There has been much concern and discussion of late regarding the presence of dioxin in feminine hygiene products. It has been long debated, and there is conflicting evidence, as to whether or not the use of such products could lead to several illnesses, including Endometriosis.
While the industry states their products are safe, conflicting studies performed by independent research institutes deem that the products do indeed contain low levels of dioxin, which has been proven harmful to humans.
Feminine hygiene products are used by up to nearly 70% of menstruating women in the United States, and the average woman may use as many as 11,000 tampons and feminine hygiene products in her lifetime. The toxic residues in tampons and feminine hygiene products come in direct contact with some the most absorbent tissue in a woman's body. Worse, the effects of dioxin are cumulative and can be measured as much as 20 or 30 years after exposure. This accumulation is cause for concern because a woman may be exposed to dioxin in tampons and feminine hygiene products for approximately 40 years over the course of her reproductive life.
Currently, the FDA requires tampon and related menstruation product manufacturers to monitor dioxin levels in their products; however, the results are not available to the public and the dioxin tests relied upon by the FDA are done by the manufacturers themselves. That's a little bit like having the fox guard the hen house! Independent, unbiased testing and publicly available results are needed now to allow women the opportunity to make informed decisions about the products they wish to use.
Several legislators have attempted to pass bills to provide for research to determine the extent to which the presence of dioxin, synthetic fibers and other additives in tampons and similar products pose any health risks, including risks of cervical cancer, Endometriosis, infertility, ovarian cancer, breast cancer, immune system deficiencies, pelvic inflammatory disease and toxic shock syndrome.
Most recently, Assemblyman Dennis Cardoza passed AB280 out of the Assembly Committee on Health for review by the Senate Committee on Health & Human Services. In 1997, Representative Caroline Maloney introduced HR2900, the "Tampon Safety and Research Act of 1997." In 1992, the late Representative Ted Weiss brought the issue up in a Subcommittee hearing of the Committee on Government Operations. He did this after his staff had uncovered an internal FDA memo which warned that "the risk of dioxin in tampons can be quite high," and that "the most effective risk-management strategy would be to assure that feminine hygiene products contain no dioxin." The California Assembly has also previously considered AB1963, which required the state Department of Health Services to determine if sanitary products contain dioxin residue and to require warning labels on all sanitary products found to contain dioxin residue.
To date, no such bill has been enacted, and the American public remains at risk.
According to a February 2000 report from the Food & Drug Administration, tampons and feminine hygiene products currently sold in the U.S. are made of cotton, rayon, or blends of rayon and cotton. Even though these products are now produced using elemental chlorine-free or totally chlorine free bleaching processes, these methods can still generate dioxins at "trace levels." Thus, there may be low amounts of dioxin present from environmental sources in cotton, rayon, or rayon/cotton tampons and feminine hygiene products. By contrast, a report released by The US Environmental Protection Agency clearly describes dioxin as a serious public health threat. The EPA report states, there is no "safe" level of exposure to dioxin - even trace amounts are a risk. Further, the EPA report confirmed that dioxin is "a cancer hazard to people;" that exposure to dioxin can also cause severe reproductive and developmental problems (at levels 100 times lower than those associated with its cancer causing effects); and that dioxin can cause immune system damage and interfere with regulatory hormones.
Dioxin exposure to women in particular, poses additional risks than just that of their own health: it crosses the placenta into the growing infant and is also present in the fatty breast milk, thereby exposing the child.
Evidence of dioxin as a catalyst for Endometriosis has been well-documented. In a 1996 Environmental Protection Agency study, dioxin exposure was linked with increased risks for Endometriosis, as well as the increased risks of pelvic inflammatory disease, reduction of fertility, and interference with normal fetal and childhood development. The EPA conclusions regarding dioxin exposure are particularly alarming in light of a 1989 Food and Drug Administration report, which stated that "possible exposures from all other medical device sources would be dwarfed by the potential tampon exposure." Dr. Philip Tierno, Jr., Director of Clinical Microbiology and Diagnostic Immunology at New York University Medical Center states that "dioxins, though they exist in the environment, have a worse effect when they contact mucous surfaces like the vagina."
In a May 1998 article in The Press Tribune, the story of an Endometriosis patient was recounted. Patient A. paid nearly $1,000 to MAXIM Technologies, Inc., a private lab in St. Paul, Minnesota, to test the dioxin levels in 10 Playtex Super-Plus Absorbency tampons. Results from the tests performed on Patient A.'s tampons showed between .6 to .7 picograms of dioxin, according to Mike DeVito, a toxicologist at the U.S. Environmental Protection Agency who evaluated the results at the request of The Press-Tribune. The EPA maintains their position that there is "no safe level of dioxin" and that the levels found in the Playtex tampons posed an unacceptable risk. DeVito further admitted that dioxin has an "extremely long half-life" - able to last in the body for as long as 11 years. "So if you get exposed to 1 picogram today, in 11 years, you'll have half a picogram in you," he noted.
Medical Journals are replete with evidence supporting the risks dioxin poses. In a September 1998 study in the Revue Medicale de Bruxelles Journal entitled "Dioxins: Current Knowledge about Health Effects," authors Wissing et al. noted that "in humans, a series of conditions related to hormonal dysfunction as undescended testis, decreased spermatogenesis, testicular cancer and Endometriosis have increased in incidence during the last decades. The chronological parallelism with the appearance of dioxins in the environment suggests that these might exert biological effects at the prevailing level of exposure." In a 1997 article entitled "Does Disruption of Immune and Endocrine Systems by Environmental Toxins Contribute to Development of Endometriosis?," authors Osteen and Sierra-Rivera noted that "evidence continues to accumulate indicating that environmental toxins, whether naturally occurring or man-made, may directly or indirectly affect the response of the endometrium to steroids, resulting in various pathological states including Endometriosis."
Authors Mayani et al. cited a research study in a 1997 Journal of Human Reproduction article, "Dioxin Concentrations in Women with Endometriosis," in which the concentrations of dioxin were measured in the blood of 44 infertile women with Endometriosis against a control group of 35 age-matched women with tubal infertility. 18% of women with Endometriosis were dioxin positive as compared to 3% in the control group. Although the concentrations of dioxin did not seem to be directly correlated with the severity of Endometriosis, these observations contribute to the accumulating data linking dioxin to Endometriosis in humans.
In a 15 year study outlined in a 1993 Journal of Applied Toxicology, world renowned scientists Rier, Martin, Bowman, Dmowski and Becker reported on "Endometriosis in Rhesus Monkeys Following Chronic Exposure to Dioxin." The incidence of Endometriosis was determined in a colony of rhesus monkeys chronically exposed to dioxin for a period of 4 years. Ten years after termination of dioxin treatment, the presence of Endometriosis was documented by surgical laparoscopy and the severity of disease was assessed. The incidence of Endometriosis was directly correlated with dioxin exposure and the severity of disease was dependent upon the dose administered. This 15-year study indicates that latent female reproductive abnormalities may be associated with dioxin exposure in the rhesus.
Serdar Bulun, MD, Director of Molecular Genetics and Reproductive Endocrinology at The University of Chicago and his team of researchers published an April 2000 article in the American Journal of Obstetrics & Gynecology entitled "Expression of Dioxin-Related Transactivating Factors and Target Genes in Human Eutopic Endometrial and Endometriotic Tissues." In Dr. Bulun's study, it was demonstrated for the first time the expression of dioxin-related transcription factors in endometriotic tissues and stromal cells. Strikingly elevated transcripts in Endometriosis may give rise to significantly increased enzyme activity and thus promote the development and growth of Endometriosis by either activating procarcinogens or inducing the formation of catechol estrogens - or both.
Still further evidence exists. In a study published in November 1999 by researchers in the Reproductive Toxicology Division of the U.S. Environmental Protection Agency, Cummings et al. discussed the "Effect of Prenatal Exposure to TCDD on the Promotion of Endometriotic Lesion growth by TCDD in Adult Female Rats and Mice." Their data confirmed the sensitivity of mice to the promotion of endometriotic lesion growth by dioxins.
In the "Genetics of Endometriosis" by Professor Stephen Kennedy published in the European Journal of Obstetrics & Gynecology/Reproductive Biology in February 1999, author noted that there was mounting evidence that Endometriosis is inherited as a complex trait, like diabetes or asthma. Professor Kennedy stated, "this implies there are environmental factors, such as dioxin, that are interacting with multiple genetic susceptibility loci to produce the phenotype."
Much is still unknown about environmental hazards like dioxin and the role they play in Endometriosis; however, incontrovertible evidence shows that independent as well as agency testing has confirmed presence of dioxin in feminine hygiene products. We further know that dioxin is linked to Endometriosis and a host of other serious illnesses. We, as female consumers and Endometriosis patients, need to demand the latest, most truthful and up to date research on this matter, so that we may make our own educated decisions regarding our products and personal care choices.
What can you do? Write your local government representatives and urge them to support State mandated independent testing to determine the true extent to which dioxin exists in our feminine hygiene products - and to determine what risks this poses to us and our children.
1. AB2820, Dennis Cardoza, 2000
2.HR2900, Carolyn Maloney, 1997
3.United States Food & Drug Administration
4.United States Environmental Protection Agency
5.Enviroweb 23 January 2000 report: www.enviroweb.org/issues/dioxin/index.html
6.Mari Edlin, CNN.com February 9, 2000
7.Amy Yannello, The Press Tribune (USPS No. 470-960)
8.Rev Med Brux 1998 Sep;19(4):A367-71
9.Semin Reprod Endocrinol 1997;15(3):301-8
10.Hum Reprod 1997 Feb;12(2):373-5
11.Fundam Appl Toxicol 1993 Nov;21(4):433-41
12.Am J Obstet Gynecol. 2000 Apr;182(4):767-775.
13.Toxicol Sci. 1999 Nov;52(1):45-9
14.Gynecol Obstet Invest 1999 Oct;48 Suppl S1:45-56
15.Eur J Obstet Gynecol Reprod Biol 1999 Feb;82(2):129-33/<
Heather Guidone is the Director of Operations of the
Endometriosis Research Center and a freelance writer with a special interest in women's reproductive health. Her work has appeared in consumer and clinical publications in the US and abroad.
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