The Ultimate Guide to Feminine Hygiene

In 2017, total sales for feminine hygiene products in the U.S. were $5.9 billion, according to Global Industry Analysts, as cited in USA Today. Worldwide, sales for the year were $20.62 billion. In 2020, those numbers are expected to reach $6.2 billion for domestic sales and $40 billion worldwide.

These statistics make it appear that women have ready access to tampons, sanitary pads, and other essential feminine hygiene products. But across the U.S., many women and girls struggle to acquire the hygiene products they need. The problem is particularly acute among women w

women gathered in circle

ho live in underserved communities.

Writing for Nonprofit Quarterly, Sheela Nimishakavi states that millions of women lack access to sanitary napkins and other essential hygiene products. “For those experiencing poverty, seven dollars per month [spent on hygiene products] per female in a household is far too expensive, especially when the family must consider how they will put food on the table each day.” Nimishakavi points out that the lack of access to these hygiene products often forces women to miss school or work, perpetuating their cycle of poverty.

Growing awareness of these access and affordability problems has increased support for removing sales taxes from tampons and other feminine hygiene products. However, feminine hygiene is more than just being able to comfortably purchase and use these products. Dr. Julitta Onabanjo, regional director for the United Nations Population Fund in East and Southern Africa, notes in a New York Times article by Karen Zraick that lack of access to hygiene products endangers the health and safety of young women in particular. To be able to afford hygiene products, young women take risks and make sacrifices that threaten their health. “We really want to ensure that going forward, this is seen as a sexual and reproductive health and rights issue,” Dr. Onabanjo says.

Additionally, there have been controversies surrounding the use of certain types of feminine hygiene products. Brands and consumers have debated whether organic or inorganic tampons are healthier for women. The definitions for an “organic” tampon can vary, but generally they are 100 percent cotton and have fewer chemicals than inorganic tampons. However, medical officials and researchers have noted that neither type of tampon is more or less beneficial to a women’s health than the other, nor is either type better at preventing toxic shock syndrome (TSS). The U.S. Food and Drug Administration defines TSS as a “a rare disease caused by a toxic substance that is produced by certain kinds of bacteria. The toxic substance can cause organ damage (including kidney, heart, and liver failure), shock, and even death.” Feminine hygiene is crucial to women of all ages and in every country. Trends in the use of feminine hygiene products, conflicts surrounding feminine hygiene, and resources for women to use in securing these necessities are examined in the following sections.

Feminine Hygiene Products and Usage

The term “feminine hygiene products” often refers specifically to items or goods that a woman uses during her menstrual cycle. These products include tampons, sanitary pads, menstrual cups, sea sponges, and others designed to manage the symptoms of a woman’s menstrual cycle. How frequently a woman uses these products can depend on her knowledge of the products, their accessibility, and their affordability.

For example, women who are not educated about certain products may experience negative outcomes/difficulties as an effect of their menstrual cycle. An example is a woman who doesn’t know that a certain product may be beneficial in addressing a particular condition related to the menstrual cycle (such as being better for heavy bleeding).

Menstrual Cycle Statistics

  • Menstruation is limited for the most part to humans and other primates, elephant shrews, and certain bat species. (British Broadcasting Corp.)

While researchers disagree on the reasons why females of certain species menstruate and others do not, a recent theory proposed by Deena Emera of Yale University states that menstruation is a byproduct of female’s use of the hormone progesterone to control how receptive the womb wall is to an embryo. For the embryo to attach to the womb wall, the wall must be thick and have a particular type of large cell. The process of preparing the womb wall for the embryo, called “spontaneous decidualization,” is triggered by the release of progesterone in the species that menstruate.

Emera’s research indicates that spontaneous decidualization is the result of “conflict between the mother and the fetus.” Two possible explanations are proposed for the evolution of the process. The first is that the fetus will attempt to burrow through the womb lining to tap into the mother’s bloodstream. This creates a conflict between the developing baby who craves nutrients and the mother who wants to conserve some of her nourishment for future babies.

The second possible explanation for spontaneous decidualization, according to Emera, is that the process came about as a way for mothers to expel embryos that have genetic abnormalities. Emera explains that a woman’s eggs may be several days old by the time they are fertilized, which increases the chances of an embryo being abnormal. Cells in the womb lining have the ability to identify an abnormal embryo and reject it as a way of saving the mother’s resources for the future arrival of a healthy embryo.

It is not uncommon for women to experience lighter or heavier bleeding than the average stated above. Menstrual flow varies from woman to woman and even from month to month. Some women experience heavier bleeding during , which is when the body begins the transition to menopause. Signs of heavy bleeding include having to change pads or tampons after one or two hours, the presence of clots in the flow that are larger than one inch in diameter, and bleeding that continues for longer than eight days.

For most women, their menstrual cycle is regular until they reach perimenopause. Perimenopause may last for several years, during which time periods will become less regular. Menopause, the end of menstrual cycles, is reached when a woman has gone 12 months in a row without a period. This generally occurs between ages 45 and 55.

  • In the U.S., the average age that a woman experiences menopause is 51. (Mayo Clinic)

Menopause is brought on by the decline of a woman’s reproductive hormones as she ages. Primary ovarian insufficiency is one cause of lower reproductive hormone levels. Menopause may also be due to a hysterectomy, chemotherapy and radiation therapy, or other factors.

Controversies regarding feminine hygiene

  • Only 32 percent of women in the U.S. stated they are comfortable talking to female classmates or colleagues about their periods. (Clue)

A survey of 90,000 women conducted by Clue, which sells an application for tracking periods and ovulation, found a similar percentage of women in other countries who feel comfortable talking to female classmates or colleagues about periods: 24 percent in Japan, 29 percent in Russia, and 34 percent in Canada. By contrast, 96 percent of women in the Philippines, 94 percent in Denmark, and 93 percent in Spain say they are comfortable discussing their periods with female friends and acquaintances.

However, the survey indicates that the percentage of Japanese women who are comfortable talking about their periods with their male classmates or colleagues was much higher at 88 percent. The survey also showed similar percentages of women in some other countries claiming they feel more comfortable talking to male classmates/colleagues about their periods than to female classmates/colleagues.

On average, a woman uses 350 packs of plastic sanitary pads in her lifetime. To address the negative environmental impact, organizations such as the Local Women’s Project have created sanitary kits that can be reused and that are both antibacterial and antifungal. Each kit includes two cotton sanitary pads, five fillings that can be washed for reuse, a bar of soap, and a reusable bag. The kits are designed to be more comfortable for women and girls than most commercial pads, which helps boost the women’s confidence.

The U.S. Food and Drug Administration (FDA) claims that the dioxin levels in tampons are safe for women, but the Campaign for Safe Cosmetics notes that “even trace levels are concerning because dioxins are cancer-causing agents [and] can disrupt the hormone system.” Similarly, some of the cotton that is used in tampons is treated with pesticides that have been linked to such health conditions as infertility and neurological dysfunction.

  • States across the U.S. have abolished or are working to remove the “tampon tax.” (National Public Radio)

Of the 45 states that apply sales tax, nine have exempted the sales tax on tampons: Connecticut, Florida, Illinois, Maryland, Massachusetts, Minnesota, New Jersey, New York, and Pennsylvania (Alaska, Delaware, Oregon, Montana, and New Hampshire do not levy a tax on any sales). In most states, however, tampons are subject to regular sales tax. In 2018, Nebraska, Virginia, and Arizona introduced “anti-tampon-tax legislation” that is currently pending, according to NPR.

Proponents of abolishing sales taxes levied on tampons and other feminine hygiene products argue that the taxes are unfair gender discrimination. While the movement has gained support among lawmakers and women across the country, it hasn’t always been successful in achieving its goals: a bill proposed for this purpose in Utah died in committee in 2018.

  • In rare cases, even organic tampons can cause toxic shock syndrome (TSS). (Chicago Tribune)

Symptoms of TSS—fever, fatigue, a rash, and low blood pressure—sometimes lead to coma and death, once the disease causes multiple organs to fail. In the 1970s, TSS was associated with highly absorbent tampons. While these tampons were pulled from the market, there are still rare incidents of TSS being caused by the use of 100 percent organic cotton brands.

Facts about feminine hygiene products

About 20 to 50 percent of women use douches, sprays, and other hygiene products in addition to tampons and pads. Usage rates for these products are “considerably higher among African-American, Latina, and low-income women,” according to Women’s Voices for Earth.

  • Women in the U.S. spend close to $2,000 on tampons through their lifetime. (Huffington Post)

The Huffington Post calculates that the 70 percent of women who use tampons go through about twenty per menstrual cycle. Women have an average of 456 periods in their life, which translates to 9,120 tampons used. At an average price of seven dollars for a box of 36 tampons, the total amount women spend on tampons is approximately $1,773.33. When the average lifetime cost of other feminine products such as heating pads, underwear, and birth control are factored in, the total cost of these products over a woman’s lifetime is $18,171.

  • The size of the women’s health market is expected to reach $51.3 billion by 2025. (Grand View Research)

According to Grand View Research, the projected 6.5 percent compound annual growth rate in the global feminine hygiene market from 2014 to 2025 is being driven by three things: growing awareness among women of the need for such products, the increase in disposable income in developing countries, and the development of products that are easy to use and that are less harmful to the environment.

  • Only 2 percent of women in China use tampons. (The Guardian)

In 2017, there were nearly 672 million females living in China, according to the World Bank, and nearly all Chinese women and girls rely on sanitary pads rather than tampons when they have their period. The Guardian’s Yuan Ren explains that the country’s culture is “much more accommodating” about topics relating to menstruation. “Chinese women will discuss periods from a practical standpoint: what helps with tiredness during menstruation, what to eat to replenish iron, and more intimate topics such as how often you should change your pad,” she writes. However, Yuan admits that Chinese women are not well-informed about the use of tampons.

The Period Poverty Crisis

Even when women are aware of the benefits and proper use of various feminine hygiene products, there remains a large number of women who either face obstacles to purchasing the products or simply can’t afford them.

Feminine hygiene support groups and organizations

  • Nearly two-thirds of the women living in St. Louis can’t always afford feminine hygiene (Reuters Health)

A survey conducted by researchers at St. Louis University found that women who lack the funds to buy feminine hygiene products use cloth, rags, toilet paper, and “sometimes even diapers or paper towels taken from public bathrooms,” according to Linda Carroll, writing for Reuters Health. The survey results indicate that 64 percent of the women polled couldn’t afford to purchase period products during the previous year, and 21 percent of them faced these difficulties on a regular basis. Nearly 50 percent of the women surveyed said they had to decide between food and period products due to financial difficulties.

  • More than 300,000 feminine hygiene products have been collected and donated to women struggling with homelessness as part of a “national period product drive.” (org)

The estimated 3.5 million homeless people in America include many women who lack access to feminine hygiene products. To support these women, there have been several drives promoted by organizations that solicit and then distribute the products to shelters. One such program is the Power to the Period campaign run by and sponsored by Kotex. Dozens of female hygiene support groups advocate for and raise awareness about these issues across the country and the world. They include organizations such as Days for Girls, which provides menstrual care and education to women in developing regions, and Period Equity, which fights for tax-exempt status on menstrual products and increased awareness about issues regarding these products. The organizations help women across the globe by dispelling myths and misconceptions surrounding period products and menstrual cycles.

How to Maintain Proper Feminine Hygiene

A woman’s menstrual health is tied inextricably to her overall health and well-being. These tips and resources provide women and girls with useful advice to ensure a healthy experience during their menstrual cycles.

Menstrual Health Tips for all ages

  • The benefits of cotton undies

Elizabeth Moore, writing for, suggests that during menstruation, women should clean their genital area with soap and water just as they would if they were not menstruating. Moore also notes that cotton underpants are preferred over their synthetic counterparts because cotton undies promote more airflow, which can inhibit “the growth of harmful bacteria and organisms.”

  • The connection between healthy eating and reduced menstrual symptoms

According to the Royal Women’s Hospital of Victoria, Australia, eating foods that are rich in omega-3 acids, such as low-fat dairy foods, legumes, eggs, and whole grains, can help women reduce many of the unwanted symptoms associated with their menstrual cycle. The hospital also recommends avoiding foods that are high in salt and caffeine. For example, caffeine has been associated with menstrual cramps. Additionally, the Royal Women’s Hospital notes that vitamins D and E, magnesium, calcium, and other vitamins and supplements may help reduce menstrual pain, regulate cycles, and address symptoms of premenstrual syndrome (PMS).

  • Menstruation and sexually transmitted diseases

Many aspects of a woman’s health are impacted directly by her menstrual cycle. ScienceDaily reports on research conducted by Oxford University that found a woman’s risk of having unwanted premenstrual symptoms may increase if she has an undiagnosed sexually transmitted disease (STD).

  • How to handle bacterial infections

Several of the bacteria types present in a woman’s vagina are harmless, but a condition that women sometimes experience during their period is bacterial vaginosis. The Western Australia Department of Health describes bacterial vaginosis as a condition that occurs “when there are too many of one kind of bacteria. . . . The main symptom is a grey discharge from the vagina with a fishy or musty smell. The smell can get stronger after sex or during your period.” The site notes that some women with the disease are asymptomatic. While the condition typically fades on its own, it has been reported to cause early labor in pregnant women. It can be treated by antibiotics or by applying a medicated cream. Women who suspect they may have this condition should contact their doctor.

Preparing for menopause

  • The symptoms that may accompany menopause

Menopause marks the end of a woman’s menstrual cycles. As stated above, menopause is reached when a woman goes 12 consecutive months without menstruating. As a woman approaches menopause, she may experience symptoms such as vaginal dryness, irregular periods, mood changes, weight gain, and hot flashes as well as chills. Irregular periods and other changes in menstruation become more common as women near menopause.

  • Mitigating health risks related to menopause

The Mayo Clinic suggests that women nearing menopause adopt a preventive health care regimen that includes regular doctor appointments, colonoscopies, mammograms, and other screening procedures. Because women who have experienced menopause are at higher risk of heart disease, osteoporosis, and other health conditions, doctors recommend that women maintain a balanced diet and exercise regularly.



Alina Health, “Is This Normal? Your Period in Your 20s, 30s, and 40s”

BBC, “Why Do Women Have Periods When Most Animals Don’t?”

Campaign for Safe Cosmetics, “Cumulative Exposure and Feminine Care Products”

Chicago Tribune, “While Rare, Toxic Shock Syndrome Can Be Caused by Organic Tampons Too” Clue,

“Talking About Periodsan International Investigation”

Days for Girls, Campaign Update

Food and Drug Administration, “The Facts on Tampons—and How to Use Them Safely”

Grand View Research, “Feminine Hygiene Products Market Size, Share & Trends Analysis Report”

Grand View Research, “Women’s Health Market Size Worth $51.3 Billion by 2025”

The Guardian, “Why Chinese Women Don’t Use Tampons”

Huffington Post, “Here’s How Much a Woman’s Period Will Cost Her over a Lifetime”, “How to Cleanse During Menstruation”

Local Women Project, Women’s Health and Hygiene Educational Program

Mayo Clinic, Menopause

Medical News Today, “Is It Safe to Have Sex During Menstruation?”

New York Times, “It’s Not Just the Tampon Tax: Why Periods Are Political”

Nonprofit Quarterly, “Nonprofits Need to Talk About Period Poverty—Period”

NPR, “More States Move to End ‘Tampon Tax’ That’s Seen as Discriminating Against Women”

Office on Women’s Health, “What Happens During the Typical 28-Day Menstrual Cycle?”

Reuters, “Even in the U.S., Poor Women Often Can’t Afford Tampons, Pads”

The Royal Women’s Hospital, “Exercise, Diet & Periods”

ScienceDaily, “Undiagnosed STIs Can Increase Negative PMS Symptoms”

USA Today, “Tampons Are Out Among Younger Women. Why Feminine Hygiene Is Newest Consumer Battlefield”

Western Australia Department of Health, Bacterial Vaginosis

Women’s Voices for the Earth, Period and Personal Care Products & Toxic Chemicals

World Bank, China Female Population Statistics