Personal Care
Period &
Bladder Care
Pads, tampons, liners, cups, discs, period underwear, bladder-leak underwear and cloth pads — held against the most absorbent tissue the body has, for days at a time, for decades.
This is not a page about fear. It is a page about a question almost nobody thought to ask until recently, and about what changed at Shake before we felt able to write it.
A person who menstruates may use more than ten thousand of these products in a lifetime. That figure comes from a 2022 review in Current Environmental Health Reports, and what is remarkable about it is not the number. It is that the number sat there, uncontroversial, for years, without anyone treating it as a reason to look closely at what the products are made of.
The materials themselves are not exotic. Cotton, , polyethylene, polyester, silicone — the same cast of characters that turns up in a t-shirt or a takeaway container. What makes this category different is not the ingredient list. It is the address.
The vaginal wall is a mucous membrane. It has no keratinised outer layer to slow anything down, it is richly supplied with blood, and it is folded in a way that considerably increases its surface area. This is not a controversial claim or an activist framing — it is precisely why the route is used to deliver medication. And as the same review puts it plainly: chemicals absorbed by the vagina “bypass by the liver and directly enter systemic circulation.”
Swallow something and the liver gets first look at it. Absorb it here and it does not.
That is a fact about anatomy, not an accusation about any product on any shelf. But it is the reason this page exists — and the reason we rewrote part of our own scoring standard before writing a word of it.
The Materials
What these products are actually made of
Most of this information is not on the box. There is no federal requirement in the United States to list what is in a menstrual product, which is why individual states have had to legislate for it — New York became the first to mandate ingredient labelling on menstrual products, and California followed. Here is the honest inventory, product by product.
Scroll table sideways →
| Product | What it is typically made of | What that means |
|---|---|---|
| Disposable pads & liners | Wood-pulp fluff core, , polypropylene topsheet, polyethylene backsheet, adhesive strip, release paper | Friends of the Earth cites estimates of up to 90% plastic in a disposable pad, and describes a single pack as roughly equivalent to four plastic bags. |
| Tampons | Cotton, rayon/viscose or a blend; cotton or polyester string; optional cardboard or plastic applicator | The FDA states that cleared tampons are made of cotton, rayon or a blend, using a bleaching process free of elemental chlorine. Absorbency is standardised and printed on the box — the reason “use the lowest absorbency you need” is workable advice. |
| Menstrual cups & discs | Medical-grade silicone, thermoplastic elastomer, or latex rubber | “Medical grade” is a family of materials, not a single specification. A brand that names the actual grade is telling you more than one that does not. |
| Period & bladder-leak underwear | Face fabric (cotton, viscose or synthetic), a wicking layer, an absorbent core (frequently polyester ), and a waterproof membrane, usually | Four materials, four questions. Composition is very often published for the outer fabric only. Under Shake’s Fibre Integrity rule, the layer that does the work sets the ceiling — a cotton gusset does not lift a polyester core. |
| Reusable cloth pads | Cotton, hemp or viscose top layer, absorbent core, PUL or fleece backing, poppers | The same layer question. And “bamboo” here is two entirely different materials depending on how it was processed — see below. |
Compositions vary by brand and product line. This table describes what is typical, not what is universal — the point of the page is that you should be able to read the specific answer for the specific product, from the brand.
Awareness
What to be mindful of
Six things worth knowing. Some are well established, some are genuinely unresolved, and we have tried very hard to tell you which is which — including where the honest answer is that nobody knows yet.
Fragrance, in a product held against mucosa
On the Shake list, undisclosed fragrance sits at Tier 3 — not a toxicant in itself, but a labelling loophole. “Fragrance” or “parfum” can stand in for dozens of undeclared components, including and known allergens.
Nothing about the ingredient changes here. What changes is where it is worn, and for how long. Scented liners and deodorised pads are the everyday version of this question.
Source: shake-avoid-toxin-list, entry “Undisclosed fragrance”, Tier 3 · EU allergen labelling rules
Metals measured in tampons — and the caveat that matters
In 2024 a research team measured sixteen metals in thirty tampons across fourteen brands, and detected all sixteen. Lead appeared at a geometric mean of 120 ng/g, cadmium at 6.74 ng/g, arsenic at 2.56 ng/g. Lead was higher in non-organic tampons; arsenic was higher in organic ones.
Then the part that rarely survives the headline. The lead author: “We don’t yet know if those metals come out of the tampon and if they do, we don’t know whether they can get into the bloodstream.” The study measured what is in the material, using an acid digestion far harsher than any human body. The FDA has since opened its own review.
Worth knowing. Not yet worth a conclusion.
Source: Shearston JA et al., Tampons as a source of exposure to metal(loid)s, Environment International 2024;190:108849 · lead author and independent analytical chemists quoted in C&EN, July 2024 · FDA review reported by UC Berkeley School of Public Health
PFAS in reusable products — and the better half of the finding
Researchers at Notre Dame and Indiana University tested more than seventy reusable products, breaking them into 323 individual layer samples. Around a third of period underwear and a quarter of reusable pads were — treated on purpose with -based chemistry, not picked up by accident.
PFAS is Tier 1 on the Shake list — persistent, bioaccumulative, with the strongest evidence weight we assign. But the more useful finding is the inverse: most products tested had none. As the lead author put it, PFAS “must not be essential in the manufacture of reusable feminine hygiene products.” Which means a brand using them has made a choice, and a brand avoiding them can prove it.
Source: Wicks A et al., Environmental Science & Technology Letters, via University of Notre Dame, 2025 · shake-avoid-toxin-list, “PFAS”, Tier 1
The certificate that covers the cotton, not the applicator
Certifications are issued for something specific — usually a fabric at a mill, not a finished product at a brand. A company can hold an entirely genuine certificate while the component you are most curious about sits outside its scope.
There is a neat worked example in this category. Earlier versions of the GOTS standard permitted “plant-based plastic” applicators on certified organic tampons. According to Natracare founder Susie Hewson, who campaigned to close it, as little as 20% plant content qualified for that description — the rest being polyethylene. Version 6.0 now requires applicators to be plastic-free, biodegradable or compostable.
The label was accurate. The impression it left was not.
Source: Natracare / Susie Hewson on GOTS v6.0 (brand’s own account, attributed) · ShakeUp v1.3, Part 7.1, the scope trap
Plastic you were never told about, in something designed to be binned
Beyond what the body meets, there is what the bin meets. Friends of the Earth cites up to 200 kg of menstrual products discarded per person over a lifetime, and beach surveys averaging 4.8 pieces of menstrual waste per 100 metres of British coastline.
Nothing about this is a reason for guilt. It is a reason to know that a “cotton” pad may be mostly polymer, and that the choice between disposable and reusable is a material choice as much as a habit.
Source: Friends of the Earth UK, Plastic periods: menstrual products and plastic pollution
Absorbency claims with no shared standard behind them
Tampon absorbency in the US is standardised and printed on the packet, which is the only reason the guidance to use the lowest absorbency you need is actionable at all.
Reusables have no equivalent. When period or bladder-leak underwear says it holds “three tampons’ worth”, there is no common test method behind the comparison — each brand may measure differently, and until very recently the field tested absorbency with saline and water rather than blood, which behaves quite differently.
So we report what a brand claims, attributed to the brand, and we do not repeat it as a measurement.
Source: US FDA on tampon absorbency labelling · reporting on menstrual-product absorbency testing, Scientific American, 2023 · ShakeUp SOP v1.3, Part 6.2
Conscious Alternatives
What to look for instead
Six things you can actually check, none of which require trusting a marketing claim. Most of them are questions rather than products — which is deliberate, because the answer changes by brand and by year.
Composition, published layer by layer
Not “cotton and bamboo”. Which fibre, in which layer, at what percentage. A brand that publishes four layers is telling you it knows what is in all four.
Where composition is not published at all, Shake treats it as the lowest band on our Fibre Integrity scale — not as a punishment, but because a brand can lift its own ceiling any time simply by saying.
Standard: ShakeUp SOP v1.3, Part 4C
A certificate number, not a badge
Three things make a certification checkable: the number as issued, the institute that issued it, and which components it covers. Any one missing and it cannot be verified.
Worth knowing: since 1 January 2024, prohibits intentional PFAS in certified articles. A verified certificate covering every layer of a garment substantiates a PFAS-free claim more firmly than the brand’s own wording ever could.
Standard: ShakeUp SOP v1.3, Part 7.1 · OEKO-TEX restricted substances
No added fragrance
The shortest possible answer to the disclosure problem. If there is no scent, there is no undisclosed scent.
Where a product is scented, look for the components named individually. “Fragrance” as a single word is the loophole, not the ingredient.
Standard: shake-avoid-toxin-list, “Undisclosed fragrance”, Tier 3
The word that follows “bamboo”
Mechanically processed bamboo — crushed, retted, combed into fibre, sometimes sold as bamboo linen — and bamboo viscose are not the same material. The second is cellulose dissolved in strong chemicals and extruded. The plant origin survives; very little else does.
US FTC rules require the second to be labelled “rayon made from bamboo” or “viscose from bamboo”. A brand writing it correctly is a brand that understands its own supply chain.
Standard: ShakeUp SOP v1.3, Part 6.1 · US FTC textile labelling rules
A silicone grade with a name
“Medical grade” describes a category. The useful version names the specification, the manufacturer, and whether the finished cup — not just the raw material — was tested.
Cups and discs are among the few products here with a genuine peer-reviewed evidence base behind their safety and function, which is a point in their favour and worth saying plainly.
Source: van Eijk AM et al., systematic review and meta-analysis, The Lancet Public Health, 2019
A bleaching process stated on the record
The FDA’s position is that the absorbent fibres in cleared tampons are made “with a bleaching process that is free from elemental chlorine, which also prevents products from having dangerous levels of dioxin.”
So a brand stating “elemental chlorine free” or “unbleached” is confirming something already expected of it, in writing. That is not a marketing claim — it is a brand putting its process where you can see it.
Source: US FDA, The Facts on Tampons — and How to Use Them Safely
Behind the scoring
Every ShakeUp score multiplies the strength of the evidence by the route of exposure — how readily something reaches the bloodstream. Until this week, the highest figure on that scale was 1.3, shared by food, leave-on skincare and supplements.
There was no figure at all for the route through , or the vaginal route — the highest-absorption routes we score, and the ones this entire category rests on. Publishing the page first and fixing the model afterwards would have meant every score on it needed redoing.
So we set two: 1.7 for anything worn internally — tampons, cups, discs — and 1.5 for external intimate contact — pads, liners, period and bladder-leak underwear. We also added a third exposure-frequency band, cyclical, because a product worn for five consecutive days every month for forty years is neither “daily” nor “occasional”, and pretending otherwise would have quietly understated the whole category.
The reasoning, the sources and the arithmetic are all written down, including the number we decided not to use and why.
How we scoreFeatured Brand
EverLeakProof
This space held three questions. We said that if the answers came we would say so, and that if they did not, that would be on the page too. They have not come, so here is the score and here is why it looks like this.
Why we featured it
Not because it scored best. It did not. We featured it because it shows something about period products that most of us are never told: they are layered. A soft cotton surface can sit over a polyester core and a plastic film, and the label often speaks for only one of those layers. So we would like you to ask more of everything that touches your body, and to ask it layer by layer.
Period underwear is also a newer arrival in our shops, a product of recent years, which means fewer people have asked it hard questions yet. It carries a real environmental argument too: a washable pair means fewer disposables in the bin and nothing to flush. We think that is worth backing, and worth questioning, which is why it is held to the same ruler as every pad and tampon on this page.
43.50%
Reconsider
People55 · ceiling
Animals47
Gaia22
Frequency50 · ceiling
Each pillar starts at 100. Evidenced concerns deduct, verified virtues add back, and some things set a ceiling instead. The overall is the average of the four. Scored under SOP v1.9, including the two conventional-cotton rows. Previously 51.00%, and 66.75% before that.
What the number is made of
What carried it. A washable garment that replaces disposable pads and liners, which we credit directly on the planet pillar. Nothing in the construction is currently evidenced against the person wearing it.
What holds it down. The absorbent core is polyester and polyamide, and the leak barrier is a thin waterproof film bonded to fabric. Those two layers do the actual work of the garment, and synthetic load-bearing layers set a ceiling on the Frequency pillar whatever else is true. That is not a criticism of the making. It is what the material is.
What moved it first. We changed one rule. Where a brand does not tell us what something is, we now score it as the worst version that kind of product has been shown to be, at the same weight as if the brand had told us. Two answers are still missing here, so two things now count. A freshness claim on bamboo viscose needs something applied to the fabric, and an unnamed antimicrobial finish is scored for what such finishes release in the wash. And PFAS is documented in this category: a 2025 study of reusable period products found close to a third of the period underwear tested showed signs of deliberate PFAS treatment. We are not saying it is in this pair. We are saying we cannot rule it out, and we score only what we can check.
Sources: Wicks et al., Environmental Science & Technology Letters, 2025 · Reed et al., Environmental Science & Technology, 2016 · ShakeUp SOP v1.6, Parts 3, 5.1b and 6.1.
What moved it next. The gusset, the layer that sits against you, is 95% cotton, and we could not find anything showing that cotton is organic. Cotton that cannot be shown to be organic carries two rows on Shake: the pesticides used to grow it, and the irrigation water it draws. That takes 10 from Animals and 20 from Gaia. It is a finding about the farm, not about anything left in the fabric. Name the odour-control mechanism and show a PFAS test from a named laboratory, and the score returns to 59.25%; add a certificate number for the gusset cotton, and it returns to 66.75%.
Sources: Shake repository, conventional cotton pesticide use in growing and conventional cotton irrigation water use (both Tier 2) · International Cotton Advisory Committee, Cotton Data Book, 2018-2022 · Textile Exchange, Life Cycle Assessment of Organic Cotton Fiber, 2014.
And the People pillar is capped at 55 rather than scored in full. Not because we found something in the product. Because we asked three questions and the answers have not arrived.
- The certificate number, the issuing institute, and which of the four layers it covers. We check every certificate by its number rather than its name.
- How odour control is achieved, if any finish is used. The outer is bamboo viscose, and the antibacterial property raw bamboo has does not survive that manufacturing process — so any odour performance in the finished garment comes from something applied afterwards.
- Third-party testing behind the PFAS-free claim. A brand’s own assurance is not the same thing as a lab result, and we hold every brand on Shake to that line.
We put these questions to EverLeakProof and the answers have not reached us. That is what the cap records: not a finding against the product, but the distance between what we could check and what we were asked to take on trust.
This costs nothing to change. A certificate number we can look up, a named laboratory report, a stated mechanism — each one removes something we currently have to assume, and the page changes the same week. It is not tied to the commercial arrangement, and it does not expire.
Shake is an EverLeakProof affiliate through Awin and earns a commission if you buy through the link on this card. That arrangement began before this score was calculated, and it had no part in the number. The score was reached under the same rules and the same materials repository as every other brand on Shake, and it has gone down since the arrangement began. Because the brand pays us through this link, the working is written out in full above, so you can check the number without taking our word for it.
The photograph is EverLeakProof’s own, supplied through Awin. Brand imagery appears on Shake only where a relationship exists, and this one does. The words beside it are ours, as they are everywhere on this site — we publish product photography, never advertising, and no claim printed on a supplied image is repeated as ours.
The Shelf, Scored
What sells, and what we would pick
We love the freedom a tampon gives. What we want is the choice, and enough information to make it. So we scored what shoppers actually buy, and what we would reach for instead, against the same four pillars, using only what each brand publishes.
Read the People score first (open Read more on any row), because it says the same thing every time. Every product in these tables is capped at 55 on People, and not one of them is capped for something found inside it. They are capped because no brand on this list publishes a contaminant test from a named laboratory. Thirty tampon products were tested for sixteen metals in 2024 and all sixteen turned up somewhere. Whether any of it crosses the lining of the vagina has never been measured. Nobody has measured how much crosses that lining. Until someone does, you deserve to know what is in them — and to choose.
Scroll table sideways →
Shake Picks
The best-scoring product of each kind on this page. Every product that scores Worth a Pause or better carries the Shake Pick badge in the list below, so you can see them in context, beside what most people buy.
Cup or disc
Saalt Menstrual Disc
83.75%Aligned
Reusable, 100% medical-grade silicone. Tied with every named-silicone cup; this one sells most.
See where to buyTampon
Organyc Tampons
77.50%Aligned
Organic cotton claimed throughout, cardboard applicator, no plastic.
See where to buyPad
Natracare Ultra Pads
73.75%Worth a Pause
Organic cotton cover over plant cellulose; the best-scoring pad we have read.
See where to buyAlready using something? Check it in ShakeUP and see which Shake Picks score higher.
Score what you useThe most sold
The period products Amazon USA shoppers buy most, grouped by type and ordered by Amazon sales rank within each group, not by our score. A product sold in many pack sizes appears once, at its best rank. Scored products that are not in the Amazon lists we read sit at the end of their group. We left out the washes, wipes and supplements that share those lists. The Shake Pick badge marks every product that scores Worth a Pause or better.
| Product | Shake score | Band | |
|---|---|---|---|
| Pads and liners | |||
Rael Organic Cotton Cover PadsAmazon USA #1 · organic cotton cover only; pulp core; polymersRead morePeople55Animals67Gaia40Frequency55 | 54.25% | Reconsider | See where to buy |
Carefree Light Panty Liners, Extra LongAmazon USA #2 · composition not published; odour claim, no named mechanismRead morePeople55Animals65.5Gaia40Frequency55 | 53.88% | Reconsider | See where to buy |
Always Thin No Feel Panty LinersAmazon USA #3 · cellulose, polypropylene, polyethylene, polyesterRead morePeople55Animals77Gaia40Frequency55 | 56.75% | Reconsider | See where to buy |
Amazon Basics Daily PantilinerAmazon USA #4 · cellulose, polyethylene, polypropylene, absorbent polymerRead morePeople55Animals77Gaia40Frequency55 | 56.75% | Reconsider | See where to buy |
Honey Pot Cooling Herbal PadsAmazon USA #5 · organic cotton top sheet claimed, no certificate number; pulp core; polymersRead morePeople55Animals67Gaia40Frequency55 | 54.25% | Reconsider | See where to buy |
Rael Daily Panty LinersAmazon USA #6 · organic cotton cover claimed; rest of composition not publishedRead morePeople55Animals55.5Gaia40Frequency55 | 51.38% | Reconsider | See where to buy |
Amazon Basics Ultra Thin PadsAmazon USA #7 · cellulose, polyethylene, polypropylene, absorbent polymerRead morePeople55Animals77Gaia40Frequency55 | 56.75% | Reconsider | See where to buy |
Always Ultra Thin, Size 1, unscentedAmazon USA #8 · cellulose, polyester, polyethylene, polypropylene, absorbent polymerRead morePeople55Animals65.5Gaia40Frequency55 | 53.88% | Reconsider | See where to buy |
Always Maxi Overnight, Size 5Amazon USA #9 · cellulose, polyethylene, polyester, polypropyleneRead morePeople55Animals77Gaia40Frequency55 | 56.75% | Reconsider | See where to buy |
Always Anti-Bunch Panty Liners, Extra LongAmazon USA #11 · cellulose, polyethylene, polyester; OdorLOCK claim, no named mechanismRead morePeople55Animals65.5Gaia40Frequency55 | 53.88% | Reconsider | See where to buy |
Stayfree Maxi Super Pads, winglessAmazon USA #18 in Sanitary Napkins · no composition published; odour claim, no named mechanismRead morePeople55Animals65.5Gaia40Frequency55 | 53.88% | Reconsider | See where to buy |
U by Kotex Clean & Secure Ultra ThinNot in the Amazon lists we read · plastic top sheet and backing, absorbent polymerRead morePeople55Animals77Gaia40Frequency55 | 56.75% | Reconsider | See where to buy |
Stayfree Ultra Thin OvernightNot in the Amazon lists we read · no composition published; odour claim, no named mechanismRead morePeople55Animals65.5Gaia40Frequency55 | 53.88% | Reconsider | See where to buy |
Natracare Ultra Pads with WingsNot in the Amazon lists we read · Organic cotton cover, plant cellulose; brand states plastic freeRead morePeople55Animals90Gaia65Frequency85 | 73.75% | Shake PickWorth a Pause | See where to buy |
| Cups and discs | |||
Flex Menstrual DiscsAmazon USA #1 · single-use disc · unnamed medical-grade polymer blend, mineral oil, carbon blackRead morePeople55Animals88.5Gaia40Frequency55 Single-use polymer: 11.5 off Animals for single-use litter, Gaia held at 40, Frequency 55 because the polymer is not named. A plant-based or medical-grade label does not change a single-use disc. | 59.63% | Reconsider | See where to buy |
Saalt Menstrual DiscAmazon USA #2 · reusable disc · 100% medical-grade siliconeRead morePeople55Animals100Gaia90Frequency90 Why not higher: People stays at 55 because no contaminant test is published for the material. | 83.75% | Shake PickAligned | See where to buy |
Softdisc Menstrual DiscsAmazon USA #3 · single-use disc · medical-grade polymers, mineral oil, antioxidants, pigmentsRead morePeople55Animals88.5Gaia40Frequency55 Single-use polymer: 11.5 off Animals for single-use litter, Gaia held at 40, Frequency 55 because the polymer is not named. A plant-based or medical-grade label does not change a single-use disc. | 59.63% | Reconsider | See where to buy |
Flex Plant Plus DiscAmazon USA #4 · single-use disc · 40% plant-based polymers claimed, rest polymer, mineral oilRead morePeople55Animals88.5Gaia40Frequency55 Single-use polymer: 11.5 off Animals for single-use litter, Gaia held at 40, Frequency 55 because the polymer is not named. A plant-based or medical-grade label does not change a single-use disc. The carbon saving quoted on the listing is the brand’s own figure. | 59.63% | Reconsider | See where to buy |
Ecoblossom Menstrual CupsAmazon USA #6 · reusable cup · 100% medical-grade siliconeRead morePeople55Animals100Gaia90Frequency90 Why not higher: People stays at 55 because no contaminant test is published for the material. | 83.75% | Shake PickAligned | See where to buy |
SHORDY Menstrual CupsAmazon USA #7 · reusable cup · silicone (medical grade not stated)Read morePeople55Animals100Gaia90Frequency90 Why not higher: People stays at 55 because no contaminant test is published for the material. The listing says silicone and does not say medical-grade. | 83.75% | Shake PickAligned | See where to buy |
Pixie DiscAmazon USA #8 (kit) and #10 · reusable disc · 100% medical-grade siliconeRead morePeople55Animals100Gaia90Frequency90 Why not higher: People stays at 55 because no contaminant test is published for the material. The listing says free from metals, PFAS and toxins; no test is published, so that earns no credit. The reusable applicator in the bundle is not scored. | 83.75% | Shake PickAligned | See where to buy |
Saalt Menstrual CupAmazon USA #11 · reusable cup · 100% medical-grade siliconeRead morePeople55Animals100Gaia90Frequency90 Why not higher: People stays at 55 because no contaminant test is published for the material. | 83.75% | Shake PickAligned | See where to buy |
Pixie Cup KitAmazon USA #13 · reusable cup · 100% medical-grade siliconeRead morePeople55Animals100Gaia90Frequency90 Why not higher: People stays at 55 because no contaminant test is published for the material. The kit also holds lube, wash, wipes and an applicator; only the cup is scored. | 83.75% | Shake PickAligned | See where to buy |
Ginalaia Menstrual CupsAmazon USA #15 · reusable cup · 100% medical-grade siliconeRead morePeople55Animals100Gaia90Frequency90 Why not higher: People stays at 55 because no contaminant test is published for the material. The listing says there is no toxic shock risk. We found nothing on the listing to support that, so it earns nothing. | 83.75% | Shake PickAligned | See where to buy |
DIVA Cup, Models 0, 1 and 2Amazon USA #16 (Model 1) and #20 (Model 0) · reusable cup · 100% medical-grade silicone, plastic free, dye freeRead morePeople55Animals100Gaia90Frequency90 Why not higher: People stays at 55 because no contaminant test is published for the material. Models 0 and 2 were read earlier; Model 1 today. | 83.75% | Shake PickAligned | |
| Tampons | |||
Tampax Pearl Regular, unscentedAmazon USA #1 (and six more Tampax Pearl listings) · rayon, cotton, polypropylene, polyethylene, polyesterRead morePeople55Animals67Gaia40Frequency65 | 56.75% | Reconsider | See where to buy |
Playtex Sport Tampons, fragrance freeAmazon USA #2 and #6 · rayon and/or cotton, polyester, plastic applicatorRead morePeople55Animals78.5Gaia40Frequency65 | 59.63% | Reconsider | See where to buy |
U by Kotex Click Compact TamponsAmazon USA #7 · ECF rayon, polyethylene/polyester cover; applicator material not stated, scored as plasticRead morePeople55Animals88.5Gaia40Frequency65 | 62.13% | Shake PickWorth a Pause | See where to buy |
L. Cotton TamponsAmazon USA #8 · organic cotton core claimed, no certificate number; plastic applicator assumedRead morePeople55Animals78.5Gaia40Frequency100 | 68.38% | Shake PickWorth a Pause | See where to buy |
LOLA Organic TamponsAmazon USA #9 · organic cotton claimed, no certificate number; plastic applicatorRead morePeople55Animals78.5Gaia40Frequency100 | 68.38% | Shake PickWorth a Pause | See where to buy |
Rael Slim Applicator TamponsAmazon USA #11 · organic cotton core claimed, no certificate number; plastic applicatorRead morePeople55Animals78.5Gaia40Frequency100 | 68.38% | Shake PickWorth a Pause | See where to buy |
o.b. No Applicator TamponsAmazon USA #16 · rayon and cotton, polyester, PET, polyethyleneRead morePeople55Animals78.5Gaia40Frequency65 | 59.63% | Reconsider | See where to buy |
Tampax Radiant TamponsAmazon USA #17 · composition not published; odour claim, no named mechanismRead morePeople55Animals67Gaia40Frequency65 On the label: OEKO-TEX Standard 100 certificate number published (24.HUS.14474). The listing does not name the testing institute or say which parts are covered, so we show it here as evidence and give it no points. | 56.75% | Reconsider | See where to buy |
Organyc Tampons, cardboard applicatorNot in the Amazon lists we read · 100% organic cotton claimed, no certificate number found; no plasticRead morePeople55Animals90Gaia65Frequency100 | 77.50% | Shake PickAligned | See where to buy |
Cora Organic Cotton TamponsNot in the Amazon lists we read · Organic cotton, plastic applicatorRead morePeople55Animals78.5Gaia40Frequency100 | 68.38% | Shake PickWorth a Pause | See where to buy |
Cups and discs, in plain words
Reusable silicone cups and discs score 83.75%. Disposable discs score 59.63%. A reusable silicone cup or disc is one moulding that is washed and worn again, nothing is absorbed, and almost nothing is thrown away. A disposable disc is a single-use polymer, thrown away after one wear, so it loses points for litter and is held back on the planet pillar. A plant-based label does not change that.
What the research says. A 2019 review of 43 studies in The Lancet Public Health found leakage was similar or lower with cups than with disposable pads or tampons in the four studies that compared them directly, and called cups a safe option. A 2022 life-cycle study (Fourcassier and colleagues, Cleaner Environmental Systems) found cups had the lowest environmental impact on every measure, in France, India and the US, about 99% lower than disposable conventional tampons. Worth knowing: the safety evidence for cups is still thin, a few cases of toxic shock syndrome have been reported, and discs have far less research behind them than cups.
Why we cannot rate the reusables better, or tell them apart. Every reusable cup and disc here that names its silicone scores the same because every brand publishes the same few things: “medical-grade silicone” without naming a grade or a test, and nothing on contaminants, colourants or additives. Without a published test from a named laboratory, People stays capped at 55, and we will not guess beyond what a brand tells us. A brand that publishes its silicone grade, a contaminant test and what colours its cup can lift its own score, and we will update it.
Sources: van Eijk AM et al., The Lancet Public Health, 2019 · Fourcassier S et al., Cleaner Environmental Systems, 2022 · Hait A and Powers S, Resources, Conservation and Recycling, 2019.
Most sold cups and discs in South Africa
Read from Amazon South Africa’s Best Sellers in Menstrual Cups and scored on the same ruler as everything else on this page. Shake is not paid on these links. The list is young: most of the top places have between one and five ratings, and that does not matter here, because we score what a brand publishes, not how many people have reviewed it.
| Product | Shake score | Band | |
|---|---|---|---|
Femagene MyowncupAmazon South Africa #1 to #3 · reusable cup · listing gives the material as “plastic”, medical gradeRead morePeople55Animals100Gaia40Frequency55 The listing names the material only as “plastic” and says medical grade. Because we cannot establish what it is made of, Frequency takes the undisclosed band (55) and Gaia the undisclosed ceiling (40). If the brand names a silicone and its grade, the score moves that week. | 62.50% | Worth a Pause | |
Nordik Beauty Reusable Menstrual Cups, 2 packAmazon South Africa #4 · reusable cups · soft medical-grade siliconeRead morePeople55Animals100Gaia90Frequency90 Why not higher: People stays at 55 because no contaminant test is published for the material. | 83.75% | Shake PickAligned | See where to buy |
Sheba Feminine Oshun Blue Menstrual CupAmazon South Africa #5 · reusable cup · 100% medical-grade siliconeRead morePeople55Animals100Gaia90Frequency90 Why not higher: People stays at 55 because no contaminant test is published for the material. The listing says it is free of toxins; no test is published, so that earns no credit. | 83.75% | Shake PickAligned | See where to buy |
Femina Menstrual Cup, 2 packAmazon South Africa #6 · reusable cups · 100% medical-grade silicone (brand field on the listing: Velobiotics)Read morePeople55Animals100Gaia90Frequency90 Why not higher: People stays at 55 because no contaminant test is published for the material. | 83.75% | Shake PickAligned | See where to buy |
Lil-Lets Reusable Menstrual CupAmazon South Africa #8 and #12 · reusable cup · medical-grade silicone, latex, BPA and phthalate freeRead morePeople55Animals100Gaia90Frequency90 Why not higher: People stays at 55 because no contaminant test is published for the material. The organic cotton storage bag in the box is not scored. | 83.75% | Shake PickAligned | |
everteen Reusable Menstrual Cup, MediumAmazon South Africa #9 · reusable cup · medical-grade siliconeRead morePeople55Animals100Gaia90Frequency90 Why not higher: People stays at 55 because no contaminant test is published for the material. The listing says odor and rash free; no evidence is published for either, so that earns nothing. | 83.75% | Shake PickAligned | See where to buy |
4 Pack Reusable Silicone Menstrual CupsAmazon South Africa #10 · reusable cups · food-grade silicone, unbranded listingRead morePeople55Animals100Gaia90Frequency90 Why not higher: People stays at 55 because no contaminant test is published for the material. The listing says food-grade silicone, not medical-grade. | 83.75% | Shake PickAligned | See where to buy |
Flo Angel Menstrual Cup SetAmazon South Africa #11 · reusable cups · 100% medical-grade siliconeRead morePeople55Animals100Gaia90Frequency90 Why not higher: People stays at 55 because no contaminant test is published for the material. The listing says free from toxins and no leaks or odour; none of that is tested on the page. The sterilizer cup in the set is not scored. | 83.75% | Shake PickAligned | See where to buy |
Saalt Soft Menstrual CupAmazon South Africa #28 · reusable cup · 100% medical-grade siliconeRead morePeople55Animals100Gaia90Frequency90 Why not higher: People stays at 55 because no contaminant test is published for the material. The listing says its dyes are tested for skin sensitisation; no report is published, so that earns no credit. | 83.75% | Shake PickAligned | See where to buy |
Reusable Menstrual Disc with Sterilizer (Pixie)Amazon South Africa #29 · reusable disc · 100% medical-grade siliconeRead morePeople55Animals100Gaia90Frequency90 Why not higher: People stays at 55 because no contaminant test is published for the material. The electric steam sterilizer in the bundle is not scored. | 83.75% | Shake PickAligned | See where to buy |
For brands
Make something that belongs on this shelf?
Apply to be scored. It is free, and we score from what you publish: applying, or working with us, never changes a score.
Check your own period care product in ShakeUP
An early test of the ShakeUP app.
Correction
Seven scores on this page changed, and not because any product did. We added two rows to our repository for conventional cotton: the pesticides used to grow it, and the irrigation water it draws. They apply wherever cotton cannot be shown to be organic by a certificate we can look up, meaning a number, the body that issued it, and what it covers. None of the listings we score from publishes one, including the four sold as organic, so every product here that contains cotton now carries those rows. That is not a finding that their cotton is not organic. It is that we could not check it.
Playtex Sport 62.13% → 59.63%, Worth a Pause to Reconsider · Natracare 76.25% → 73.75%, Aligned to Worth a Pause · Organyc 80.00% → 77.50% · Cora 70.88% → 68.38% · Tampax Pearl 59.25% → 56.75% · Rael 56.75% → 54.25% · EverLeakProof 51.00% → 43.50%.
Most moved on Animals only, because a planet ceiling was already holding them down and the new rows could not push them below it. Nothing we have scored has been dropped: products are now grouped by what they are, with the most sold first. A certificate number with its scope removes both rows, free, and the page changes the same week.
Three things this table does not say
It does not say a disposable is better than a reusable. The one reusable pair scored on this page, the featured card above, has the lowest score, and it has it for a reason that has nothing to do with being reusable: two questions we asked about it are still open, and we score an unanswered question as the worst thing that construction is evidenced to be. Its cotton gusset is also scored as conventional cotton, because we found no certificate for it, which is the same rule every cotton product above it is held to. Answer them and it moves the same week. On the planet, every lifecycle study we could find puts cups and reusables far ahead of anything disposable.
It does not say organic is safe and the rest is not. In the 2024 tampon study, lead was higher in the non-organic products and arsenic was higher in the organic ones. A “certified organic cotton cover” certifies the cover. It says nothing about the core, the backing or the glue.
It does not say anything is poisoning you. A South African study published this year found hormone-disrupting chemicals in every pad and liner it tested, and calculated exposure from a model rather than measuring it. The South African Bureau of Standards told Parliament in March that pads on sale here are safe. Both of those are true at once, and the honest position is the uncomfortable one: the chemicals are there, and nobody has yet measured what reaches you.
What would move any of these numbers
A contaminant test from a laboratory anyone can name. A composition listed layer by layer rather than as one long list. A certificate number instead of a badge. Any brand on this table can send one, free, at any time, and the score changes that week. It has never been possible to pay us to look.
Scored under the ShakeUp Standard Operating Manual v1.9, with sales ranks read from amazon.com Best Sellers and the two conventional-cotton rows applied (see the correction on this page). Sources for every row: Shearston et al., Environment International 190 (2024) · Blignaut et al., Science of The Total Environment 1018 (2026) · Gao & Kannan, Environment International 136 (2020) · Marcelis et al., Environment International 198 (2025) · Fourcassier et al., Cleaner Environmental Systems 7 (2022) · UNEP, Menstrual products and their alternatives (2021) · ACMT position statement (2024) · the brands’ own published materials, read at the time of scoring.
We earn from Amazon on the links in these tables, not from the brands. Amazon pays the same commission whether a product scores 40 percent or 95 percent, and none of these brands had any part in the number beside their name. The one exception is the featured card above, where the brand pays us directly — and that card carries the lowest score on the page.
Also worth knowing
A brand not yet scored
It carries no score because we have not assessed it yet — not because of anything it has or has not done. There is no buy button because Shake has no affiliate relationship with it. It is here because it answers at least some of the questions above in public, on its own website, where anyone can check.
Reusable cloth pads
Cloth pads in organic cotton, made in the USA, and one of the longest-running names in reusables. The appeal here is material simplicity: a single fibre doing the absorbing, with no membrane and no core to ask questions about.
The plainest illustration on this page of what “fewer layers, fewer questions” actually looks like.
The description is drawn from the company’s own published material and from the independent sources cited elsewhere on this page. Shake has not verified any certification held by this brand and awards no score on the basis of one. Inclusion here is editorial interest, not endorsement.
Material Awareness
The four words worth learning
Almost everything on this page reduces to four terms. Learn these and you can read any product page in this category in about ninety seconds.
Viscose & rayon
Cellulose — from wood, or from bamboo — dissolved in strong chemicals and extruded as fibre. Soft, absorbent, plant-derived, and heavily processed. Not a villain; simply not the same thing as the plant it came from.
PUL
Polyurethane laminate. The thin waterproof membrane inside almost every piece of period and bladder-leak underwear. It is what stops the leak, it is a plastic film, and it is very rarely mentioned in the composition a brand chooses to publish.
Superabsorbent polymer (SAP)
The gel that makes a thin disposable pad hold what it holds. Usually sodium polyacrylate. It is the reason modern pads are thin, and part of the reason they are largely plastic.
Microfibre
Very fine synthetic filament, usually polyester or polyamide, often the absorbent core of period underwear. Excellent at wicking. Sheds fibres into the wash, which is where the Animals and Gaia pillars take an interest.
There is no verdict at the end of this page, and that is not us hedging. The metals study does not yet know whether metals leach. The absorption research is clear about the route and quiet about the magnitude. Most reusable products contain no PFAS at all, and a third of one category does.
What we can say is smaller and more useful: this is the most absorbent route on our entire scale, the products are worn for a very long time in total, and almost none of the information you would need is required to be on the box.
So the question is not whether to be worried. It is whether the brand you buy from can answer three straightforward questions about its own product. Most cannot yet. The ones that can are worth knowing about — and that is the whole job of this page.
Words on this page
We would rather explain a word than avoid it. Tap any dotted term above, or read them here.
- SOP
- Standard Operating Manual — Shake’s written scoring rulebook. It sets out how a product is assessed, what counts as evidence, and what each score means. It is versioned, and every score records which version produced it, so you can check what that version actually required.
- The skin of the vulva
- The vulva is the external genitals — the parts you can see. Distinct from the vagina, which is internal. The difference matters here because the two absorb differently, and a product worn outside the body is not doing the same thing as one worn inside it.
- First-pass metabolism
- The liver’s first go at anything you swallow, breaking much of it down before it reaches the rest of you. Things absorbed through a mucous membrane skip that step and enter the bloodstream directly — which is why the same substance can behave very differently depending on how it gets in.
- Phthalates
- Plasticisers — they soften plastic and make scent last longer. Tier 1 on Shake’s list, because they are endocrine disruptors — substances that interfere with the body’s hormone signalling. Often not listed by name at all, but hidden inside the single word “fragrance”.
- PFAS
- A large family of synthetic chemicals used to repel water, oil and stains. They break down extremely slowly, which is why they are often called forever chemicals. Their usefulness and their persistence are the same property.
- Deliberately fluorinated
- Treated on purpose with PFAS-based chemistry, usually to make a fabric repel liquid. Worth distinguishing from contamination picked up by accident somewhere in a supply chain — one is a manufacturing decision, the other is a manufacturing failure.
- OEKO-TEX STANDARD 100
- A textile certification. Since 1 January 2024 it prohibits intentionally added PFAS. Every genuine certificate carries a number, an issuing institute, and a stated scope — which is why we ask for all three rather than accepting the logo.
- Viscose (rayon)
- A fibre made by dissolving plant cellulose in chemicals and reforming it as thread. It begins as a plant and ends as a heavily processed fibre. This is why fabric made this way from bamboo must legally be labelled “rayon made from bamboo” rather than simply “bamboo”.
- PUL
- Polyurethane laminate — a thin plastic film bonded to fabric to make it waterproof. It is the layer that stops a leakproof garment leaking, and it is the reason most of them contain plastic somewhere.
- Superabsorbent polymer
- Usually sodium polyacrylate. The gel that lets a thin disposable pad hold what it holds. It is why modern pads are thin, and part of why they are largely plastic. Often shortened to SAP.
- Microfibre
- Very fine synthetic filament, usually polyester or polyamide, often the absorbent core of period underwear. Excellent at wicking. Sheds fibres into the wash, which is where the Animals and Gaia pillars take an interest.
The label writes the score. We don’t. Only evidence moves it.
Affiliate disclosure. Shake earns commission on some links across this site. Shake is an affiliate of EverLeakProof, the brand featured above, through the Awin network — disclosed again on the card itself. That relationship began before the score was calculated and had no part in it. The brand not yet scored carries no link and has no commercial relationship with Shake. Our editorial positions are not for sale, and a commercial relationship is never an input to a Shake Score.
Not medical advice. Shake describes materials and exposure routes. It does not diagnose, treat or advise on any medical condition, and nothing here should be read as a claim that any product prevents or reduces one. Bladder leakage, heavy bleeding and pelvic pain are worth raising with a clinician, not a publication.
On our sources. Every factual claim on this page is attributed in the card that makes it. Where the evidence is unresolved, we have said so rather than rounding it into a conclusion. The featured card has been re-scored under the ShakeUp Standard Operating Manual v1.9, including the conventional-cotton rows, and before that under v1.6, having first been published under v1.4.
