A sustainable period, honestly assessed

A person who menstruates for forty years will bleed on somewhere between four and five hundred occasions. Whatever is used to absorb that is bought hundreds of times, worn against thin, highly permeable tissue, and then thrown away. Very few household decisions repeat that often. It is worth spending an hour thinking about it once.

This is a practical guide, written the way we write about any material: what the thing is made of, what the evidence says, what we would use, and where we are still unsure.

The short version

• Reusable cotton pads with wings are the most robust everyday option: natural fibre against skin, no plastic layer, five to ten years of use, and cheap per wear.
• Period underwear is the same idea built into the garment — more comfortable, less to fiddle with. We have not yet found a brand we are willing to name.
• Disposable cotton pads are the honest emergency option. They exist, but the choice is thin, and most of the shelf is plastic.
• Tampons are the one category we would not personally use, for reasons that are partly evidence and partly caution.
• Most conventional disposables are plastic products. That deserves the same scrutiny we gave disposable nappies.

What a conventional pad actually is

Open one up. A typical disposable pad is a layered composite: a polypropylene or polyethylene topsheet, a fluff-pulp core dosed with superabsorbent polymer (usually sodium polyacrylate), a polyethylene backsheet, and pressure-sensitive adhesive. Life-cycle work on menstrual products consistently finds that the plastic content is substantial — commonly cited figures put a single pad at roughly the plastic equivalent of several carrier bags, with the packaging and wrapper on top of that.

Two consequences follow, and they are different in kind.

The environmental one is not in dispute. These are single-use, mixed-material, non-recyclable items produced at a scale of billions per year. Nothing about the material stream can be separated after use. Comparative life-cycle assessments of menstrual products — including UK and EU studies — consistently place reusables (cloth pads, period underwear, cups) far below disposables on climate and resource impact, even after accounting for the washing, provided you wash at moderate temperatures and do not tumble dry every load.

The health one is more careful, and we will not overstate it. Testing programmes have detected volatile organic compounds, phthalates, and per- and polyfluoroalkyl substances (PFAS) in some disposable menstrual products, and a 2024 study reported measurable lead and other metals in a range of tampon brands. What is not established is a dose–response link between those detections and specific disease outcomes in users. Vulvar and vaginal tissue is more permeable than skin elsewhere, which is a legitimate reason to prefer fewer synthetic inputs — but "more permeable, so choose plainer materials" is a precaution, not a proven harm. Anyone who tells you otherwise is selling something.

This is exactly the shape of the disposable-nappy argument. A synthetic composite, worn continuously against sensitive tissue, replaced several times a day, for years — and a waste stream with no viable end-of-life. The uncertainty runs in one direction only: the plainer material has no plausible downside.

Reusable cotton pads: the practical baseline

This is what we would actually recommend to someone starting from scratch.

A reusable cloth pad is a shaped absorbent core — cotton, bamboo, hemp, or a blend — with a fabric top and a wing that snaps under the gusset. Better ones are undyed or plainly dyed cotton throughout. Many include a thin waterproof layer; if you want to avoid polyurethane laminate entirely, look for all-cotton or wool-backed designs and accept slightly lower leak security on heavy days.

What to look for

• Certified organic cotton, or at minimum a stated fibre content. "Eco" on the packet means nothing.
• Snaps rather than adhesive, and a wing wide enough to actually wrap.
• A range of lengths — light, regular, night. One size does not work.
• Flat, topstitched construction that dries fully. Thick quilted cores hold damp.
• No fragrance, no "freshness" treatment, no antimicrobial finish.

Living with them

Rinse cold first — cold, not hot; heat sets protein stains. Then a normal 40 °C wash with the rest of the laundry, no fabric softener (it coats fibres and kills absorbency), line dry. A wet bag in your handbag handles the day out. Twelve to sixteen pads covers a full cycle without emergency laundry. Expect three to five years of hard use, often longer.

Where to buy. Small independent makers on Etsy sell four-packs of winged cloth pads, frequently in organic cotton and often personalised in fabric and length — this listing is a fair example of the format and price. We have no arrangement with the seller and have not tested that particular shop; we link it because the type of product is right. Buying from any competent maker, a high-street reusables brand, or sewing your own is equally valid — the pattern is simple, and offcuts of old cotton bedsheets and towelling make good cores. What matters is the fibre and the fit, not the shopfront.

Period underwear: the same idea, better integrated

Absorbent gusset built into an ordinary pair of briefs. No pad to shift, nothing to snap, nothing to feel. For most people it is straightforwardly more comfortable than a pad, and it is the option we would expect to win on daily wear.

The caution is materials. Much of the category is polyester, elastane, and a laminate membrane — which is fine as engineering and against the whole point if you came here to reduce synthetics against permeable tissue. PFAS have been detected in some brands' gussets in past testing, and at least one large brand settled a class action on that basis. Several have since reformulated. The market moves faster than any article can.

So: we want a period-underwear recommendation, and we are still looking for one we would stand behind — natural fibre in the layer that touches skin, transparent testing, no fluorinated finishes, and made to last. If you wear a brand that meets that description, tell us and we will buy a pair and test it. Until then we would rather name nothing than name something we have not worn.

Disposables, for the days you need them

Travel, hospital, the first hour of a heavy day away from home. All-cotton disposable pads exist — organic cotton top and core, no superabsorbent polymer, and in the better ones a plant-based rather than polyethylene backsheet. They cost more, they are bulkier, and they absorb less per millimetre because there is no polymer gel doing the work.

The problem is availability. In most supermarkets the choice is one brand, in one size, if any. Keep a small box at home and a couple in a bag; treat them as the exception rather than the system.

Tampons and cups: where we are cautious

We have never used tampons, and the honest starting point is that this was intuition before it was evidence. Having looked, the intuition holds up better than we expected — though the picture is more mixed than the internet suggests.

• Toxic shock syndrome is real, rare, and dose-related: risk rises with absorbency and with leaving a tampon in longer than recommended. It is the reason absorbency labelling is regulated at all.
• The vaginal microbiome is a self-regulating system. An absorbent plug does not simply remove blood; it holds it, along with normal secretions, at body temperature for hours. Studies have found associations between tampon use and shifts in vaginal flora, though the direction and clinical significance are genuinely contested.
• Drying and micro-abrasion of the vaginal wall from high-absorbency tampons is documented, particularly when used on light flow days.
• Odour is largely a consequence of stagnation rather than of blood itself; fresh menstrual blood has very little smell.
• Materials. Rayon/viscose or cotton-rayon blends dominate, and the 2024 metals study covered tampons specifically. Again: detection is not the same as demonstrated harm.

Menstrual cups sit somewhere in between — medical-grade silicone, reusable for years, excellent on waste, and with a much better track record than tampons on infection, though also collecting rather than absorbing. Plenty of people find them the best answer available. It is not the one we reach for, and we would not argue with anyone who does.

What we would do

Cloth pads with wings as the daily system, in organic cotton, bought from a small maker or made at home. Period underwear once we find a brand worth naming. A handful of all-cotton disposables kept for emergencies. Nothing scented, nothing "antibacterial", nothing whose fibre content is not printed on the box.

None of this needs to happen at once. Buy four pads, use them on light days, and see. The cost of trying is about the price of two months of disposables.