Menstrual Hygiene Products Research Articles

Development and application of a novel method to assess exposure levels of sensitizing and irritating substances leaching from menstrual hygiene products

Menstrual hygiene products (MHPs) like tampons, sanitary towels and panty liners are widely used by women and come in close contact with the intimate parts of the human body, which consist of mucosae that lack the important barrier function of normal skin. Hence, substances leaching from MHP can easily penetrate and become systemically available. This study aims to develop a new in chemico methodology that allows to identify and measure realistic consumer exposure levels of several skin sensitizers and irritants leaching from MHPs under simulated use conditions. To assess the leaching of chemicals from MHPs, a menstrual fluid simulant (MFS) simulating pH, osmolarity and protein binding was first established. Subsequently, an analytical methodology was developed for nine well-known skin sensitizers and skin irritants. In short, the MFS samples underwent salting-out assisted liquid-liquid extraction before ultra-high performance liquid chromatography coupled with a triple-quadrupole mass spectrometry analysis. Validation was performed according to the total error approach with acceptability limits of ±15% regarding the total analytical error (including systematic and random bias). Fifteen commercially available MHPs were assessed. Six products were found to leach at least one of the following five sensitizing and irritating compounds: α-isomethyl ionone, benzyl salicylate, hexyl cinnamaldehyde, linalool and piperonal. Piperonal was the most abundant compound leaching from the MHPs, with leaching concentration levels measured to 28.22 μg/g. In addition, the leaching level of benzyl salicylate was found to be 11.03 μg/g. The latter fragrance concentration is above 10 μg/g and would trigger mandatory labelling if the Cosmetic Regulation would apply for MHPs. However, none of the identified and quantified skin sensitizers were mentioned on the packaging. In conclusion, this novel methodology makes it possible to estimate realistic human exposure levels to skin sensitizers and irritants through the use of MHPs. Availability of these exposure estimates is vital to carry out a quantitative health risk assessment of these substances.

Law’s Ability to Further the 'Menstrual Movement'

The current menstrual movement calls for overcoming the cultural stigma associated with menstruation and achieving “menstrual equity” and “period poverty”. The movement seeks to increase awareness of menstruation by rectifying and removing discrimination against those who menstruate and providing greater access to menstrual hygiene products (“MHPs”), particularly for the homeless and those with lower incomes. To achieve these goals, the movement is advocating for the elimination of the “tampon tax” and requiring schools provide MHPs to students for free. There are also lawsuits challenging the constitutionality of the tampon tax. Advocates view these legal changes as instrumental in furthering the goals of equity and access to MHPs underlying the movement. This essay discussions whether these legal changes achieve the movement’s goals and also explores their expressive effects. The essay concludes that the process of demanding these legal changes, and sometimes achieving them, plays a more significant role than the law’s actual operation in reaching the movement’s goals.

Menstruation Experiences of Middle and High School Students in the Midwest: A Pilot Study.

The purpose of this pilot study was to expand understanding of the experience of menstruation for girls in the United States and its impact in the school setting. A qualitative approach was used to gather data from focus group interviews. Descriptive content analysis was used to categorize the range and types of menstruation experiences described by 12 participants aged 12-16 years. Findings revealed four main themes: (1) learning about menstruation, (2) experiencing menstruation, (3) managing menstruation, and (4) social norms and meaning of menstruation. Participants described multiple challenges faced learning about and experiencing menstruation, especially in the school setting. Participants described the limited understanding of menstruation experiences and confusion about the use of menstrual hygiene products. Challenges experienced at school included not having adequate access to menstrual hygiene products, limited time for changing products, fear of leaking menstrual blood, and impacts on school attendance. School nurses are well-positioned to contribute to creating school environments that are supportive of menstruation.

Acceptability of the menstrual cup among students in further education institutions in KwaZulu-Natal, South Africa

Objective The primary objective of this research was to evaluate long-term user acceptability of menstrual cups in a student population in South Africa. Methods A cohort of female students aged 18–24 years attending 10 further education institutions including 22 campus sites in KwaZulu-Natal, South Africa, were offered menstrual cups after receiving education and training in their use. The students were followed for up to 12 months to assess menstrual cup acceptability, user experiences and continuation. Results A total of 509 students were enrolled. Disposable pads were the primary menstrual hygiene product used in the 3 months prior to the baseline interview (95.5%, n = 486), and 8.1% (n = 41) of students reported that they had used toilet paper or newspapers. Of the 463 (91%) students interviewed at 1 month follow-up, 86% reported that they had tried to use the menstrual cup. There was mixed reporting on ease of insertion and removal on first use. Of those who attempted use, half (49.5%, n = 197) reported that inserting the menstrual cup on first use was very easy or quite easy. Of those who did not find it easy, 80% reported that two to three insertions were required to achieve comfort. A maximum of five insertions was mentioned to achieve comfort. The majority who had used the cup (>90%) reported they would continue to use it at each follow-up visit. Conclusion The menstrual cup was well accepted among this student population and should be considered as a cost-effective and environmentally sustainable option in menstrual health management initiatives in South Africa.

Piloting an acceptable and feasible menstrual hygiene products disposal system in urban and rural schools in Bangladesh

BackgroundAccess to washroom facilities and a place to dispose of menstrual waste are prerequisites for optimal menstrual hygiene management in schools. Like other low- and middle-income countries, Bangladeshi schools lack facilities for girls to change and dispose of their menstrual absorbents. We explored existing systems for disposing of menstrual absorbent wastes in urban and rural schools of Bangladesh and assessed the feasibility and acceptability of alternative disposal options.MethodsWe explored how girls dispose of their menstrual products, identified girls’ preferences and choices for a disposal system and piloted four disposal options in four different schools. We then implemented one preferred option in four additional schools. We explored girls’, teachers’, and janitors’ perspectives and evaluated the acceptability, feasibility, and potential for sustainability of the piloted disposal system.ResultsBarriers to optimal menstrual hygiene management included lack of functional toilets and private locations for changing menstrual products, and limited options for disposal. Girls, teachers, and janitors preferred and ranked the chute disposal system as their first choice, because it has large capacity (765 L), is relatively durable, requires less maintenance, and will take longer time to fill. During implementation of the chute disposal system in four schools, girls, teachers, and janitors reported positive changes in toilet cleanliness and menstrual products disposal resulting from the intervention.ConclusionsThe chute disposal system for menstrual products is a durable option that does not require frequent emptying or regular maintenance, and is accepted by schoolgirls and janitors alike, and can improve conditions for menstrual hygiene management in schools. However, regular supervision, motivation of girls to correctly dispose of their products, and a long-term maintenance and management plan for the system are necessary.

Students' Menstrual Hygiene Needs and School Attendance in an Urban St. Louis, Missouri, District

PurposeTo assess the menstrual hygiene needs and related school absences among female students in an urban St. Louis, MO district. MethodsStudents (n = 58) completed a self-administered survey during registration and orientation before the 2019–2020 school year. ResultsNearly half (48.3%) needed period products at least once last school year but did not have money to buy them. The majority (62.1%) accessed period products at school last year. Seventeen percent missed at least one day at school because of an inadequate supply of period products, including significantly more ninth graders than 10th–12th graders (33.3% vs. 6.1%, respectively, p < .01). ConclusionsStudents reported a substantial need for menstrual hygiene products but also frequent utilization of school resources to access products. Given that incoming ninth graders reported more absences related to an inadequate supply of products, the district may need to focus more attention on this issue in the junior high school and younger grades.

Menstrual Hygiene Needs Among Women Receiving Substance Use Disorder Treatment [27B

INTRODUCTION: Recent research has highlighted the high unmet menstrual hygiene product needs among low income women. The aim of this study was to evaluate the menstrual hygiene needs of women receiving treatment for substance use disorders (SUD). METHODS: Patients were recruited from an urban, outpatient SUD clinic to complete a voluntary, electronic, cross-sectional survey between July and September 2019. Menstrual hygiene questions were modeled from prior work (Kuhlmann et al., Obstetrics and Gynecology, February 2019) with author permission. Women were classified as having menstrual poverty if they reported needing menstrual hygiene products but not having the money to buy them in the past 12 months. Factors associated with menstrual poverty were assessed using χ2 tests. Exempted by VCU IRB. RESULTS: Eighty-six (94.5% response rate) women completed the survey, of whom 36 (41.9%) had a period in the past 12 months and were included in the study. Almost all (94.4%) were in treatment for opioid use disorder. Mean age was 34.69 (SD 7.433) years. Women were predominantly African American (50%), educated at a high school level (55.6%), unemployed (55.6%), and receiving public assistance (66.7%). Most (n=29; 80.6%) reported menstrual poverty. Menstrual poverty was not associated with heavy menstrual bleeding but was associated with food insecurity (P=.005). Many (n=23; 63.9%) stated they would like to receive hygiene products at the addiction clinic. CONCLUSION: Menstrual hygiene products are a necessity that women receiving addiction treatment lack. In the opioid crisis, providers should be aware of this disparity. Integration of reproductive/sexual health with addiction services should be prioritized.

A Study of menstrual hygiene practices of non-working women

Menstrual hygiene practices are indispensable for women and girls. Menstrual hygiene is vital to the health, well-being, dignity, empowerment, mobility and productivity of women and girls. This study was conducted of menstrual hygiene practices, knowledge and availability and to know menstrual hygiene practices among non working women of Udaipur, Rajasthan who were below 35 to above 35 years using structured proforma. The results indicated that all the respondents were aware of menstrual hygiene products. Among them, 75 per cent used sanitary pads, 20 per cent cloth, and 5 per cent used tampons during their menstrual cycle. Majority of respondents (92.5 %) purchased menstrual hygiene products on their own, 7.5 percent took family members help to buy menstrual hygiene products. Information gathered regarding satisfaction reveals that 62.5 per cent were completely satisfied while 37.5 per cent were not. Problems faced on use of menstrual products include rashes (17.5 %), itching (5 %), irritation (5 %). Around 62.5 per cent. respondents stated that they were influenced by advertisements shown in media and 37.5 per cent respondents stated that media had no influence on their choice of menstrual products. There is necessity to increase knowledge among non working women regarding hygienically safe menstrual practices. In menstrual hygiene products the sanitary pads is most popular for non working women because it is hygienically safe and comfortable in menstrual cycle and easily available in every locality.

Exploring college student's menstruation-related difficulties during early COVID-19 lockdown period in North India

Objective: Sanitary napkins are an essential aspect of the menstrual hygiene management. Despite its critical importance to women and adolescent girls from menarche and menopause, access to menstrual hygiene products has been neglected during the COVID-19 pandemic. At the time of this writing, there was no information on the challenges associated with accessing menstrual hygiene products in Indian settings during this period. This paper investigates the prevalence of socio-demographic correlations of access to sanitary napkins among college students in Lucknow, the largest state located in North India. Methods: Students of undergraduate (UG) and post-graduate (PG) courses currently studying in colleges in Lucknow were eligible to participate in the study. An online cross-sectional survey was conducted in Lucknow in September 2020. In total, 1439 participants took part in the survey. After removing 55 participants who quit the survey by clicking on the disagree button and 13 who did not satisfy inclusion criteria, the final sample comprised 1371 participants. The data collection was anonymous. Responses were analysed using descriptive statistics and bivariate logistic regression. Results: Up to 1371 students completed the survey, resulting in a response rate of 96.2 percent. The analysis revealed that about 12.5 percent of students reported problems in access to sanitary pads during the lockdown. Logistic regression analysis showed that being Muslim, having less-educated fathers, having farmers as fathers, having low income, rural residence, and a history of using cloth, all independently predict challenges in getting access to sanitary pads during the COVID-19 lockdown (P < 0.05). Conclusion: During the COVID-19 lockdown, students were dependent on either locally available resources as absorbents during menstruation or paid more to buy sanitary pads in Lucknow. Low-income families are reluctant to spend on sanitary pads, which is why few college girls resumed their previous practice of managing their periods using cloth pieces or rags. This study's findings may be used to plan and implement interventions during a future pandemic or such crises to maintain the supply chain of sanitary pad.

COVID-19 Induced Menstrual Hygiene Management Adversities and Impact Assessment of Project Baala's Intervention in Response to These Adversities in Peri-Urban Fringes of Delhi

Background: Only 57.6% use hygienic methods for their menstrual needs in India (NFHS,4). There is an accompanying challenge of access to WASH (Water, Sanitation and Hygiene) facilities. 63 million adolescent girls live in homes without toilets, which compounds discomfort during menstruation (Dasra, 2014). Awareness levels related to menstruation, menstrual hygiene and age-old myths and taboos continue to be low in parts of the country. COVID-19 resulted in an apparent reduction/elimination of access to Menstrual Hygiene Management (MHM) products and facilities, adoption of unhygienic menstrual management practices even by healthcare workers, decrease in access to menstrual-related knowledge, increase in the risk of occurrence and severity of several stress-related menstrual disorders, and a shift of public focus from menstrual health and wellbeing promotion (Ajari, 2020). This research aims to study add to the literature by studying the impact of COVID-19 on MHM and the impact of an intervention conducted by Project Baala to reduce MHM adversities owing to COVID-19.Methods : We collated data of 368 women from the 20 clusters of Delhi to study their patterns and the impact of the intervention. We undertook a quantitative study to understand the patterns in the community. The sample of women and girls was based on convenience sampling. We surveyed women and girls over a phone call for which oral consent was taken before administering the survey. Results: 31.8% of women reported restricted access to menstrual products and an overwhelming proportion 61.6% cited limited financial resources as the reason. During the lockdown, the access to school supply was disrupted for 80% of the girls. During the lockdown, 27.4% of the respondents had to use alternative methods for their menstrual needs such as old cloth lying at home due to the pandemic-induced scarcity. Results of our intervention suggest that of the 62.8% women who have used the Baala pads at least once, 96.5% of them reported that the reusable pads have increased their comfort level with regard to using menstrual products and about 86% women urged that this usage has facilitated mobility and improved participation in activities. Owing to these benefits, 94.8% respondents find the Baala pads to be reliable and 81% would continue using them after the pandemic, pointing out to the wide acceptance of sustainable menstrual hygiene products by all.

Menstruation Management in United States Schools and Implications on Attendance, Academic Performance, and Health

This study surveys 693 females between 18-25 years old, all of which attended United States high schools, asking them about their need for, and the availability of, menstrual hygiene products (MHPs) in high school and the impact, if any, the lack of access to MHPs in school had for their attendance, academic performance, and health. Respondents indicated that most (640, 92.35%) needed MHPs while at school, but only 292 (42.13%) attended schools providing MHPs (many of which required students to pay for them). Respondents indicated that this lack of access to MHPs resulted in 88 (12.7%) missing school, 104 (15.01%) being late to school, and 165 (23.91%) leaving school early. The lack of access was also identified by 122 (17.6%) respondents as impacting their ability to learn and resulting in 53 (7.65%) to experience health issues. The study finds a statistically significant correlation between a school’s failure to provide MHPs and a student missing school or leaving school early and negative impacts on their ability to learn.

Menstruation Management in United States Schools and Implications for Attendance, Academic Performance, and Health

Six hundred and ninety-three young women, 18–25 years old, all of whom had attended United States high schools, were surveyed to ask about their need for and the availability of menstrual hygiene products (MHPs) in high school and the impact, if any, that lack of access to MHPs in school had for their attendance, academic performance, and health. Most (640, 92.35%) needed MHPs while at school, but only 292 (42.13%) attended schools that provided MHPs (and those that did often required students to pay for them). Lack of access to MHPs resulted in 88 (12.7%) having missed school, 104 (15.01%) having been late to school, and 165 (23.91%) having left school early for the day. Lack of access was also identified by 122 (17.6%) respondents as having impacted their ability to learn and having resulted in health issues for 53 (7.65%) of them. There are statistically significant correlations between a school’s failure to provide MHPs and a student having missed school, having left school early, and negative impacts on their ability to learn.

Menstrual Blood-Derived Mesenchymal Stem Cells: Women's Attitudes, Willingness, and Barriers to Donation of Menstrual Blood

Background: Menstrual blood contains mesenchymal stem cells (MenSC), considered a potential "off-the-shelf" treatment for a range of diseases and medical conditions. Samples of menstrual blood can be collected painlessly, inexpensively, and as frequently as every month for cell therapy. While there has been considerable previous research into the clinical advantages of MenSC, there is currently little understanding of potential donors' attitudes regarding menstrual blood donation and MenSC. Methods: One hundred women 18 years of age or over were surveyed to understand attitudes and potential barriers to menstrual blood donation. The questionnaire assessed participant age and brief medical history (giving birth, donating blood, donating stem cells), menstrual experience (period rating, preferred menstrual hygiene products), and whether participants would donate MenSC or accept MenSC therapy. Results: MenSC was met with a generally positive response, with 78% of menstruating women willing to donate menstrual blood. No significant relationship was recognized between willingness to donate menstrual blood with age, history of childbirth or blood donation, menstruation perception, and preferred menstrual hygiene product. Women rated their period experience better after being made aware of the ability to donate menstrual blood, meaning MenSC therapy can be beneficial for donors as well as patients. Conclusions: Considering women's attitudes to MenSC and donation of menstrual blood, the future of MenSC therapy is positive; women are generally willing to donate menstrual blood, independent of age, perception of periods, and history of childbirth and blood donation.

Do menstrual cups increase risk of IUD expulsion? A survey of self-reported IUD and menstrual hygiene product use in the United States

Purpose: To gather preliminary data about menstrual hygiene product use and associated risk of intrauterine device (IUD) expulsion.Materials and methods: We conducted an Internet-based survey using the Amazon Mechanical Turk (MTurk) platform and Researchmatch.org. Eligible participants were women at least 18 years old and self-identified as current or previous IUD users.Results: Of 902 survey responses, 71% reported current or previous IUD use and 19.7% reported menstrual cup use. IUD users were significantly more likely than non-IUD users to use a menstrual cup or tampons. Among all IUD users, 56 individuals reported experiencing at least one expulsion (8.8%). We found a positive association between concurrent menstrual cup use and IUD expulsion (OR: 2.75, 95% CI: 1.40–5.42, p = .002), but no association with concurrent tampon or pad use. Of concurrent IUD and cup users who experienced an expulsion, one reported it occurring ‘while using a menstrual cup’, with others reporting the expulsion during other events.Conclusions: Menstrual cup use may be higher than previously reported, particularly in IUD users. Concurrent menstrual cup use may increase the risk of IUD expulsion. Prospective research is necessary to fully explore the relationship between menstrual hygiene product use and IUD expulsions.

Age of menarche and menstrual hygiene of pubertal female students in Bhutan: a cross-sectional survey, 2017

Introduction: In Bhutan, pubertal and adolescent female students (10-19 years) make up 8.5% of the population. The need for menstrual hygiene management (MHM) is more urgent in post-menarcheal female students and in resource-poor settings. However, until recent time, there were strong socio-cultural barriers to discourses on menarche and MHM. This study was conducted to determine the age of menarche among Bhutanese female students to identify when to offer MHM support, their knowledge on menstruation and practices related to menstrual hygiene. Methods: This was a cross-sectional survey of female students studying in Grade 10 in Thimphu, Bhutan. A multistage clustered sampling was used. Data was collected using a self-administered questionnaire developed for the purpose of this study. Results: A total of 439 post-menarcheal female students were interviewed. The mean age of menarche was 12.8±1.1 years, and fear (38.3%) and confusion (25.1%) were the commonest responses. The mean score on knowledge on menstruation and MHM was 5.9±1.5 out of 9. The proportion of students with good knowledge was 36.7%. The common sources of information were the mother, teacher, and sister. The majority used commercial pads (92.5%) while some used clean cloths (5.7%) and tampons (1.6%). The proportion who stayed absent from school during menstruation in the month prior to data collection was 9.8%. Visiting religious places (67.6%) and participating in sports (4.3%) were common restrictions during menstruation. Conclusions: Female students experience difficulties in menstrual hygiene management in schools. Menstruation could lead to missing schools and other activities. Keywords: Developing country; Health behaviour; Menstrual hygiene product; Standard of living.

Imperfect Information in Menstrual Health and the Role of Informed Choice

This article explores how imperfect information and the culture of silence around menstruation have shaped the menstrual hygiene product market. It is generally considered that the use of sanitary napkins is equivalent to hygiene. This view is critically evaluated in light of evidence. In a highly competitive market, materials used in sanitary napkin products have evolved significantly. Policymakers and regulators need to be informed about the nature of products entering the Indian market and their implications on women’s health and cost to the environment. The menstrual hygiene market now offers some less-known innovations such as menstrual cups, reusable cloth pads and compostable sanitary napkins that could offer a more sustainable direction to the industry. However, they also have their own barriers to access and use. Given the increasing choice available in the market and potential for accessing information, it has become pertinent that relevant stakeholders—such as women, government officials and the media—are made aware of the basket of options for menstrual hygiene management. Field experiments done to this end indicate that informed choice will automatically ensure that cost to women’s health and the environment is minimised.

Insights from outside BJOG

Insights from outside BJOG

Who Benefits from Repealing Tampon Taxes? Empirical Evidence from New Jersey

Many state and local governments exclude some medical products from the sales tax base, including some that are primarily used by men such as hair growth products. However, tampons and other menstrual hygiene products are subject to sales taxes in most states. A recent social movement advocates for the repeal of these “tampon taxes” and several class action lawsuits have been filed against states citing equal protection violations. In this article, we use the 2005 elimination of menstrual hygiene products from the sales tax base in New Jersey as a natural experiment to study who benefits from the repeal of tampon taxes. We find that the tax break is fully shifted to consumers, but that the tax break is not distributed equally. Low‐income consumers enjoy a benefit from the repeal of the tax by more than the size of the repealed tax. For high‐income consumers, the tax break is shared equally with producers. The results suggest that repealing tampon taxes removes an unequal tax burden and could make menstrual hygiene products more accessible for low‐income consumers.

MAPPING THE BARRIERS OF RECEIVES AFFORDABLE MENSTRUAL HYGIENE PRODUCTS AND HEALTHCARE SERVICES AT THE RURAL SETTING OF BANGLADESH

Background: Menstrual hygiene health has paramount importance for the adolescents and women. The evidence based studies on menstrual hygiene management are very few and far less in rural setting of Bangladesh possibly for lack of interest in research and non-availability of the fund. Relatively menstrual hygiene do not lessen its importance as a subject as it one of the major cause of reproductive tract infections of adolescents and women. Methods: The study had two sets of data: one set of data was collected from the community through in-depth interview and another was from Informal Group Discussions (IGD). Fisher (1993) formula was followed to determine the sample size. The data has been analyzed using SPSS. Descriptive and Qualitative statistical tools were performed to analyze the collected data. A total 500 adolescents and women were interviewed from four Upazilas. Results: Mothers (78%) were the reliable place for the sharing respondent's first menstrual experiences. About 95% respondents believed myths of the society about menstrual hygiene. About 78% respondents were used to old cloth. The collection of menstrual hygiene materials and dispose of used products were vexing problems in the rural setting. The major portion (63%) has dreamed of having of menstrual hygiene product with good quality. The low cost of a product (p&lt;.001), expected healthcare services (p&lt;.040), awareness programs (p&lt;.001), social media (p&lt;.002) are useful tools to increase the user's having menstrual hygiene products and receiving services in the rural setting. Conclusions: The government should have scheme for adolescents and women at rural setting address to culture and beliefs, resources and practice. To improve the capacity of adolescents and women to practice quality and affordable sanitary napkin, it is recommended that to start sensitizing activities at community setting immediately.

Status of Use of Menstrual Hygiene Products and Genital Organ Hygiene Management in Unmarried Women.

The purpose of this study was to investigate the status of use of menstrual hygiene products and genital organ hygiene management in unmarried women. Data from 161 unmarried women were used for analysis. The instruments consisted of self-reported questionnaires that included 40 items: 20 on General Characteristics & Sexual Health Related Characteristics, 8 on Using Status of Menstrual Hygiene Products, 12 on Genital Organ Hygiene Management. The subjects used disposable sanitary napkin as the most frequently but the satisfaction was low, while the use of reusable sanitary napkin and tampons were few, but satisfaction was high. Sixty-seven percent of the unmarried women had sex experience, and more than 60% experienced abnormal symptoms in the genital organ. There was a significant difference in genital organ hygiene management according to sex experience. Among subjects of this study, 44.1% wanted to use menstrual cup, and 98.8% wanted to have education for their menstrual hygiene products. Based on results of this study, a nationwide survey of the demand for menstrual hygiene products used by Korean women is needed, it is necessary to educate about the proper use of menstrual hygiene products and genital organ hygiene management.