A few days ago, I overheard one woman telling another how effective cotton wool was during her period. She said, “I don’t use pads o, I use cotton wool…” When the other woman asked how she used it, she explained that she folded the cotton wool, inserted it inside her body, and once it was full, it would slip out on its own.
I remember feeling a knot in my stomach. Cotton wool sounds soft and harmless, but used this way, it can trap bacteria, shed fibers inside the body, cause irritation, and even lead to infections that may affect fertility or overall health. What she described wasn’t an alternative, it was a serious health risk waiting to happen.
Menstruation is universal, but safe, regulated products are not. Across many households and countries, people who menstruate manage their periods with improvised materials, old cloth, rags, tissue paper, cotton wool, paper, mattress foam, leaves, even ash, because commercial products are too costly, unavailable, or unreliable. UNICEF’s cross-country data highlight that in some settings people still use paper or nothing at all, underscoring how precarious “menstrual management” can be without access and oversight (UNICEF fact sheet) UNICEF.
This article explores what “unregulated” means in this context, the most common alternatives used in resource-constrained settings, the health risks (microbial, chemical, dermatologic), including those from cotton wool, and what governments, NGOs, and communities can do right now.
What does “unregulated” mean in the context of period products?
- Improvised or traditional absorbents: Items never designed for menstrual use, old cloth, rags, paper, tissue, leaves, ash, sand/soil, husk, and cotton wool. These are outside any product standard. UNESCO training materials and regional surveys document such substitutes being used when safe options aren’t accessible. Wikipedia, UNICEF
- Locally made/distributed pads without adequate quality control: Products that lack validated absorbency, microbial safety testing, or ingredient disclosure.
- Counterfeit or substandard branded goods: In markets with weak regulation, fake or substandard hygiene products circulate. Nigeria’s regulator (NAFDAC) regularly warns about falsified imports and emphasizes market surveillance, signaling vigilance is needed across all regulated categories, including hygiene goods.
What people actually use when safe options are out of reach
Large-scale and country-level studies show extensive use of old cloth/rags, paper/tissue, and even underwear alone, with more extreme cases involving ash, husk, soil, or mattress foam. Cotton wool is also common, seen as affordable and absorbent—but its fibers can shed internally, absorb fluid too quickly (causing dryness and micro-tears), and if not changed frequently, turn into a breeding ground for bacteria.
UNICEF’s WASH guidance and fact sheets document these materials and emphasize how access to water, privacy, and soap influences product choice as much as cost. UNICEF+1, washdata.org
The health risks: what they are
1) Microbial and infection risks from absorbents that stay damp or aren’t cleaned safely
- A study in Odisha, India, found that using reusable absorbent pads (typically cloth) was linked to higher odds of urogenital infections, bacterial vaginosis (BV) or urinary tract infections, compared to disposable pads (Adjusted OR 2.8; 95% CI 1.7–4.5). PMC
- A broader 2018 study associated reusable cloths with increased Candida infections and a smaller but notable connection to BV. PMC
- These findings underscore that poor washing/drying conditions drive the risk of reproductive tract infections.
Cotton wool-specific risks: It holds moisture deep inside the vagina, creating an ideal environment for bacterial growth. Fibers may break off internally, causing irritation or inflammation. Left unchanged, it poses similar infection risks to an over-worn tampon.
2) Skin and vulvar health: dermatitis, chafing, and sores
Rough or bunching fabrics, old rags or cotton wool that clumps when wet, can cause irritation, micro-abrasions, and even tiny sores in the vaginal wall, leaving the area vulnerable to infection. Wikipedia
3) Toxicants and chemicals in poorly overseen commercial products
Even commercial products can carry risk where ingredient disclosure is weak:
- PFAS (“forever chemicals”) have been detected in reusable pads and period underwear. Some products contained high levels (up to 77,000 ppm) suggesting intentional use. American Chemical Society
- Earlier, PFAS presence in menstrual products was flagged by researchers, raising concerns about long-term exposure. EWG
- Other studies show exposure to volatile organic compounds (VOCs), phthalates, dioxins, PAHs, and metals, some of which are carcinogenic or disrupt hormones. Wikipedia+1
4) System-level harms: missed school/work, psychosocial stress
Lack of safe feminine products contributes to school or work absenteeism, reduced performance, and mental stress, especially when people fear stains, odor, or leaks. World Bank
Practical harm-reduction if you must improvise
- Using cloth/reusable pads: Wash promptly with soap and clean water; boil when possible. Sun-dry in open air (UV helps disinfect). Store clean and dry; replace worn or rough fabric.
- Using cotton wool: Change very frequently (every few hours). Avoid deep insertion and never reuse. Always wash hands before and after.
- Avoid inherently unsafe absorbents like ash, soil, leaves, foam, or paper, these pose high contamination and irritation risks. Wikipedia
- Commercial products in weakly regulated markets: Choose only those with clear ingredients and regulatory marks. Beware overly cheap or heavily scented items, and change them regularly to reduce moisture buildup.
Policy and program actions that work
- Implement no- or low-tax policies on safe menstrual products and supply them in schools, prisons, and during emergencies.
- Establish strict ingredient and labeling regulations, banning harmful chemicals like PFAS and limiting VOC exposure.
- Invest in WASH infrastructure, private stalls, water access, soap, to allow hygienic reuse options. washdata.org, UNICEF
- Enhance market regulation and surveillance, including hotlines and recalls, similar to NAFDAC’s approach.
- Launch community education programs to promote safe reuse, drying cloth properly, handling cotton wool safely, and early product change.
The takeaway
Unregulated or improvised period products can do more than inconvenience, they can lead to infections, skin damage, chemical exposure, and interruptions in education or work. Cotton wool, though well-meaning, carries specific risks that are all too real for people with limited choices.
These conversations need to be brought up, because it’s about safety and dignity. Managing a period shouldn’t put health or future at risk.
Written By: Victory Wekulom
Victory Wekulom is a writer and communications personnel passionate about storytelling for social change. They currently serve as a Media and Communications Assistant at IGE-SRH and contribute to the community, where they use words to amplify gender justice, queer advocacy, and community voices. Their writing blends clarity, heart, and a deep commitment to centering underrepresented perspectives.
