Sanitary Products

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In this guide to period products:

• We give you the low-down on the different eco-friendlier reusable options out there as well as some advice from you, our very own reusable-using readers.
• We understand that reusables are not for everyone. We have found plenty of organic and pure cotton disposable options that are cutting out the plastic and avoiding harmful chemicals.
• We explore some of the wider issues such as the tampon tax, period poverty and the taboo around periods, looking at whether the brands on our table are doing anything to tackle these issues.

There has been a revolution taking place in the world of sanitary products.

This is thanks to both an increased awareness of the impacts our purchases have and the fact that it is becoming more acceptable to actually acknowledge the fact that many of us humans do actually bleed from our vaginas once a month.

More and more women are now turning away from the toxin-laced, plastic-filled pads and tampons that, after potentially contaminating our bodies, go on to do to just the same to the environment. To the conscientious menstruator, it’s now all about reusables.

Better for your pocket. Better for your person. Better for the planet. Better, period.

Table highlights

Cotton Sourcing

Many sanitary products are largely made out of cotton. A lot of the cotton farmed in the world is genetically modified, which allows farmers to grow in monocultures using a much higher concentration of pesticides and other chemical inputs.

Uzbekistan and Turkmenistan also produce a large proportion of the world’s cotton and systematically use forced labour to do so. (Update: In March 2022  it was announced that the long-running boycott of Uzbek cotton was being lifted. For the first time, in the 2021 cotton harvest, Uzbek Forum for Human Rights found no government-sponsored forced labour. This came five years after the Uzbek Government first entered into negotiations with campaigners to work towards ending the boycott.

The End Uyghur Forced Labour (EUFL) also says that there is evidence of the Chinese government using “forced labour as a means of social control” throughout the cotton-producing Uyghur region of Xinjiang.

We therefore expect companies selling cotton to have policies and procedures in place to ensure their cotton isn’t produced using GM, pesticides or forced labour.

If they did not, they were marked down in the Workers’ Rights (Uzbek and Xijiang cotton), Pollution & Toxics (pesticides), and Controversial Technologies (GM) categories. Here’s how the companies rate on their cotton sourcing:

Best: TOTM, Naty, THINX, Aisle, Natracare, Kind Organic, Imse Vimse, Kale and Bee

Middle: Hey Girls, Corman

Worst: Tesco, Wal-Mart/ ASDA, Sainsbury’s, Boots, Superdrug, Kimberly-Clark, Essity, Morrisons, Procter & Gamble, Lune Group, Brait/ Lil-Lets, Johnson & Johnson, ModiBodi

Not rated (does not use cotton): Mooncup, Organicup, DivaCup, The Keeper cup, Lily and Ziggy cup, Fair Squared cup

Animal Testing

As sanitary products are classified differently to cosmetics, our Animal Testing rating was applied slightly differently in this market.

Some companies sold toiletries such as shampoo and moisturiser and were therefore expected to have an animal testing policy with a fixed cut-off date, the same as other cosmetic companies.

However, companies that only sold sanitary products and were certified as vegan by the Vegan Society or were certified as cruelty-free by PETA were not marked down for not having a fixed cutoff date. Companies that sold disposable pads and tampons but had no animal testing policy received our worst rating.

Tax Avoidance

While we are paying our ‘tampon tax’, a number of companies on our list are likely to be avoiding paying their fair share of corporation tax.

Kimberly-Clark (Kotex), Johnson & Johnson (Carefree), Brait SE (LilLets), Procter & Gamble (Always and Tampax), CK Hutchinsons (Superdrug), Sainsbury’s, WBA Investments (Boots), Tesco and Morrisons all received our worst rating for likely use of tax avoidance strategies. Essity (Bodyform) received a middle rating.

The remaining companies all received our best rating.

Sustainable sanitary products

Ruth Walton from The Green Shopper website guides us through the eco-friendly options.

In France, you might hear talk of ‘Strawberry Season’. In Italy ‘The Marquis’ may visit, and in Denmark, there are ‘painters in the stairway’.

Around the world, it’s common to use euphemisms when referring to menstruation. The UK has dozens, from the astrologically inspired ‘Moontime’ through to the simple ‘Time of the Month’.

More formal euphemisms can be found in pharmacies. Feminine Care, Feminine Hygiene and Sanitary/Menstrual Products are common terms, but are all slightly indirect. Women need to be able to discuss period-related needs in plain language.

Being able to refer directly to sanitary products is key to feeling comfortable about the process.

So, without any more fannying about, here is a guide to ethical and sustainable sanitary products.

Washable sanitary pads

With proper care, cloth pads can last many years, saving a huge amount of money as well as reducing waste. With a wide choice of brands and materials available, here are some tips to consider:

What are they made from?

Washable pads are made from layers of fabric with an absorbent inner core and often have a waterproof membrane made from polyurethane laminated polyester (PUL).

The core and outer can be made from cotton, organic cotton, bamboo viscose, polyester microfibre, fleece, wool, organic wool. Some companies use fabric remnants to manufacture pads, helping reduce textile waste. Plastic or metal poppers are usually used to hold the pads in place.

How many will I need?

This really depends on your cycle length and flow, and how often you do the laundry! Most companies offer bundles or starter kits. It’s worth buying and trying out a single pad before investing in a whole kit, as there are so many sizes and styles available.

Period pants

These absorbent knickers are a recent innovation. Several companies now make leakproof period underwear, meaning no pads or tampons are necessary! Most brands recommend rinsing and machine washing at a low temperature without fabric conditioner. 

Useful Accessories for Washables

• It’s useful to have a waterproof bag to transport used pads home for washing while you’re out and about. ImseVimse make these.
• Keep a small lidded bucket in your bathroom to soak rinsed pads before they go in the laundry. 
• Adding a spoonful of bicarbonate of soda helps stop smells. If your washable sanitary items are made with synthetic fibres, use a Guppyfriend wash bag to stop microplastic pollution from your laundry entering the waterways.

Menstrual cups

A menstrual cup is a soft container which is worn internally and sits below the cervix collecting menstrual blood before it leaves the vagina. There are many designs and colours to choose from. Materials include medical-grade silicone, Thermoplastic Elastomer (TPE) and Fairtrade rubber.

Cups need to be sterilised monthly, but can then be emptied, rinsed or wiped and reinserted for the rest of your cycle. They are a relatively inexpensive option, as you only need one, and with proper care it will last many years.

Menstrual cups were probably invented around the same time as tampons in the 1930s, but the production, which started around the beginning of World War II, stalled due to shortages of rubber and sales never took off.

By the 1980s, according to the women who own the Keeper business, “Changing culture meant women had new power and ownership of their bodies."

In those days, ideas were spread by word of mouth rather than social media, and it was a cyclist hearing about the rubber cups at a Critical Mass demonstration in 1999, that led to the development of the silicone Mooncup.

Mooncup name 2015 as “the year the taboo was broken”, quoting the Daily Mail’s headline “Would YOU use a menstrual cup? One mother did and says they might not just be for hippies, after all ...”

Menstrual cups have shot from a product only available by mail order or from independent wholefood shops (and promoted by dedicated environmentalists secretly slapping stickers on the inside of the doors in public toilets) to being available on the shelves of Asda, Superdrug and Sainsbury’s.

On our table we have:

• The Keeper, made in the US from brown rubber or medical grade silicone since 1987.
• Mooncup, made in the UK from medical grade silicone since 2002.
• Lily cup and Ziggy cup, medical grade silicone from Sweden.
• Organicup, medical grade silicone from Denmark.
• Diva Cup, medical grade silicone from Canada.
• Hey Girls, a Scottish company whose medical grade silicone cups are made in China/EU.
• Fair Squared cup, a German company using fair trade rubber from Sri Lanka.
• TOTM and Kind Organic, TPE from the UK.
• Lunette, a Finnish company using medical grade silicone.

There are many other brands on the market, but some of them may be very cheap but not necessarily safe.

The great thing about menstrual cups is not only do they save you money, as they should last at least 10 years, they also save loads of waste.

Mooncup stated that by their 15th birthday, in 2017, their users had ensured that 1.7 billion fewer tampons and pads had ended up on beaches or in a landfill.

‘Natural’ disposables

It isn’t always possible to use washable sanitary products, but there are lots of great plastic-free disposable sanitary products. Look for pads and tampons made from unbleached organic cotton, with plastic-free packaging.

If you use applicator tampons, check that the tube is cardboard. Or better still, THINX makes a reusable tampon applicator and Waitrose also sells one, although made by Dame, a brand not rated in this guide

Other options

• Washable Tampons are completely plastic-free. They are a long piece of cloth with a string attached, that is rolled up and inserted into the vagina. They can be worn for up to six hours before changing and need boiling to sterilise.
• Labia Pads are small leaf-shaped pads, worn inside the labia. They can be used as a backup for menstrual cups or tampons, or for mild incontinence.
• Menstrual Sponges are a controversial option. They are worn internally and can offer up to three hours of protection. At the end of their lifespan, they are completely compostable. There has been some concern about their safety and it would be worth investigating further before trying this option.

Whatever option you choose to use, making the switch to natural sanitary products will be healthier for your body as well as the planet!

Reusables save money

Jeniya Marsh, from the 8th Day cooperative vegetarian health food shop and cafe in Manchester puts the financial case for the switch to reusables.

According to the charity Bloody Good Period, the average number of periods a woman will have in their lifetime is around 450.

The average number of tampons or towels used per period is around 22. So that means that the average woman will use around 9,900 tampons or towels over their lifetime.

According to a report by Channel 4 news, an estimate of the amount the average woman spends is around £10 per period or £4,500 over the lifetime of their period.

Switching to a menstrual cup or reusable pads and towels can dramatically cut these costs and the waste incurred. Whilst the initial outlay may seem daunting (Mooncup costs £22, ImseVimse’s 12 cloth pads starter kit is £55), based on these prices, a menstrual cup will typically start saving the user money after around three periods and a set of reusable towels after around six periods.

Cups can typically last between 3-10 years depending on the manufacturer, and pads typically last around 10 years, so that’s a lot of tampons and towels saved from the rubbish bin and a lot of cash saved.

How have you found the reusable experience?

We understand that, for many, switching to reusables might seem daunting. So, we went to our most trusted resource, our readers, to ask for their experiences using reusable sanitary products. We asked:

What advice would you give others thinking about trying reusables?

“Totally worth it! Start with pads and pantyliners if you’re nervous about using a cup. They’re easy enough to store in a wet-bag, and wash on a warm cycle with the rest of the laundry. If you’re puzzled about cups and worried about the expense, there’s a handy quiz on Putacupinit.com that can help you narrow down which option might suit you best.”

“Don’t give up too easily even if it doesn’t seem to work for you straight away. Persevere with it, try different sizes and products, and hopefully you’ll find what works for you!”

“Talk about it. Reusables are becoming very popular and there are high chances that a friend or a colleague of yours is already using them. So, you’ll be able to ask any questions and be assured that there is nothing to be scared about and reusables are indeed incredibly comfortable, convenient and very low-cost.”

What’s in disposable products?

Considering how frequently we use them and how close they get to us, it is surprisingly hard to access clear information about what goes into our sanitary products. The classification of sanitary products mean that companies do not have to list ingredients or components on the packaging.

Rayon

Many conventional tampons are made with rayon or a rayon and cotton blend and there have been a number of concerns raised over the years about the suitability of rayon for this use. Much of this was in relation to the bleaching process used, which meant that rayon often had high levels of an endocrine disrupter chemical called dioxin.

However, the bleaching process has now changed and levels of dioxin found in sanitary products are considered to be at a safe level.

The Women’s Environmental Network reported in March 2018 the following concerns regarding rayon-based tampons:

“The results of the testing detected carbon disulfide, a known reproductive toxin, in all four brands of tampons that contain rayon. Carbon disulfide is a chemical that is predominantly used in the manufacture of rayon; it was not detected in the all-cotton tampons that were tested.”

There is other anecdotal evidence that rayon may shed more fibres than cotton.

Fibres could remain in the vagina and become a source of irritation or infection. 

However, again it is difficult to find clear, independent and extensive studies on this (which perhaps says something in itself!).

Dangerous chemicals

Testing of tampons and menstrual pads have found pesticide residues, parabens and phthalates linked to hormone disruption, antibacterial chemicals like triclosan, and various carcinogens including styrene and chloroform.”

In 2014, US women’s health NGO Women’s Voices for the Earth commissioned a test to find out what was in Always pads and announced that they had found a number of concerning chemicals including: 
Styrene: carcinogen, Chloromethane: reproductive toxicant, Chloroethane: carcinogen, Chloroform: carcinogen, reproductive toxicant, neurotoxin, Acetone: irritant.

Following these kinds of studies, ‘Detox the Box’ campaigners began putting pressure of Procter & Gamble as well as Kimberly-Clark to properly disclose the ingredients in their sanitary products.

The campaign successfully led to the companies publishing ingredients lists online. Procter & Gamble have also just announced that it will be releasing a line of organic tampons and pads under brand names Tampax PURE and Always PURE.

These did not appear to be currently available in the UK so were not included in our table.

It is often argued that these products are perfectly safe because chemicals are found at levels below those considered to be dangerous.

However, The French Agency for Food, Environment and Occupational Health and Safety (ANSES) had called for greater regulation of chemicals in sanitary products.

It argued that, while chemicals found in tests may be present at a level deemed safe, there had not been enough research into whether people were also being exposed through other means and how this might increase risk.

All of the disposable brands in our recommended buys received our best rating for the use of toxic chemicals and are made with organic-certified cotton rather than rayon or other materials.

Other ingredients

Conventional pads may also contain superabsorbent gels, latex, heavy metal dyes, synthetic fragrances, chlorine-bleached pulp or cotton and wood pulp from unsustainable sources.

What's in our ‘Recommended’ disposable pads

Our ‘Recommended’ disposable pads generally don’t contain any of that stuff:

TOTM – Pads made with organic cotton, no fragrance, deodorants, wood pulp or chlorine bleach.

Kind Organic – organic cotton and free from artificial absorbents and perfumes.

Natracare – FSC-certified sustainable pulp with an organic cotton top layer, chlorine-free bleaching, no gels, perfume and dye free.

Plastic-free periods

Many widely available tampons come with a plastic applicator which leads to a large and highly unnecessary amount of single-use plastic. Three of the biggest brands in this guide are still making tampons with plastic applicators: Tampax Pearl, Boots, and Kotex. If they ditched plastic applicators it would have a massive impact.

However, even those companies not using plastic applicators are still using plastic wrappers and plastic in the string and inside the tampon.

Pads not only contain plastic as a leakproof layer, but they are invariably packaged in individual plastic wrappers inside a plastic outer wrapper.

Even our reusable brands are not necessarily plastic-free.

ImseVimse and Lunapads both use a thin layer of PUL and some menstrual cups are made of plastic (TPE). However, being reusable does mean that it is not single-use plastic.

Find out more about the campaign for plastic-free periods including signing a petition.

Plastic-free disposables

We had a closer look at what our recommended disposable brands were doing to be entirely plastic-free:

Make your own menstrual pads

Making your own menstrual pads is a simple way to reuse materials and save some money. There are lots of patterns, instructions and videos online.

Our favourite was a simple video from PCV Media, a YouTube channel from the Peace Corps Volunteers in Ghana:

The three-minute video shows you all the equipment you’ll need including upcycling old towelling, flannel and a piece of plastic. It uses hand-sewing rather than a sewing machine.

Don’t worry if you don’t have sewing skills – in the video they use the most basic running stitch.

Incontinence products for adults

A reader pointed out to us that our nappies and toilet paper guides did not cover incontinence products for adults.

Whilst it wasn’t right to put them in either of these guides we have checked out the brand leaders, Tena, Always and Boots, and some alternative brands from our nappies and menstrual products guide.

•     Natracare was a Recommended buy for menstrual products and scores 15.
•     Eco by Naty was a Recommended buy in the nappies guides and scored 10.
•     Ontex, the owner of Moltex nappies, make Lille Suprem and iD. The company scored 8.5
•     Tena is owned by Essity which appeared in our toilet paper guide as the owner of the Cushelle and Velvet brands. It scored 5.5.
•     Always is owned by Procter & Gamble which appears in the nappies guide as the owner of Pampers. It scored 2.5.
•     Boots is in our nappies guide, and it scored 0.5.

There may also be disposable pads in this menstrual products guide that might be suitable.

Reusable and washable incontinence briefs and pads

Just like for nappies and menstrual products, products that are reusable are better both environmentally and financially than disposables.

Tena do reusable incontinence briefs.

The reusable products listed in this menstrual products guide might be suitable such as Imse and Aisle (previously known as Lunapads), Nora, Modibodi, Hey Girls which all scored highly.

We also found a number of other reusable brands specifically marketed as incontinence products that you might want to try. But we haven’t rated these companies.

Here’s a few of them:

• Age UK briefs and pants
• Cheeky Wipes pads and pants
• Lady Days pads
• Jude’s pants