After spending 25 hours on research, reading papers on materials, speaking with five experts on menstrual technology and tampon ingredients, and unwrapping and testing more than 60 individual tampons in assorted sizes across 10 brands with a whole lot of red-dyed liquid, we found that the U by Kotex Click grabbed liquid the fastest and leaked the least of all the tampons we tried, even when oversaturated. It’s more compact than the competition, with an applicator that extends when you’re ready to use it, and it’s easy to insert. If you’d rather go for an applicator-free tampon, we like the o.b. Pro Comfort best. This easy-to-insert cylindrical tampon absorbed liquid quickly in our tests, didn’t get red food coloring all over my floor, and costs less than the other applicator-free tampons out there.
We’ve learned a lot in our dozens of hours of testing tampons, but one big takeaway is that “sport” tampons are nothing special—and neither are organic tampons, if you’re buying them because they’re “natural” or hoping they’re healthier for you. We’ve also been able to debunk a few rumors: We can assure you that the string is unlikely to break, and tampons contain no chemicals that pose an immediate danger.
*At the time of publishing, the price was $12.
If you like applicator-free tampons or hate throwing out applicators and contributing to the garbage, the o.b. Pro Comfort line is your best bet. o.b. has a huge and loyal following, apparently for good reason: In our tests, the tampons remained sturdy, absorbed quickly, and didn’t leak when full.
If you’ve got your heart set on an organic tampon (and we’ll go over the reasons you might want to reconsider that), you can take your pick between the Seventh Generation and Veeda applicator-free tampon lines. Organic tampons are made out of 100 percent organic cotton, as opposed to a cotton/rayon blend, and sourced according to FDA guidelines. Both companies also make tampons with applicators, but we tested only their more environmentally friendly applicator-free versions. In all our tests they performed exactly the same—as far as we can tell, they may be the same tampons simply repackaged for different companies.
If you don’t like our other picks or you know that tampons that expand widthwise work better for your vagina shape, the Tampax Pearl is a good alternative. We found that this tampon leaked a bit when full, but the braided string effectively captured the leakage.
You probably already know whether you like tampons. If you do, we’ll tell you about the best choices in this guide. If you currently don’t use tampons for fear of toxic shock syndrome, you might want to reconsider them. If a reusable cup doesn’t work for you, and you find pads uncomfortable, try our tampon picks.
If you already have a tampon that you like, stick with it. Our tests didn’t show any notable winners or losers (except for the sea sponges), and since vaginas come in all sorts of shapes and sizes, if your tampon style is comfortable to wear and doesn’t leak, keep using it. In contrast, if you struggle with leakage or find your current tampons uncomfortable, read on for why we picked the ones we did.
If you’re springing for organic-cotton tampons because you’re worried about exposure to harmful ingredients, that isn’t necessary. As we’ll explain in our ingredients section, there’s no evidence that nonorganic tampons are any worse for you than organic ones.
For this guide, we talked to two representatives from tampon manufacturers: Anne Hochwalt, a researcher at Procter & Gamble; and Terry Balluck, a spokesperson for Kimberly-Clark. We also spoke to Deborah Kotz, a representative from the FDA; Sharra Vostral, a historian who wrote Under Wraps: A History of Menstrual Hygiene Technology; and Philip M. Tierno Jr., a professor and researcher at the NYU School of Medicine who was one of the first to raise concerns about the correlation between toxic shock syndrome and tampon use.
During our research, we read a lot of papers on the risk of toxic shock syndrome (and we have a long discussion about it below), as well as on the various materials found in tampons that people are concerned about. We also read a lot of documents from environmental groups—and threw most of them out because they lacked scientific merit. We trawled message boards, watched video reviews of tampons on YouTube, read Amazon user reviews, and asked our friends what their favorites were.
A tampon should be two things: comfortable and functional. It should be easy to insert and remove, it should cause no discomfort, it should absorb the amount of menstrual fluid its label says it will (more on that later), and it should keep that blood contained. Cost is also a factor, since tampons are disposable, and the average person who menstruates will go through a lot of them (people using tampons regularly will use from 8,000 to 15,000 tampons in their lifetime).
(A quick note: In this guide we use the term “blood” colloquially to refer to the stuff that the tampon is absorbing. In reality, tampons absorb menstrual fluid, which is made up of blood, vaginal secretions, cervical mucus, and tissue from the endometrium.)
Tampons are a “Class II medical device” subject to Food and Drug Administration regulations, particularly regarding how much blood they should be able to absorb according to their size. Those sizes—light, regular, super, super plus, and ultra—are all defined by specific absorbance according to FDA dictate. The absorbency levels are supposed to be standard across brands.
We’ll talk about a few different types of tampons in this guide, but we’ve divided them into two main groups: tampons with and without applicators.
Tampon applicators can be made out of plastic or cardboard, and come in a variety of designs. Some organic tampons use cardboard tubes, as do some generic drugstore brands, but the only cardboard-applicator tampon we tested was the one that seems to have full control of that market, the Tampax cardboard version.1 The rest are plastic.
Applicator-free or applicator-less tampons—those that you use your finger to insert—are easier to store, designed to produce less waste, and often more compact, but some people don’t like inserting a tampon with their finger. That comes down to personal preference, so we’ve chosen two top picks, one with an applicator and one without.
When shopping for tampons, you might have noticed that you don’t have many brands to choose from. To determine our testing field, we read a lot of reviews on Amazon and comments on forums, and we asked our friends which tampons they liked best. From that list, we tried to get at least a few different brands for both applicator and applicator-free tampons, as well as a mix of regular and organic versions. Ultimately we got samples of the heavy hitters—Kotex, Playtex, and Tampax—as well as the cult-favorite o.b. and the environmentally conscious Seventh Generation, Veeda, and Sea Pearls sea sponges, for 10 products in all.
Some manufacturers advertise a “sport” version of their tampons. In every test we conducted, the sport tampons were the same as their non-sport counterparts. Sport versions also tend to be a little more expensive. Save your money—buy the regular version.
We decided not to review scented tampons. It’s hard to say what’s in them, and people might find various scents irritating. If your period is accompanied by strong, unpleasant odors, you should consult a doctor to make sure nothing else is going on.
If you’re particularly concerned about environmental impact, you might be tempted to try “sea sponges” that you can wash and reuse multiple times. In our tests they leaked all over the place and proved to be awkward to insert. If you’re worried about environmental friendliness, you might try a reusable menstrual cup instead.
Overall we tested a total of about 65 individual tampons from 10 product lines at each absorbency they came in, from light to super plus. We trusted the absorbency rating on the package for each one; since the FDA regulates that, we didn’t test it explicitly.
First, we determined whether the tampons were easy and comfortable to insert. For applicator-free tampons, assessing this was pretty straightforward—they were all about the same. For applicator tampons, I scraped the tip of each applicator against my forearm to test for roughness, and none caused any problems.
We did test one cardboard-applicator tampon, which was rougher to the touch and a little harder to insert since the tip isn’t a smooth surface but rather the edge of the tampon itself squeezed out like a muffin top. Since cardboard-applicator tampons aren’t much cheaper than the plastic-applicator type, we suggest going with a plastic one. If you’re worried about plastic garbage from the applicators, go with an applicator-free tampon and cut that waste altogether.
Second, we looked at how the tampons absorbed blood. We found that tampons come in lots of shapes (bell-shaped, winged, tube-shaped), but ultimately shape didn’t play a substantial role in how quickly tampons absorbed liquid or how well they held it. Because every vagina, and every menstrual flow, is different, some people might find that certain tampon designs are more comfortable than others. According to some research, there are five basic vagina shapes, which means that for some people a bell shape will work best while for others a wing design will do best. We’ve noted the different shapes below.
We dipped each tampon in the amount of liquid it was rated to absorb (from 6 to 18 grams of blood depending on the size) to see how quickly it pulled in the “blood” (in our case, water with red food coloring). Some tampons were faster than others, but overall none of them were slow enough for their absorbency to be a dealbreaker. (It isn’t as if you have a fire hose in there.) Most of them ended up with extra dry space, but a few were totally filled with the amount of liquid they were rated to hold, and we eliminated those; everybody has left a tampon in a bit too long, and nobody wants a leak.
Third, we evaluated the tampons’ ability to keep the liquid in. We tested this by dipping them in a bit more liquid than they were rated to hold and hanging them on a string. Some tampons kept the liquid in tightly, with not a drop making its way down the string. Others dripped all over, with some strings quickly becoming wet and red. We eliminated those.
Fourth, we tested whether each tampon was easy to remove. One of the biggest fears people seem to have about tampons is the string breaking, and the tampon getting stuck in the vaginal canal. We figure this an old-fashioned worry, because we tested the string strength of each type of tampon while they were both wet and dry, and although we could pull the string off a few of them, doing so took way more force than you would ever need to get the tampon out of your body. So don’t worry about a string breaking—it’s highly unlikely.
In our experience, as soon as a drop of water hit the tampon, the material instantly sucked it right in (I said “Whoa!” out loud when I started the absorption test). Once the U Click was full, not a drop moved down the string after hours of the tampon’s being hung up, and it never dripped onto the floor even when we overfilled it. In contrast, the string on the Playtex Gentle Glide 360 quickly saturated, and the Tampax cardboard-applicator tampon ended up dripping onto the floor.
The U by Kotex Click’s applicator is a little different from some of the others in our test group. Rather than coming with the plunger extended, the U Click comes compacted, which makes it a little more discreet than other models. Before insertion, you have to pull the plunger out until it clicks, hence the name. (If you really care about economic use of purse space, go for an applicator-free tampon.) Once extended, the applicator was just as smooth and comfortable as the others we tried.
The U Click tampons are tube-shaped, so they expand in both length and width. This design didn’t seem to affect speed of absorption either way.
Sometimes the U by Kotex Click is a bit more expensive than its competitors—maybe 5 to 10 cents more per tampon—which is a drawback since you’ll be buying a lot of them. But it isn’t so much more expensive to be a burden.
One thing I found a bit annoying about the U Click is that the tampons sold in a multipack are not color-coded to their absorbency, which means that a tampon in a bright-green wrapper might be a regular or a super, for instance. Each tampon does have a little R or S on its outer wrapping, but I would prefer being able to look into my bag and simply choose by color. This is a minor irritation, though, and it isn’t unique to the U Click.
On top of that, this tampon almost looks like it’s made for teenagers (the colorful wrappers and swirly designs certainly made me a bit skeptical). But the care that Kotex puts into the packaging seems to extend to the actual tampon.
For some people, the fact that these are applicator-free tampons is itself a dealbreaker. But if you’ve never used an applicator-free tampon before, we suggest trying these. Using them takes a bit of practice, but in the end they’re less wasteful and more discreet to carry around, and in our tests they performed just as well as the U by Kotex Click.
If you don’t like the o.b. tampons, chances are good that you won’t like the other applicator-free tampons we tested, because they’re all the same shape—and you probably won’t like our applicator pick, the U by Kotex Click, which is also cylindrical. If o.b.’s shape doesn’t work for you, try the Tampax Pearl. It comes in an applicator, but it has a winged shape that might hug your inside curves better. If you’re experiencing leaking issues with o.b. and you’re not pushing your tampons too far, few other applicator-free tampons will work for you.
If you really want to spend extra (you’ll pay about double the price) on an organic-cotton tampon, go for applicator-free tampons from either Seventh Generation or Veeda. They’re exactly the same, as far as we can tell, so buy whichever one is cheaper. In our leak test, the Seventh Generation and Veeda tampons performed better than some of the non-organic applicator tampons, leaking less than both the Playtex Gentle Glide 360 and the Tampax cardboard-applicator tampon.
The Seventh Generation and Veeda tampons, however, shared one weird quality in our testing: When I pulled the string down from its compressed position at the base of the tampon, a bunch of fuzz from the tampon came with it, hanging down into the string area. The tampons are a bit softer than their competitors, but that softness comes with a price—some of them produced only a little fuzz, but others got pretty cotton-ball-like at the bottom and left behind some chunks of fiber on the string and on my hands.
The Tampax Pearl came close to the U Click in terms of quality. In our tests it leaked a bit, but the braided-string design helped it grab and hold more liquid than some of the other tampons on our list. It’s less compact than the U Click, since the applicator comes extended (Tampax also sells a subtype called Pearl Compak, which has an extendable applicator similar to that of the U Click). The Pearl has a winged design—one that I affectionately refer to as “the scorpion”—which will work better with some vagina shapes than others. If any of the cylindrical tampons aren’t doing the job for you, try this one out.
When it comes to their contents, tampons get a little controversial. Tampon manufacturers are not required to disclose exactly what is in their tampons, or in what quantities. About 10 bills, including one that is currently in a congressional committee, have proposed that the US Congress require tampon manufacturers to disclose the chemicals and processes they use in their sanitary products.
Every tampon we tested came with ingredients lists that said whether they were made of “rayon and/or cotton fiber” and “polyester or cotton string.” But these ingredients lists aren’t specific, and they don’t detail how much of any material a tampon is made of.
It’s hard to find anybody who works on tampons or tampon-related research who isn’t firmly in one of two very opposite camps. Organizations that back holistic and “natural” products tend to talk about tampons as if they were poison capsules, while researchers at tampon-manufacturing companies maintain that their products are safe. Anne Hochwalt, a researcher at Procter & Gamble, told us in an interview: “All tampon materials and finished products are assessed for safety using the broadly recognized risk-assessment principles established by the US National Academy of Sciences and World Health Organization.”
Here’s what we do know: Millions of people use tampons every month without any problems. We couldn’t find any papers showing that the materials or chemicals used to make today’s tampons pose a danger or produce side effects. Tampons do come with the risk of toxic shock syndrome, but that risk is low if you use tampons properly, and the materials that experts believe were responsible for a TSS spike in 1979–1980 are no longer in use.
Scientists still haven’t answered some questions about tampons—for example, we could find no studies that track people who use tampons over their whole lives, to see if continued use has any side effects. Some advocacy groups argue that tampon users should be particularly worried about compounds that might be absorbed through the vagina, since they go through the mucous membrane and directly into the bloodstream. Unfortunately, not a lot of scientific data exists on this matter, and scientists need to study it more thoroughly. But right now, we have no scientific evidence that using tampons properly will cause you harm.
And before you spend your money on organic tampons, keep in mind that a “100% organic” label addresses only how the cotton is grown and sourced (according to USDA standards, if you’re buying such tampons in the US). However, even organic cotton can be pretty harsh on the environment, and it still requires pesticides to grow.
Organic tampons are not necessarily processed any differently than tampons made from synthetic materials, and they are not necessarily any healthier for you. Just like the other companies, organic-tampon manufacturers don’t have to disclose their manufacturing processes; these companies have only to comply with the FDA regulations as they stand (see below).
Rayon: Many tampons are made from a mix of cotton and rayon. Manufacturers use rayon because it’s more absorbent than cotton and it’s not a crop, which means that they aren’t totally reliant on a plant that might have a bad year and suddenly become more expensive. Some people worry that synthetic fibers increase the risk of toxic shock syndrome because they were implicated in the TSS boom in the late 1970s, but tampon makers no longer use those particular fibers. According to the FDA, the presence of rayon in a tampon does not appear to increase the risk of TSS.
Dioxins: Tampons undergo bleaching during the manufacturing process. This step makes them white in color and also helps remove waxes, lignins, and anything else that might impede absorption. The FDA now requires tampons to be bleached using what’s called “elemental chlorine-free” processes. That means that the process uses no elemental chlorine gas but might include chlorine dioxide. Although chlorine dioxide is toxic in large doses, it’s safe for bleaching things like tampons and flour, and for disinfecting municipal drinking water.
People worry about bleaching with elemental chlorine because the process can produce dioxins and “dioxin-like compounds.” Dioxins are highly toxic in the right doses, and the World Health Organization calls dioxins environmental pollutants. But tampon makers no longer bleach their products with elemental chlorine. The FDA, meanwhile, asks tampon manufacturers to regularly monitor the level of dioxins in their products; the FDA also says that those levels are low enough that they’re not worth worrying about. Plus, dioxins are all around us in low levels: Meat, dairy, fish and shellfish all contain dioxins. In one paper that examined the level of dioxins in both tampons and diapers, the authors conclude that “the refined exposure analysis indicates that exposures to dioxins from tampons are approximately 13,000–240,000 times less than dietary exposures.” In other words, don’t worry about it.
Some of the tampons in our test group bear a “chlorine free” label, which means that the manufacturer doesn’t bleach those tampons at all. Such tampons perform just as well as others, and since the result of bleaching isn’t something you should worry about, a “chlorine free” designation shouldn’t be a factor in which tampon you pick.
And nothing we read raised health concerns about the materials in the applicators. You can choose between plastic and cardboard based on other parameters, without having to think about safety; your choice should come down to comfort and how you feel about the garbage you produce. Although Tampax claims that its cardboard applicators are biodegradable and flushable, many plumbers disagree. (The only things that should go down a toilet, they say, are the three P’s: pee, poop, and toilet paper.) Plastic applicators are likewise not recyclable; if you’re going to use a tampon, applicator-free designs are the most environmental option.
The vagina is full of natural bacteria. Most of the time, the bacteria live peacefully and don’t cause problems. But about 3 percent of people with vaginas have a natural population of a strain of Staphylococcus aureus, the type that results in TSS when it grows unchecked.
TSS can result from things other than tampons. But the materials used in certain tampons (such as polyester foam and cross-linked carboxymethylcellulose) made in the late 1970s and early 1980s provided a particularly suitable environment for the bacteria that can cause TSS, and most people know about TSS because of the spike in tampon-based cases around that time.
Between October 1979 and May 1980, the Center for Disease Control (as it was called at the time) recorded 55 cases of the previously rare TSS. Seven women died, and some who survived had to have limbs amputated to stop the infection from spreading. When the CDC dug further, it found that the vast majority of the cases were in women who were menstruating. Upon even deeper investigation, the CDC found that women who used a tampon called the RelyPr were far more likely to come down with TSS than women who used other brands. In September 1980, the manufacturer of RelyPr tampons removed them from the market.
Researchers who study Staphylococcus aureus think that the synthetic materials used in RelyPr, the aforementioned foam and cellulose, created perfect conditions for the bacteria to grow. (Those materials are no longer present in tampons.) And since RelyPr was one of a handful of “super-absorbent” tampons, designed to be left in for longer than your average tampon, it gave the bacteria plenty of time to multiply.
Since then, the CDC has been watching for cases of TSS. Between 1979 and 1996, it noted 5,296 recorded cases. Researchers who looked at the rate of TSS between 2000 and 2006 reported in 2011 that the rate of TSS remained low and relatively stable. The FDA now requires tampon manufacturers to put warnings about TSS on their boxes, reminding users not to leave tampons in for an extended period of time.
Over time, people who do have what’s called the “toxigenic strain” will develop antibodies to protect themselves from unchecked infections. Philip M. Tierno, a professor of microbiology and pathology at the NYU School of Medicine and one of the experts on TSS, told us in an interview that at the age of 15, a person who menstruates has about a 60 percent chance of having natural antibodies to protect them. That percentage goes up over the years: At 20, they have a 75 percent chance of being protected; at 30, they have a 90 percent chance of having those safety antibodies. It’s never a sure thing, but Tierno told us that younger people should be more careful with their tampon use than older people who might already be protected even if they have the rare toxigenic strain living in their vaginas.
Symptoms of TSS include a sudden fever, vomiting, diarrhea, muscle aches, a sunburn-like rash, headaches, and seizures. TSS is a real concern, and while the rates of TSS have dropped significantly since researchers first identified the correlation, cases do still occur. To reduce risk, never leave a tampon in for longer than eight hours; ideally you should change your tampon every four to six hours. If possible, opt for the lighter-absorbency tampons even if it means changing them more often. The less time bacteria has to grow on a tampon, the safer you are.
One study we found says that organic-cotton tampons decrease the risk of TSS dramatically, but the evidence to support that isn’t conclusive. So if you’re buying an organic-cotton variant purely out of fear of TSS or worries about other chemicals in tampons, save your money.
All the tampons we tested (except for the sea sponge, which we’ll get into below) worked fine when we filled them with the amount of liquid they were rated to hold. So if you’re overwhelmed by the tampon selection at the store, keep in mind that any of these will be fine for you as long as you don’t push your luck with how much you expect them to absorb. That said, you don’t always know how much fluid your uterus will release on any given day, so it’s better to have the insurance of a great tampon.
Tampax Pearl (applicator): I wound up nicknaming this tampon “the scorpion” because of the way it unfolds into a bilobed shape. It performed well in all our tests, but it will probably work better for certain people than others, depending on the shape of their vaginas.
Tampax Pearl Active (applicator): The applicator for the Active is slightly different from that of the regular Tampax Pearl in that its end is tapered to a finer point, but in every test we did of the tampon itself, the Active performed exactly the same as the regular Pearl. I suspect that they are the same tampon in slightly different tubes. You should buy whichever one is cheaper.
Playtex Gentle Glide 360 (applicator): These tampons expand into a bell shape, but in our tests they were leakier than the other tampons we tried, and the string quickly saturated with liquid.
Playtex Sport (applicator): As with the Tampax Pearl Active design, the Playtex Sport offering seems to be the same exact tampon as the non-Active version with a slightly different applicator. If you use Playtex, go for whichever one is cheaper.
Tampax with Anti-Slip Grip Cardboard Applicator: This model was the only cardboard-applicator tampon we tested, and it had the roughest tip for insertion of all the designs we tried, applicator or no applicator. This tampon was the only one to have a little skirt of thin material that hung down from the tampon itself, we guess to catch liquid. On our leak test, however, the skirt filled pretty quickly and dripped onto the ground. These cardboard tampons aren’t all that much cheaper than their plastic-applicator cousins, which generally performed better as well. Treat yourself to the better ones.
Seventh Generation Organic Cotton Tampons (applicator): Seventh Generation sells applicator tampons as well. The applicators are cardboard, and the tampon inside is actually a totally different tampon from the applicator-free version. The applicator-free tampon is a tube shape, whereas the applicator version unfolds into a winged shape. We didn’t test the applicator version of the Seventh Generation tampons. If you’re buying organic because you care about the environment, go for a tampon without the waste of an applicator.
Jade & Pearl Sea Pearls (applicator-free): This is the only tampon we tested that I would warn people away from. In 2014, Jade & Pearl received a warning from the FDA for not classifying these sponges as medical devices the way that tampons are supposed to be, which meant that the sponges weren’t subject to the same safety regulations as tampons. And one study from 1982 found that women using sea sponges had an increase in the amount of Staphylococcus aureus (the bacteria that causes TSS) during use, while women using pads and tampons did not. The supposed appeal of sea sponges is that they’re reusable for three to six months—“or more,” according to the Jade & Pearl website—but the FDA warning calls this claim into question.
In testing, we found that the sea sponge had no outer layer to trap liquid. Any amount of pressure sent red liquid all over the place, even when the sponge wasn’t even close to full. These sponges also don’t come with a string of any kind; some reviewers on Amazon describe difficulty getting them out, and others recommend sewing some dental floss to the bottom of the sponge. If you’re worried about waste, a menstrual cup may be a better option. If you’re worried about chemicals in tampons, we discuss above why that concern might be misguided.
In other words, avoid the sea sponge.
Pads, which have long been more popular than tampons, seem to be on track to continue being the more popular choice. But you can find new period products on the market too—things like underwear designed to handle your flow, and menstrual cups. Some people think that everyone will use menstrual cups eventually, but researchers who study behavior regarding menstruation aren’t so sure.
As far as tampons go, people have plenty of interesting ideas for how to make them better. Some have proposed making tampons out of highly absorbent “hydromash” made from jellyfish flesh. Several companies are staking their territory in the field of using the tampon as a medical device—something that can monitor a vagina and notify the person if something is wrong. Others are thinking about creating tampons that help modify the vagina’s pH balance. It’s a brave new world down there. While most of these products are independent from the tampon market, we hope to expand our coverage of these items in the future.
(Photos by Rose Eveleth.)
Originally published: March 30, 2016