Tampon use, environmental chemicals and oxidative stress in the BioCycle study

Jessica Singh,Enrique F Schisterman,Sunni L Mumford,Marianthi-Anna Kioumourtzoglou,Ana Navas-Acien,Marc G Weisskopf,Anna Z Pollack

doi:10.1186/s12940-019-0452-z

Abstract

BackgroundTampons are used by up to 86% of US women and are a rarely considered potential source of pesticide and metal exposure. Tampons may be of particular concern given the likely higher absorption that occurs in the vagina. Our objective was to examine the potential associations between tampon use and metal concentrations, and biomarkers of inflammation and oxidative stress among healthy women.MethodsWe used information from a prospective cohort of 259 regularly menstruating women, aged 18–44, followed for two menstrual cycles. Tampon use was assessed using information provided in participant study diaries. Metal concentrations were measured from a blood sample collected at enrollment. Oxidative stress and inflammation biomarker concentrations were determined from blood samples collected at up to 8 clinic visits for each cycle. Linear regression models were used to estimate associations of tampon use with metal exposure, and linear mixed models to estimate associations of tampon use with inflammation and oxidative stress biomarkers at different times during the menstrual cycle.ResultsWe observed non-significantly higher mean levels of mercury for tampon users compared to non-tampon users (exp(β) = 1.25, 95% CI = 0.93, 1.68). We found no evidence of an association between tampon use and inflammation biomarkers. We observed consistently higher isoprostane levels, an oxidative stress biomarker, among tampon users compared to non-tampon users (e.g. exp.(β) = 1.05, 95%CI = 0.96, 1.16, for the average isoprostane during the menstruating week); however, these results were not statistically significant.ConclusionsWhile our results are not statistically significant, we observed suggestive associations between tampon use and elevated levels of mercury and oxidative stress biomarkers. Although our finding should be interpreted in light of our limitations, they indicate that tampons may be a source of exposure to metals and chemicals that have been largely ignored, and any related health effects are an important public health concern.

Highlights

Tampons are used by up to 86% of US women and are a rarely considered potential source of pesticide and metal exposure
Study population The BioCycle Study is a prospective cohort study that was designed to understand the relationship between reproductive hormone levels and oxidative stress during the menstrual cycle [18]
We considered any use during the study period using the information provided in the diaries

Summary

Introduction

Tampons are used by up to 86% of US women and are a rarely considered potential source of pesticide and metal exposure. The vaginal route is a potentially important yet understudied route of chemical exposure. A commonly used feminine hygiene product, with 50–86% of women in the United States report using them during menstruation, are inserted into the vagina to absorb menstrual blood [1]. If tampons do contain harmful chemicals, tampon use may [1] be a potentially important source of these chemicals via the vaginal route given the rapid absorption that occurs in the vagina and the cumulative exposure to tampons over a women’s reproductive life and [2] may affect the epithelial integrity of vaginal and cervical cells, potentially increasing susceptibility to sexually transmitted infections

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