Here at R29 Health HQ, it feels like we get pitched a new brand of fancy organic-cotton tampons every week — and we know you’ve been seeing them on the shelves more, too. Though organic tampons have been around for years, more recently these products have made the jump from the internet and natural-food-store aisles to mainstream locations such as Walgreens and even your corner bodega. Press releases for these products — and other proponents of them, including the editors of Goop — often imply that organic tampons are better for you because they don’t have scary “chemicals,” you know exactly what’s in them, and they’re better for the Earth. But is any of that actually true? Or helpful? (For the extra cost, it had better be.) The main selling point for organic tampons seems to be that they have one ingredient. While traditional, non-organic tampons are made with cotton, rayon, or a blend of the two, organic tampons are made of just organic cotton. Susie Hewson, who founded the first organic-tampon brand, Natracare, back in 1989, says that the purity of ingredients is especially important to millennial women: "This generation of young women is seeking wellness — not just good health or absence of disease," Hewson says. "They want total wellness." "It’s about knowing what you’re putting in your body," adds Jordana Kier, cofounder of LOLA, another organic-tampon brand. "Traditional feminine-care brands are not required to fully disclose the ratio of ingredients in their tampons, so they don’t.” She’s right. The FDA regulates tampons as a Class II medical device, which sounds intense but just means that those devices are subject to extra safety monitoring when they’re on the market. And tampon makers are not required to share specifics of their ingredients, nor do they need to provide studies to anyone other than the FDA showing their products are safe. Class II is the same category in which condoms, wheelchairs, and even some pregnancy tests reside. The FDA estimates that 43% of all medical devices fall into Class II. For decades now, Congresswoman Carolyn Maloney (along with advocacy groups such as Women's Voices for the Earth) has been pushing Congress to require tampon manufacturers to operate with more transparency. She first introduced a bill asking for more transparency from manufacturers in 1997, but that bill failed, and since then she has reintroduced the bill 10 more times, most recently in April of last year. Maloney’s fight for more transparency (and organic brands’ honesty about what’s in their products) is admirable, for sure, but that still doesn’t explain whether organic tampons truly deliver on the promise of “total wellness,” as Hewson put it. Is Organic Cotton Really Better? Your vagina is a mucus membrane that absorbs things more readily than, say, your skin, explains Joshua Holden, MD, assistant professor at Columbia University Medical Center. And that’s a fact that organic-tampon companies readily take advantage of: Some claim that this makes it even more important that you’re totally sure what you’re putting up there is safe. The problem is that, as far as scientists can tell, there doesn't seem to be any huge reason to fear our current tampons. "We don’t have any data saying that organic tampons would be better than [traditional tampons],” says Julia Cron, MD, assistant professor of obstetrics, gynecology, and reproductive sciences at Yale School of Medicine. The most obvious reason to choose organic tampons might be that you’re someone who believes organic is always better — whether that’s your spinach or your feminine-hygiene products. For instance, some proponents of organic tampons prefer them because of the farming practices associated with organic cotton. Specifically, that means cotton that isn't grown with pesticides, including the ever-controversial Roundup. However, just last month, the EPA joined European Food Safety Agency and the UN’s Food and Agriculture Organization in concluding that Roundup likely doesn’t cause cancer, which is many consumers' main concern.
Others may be worried specifically about dioxins, a group of compounds created as a byproduct of the traditional tampon-bleaching process. But one thing the FDA does require of tampon manufacturers is routine tests to make sure that dioxin levels are below hazardous levels. The agency confirmed to Refinery29 that "this exposure is many times less than normally present in the body from other environmental sources, so small that any risk of adverse health effects is considered negligible." Another health concern might be that plastic applicators contain endocrine disruptors. These are chemicals that mimic hormones in your body and may alter the way they're meant to work. For instance, bisphenol-A (BPA) is an endocrine-disrupting compound found in many plastic products that has been linked to an increased risk for breast cancer and fertility issues, among other things. However, Dr. Holden explains that the amount of time for which you're exposed is key — kind of like how “you don’t smoke one cigarette and develop lung cancer,” he says. In the case of tampons, the applicator is only touching you for a few seconds during application, and a super-short exposure like that (even one that happens again and again) is unlikely to make a difference as far as risks to your health, Dr. Holden says. But you're concerned about the environment, you say? Well, fair enough. Everyone who menstruates goes through an astonishing estimated 12,000 tampons in a lifetime. That's a considerable amount of waste — especially if you're using plastic applicators. Luckily, cotton (organic or not) and rayon tend to break down relatively quickly, but once again the plastic applicator poses an issue for the eco-conscious. "The individual components used to manufacture tampons will decompose at varying rates. Cotton — organic and not — and rayon would be expected to decompose in a landfill in a matter of months, as would cardboard applicators," explains a spokesperson for the New York State Department of Environmental Conservation. "However, the plastic applicators used in some tampons would decompose at a much slower rate, ranging from decades to hundreds of years." This means if you’re worried about waste, the fix isn't about organic versus non-organic — it's about avoiding plastic applicators. Both organic and non-organic tampon manufacturers make products with cardboard applicators or — for the especially adventurous — without any applicators. Plus, you've got a plethora of non-tampon options as well, including menstrual cups and reusable pads, which are really the way to go if you’re trying to reduce the environmental impact of menstruation.
We don’t have any data saying that organic tampons would be better than [traditional tampons].
Dr. Julia Cron
And finally, we’ve got to talk about everyone’s biggest tampon fear: toxic shock syndrome (TSS), which is where things get a little bit more complicated. Much of our current worries about tampons generally can be traced back to the 1980s, when there was a spike in cases of TSS. That's when "super-absorbent" tampons hit shelves, made with materials that were linked to an increased risk for infection. Since the '80s, though, manufacturers have changed the composition of tampons considerably. Today TSS remains a serious — but very rare — occurrence. You can lower your risk for TSS by using the lowest level of absorbency that you need and changing your tampons frequently. However, what you might not know is that it’s not actually the tampon that causes TSS. Instead, it’s caused by the Staphylococcus aureus or Streptococcus pyogenes bacteria, which are often normally present in your vagina. The exact way tampons are involved in TSS remains unexplained. Philip Tierno, PhD, a microbiologist who has studied TSS for decades, says that about a quarter of women in the U.S. have the staph or strep bacteria present in their vaginas, but only around 3% carry the strains that, when given the opportunity by a tampon, produce TSS-causing toxins. Dr. Tierno says his research shows that non-organic tampons actually do provide an environment that allows bacteria that are already present to flourish — and that organic tampons haven’t shown the same effect. However, other researchers have been unable to replicate his results and heed caution in interpreting Dr. Tierno’s research. So the science isn’t conclusive enough for many gynecologists to recommend organic tampons over traditional ones. So what should I do? The bottom line is that organic tampons aren't going to hurt you: If you want to use them, go for it. Both Dr. Cron and Dr. Holden say that if it makes their patients feel better and safer, they're totally fine with them using organic tampons. However, you should make that choice knowing there’s no conclusive evidence (and, in fact, very little evidence, period) suggesting the switch is a meaningful one. "There’s not a lot of data on the pros and cons to using all organic substances," adds Dr. Cron. (Even the studies looking into the health benefits of eating organic foods are inconclusive.) Even if well-meaning, companies can turn our totally normal and understandable vigilance about our bodies to sell us stuff we don't really need. “It all goes back to marketing’s use of patients' concern over their overall health and the unknown of certain chemicals [to sell products],” says Dr. Holden. The one thing we can all agree on? We'd like a little more information — and fewer unhelpful pitches.