1
|
Cetera GE, Punzi MC, Merli CEM, Vercellini P. Menstrual products: culprits or bystanders in endometriosis and adenomyosis pathogenesis? Arch Gynecol Obstet 2024:10.1007/s00404-024-07713-w. [PMID: 39198282 DOI: 10.1007/s00404-024-07713-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 08/19/2024] [Indexed: 09/01/2024]
Abstract
Products that may reduce menstrual flow from the endometrial cavity to the vagina (i.e. tampons and menstrual cups) could facilitate retrograde menstruation and the spillage of blood into the myometrium, two mechanisms which could be major determinants in endometriosis and adenomyosis pathogenesis. The aim of this narrative review is to summarize the evidence regarding the mechanical role menstrual products may have in the pathogenesis of these two conditions. Evidence in this regard is inconclusive. While Darrow and colleagues observed that 14 or more years of tampon use were associated with endometriosis (OR 3.6; 95% CI, 1.04-13.5); in Meaddough and colleagues' retrospective study, the percentage of women using pads only was significantly higher among those with endometriosis than among those without the condition (31% vs 22%). Three further groups failed to find an association between endometriosis/adenomyosis and any type of menstrual product. The only case that may be considered as a sort of proof-of-concept of the association between products potentially reducing anterograde menstrual flow and endometriosis was reported by Spechler and colleagues, who described the case of a 41 year-old who developed endometriosis after having used a menstrual cup on a regular basis. However, the number of studies on the subject is scarce, study populations are exiguous and a greater attention to temporality of endometriosis onset in relation to when women started habitually using a specific menstrual product is needed. Confounding variables including type and quantity of endocrine disruptors contained in menstrual products should also be addressed. At the present moment, no recommendation can be provided on the safety of one type of menstrual product compared to another.
Collapse
Affiliation(s)
- G E Cetera
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Academic Center for Research On Adenomyosis and Endometriosis, Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy
| | - M C Punzi
- Business-Society Management Department, Rotterdam School of Management, Erasmus University, Rotterdam, the Netherlands
| | - C E M Merli
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - P Vercellini
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Academic Center for Research On Adenomyosis and Endometriosis, Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy
| |
Collapse
|
2
|
Shearston JA, Upson K, Gordon M, Do V, Balac O, Nguyen K, Yan B, Kioumourtzoglou MA, Schilling K. Tampons as a source of exposure to metal(loid)s. ENVIRONMENT INTERNATIONAL 2024; 190:108849. [PMID: 38963987 DOI: 10.1016/j.envint.2024.108849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/18/2024] [Accepted: 06/21/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Between 52-86% of people who menstruate in the United States use tampons-cotton and/or rayon/viscose 'plugs'-to absorb menstrual blood in the vagina. Tampons may contain metals from agricultural or manufacturing processes, which could be absorbed by the vagina's highly absorptive tissue, resulting in systemic exposure. To our knowledge, no previous studies have measured metals in tampons. OBJECTIVES We evaluated the concentrations of 16 metal(loid)s in 30 tampons from 14 tampon brands and 18 product lines and compared the concentrations by tampon characteristics. METHODS About 0.2 - 0.3 g from each tampon (n = 60 samples) were microwave-acid digested and analyzed by inductively coupled plasma mass spectrometry (ICP-MS) to determine concentrations of arsenic, barium, calcium, cadmium, cobalt, chromium, copper, iron, manganese, mercury, nickel, lead, selenium, strontium, vanadium, and zinc. We compared concentrations by several tampon characteristics (region of purchase, organic material, brand type) using median quantile mixed models. RESULTS We found measurable concentrations of all 16 metals assessed. We detected concentrations of several toxic metals, including elevated mean concentrations of lead (geometric mean [GM] = 120 ng/g), cadmium (GM = 6.74 ng/g), and arsenic (GM = 2.56 ng/g). Metal concentrations differed by region of tampon purchase (US versus European Union/United Kingdom), by organic versus non-organic material, and for store- versus name-brand tampons. Most metals differed by organic status; lead concentrations were higher in non-organic tampons while arsenic was higher in organic tampons. No categoriy had consistently lower concentrations of all or most metals. DISCUSSION Tampon use is a potential source of metal exposure. We detected all 16 metals in at least one sampled tampon, including some toxic metals like lead that has no "safe" exposure level. Future research is needed to replicate our findings and determine whether metals can leach out of tampons and cross the vaginal epithelium into systemic circulation.
Collapse
Affiliation(s)
- Jenni A Shearston
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA; Department of Environmental Science, Policy, & Management and the School of Public Health, University of California Berkeley, Berkeley, CA, USA.
| | - Kristen Upson
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Milo Gordon
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Vivian Do
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Olgica Balac
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Khue Nguyen
- Lamont-Doherty Earth Observatory of Columbia University, Palisades, NY, USA
| | - Beizhan Yan
- Lamont-Doherty Earth Observatory of Columbia University, Palisades, NY, USA
| | | | - Kathrin Schilling
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| |
Collapse
|
3
|
Zota AR, Franklin ET, Weaver EB, Shamasunder B, Williams A, Siegel EL, Dodson RE. Examining differences in menstrual and intimate care product use by race/ethnicity and education among menstruating individuals. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1286920. [PMID: 38126001 PMCID: PMC10731462 DOI: 10.3389/frph.2023.1286920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/07/2023] [Indexed: 12/23/2023] Open
Abstract
Introduction United States consumers spend over two billion dollars a year on intimate care products. These products, along with scented menstrual products, are marketed for odor control, perceived "freshness," and vaginal/vulvar cleanliness. However, these scent-altering products may increase exposure to carcinogenic and endocrine-disrupting chemicals. Prior research has not adequately characterized demographic differences in product use. The objective of our study is to examine racial/ethnic and educational differences in menstrual and intimate care product use among people who menstruate. Methods We pooled data from two US-based cross sectional studies to examine demographic characteristics and product use in 661 participants aged 18-54 years. Participants reported use of scented and unscented menstrual products (tampons, sanitary pads, and menstrual cups) and intimate care products (vaginal douches, sprays, wipes, and powders). We examined differences by race/ethnicity and education using log-binomial regression and latent class analysis (LCA), which can identify groups based on product use patterns. Results Our sample was 33.4% Black, 30.9% Latina, 18.2% White, and 16.2% another identity. Approximately half the population had a bachelor's degree or more; 1.4% identified as transgender and 1.8% as non-binary. In adjusted models, scent-altering products (i.e., scented menstrual and intimate care products) were more likely to be used by those with less formal education (p < 0.05). Unscented menstrual products were more likely to be used by those with more formal education. Compared to Black participants, White participants were more likely to use unscented tampons and menstrual cups and less likely to use douches and wipes (p < 0.05). Using LCA we identified two groups: one more likely to use scent-altering products, and a second more likely to use unscented menstrual products. Less education and older age, but not race/ethnicity, was significantly associated with membership in the group more likely to use scent-altering products. While sex/gender composition did not statistically vary across groups, all non-binary participants fell in the unscented menstrual product group. Discussion Lower educational attainment was consistently associated with greater use of scent-altering menstrual and intimate care products. Future research should examine associations between body odor stigma, product use, and health risks at intersections of race, class, and gender.
Collapse
Affiliation(s)
- Ami R. Zota
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | | | - Emily B. Weaver
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Bhavna Shamasunder
- Departments of Urban and Environmental Policy and Public Health, Occidental College, Los Angeles, CA, United States
| | | | - Eva L. Siegel
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | | |
Collapse
|
4
|
Menstrual Products as a Source of Environmental Chemical Exposure: A Review from the Epidemiologic Perspective. Curr Environ Health Rep 2022; 9:38-52. [PMID: 35302185 PMCID: PMC9876534 DOI: 10.1007/s40572-022-00331-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW Menstrual bleeding is a regular, common occurrence in a substantial portion of the population. Menstruators may use more than 10,000 menstrual products over the lifetime. Given the potential for environmental chemicals in menstrual products to be absorbed by the vulvar and vaginal epithelium into systemic circulation, we reviewed the available data on menstrual products as a source of environmental chemical exposure. RECENT FINDINGS Nearly two dozen studies have been conducted measuring environmental contaminants in menstrual products; all have detected environmental chemicals but had discrepant conclusions on exposure risks. Only three human studies have investigated menstrual product use and environmental chemical concentrations and all observed associations. Detection of environmental chemicals in menstrual products, in combination with challenges of exposure assessment, scarcity of human studies, and the exceedingly common occurrence of menstrual bleeding, motivates the need for further research. We provide recommendations to move this field forward.
Collapse
|
5
|
Yang J, Du J, Huang W, Ning H, Li N. Optimized Method for Determination 57 Volatile Organic Compounds in Nitrogen Using GC × GC-FID. J Chromatogr Sci 2021; 60:713-724. [PMID: 34686870 DOI: 10.1093/chromsci/bmab118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 07/09/2021] [Accepted: 09/11/2021] [Indexed: 11/13/2022]
Abstract
The sample containing 57 volatile organic compounds (VOCs) in nitrogen at a nominal 1 ppmv was prepared in our lab using weighting method. A methodology for determination of the 57 VOCs using a two-dimensional gas chromatography equipped with Deans switches and two flame ionization detectors (GC × GC-FID) was developed and validated for resolution, asymmetry, sensitivity, precision (intra-day precision and inter-day precision), linearity, limit of detection (LOD), limit of quantification (LOQ) and accuracy. In this study, resolution, asymmetry and sensitivity of the analytical method were improved,intra-day precisions of all the compounds were <1% and inter-day precisions were between 0.9 and 3.0%. In addition, LOQ and LOD were in the range of 0.024-0.185 ppmv and 0.012-0.092 ppmv, respectively. An excellent linearity was obtained (R2 > 0.9995). At the meantime, the accuracy of the analytical method was evaluated by determining the concentration of a certified reference material.
Collapse
Affiliation(s)
- Jing Yang
- Institute for Environmental Reference Materials, Environmental Development Center of the Ministry of Ecology and Environment, No. 1 Yuhui Road, Chaoyang, Beijing, 10029, China
| | - Jian Du
- Institute for Environmental Reference Materials, Environmental Development Center of the Ministry of Ecology and Environment, No. 1 Yuhui Road, Chaoyang, Beijing, 10029, China
| | - Wei Huang
- Institute for Environmental Reference Materials, Environmental Development Center of the Ministry of Ecology and Environment, No. 1 Yuhui Road, Chaoyang, Beijing, 10029, China
| | - Hongbing Ning
- Institute for Environmental Reference Materials, Environmental Development Center of the Ministry of Ecology and Environment, No. 1 Yuhui Road, Chaoyang, Beijing, 10029, China
| | - Ning Li
- Institute for Environmental Reference Materials, Environmental Development Center of the Ministry of Ecology and Environment, No. 1 Yuhui Road, Chaoyang, Beijing, 10029, China
| |
Collapse
|