Leading reproductive health bodies have pushed back against a recent University of the Free State (UFS) study that found endocrine-disrupting chemicals (EDCs) in sanitary pads and pantyliners, saying the findings do not indicate any immediate health risk.
The peer-reviewed study, published in Science of the Total Environment last month, analysed 16 brands of sanitary pads and seven types of pantyliners purchased from popular retailers. The products included items marketed as “organic”, “plant-based” or “free from harmful chemicals”.
Researchers screened for three major classes of EDCs — phthalates, bisphenols and parabens — and found that every pad and pantyliner tested contained at least two of the target chemicals.
The authors said that while the substances were not intentionally added during production, they could migrate into products from plastics, adhesives, packaging or contaminated water used. Although the amounts detected in individual products might appear small, the study warns that the real concern lies in cumulative exposure over time.
Menstrual products are worn directly against permeable genital and mucosal tissue, which absorbs chemicals more readily than the skin on other parts of the body. Most users rely on pads and liners for several days every month over decades.
“EDCs, such as phthalates, bisphenols and parabens, are widely used in consumer products and have been associated with reproductive toxicity, hormonal imbalance and cancer,” the authors wrote.
“Menstrual products represent a potential but under-recognised source of exposure.”
Expert bodies provide perspective
The South African Society of Obstetricians and Gynaecologists, the South African Society of Reproductive Medicine and Gynaecological Endoscopy and the College of Obstetricians & Gynaecologists said the finding “requires context, perspective and correct interpretation of the data, with clear messaging on the broader implications for the public and for the country”.
EDCs were products that had the potential to interfere with the action of hormones, especially reproductive and thyroid hormones, when the quantities exceeded permissible concentration levels, they said in a statement.
Permissible levels were determined by expert panels such as the Cosmetic Ingredients Expert Panel, whose recommendations were implemented by regulatory bodies, among them the US Food and Drug Administration (FDA).
“These endocrine disruptors are very common and are present in low concentrations in various foodstuffs, household products, personal care and beauty products such as toothpaste, shampoo and conditioners, body lotions, lipsticks, clothing and electronics.
“Thus, the finding that they are also found in menstrual products is not surprising,” the organisations said.
They pointed to previous international research showing that sanitary pads contribute only a small fraction of total EDC exposure from personal care products.
For instance, a study conducted in China reported that 40% of EDC exposure came from food, another 40% from personal care products, 18% from indoor dust and only 6.8% from sanitary pads.
“Thus, if we extrapolate approximately this data to the study under discussion, it is clear that perspective is required in interpreting the data which should not be isolated to sanitary products, which appear to be a small contributor to the overall total EDC exposure,” the bodies said.
Importantly, the UFS study did not establish causation between the presence of endocrine disruptors in menstrual products and infertility, hormone dysfunction or cancer.
“If the data is critically analysed in context, one reaches the conclusion that, while it is important to note the existence of the endocrine disruptors in products used in our daily lives, there is no need to panic.
“The implication to the general public of harm has not been proved in this study. The daily doses have been found to be low and the cumulative health risk has not been studied. The evidence at present does not support a change of usual practice.”
The reproductive health bodies recommended that regulatory authorities conduct further testing and studies to determine the safety of these products, noting that the study itself did not recommend that any products be withdrawn from the market.
“We do not have evidence to recommend that patients stop using any menstrual health products and we do not recommend any change of usual practice,” they said.
UFS statement
Deon Visser, the head of the chemistry department at the UFS, referred the Mail & Guardian to the university’s statement issued on 27 February, which underscored that the research had attracted significant media attention.
The research comprised an in vitro laboratory detection study and did not involve testing on human subjects, the UFS said.
The results had highlighted the importance of the discussion generated by the study around consumer safety, product quality, regulatory oversight and research gaps.
It had also raised broader questions regarding the potential implications for public health in the country, the UFS said.
“The university affirms the scientific integrity and credibility of both the research process and its findings.
“The study was conducted in accordance with rigorous academic and ethical standards and established scientific protocols by researchers with recognised expertise in chemistry, microbiology and biochemistry.
“The research methodology, data analysis and conclusions were subjected to independent peer review in an international scientific journal, underscoring the reliability of the work.”
The UFS study confirmed that all tested pads and pantyliners contained at least three types of EDCs — phthalates, bisphenols and parabens.
“These substances are known for their potential to interact with the body’s hormonal systems,” the UFS said.
“The study raises concerns about cumulative exposure over time, particularly considering the prolonged and repeated use of menstrual products across a woman’s reproductive lifespan.”
However, the university said it did not claim that short-term use of menstrual products caused specific health conditions, nor was it designed to establish a direct causal relationship between detected chemicals and disease outcomes in women.
The research findings were intended to present peer-reviewed scientific data and identify areas for further investigation.
“Additionally, the research does not recommend that current products be withdrawn from the market.”
The UFS emphasised that the study did not make any findings of unlawful conduct, regulatory non-compliance, negligence or intentional wrongdoing by any manufacturer, supplier or distributor. Compliance with legislation and regulatory standards fell under the mandate of relevant authorities.
The research recognises that the findings may raise concern, particularly among women and girls who rely on these products daily.
“The purpose of the scientific research conducted at the university is not to create fear, anxiety and panic but to inform and empower consumers, policymakers and health professionals through robust data and scientific evidence.”
Manufacturer rejects findings
Sylko NSP, the manufacturer of Comfitex sanitary products, rejected the findings of the study, describing them as “vague” and unvalidated.
The company does not test for parabens, phthalates or bisphenols because “they do not form part of the raw materials in making of the sanitary products”, group secretary Vandana Maharaj said.
Sylko NSP’s products complied with South African National Standard SANS 1043:2021 edition 3.1 and ISO 9001:2015 certification, as well as applicable European and US safety standards, Maharaj added.
“These findings by UFS are vague and are not validated. Therefore one cannot rely on their findings. It seems as if they did this to cause a stir and public panic,” she said.
“None of our products are in contravention of sections 24 and 55 of the Consumer Protection Act. Our products have been on the market for over 40 years and there has never been any incident that is linked to any endocrine linked medical issues. Therefore, their findings are incorrect and misguided.”
Citing the FDA, she added: “At this time we do not have information showing that parabens as they are used in cosmetics have an effect on human health.”
South Africa does not set specific legal concentration limits for parabens, phthalates or bisphenols in sanitary pads, though biological and microbiological testing is required under SANS standards.
“It is important to note that no sanitary product manufacturer in South Africa adds any of these chemicals to their sanitary products, as these are not necessary for any enhancements in the product.
“The detection of such minute levels does not mean that a product is unsafe. Safety assessments are based on actual exposure during normal use and internationally recognised safety thresholds. Our products remain well within established
safety margins.”
The company said it would cooperate with the National Consumer Commission, which is investigating a complaint lodged by the Democratic Alliance.
“Sylko NSP (Pty) Ltd is committed to ensuring our products are held to the highest quality and safety standards. In pursuit of this, the Comfitex brand of products is subject to independent laboratory testing, by accredited laboratories, in line with the requisite testing mandated by SANS 1043:2021 edition 3.1.”
Maharaj said that due to the interest in the safety of sanitary pads, the company was embarking on obtaining detailed laboratory tests.
“However, there is no need to panic as the products are compliant with current mandated legislation.”
Together with sanitary pad and pantyliner manufacturers, specialists say there is no evidence of a health risk even though a UFS study has found they contain hormone-disrupting chemicals