“Titanium dioxide is the natural compound that is created when titanium reacts with oxygen in the air,” explains Natalist endocrinologist and reproductive health company consultant Aimee Eyvazzadeh, MD. “As an oxide, titanium is found in minerals in the earth’s crust and is also found with other elements, including calcium and iron.”
The US Food and Drug Administration (FDA) approved titanium dioxide for human consumption in 1966, cementing its presence in a variety of foods, including candy and other processed foods. It is primarily used to help white foods appear whiter (such as milk and candy) or to extend the shelf life of foods that are sensitive to ultraviolet light. (The FDA says manufacturers can have no more than 1 percent TiO2 in food.)
However, problems arose for the ingredient in 2021 when the European Food Safety Authority (EFSA) issued a statement that titanium dioxide “could no longer be considered safe” as a food additive. In its report, EFSA stated that it could not rule out the possibility that titanium dioxide causes DNA damage (“genotoxicity”) and therefore could not establish a safe level of daily intake. This finding prompted the European Union to ban TiO2 as a food additive earlier this year, but in the US, the ingredient is still considered safe in food within limits set by the FDA.
However, titanium dioxide is not just a popular ingredient in food. It also appears in sunscreens and cosmetics, two categories where the ingredient is also generally considered safe. It’s also often used to make things like paint, and most relevant for our purposes, it’s used to make sanitary pads and tampons look whiter.
It’s unclear exactly how many brands use TiO2 in their menstrual products. The FDA classifies tampons and sanitary napkins as medical devices and therefore manufacturers of these products are encouraged, but not required, to list their ingredients. (That’s slowly changing after New York passed a law requiring ingredient lists on menstrual products sold in the state.) That said, well-known brands like Tampax and L. do include TiO2 in their products, while brands like Rael, Cora, and The Honey Pot currently don’t have this ingredient in their pads or tampons.
So, the million dollar question: is it safe to have titanium dioxide in pads and tampons? Here, Dr. Eyvazzadeh and Erin Flynn, MPH, DNP/FNP, LGBTQ+ care expert at birth control startup Favor, share the complicated truth behind this question. Just keep in mind: If you have any specific health issues to weigh, it’s critical that you contact your gynecologist or primary care physician to make the right decision for you.
What are the possible adverse health effects of titanium dioxide?
One of the tricky things about titanium dioxide is that it can be consumed in so many ways, making it difficult to calculate risk. “The potential risks of titanium dioxide vary depending on the method of exposure,” says Dr. Eyvazzadeh. Inhaling titanium dioxide while painting a room or working on a construction site, for example, can irritate your eyes, nose, and throat. But there isn’t much research to tell us what the potential effects of TiO2 are in certain other formats, like if you ingest a little of it in food or regularly insert small amounts of it into your body through a tampon for a few days each. . month.
“There is no currently available published research that has examined the impacts of vaginal or vulvar exposure to titanium dioxide.” —Aimee Eyvazzadeh, MD
There it is some evidence to suggest that titanium dioxide may have a carcinogenic effect in some formats. “[TiO2] can cause cancer based on animal studies, and has been associated with lung cancer when inhaled,” says Dr. Eyvazzadeh, which is why the government sets exposure limits for workers. Other human studies, however, have not have found no link between lung cancer and titanium dioxide AND, honestly, there isn’t a ton of reliable data on the ingredient to help us draw any better conclusions, the authors of this 2011 review argue.
There’s also some evidence to suggest the common ingredient may be an endocrine disruptor, Flynn says, meaning it can affect a person’s hormonal system. “[P]Previous studies have shown that titanium dioxide can cause alterations in the reproductive system, including shrinkage of ovarian follicles and the formation of ovarian cysts,” he says. However, these studies were done on mice that consumed titanium dioxide via the oral, so extensive human clinical research is still needed before we can definitively link TiO2 to reproductive impairment, or assume those risks definitely stem from other intakes of the ingredient.
As for the potential risks (or lack thereof!) of using pads and tampons with titanium dioxide… we just don’t know for sure. “There is currently no published research that has examined the impacts of vaginal or vulvar exposure to titanium dioxide,” said Dr. Eyvazzadeh. “But while no study has positively linked titanium dioxide exposure to ovarian cancer, miscarriage or urinary tract infection, we also don’t have the science to make sure this type of exposure is perfectly safe.” This lack of data is incredibly frustrating, given that 26 percent of the world’s population is of reproductive age and presumably uses pads and tampons regularly to monitor their cycles.
What this means for titanium dioxide found in menstrual products and how to make a conscious purchasing decision the next time you stock up
Because there is so little conclusive research on the potential effects of titanium dioxide, you won’t find a clear and concise guide to buying tampons by studying. So what do you do instead?
Some experts say there’s no need to lose sleep over having titanium dioxide in tampons. “If you are concerned about this, then don’t use products that have this on them,” shared Jennifer Lincoln, MD, in a video. “But it’s the dose, it’s the pathway that produces the ‘poison’, so just because something can cause lung cancer, for example, doesn’t mean it’s going to cause a problem in a tampon.”
Dr. Eyvazzadeh and Flynn agree that it’s okay to approach the ingredient with caution. “If you’re uncomfortable with the potential risks associated with titanium dioxide, look for products that don’t list titanium dioxide on the ingredient list,” says Flynn. “While most cosmetic products will disclose whether or not titanium dioxide is an ingredient, some states require it, it is important to note that the FDA does not currently require brands to disclose this information.”
Fortunately, many new wave period care companies are extremely transparent about their ingredient lists. As a result, it’s not too difficult to buy TiO2-free buffers if you’re concerned and have the financial means to do so. It’s also worth being skeptical of any definitive claims that the titanium dioxide in tampons is super-harmful. As Dr. Eyvazzadeh points out, we just don’t know either way, no matter how confident Becky appears on TikTok.
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