, inorganic-arsenic, total-mercury, methylmercury, chromium-speciation, tin, or organotin occurrence values. The brand firewall is clean: the source sometimes counts brands in underlying studies, but this page reports only product-category values. Product and matrix slugs were checked against the closed taxonomy; panty-liner data are routed through menstrual-pads because no narrower panty-liner slug exists, while cups, discs, and period underwear are not routed because the source says peer-reviewed occurrence data were absent.

Page history

The five most recent substantive edits to this page. The full version history lives in git; when DOI minting comes online (see schema docs), each entry below will also link to a version-pinned DataCite DOI.