Hormonal health
High PFAS levels found in period products
Toxic PFAS chemicals have been detected in some reusable menstrual underwear and pads, with one-third of tested items showing signs of intentional use.
Researchers analysed 59 products, including 43 pairs of period underwear, eight reusable pads, four menstrual cups, three reusable incontinence underwear and one reusable incontinence pad.
PFAS – short for per- and polyfluoroalkyl substances – are synthetic chemicals that do not break down in the environment and have been linked to cancer, obesity, high cholesterol, reduced fertility, hormone disruption and other serious health issues.
Some products contained neutral PFAS at levels measured in parts per million – significantly higher than the parts per trillion often considered safe.
Neutral PFAS, which carry no electrical charge, may be more easily absorbed through skin and mucous membranes such as vaginal tissue.
The study, led by the University of Notre Dame, found that 33 per cent of period underwear and 25 per cent of reusable pads contained PFAS at levels indicating they had likely been added deliberately, most likely for leak protection.
Professor Graham Peaslee, of Notre Dame’s departments of physics, chemistry and biochemistry, said: “What’s shocking is that we found 33 per cent of period underwear and 25 per cent of reusable pads had intentional PFAS use — meaning the chemicals had been put there, likely to keep the products from leaking.”
The researchers also observed inconsistent PFAS placement in the products.
Peaslee added: “It did seem to be random — sometimes they put PFAS in the inside layer of material, sometimes on the outside, sometimes between the layers, all of which suggests they have no idea what they’re doing.
“There’s no labelling, so consumers have no clue because there’s no way they can tell.”
Many of the materials were sourced from third-party suppliers overseas, where awareness of PFAS-related risks may be lower than among US-based manufacturers, the study noted.
The findings come as more people seek eco-friendly menstrual products, although there is limited research on how much PFAS may be absorbed through vaginal tissue over time.
Dr Kathrin Schilling, assistant professor of environmental science at Columbia University Irving Medical Center, said: “That is a huge gap in our understanding, especially given how many people rely on these products monthly for years.
“While these findings might seem niche at first glance, they point to a broader need for research, regulation, and transparency around the materials used in all menstrual products.”
The products tested came from manufacturers in the US, as well as from South America, Australia and Europe.
While the sample size was relatively small, the researchers said it provides a representative snapshot of the current market.
Simultaneous exposure to toxic chemicals and climate-related heat may be worsening fertility harms across humans and wildlife, research suggests.
The review of scientific literature looks at how endocrine-disrupting chemicals, often found in plastic, together with climate-related effects such as heat stress, are each linked to lower fertility and fecundity, meaning the ability to reproduce, across species including humans, wildlife and invertebrates.
Though the reproductive harms of each issue in isolation are well studied, there is little research on what happens when living organisms are exposed to both.
“Together, the two issues are likely to pose a greater threat to fertility, and the additive effect is “alarming”, said Susanne Brander, a study lead author and courtesy faculty at Oregon State University.
“You’re not just getting exposed to one, but two, stressors at the same time that both may affect your fertility, and in turn the overall impact is going to be a bit worse,” Brander said.
The paper looked at 177 studies.
Shanna Swan, a co-author on the new paper, co-produced a 2017 study that found sperm levels among men in western countries had fallen by more than 50 per cent over four decades. Other research has suggested human fertility has been declining at a similar rate.
The University of Washington’s Institute for Health Metrics and Evaluation has previously said the world was approaching a “low-fertility future”, with more than three quarters of countries below replacement rate by 2050.
The new paper’s authors focused on the effects of endocrine-disrupting chemicals and substances, including microplastics, bisphenol, phthalates and PFAS.
These are thought to cause a range of serious reproductive problems, disrupt hormones and be a potential driver of falling fertility.
Brander said the harms linked to these chemicals are often similar across organisms, from invertebrates to humans.
Phthalates, for example, have been linked to altered sperm shape in invertebrates, spermatogenesis in rodents, meaning sperm production, and reduced sperm counts in humans.
PFAS are also thought to affect sperm quality, and both have been linked to hormone disruption.
The chemicals are widespread in consumer goods, so people are often regularly exposed.
Meanwhile, previous research has shown how rising temperatures, lower oxygen levels and heat stress, among other effects linked to climate change, may also worsen infertility.
Heat stress has been found to affect human hormones, and is linked to spermatogenesis in rodents and bulls.
Research shows temperature also plays a role in sex determination in fish, reptiles and amphibians.
The species has evolved to choose which sex it produces in part based on temperature, and the heating planet can “push it too far in one direction or the other, which overrides that evolutionary benefit”, Brander said.
Similarly, many endocrine disruptors may alter environmental sex determination.
The study set out some of the overlapping effects of chemical exposure and climate change across taxonomic groups, from invertebrates to humans.
In birds, for example, exposure to increased temperature, PFAS, organochlorines and pyrethroids may each individually cause abnormal sperm, increased fledgling mortality, abnormal testes and population decline.
“What happens if they’re exposed to more than one of those stressors at the same time? There has been little exploration of that question.
“Even if there have not been a lot of studies looking at these simultaneously, if you have two different factors that both cause the same adverse effect, then there’s a likelihood that they are going to be additive,” Brander said.
Katie Pelch, a senior scientist with the Natural Resources Defense Council nonprofit, who was not part of the study, said the authors had reviewed high-quality science.
She said she wanted to see more examples of the overlap in impacts, but agreed with the overall premise.
“It is likely [multiple stressors] would have an additive effect, at very least, even if they have different mechanisms of harm,” Pelch added.
The solution to the systemic problems would involve tackling climate change and reducing the use of toxic chemicals.
The study cites the global reduction in the use of DDT and PCBs achieved under the Stockholm Convention as an example of an effective measure, but Brander said much more is needed.
“There is enough evidence in both areas to act to reduce our impact on the planet,” she said.
Weight loss jabs are being studied to see if they could help women with polycystic ovary syndrome (PCOS)
The condition, which affects up to one in ten women, changes how the ovaries work and is linked to infertility and weight gain.
Dr Shagaf Bakour has won a £60,000 NHS research grant through Sandwell and West Birmingham NHS Trust to look at whether drugs such as Mounjaro and Ozempic might help.
“The research could lead to earlier support, better long-term health, and more joined-up care for a condition that affects many women but is still often overlooked,” she said.
Women with PCOS have higher levels of male hormones and can suffer from irregular periods and symptoms such as excess body or facial hair, the NHS said.
Associated weight gain can also lead to an increased risk of diabetes and heart problems.
Bakour, a gynaecologist and director of medical education at Aston Medical School, will work with a team to evaluate the effect of the weight loss medicines on metabolic and reproductive outcomes.
The drugs mimic a hormone called GLP-1, which suppresses appetite.
Bakour, alongside Dr Hoda Harb, a consultant obstetrician and gynaecologist at the NHS trust, will review existing evidence on their use and assess how they help patients with PCOS.
“The aim is to give women with PCOS evidence-informed, clearer treatment options and more consistent care,” she said.
“The project hopes to show whether these medicines can improve both general health and fertility health, while also helping local services develop clearer care pathways.
Prof Elizabeth Hughes, director of research and development at the NHS trust, said the effects of PCOS, including infertility, were “very emotive subjects”.
“We should be doing all we can within research and development to advance healthcare for women and to better help future generations with this condition,” she added.
Health secretary Wes Streeting has relaunched England’s women’s health strategy, vowing to stop women being “gaslit” by doctors.
Speaking before publication of the renewed strategy, the health secretary said the NHS was “failing women” and set out measures to help them access the healthcare they need.
The government said the strategy would include a new standard of care to ensure women were offered pain relief for invasive procedures, such as fitting a contraceptive coil and hysteroscopies.
Feedback would be directly linked to provider funding through a new trial, giving women more power to affect change if they have a poor experience.
Action would also be taken to ensure women no longer face long waits for diagnoses for conditions such as endometriosis, which can take a decade to diagnose.
Streeting said: “[Women] have for so long been let down by a healthcare system that too often gaslights women, treating their pain as an inconvenience and their symptoms as an overreaction.
“Whether it’s being passed from one appointment to another for conditions like endometriosis and fibroids, or a lack of proper pain relief during invasive procedures, through to having to navigate symptoms for years before receiving a diagnosis, it’s clear the system is failing women.
“Women’s voices must be central to delivering effective, respectful and empathetic care. We need to hit medical misogyny where it hurts – the wallet.
“Today’s renewed strategy will tackle the issues women face every day and ensure no woman is left fighting to be heard.”
A report last month by the women and equalities committee found that gynaecological and menstrual health had not been “sufficiently prioritised” by the government.
MPs said parts of the 10-year women’s health strategy, launched in 2022 by the Conservatives, were at risk of being scaled back or discontinued under wider changes to the NHS.
These included initiatives that had reduced waiting lists and improved women’s access to healthcare, such as women’s health hubs.
Sarah Owen, chair of the committee and a Labour MP, said: “This would be a disaster for girls’ and women’s menstrual healthcare, when it is in dire need of more support.
“It is a national scandal that nearly half a million women are on hospital gynaecology waiting lists when there are effective treatments that could be administered in primary and community care, if only they could access them.”
The report said women faced “medical misogyny” and were left to “suck it up” and suffer in pain for years because of a lack of awareness of women’s health conditions.
A redesign of clinical pathways for some women’s health issues will aim to speed up diagnosis and treatment, and there will be a review of support for families who experience repeated baby loss.
The government also promised a “single referral point” to ensure women were directed to the right place the first time they sought help.
Dr Sue Mann, NHS England’s women’s health director, said too many women were dismissed for “serious symptoms” that affected every part of their lives.
“The renewed women’s health strategy will build significantly on the work the NHS has been doing to ensure women are heard and get the specialist care they need,” she said.
Women’s health groups cautiously welcomed the renewed strategy. Emma Cox, chief executive of Endometriosis UK, said decisive action would be vital to improve women’s healthcare in England.
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