Menstrual product use varies by demographic and health characteristics

Menstrual product use varies by demographic and health characteristics | Image Credit: © zakalinka - © zakalinka - stock.adobe.com.

A cross-sectional analysis published in the American Journal of Obstetrics & Gynecology found that menstrual product use in the United States varies significantly by sociodemographic, gynecological, and menstrual cycle characteristics.¹

Overall product use

The prospective digital cohort recruited participants through the Apple Research application beginning November 14, 2019. Eligible participants were aged 18 years or older, had menstruated at least once, and provided written informed consent.² Data for this analysis included 11,455 participants who completed surveys between November 2019 and January 2024.¹ Median age at enrollment was 33 years, with an interquartile range of 26 to 40 years. Ninety-seven percent of participants self-identified as women and 81% reported at least a college level education.

"Examining variations in menstrual product use across sociodemographic groups could deepen the understanding of usage differences, especially among historically marginalized groups," wrote investigators.

Across the cohort, the most frequently reported products were regular tampons in 48% of patients, sanitary pads in 47%, panty liners in 43%, super-absorbent tampons in 36%, period underwear in 20%, and menstrual cups in 18%. In addition, 18% of participants reported using a combination of tampons and pads non-simultaneously, 2% used other products, and 4% reported using no product. Among tampon users, 61% reported sleeping overnight with a tampon in place.

Sociodemographic differences

Product use differed across age groups. Compared with participants aged 30 to 39 years, younger participants aged 18 to 19 years reported more pad use and less cup use, at 57% and 12%, respectively, vs 35% and 21%, respectively in the older group. Participants aged 50 years or older reported lower use of regular tampons and cups, at 32% and 7%, respectively. In comparison, tampon use was reported in 50% of those aged 30 to 39 years.

Patterns also varied by race and ethnicity. Compared with non-Hispanic White participants who had regular tampon use of 50% and cup use of 19%, those who self-identified as non-Hispanic Asian, Hispanic, or non-Hispanic Black reported lower use of tampons, at 37%, 39%, and 31%, respectively. Cup use was lower among Asian and Hispanic participants at 15% each.

Socioeconomic status (SES) also influenced use. Compared with participants in the low SES group, those reporting high SES were less likely to use pads at 50% vs 42%, respectively, and more likely to use cups at 17% vs 21%, respectively, or period underwear at 19% vs 22%, respectively.

Gynecological and menstrual cycle differences

Participants with gynecological conditions demonstrated distinct usage patterns. Those with endometriosis reported higher use of super-absorbent tampons at 38% vs 33%. Participants with fibroids more frequently reported sleeping overnight with tampons at 69% vs 60%. Those with infertility reported higher use of pads, super-absorbent tampons, and period underwear compared to participants without infertility.

Menstrual cycle length and bleeding days were also associated with product choice. In participants reporting a cycle length of 26 to 31 days, cup use was 23%, but those with cycles under 21 days, at least 40 days, or that were irregular were less likely to use cups, with rates of 10%, 18%, and 15%, respectively. Use of pads, super-absorbent tampons, cups, and period underwear increased incrementally with longer bleeding durations.

Clinical and public health context

“Our findings contextualize menstrual product use in the United States, which could be useful for discussions among clinicians, policymakers, and patients regarding menstrual management," wrote investigators.

The study authors noted that differences in product use may reflect cultural norms, socioeconomic barriers, and health conditions influencing menstrual management. They also highlighted that these findings provide reference data for clinicians counseling patients on menstrual health, particularly among historically underrepresented groups.

In this large US cohort, tampons and pads remained the most commonly used products, while menstrual cups and period underwear were less frequently used. Usage varied significantly by age, race and ethnicity, SES, gynecological diagnoses, and menstrual cycle characteristics. The authors concluded that further research is needed on affordability, accessibility, and potential health implications of different menstrual products.

References

1. Wang Z, Peebles E, Baird DD, et al. Menstrual product use patterns in a large digital cohort in the United States: variations by sociodemographic, health, and menstrual characteristicz. Am J Obstet Gynecol. 2025;233:184.e1-15. doi:10.1016/j.ajog.2025.03.002
2. Mahalingaiah S, Fruh V, Rodriguez E, et al. Design and methods of the Apple Women's Health Study: a digital longitudinal cohort study. Am J Obstet Gynecol. 2022;226(4):545.e1-545.e29. doi:10.1016/j.ajog.2021.09.041