My Period Changed. What Now?

By Kylie Gilbert

As teens, “period management” came down to choosing between tampons or pads at CVS and trying not to worry about TSS. And as we age, most of us continue buying the same box month after month. But when perimenopause hits, sometimes your go-to period products don’t suffice anymore.  

The hormone rollercoaster of middle age can vastly influence your cycle. As New York-based gynecologist Alyssa Dweck, M.D. explains, women ages 35-45 are often “plagued with irregular flow, maybe erratic flow — where sometimes it’s super heavy with clots, sometimes it’s ‘flooding’, sometimes it’s just spotting. But what I hear all the time is it’s always a waiting game to [see] what it’s going to be like — and this goes on for years,” she says. 

Even if you defy generational stereotypes and are open to trying one of the new, environmentally-friendly options flooding the market, it might not actually work well. On top of that, layer fresh concerns over just about every period product. Negative headlines about Thinx underwear (the brand recently settled a $5 million lawsuit), join a stream of studies reporting dangerous chemicals in tampons and pads. 

Dr. Dweck says her patients will often opt for a hormonal IUD both for contraception and as a way to keep their periods “more tame and manageable” — or even go as far as requesting an endometrial ablation. (FYI, while pregnancy isn’t likely after the procedure, it can happen and significantly ups the risk of miscarriage and other problems, so ob-gyns recommend women who have endometrial ablation use birth control until after menopause.)

If you were using Thinx or the like, know that its lawsuit centered on false marketing (products were labeled as ‘organic, sustainable, and non-toxic’) not any known health issues experienced by customers, explains ob-gyn Lauren Streicher, M.D., Medical Director of the Northwestern Medicine Center for Sexual Medicine and Menopause and host of the podcast Dr. Streicher’s Insider Information. We don’t have research specifically connecting period underwear to negative health outcomes. But we do know that the chemicals found in their product, called PFAS (perfluoroalkyl and polyfluoroalkyl substances), are endocrine disruptors. As Dr. Dweck explains, these chemicals interfere with the body’s natural hormones and reproductive function, which is certainly not ideal. And they’re found in everything from your nonstick cookware to yoga pants.

“Practically every disposable product and reusable product contains unsafe things, and we put them right up against our genital skin. And that’s not okay,” says Kate Clancy, Ph.D., author of the forthcoming Period: The Real Story of Menstruation. She’s referring to a series of lab analyses commissioned by the consumer watchdog site Mamavation and Environmental Health News, which found that 48% of pads and 22% of tampons contain PFAS, including several labeled as “organic.” Perhaps, like you, she finds data like this off-putting.

“I’m a ‘zillennial’ and there is a part of me that’s like, are you kidding? I have to learn how to use a disc now? I’ve been literally menstruating for 30 years. I don’t want to figure out a new thing to insert,” she says.

Those who are worried about the environment or want to reduce their exposure to chemicals are often counseled to try a menstrual cup. But ob-gyns point out they’re generally more of a young person’s game. As Dr. Clancy explains, finding the size and shape that works for you can be especially difficult for women who have gone through vaginal childbirth, since some level of prolapse, which happens when the muscles and tissues that support your pelvic region are weakened, is common. 

If you have found an option that fits (and is made of more expensive, 100% medical-grade silicone, not rubber or thermoplastics), you don’t need to worry about errant claims that a menstrual cup will ‘suck out’ your cervix. “It’s not going to cause prolapse,” Dr. Streicher says. “That’s like saying don’t squat, don’t lift weights, don’t cough, don’t sneeze. There’s no science behind it and no reason I would ever tell a woman that she should avoid a menstrual cup for that reason.” The benefits compared to disposable products (less waste, fewer leaks, and longer wear time) are hard to argue with. Discs may be better suited to anyone with a weakened pelvic floor because they sit higher in the vaginal canal, according to one brand’s FAQ’s page. Saalt sells period underwear, cups and discs, and says the latter can be left in longer — even during sex — due to their unique positioning.

Dr. Clancy, who also writes a weekly newsletter on periods, actually airs out her tampons and pads before using them. “I lay a whole bunch of Always disposable pads out in my bathroom to let them release volatile organic compounds (VOCS).” This won’t help with phthalates, but doing something gives her some peace of mind. She also name-drops Dear Kates and Aisle as her current period-underwear go-tos, saying she’ll only buy from brands that disclose what’s in their products. 

The unsatisfying answer is that there is no perfect answer for what to do with our periods. “We have to ask: What can we afford? What do we need to manage our lives? And what are we comfortable with knowing and not knowing?” Dr. Clancy says. Put another way: What can you deal with on top of everything else in your life?

At the end of the day, while pads and tampons are considered medical devices, the FDA does not require manufacturers to disclose ingredients to consumers. That said, new companies like August, a subscription-based pad and tampon brand that just launched in Target stores, are out to change this. 

“A lot of people who have been menstruating for longer, like Gen X or older millennials, are often using the same brand that they were given when they got their period for the first time,” August co-founder Nadya Okamoto says. 

Dr. Dweck is hearing from her patients, though, and there’s one consensus. “‘I just don’t have time for this!’,” she says, adding, “This is a professional population — they just can’t have their day to day interrupted by their menstrual flow.”