Menstrual product use patterns in a large digital cohort in the United States: variations by sociodemographic, health, and menstrual characteristics.

backgroundUsing menstrual products is a part of managing menstrual bleeding. Product use may represent individual, social, and economic influences. A few studies on menstrual product use from specific regions in the United States reported differences in use across demographic factors like age and race and ethnicity.

objectiveTo evaluate menstrual product use patterns and how they vary by sociodemographic, health, and menstrual characteristics in a large US cohort. STUDY

designWe used data from 11,455 participants across the United States from the Apple Women's Health Study, an ongoing mobile application-based US cohort, who provided consent, enrolled between November 2019 and January 2024, and responded to relevant surveys. Data included age, race and ethnicity, ancestry, gender identity, socioeconomic status, gynecological conditions, menstrual characteristics, use of menstrual products (panty liners, sanitary napkins or pads, regular tampons, super-absorbent tampons, a combination of pads or tampons but not used together, internal cup menstrual collection device, period underwear, or other), and whether sleeping with a tampon among tampon users. We obtained the percentages and 95% confidence intervals of each product use, overall and by several characteristics. We used chi-square tests and 95% confidence intervals to compare percentages across categorical characteristics.

resultsOverall, the prevalence of regular tampons use was 48%, followed by pads (47%), panty liners (43%), super-absorbent tampons (36%), period underwear (20%), cups (18%), a combination of pads or tampons but not used together (18%), other products (2%), and no product (4%). Among tampon users, 61% sleep with a tampon. Compared to individuals aged 30 to 39 years, those aged <20 years were more likely to use pads (57% [95% confidence interval: 53-61] vs 45% [95% confidence interval: 43-46]) and less likely to use cups (12% [95% confidence interval: 10-15] vs 21% [95% confidence interval: 19-22]) or period underwear (17% [95% confidence interval: 14-20] vs 22% [95% confidence interval: 21-23]), and those aged ≥50 years were less likely to use regular tampons (32% [95% confidence interval: 28-36] vs 50% [95% confidence interval: 48-52]). Compared to non-Hispanic White participants, those who self-identified as Asian, Hispanic, or non-Hispanic Black were less likely to use tampons (37% [95% confidence interval: 31-42], 39% [95% confidence interval: 36-43], 31% [95% confidence interval: 27-35] vs 50% [95% confidence interval: 49-51]); Asian or Hispanic individuals were less likely to use cups (15% [95% confidence interval: 11-18], 15% [95% confidence interval: 13-17] vs 19% [95% confidence interval: 18-20]). Compared to those with high socioeconomic status, participants with lower socioeconomic status used pads more frequently (50% [95% confidence interval: 48-52] vs 42% [95% confidence interval: 41-44]). Compared to those without any gynecological conditions, those with endometriosis were more likely to use super-absorbent tampons (38% [95% confidence interval: 35-41] vs 33% [95% confidence interval: 32-35]). Those with longer bleed days used pads more often than those with shorter bleed days; similar patterns were seen for super-absorbent tampons or period underwear (P values < .05).

conclusionIn this cohort, tampons and pads were reported with high frequency, in contrast to the low frequency for period underwear/cups. Use differed by sociodemographic, health, and menstrual characteristics. Our findings provide insights into menstrual product use among US adults, informing discussions among clinicians, policymakers, and patients regarding menstrual management.