When Emma Cihanowyz was in middle school, she and her friends used code words to talk about their periods. If someone asked for a “missile”, it meant they were looking for a tampon. “Shields” meant pads. “We spoke like we were at war,” she said. “The biggest thing for us was making sure that we could take products to the bathroom without the boys seeing.” Now Cihanowyz is 21, a senior at Penn State, and a student activist who campaigns for free sanitary products in all campus bathrooms. She’s no longer afraid of boys, or anyone, knowing she’s having her period. Cihanowyz calls herself a “menstrual fairy”, who walks around school with a bag full of tampons, liners, pads and cups, just in case she runs into anyone who needs a spare. The products Cihanowyz carries have been around for over a century: the first pads were developed in the 1880s. Tampons and menstrual cups came around in the 1930s, with the first modern tampon designed by Tampax patented in 1931 (although makeshift tampons made from rags or reeds had been in use for millennia). Why are there still so few good options available? Cihanowyz chalks the lack of innovation up to what one of her professors, the gender studies academic Jillian Wood, calls the menstrual concealment imperative. Young girls are conditioned to view their periods as dirty and shameful, the theory goes, so they grow into adults who believe that menstruation should be a private, silent experience. Essentially, people take what they can get and shut up about it. “When you walk into CVS, menstruation products are all the way to the back, like they’re hidden,” Cihanowyz said. “I remember the fear when I was a teen of being in that aisle. I just walked in and grabbed the first thing I saw, at eye level, especially if it looked like it was tiny and I could hide it.” Not everyone in the US can afford period products: an estimated 16.9 million menstruators live in poverty, sometimes having to choose between buying food and pads. Those who can may still be using the first type of pad or tampon they ever bought. In the 2010s, there was some innovation marketed to millennials who craved a more comfortable way to deal with menstruation. Period underwear brands led by Thinx cropped up, often using suggestive advertising like yonic-looking fruit to hawk the panties. (Knix, Aisle and Bambody are other popular labels.) Suddenly, menstruators had a bit more choice, though many still felt that their best choices were uncomfortable tampons or bulky pads. “What someone uses for menstruation gets decided early on, and people typically stick to one brand, or product,” said Ida Tin, the co-founder of Clue, a period tracking app. “But what you need when you’re 12 is not the same as what you need just after you gave birth. Or what you want on a camping trip is different than what you use when you’re at home.” According to Candice Matthews, who invests in the period care brand Femi Secrets, the average woman will only switch menstrual products four times at most in her life. “If that’s the case, a brand has got her for 10 years,” she said. Such devotion may be why people feel so emotionally connected to whatever they use. In January, Thinx settled a class-action suit with customers regarding its supposedly “organic, sustainable, and non-toxic” panties. Though the company denied any wrongdoing in court, it faced allegations that the product contained “the presence of short chain per-and polyfluoroalkyl substances (‘PFAS’)”, also known as “forever chemicals”. About 1 million people use Thinx. Many began questioning what they would turn to in the wake of the settlement. “Finding a menstrual product you like is so insanely frustrating because not everything works for everybody,” one customer told the Guardian at the time. Thinx is not the only period product that potentially contains toxic chemicals. The FDA classifies menstrual products as “low- or medium-high risk”, which means the products are not subject to extensive testing, and that manufacturers do not need to disclose every material they use. A series of lab tests conducted by watchdog groups found the presence of PFAS in 48% of sanitary pads and panty liners, 22% of tampons and 65% of period underwear. ‘You can find more information about what ingredients are in a fucking Q-Tip than a tampon’ Activists say that the stigma around periods, and the idea that a woman’s cycle should be a hidden, discreet experience, means that people are not conditioned to take a closer look at what’s inside their products. “If you convince customers that this is a ‘bad’ topic to talk about, you’re disincentivizing customers from giving any real feedback, and setting a very low expectation for the quality of products,” said Nadya Okamoto, founder of the period care brand August. “That’s why you can find more information about what ingredients are in a fucking Q-Tip than a tampon.” One way to tackle that stigma: Okamoto, who is 25, regularly posts videos of herself putting in tampons and changing her pad on TikTok, where she has 4 million followers. Her videos regularly include closeup shots of the blood and clots that appear on her panty liners. Okamoto is used to the app flagging her videos as “sensitive” content; many of her TikToks have disclaimers in front of them that read: “Some people may find this video disturbing.” “A lot of my videos get banned or taken down, but people post surgery videos on TikTok and that’s totally fine,” Okamoto said. “It doesn’t surprise me, but it is frustrating.” When Okamoto started her brand, she had plans to tackle the issue of plastic usage and excess waste that comes with using disposable products. Plastic menstrual products generate more than 200,000 tonnes of waste a year, and the majority of single-use hygiene products are made of plastic that can take up to 800 years to decompose. Okamoto initially thought she would sell menstrual cups or period underwear. But then she started talking to people about their menstruation. “Ninety-nine per cent of people were only interested in tampons and pads,” Okamoto said. “They cared about sustainability, but they were like, ‘I don’t want to use anything that requires me to touch my period blood. Some of my most progressive, feminist friends think that reusing any item for their period will cause a disease or illness.” Most period underwear should not be put in the washing machine – which means that its users also have to get close to their own period blood, when they wash it by hand in their sinks. “In order for someone to be comfortable with period underwear, they have to be comfortable with their own period blood,” Okamoto said. “They’re getting blood on their hands, or washing it in the shower. Those people may have a closer and deeper relationship with their bodies than people who prefer tampons or pads.” ‘The market has failed women’ Ida Tin coined the term “femtech” in 2016 to describe the boom in tech startups that centered on women’s health. “It was a word that was needed back then, because people are still using it in 2023,” Tin said. “Now, investors can more easily recognize that there’s a big movement happening.” Some female founders have taken issue with the term, saying it sidelines periods and fertility as niche “women’s issues”. Investment in femtech brands has declined after a peak in 2018, when femtech companies received roughly 6.6% of digital health funding. By 2020, that had declined to 1.8%. “We’ve underinvested in this space,” Matthews, the femtech investor, said. “The market has failed women because a lot of male investors are still uncomfortable talking about something that happens once a month.” Matthews added that most men who fund period product development do not really want to hear about any innovation. She thinks the best way to pitch menstrual products to men is to remind them the items make for a great subscription service. But a new crop of startups are reimagining what’s possible – if they can get the funding. Vyld, a Berlin-based brand founded by Ines Schiller, uses seaweed kelp to make its tampons, or “kelpons”. Though Vyld has yet to come to market and is still in the research and development process, Schiller hopes the brand can satisfy shoppers’ desire for a period product that is both eco-friendly and leak-resistant. “I always bought organic cotton period products, but I was so disappointed that they leaked,” Schiller said. “Seaweed is a natural absorbent, and it’s completely biodegradable.” Another simple idea is Egal Pads on a Roll. The Massachusetts-based startup creates pads that are packaged exactly the same as a roll of toilet paper, which makes them perfect for public bathrooms. Egal sells to distributors who have contracts with schools and other public buildings. Since October, 16 states and Washington DC have passed legislation requiring free period products be available in public schools. That’s good business for Egal, but not all of these bills are successful. In March, Idaho’s Republican-controlled state house of representatives failed to approve legislation that would have required public schools to offer free period products. Thirty-five Republicans opposed the move on the basis that it was, essentially, too woke. Representative Heather Scott told the AP that the policy was “very liberal” and asked: “Why are our schools obsessed with the private parts of our children?” “Whenever I hear that, I ask why we treat this one bodily function differently than peeing and pooping,” said Penelope Finnie, the CEO of Egal. “It’s only the adults who talk like that. When I speak to students about free period products, they’re almost nonplussed. They wonder why it hasn’t been around before.” More hi-tech are products like Emm, a “smart menstrual device” that consists of a reusable cup that someone can apply with a separate, tampon-like applicator. The cup has a string that’s similar to a tampon, so it can be pulled out without the wearer having to put their fingers inside their body. When it’s not in use, the cup lives inside a UV cleaner that can sterilize it in minutes. The cup is made of medical-grade silicone. Inside it contains sensors that track information about a user’s flow, or when the cup is about to overfill. That information gets uploaded to an app. The Emm CEO, Jenny Button, said that menstruators can share this information with their OB-GYNs to learn more about their reproductive system. “If you read medical literature, you can see that flow rate and volume directly correlate to conditions like endometriosis, polycystic ovaries or fertility issues, but there’s no accurate method of data capture for those metrics,” she said. Button is based in Bristol, England, but is well aware that period tracking apps have been the subject of much scrutiny in post-Roe America. Police in many US states can access period data without a warrant, which could put people who seek abortions at risk for prosecution. In February, Virginia’s Republican-controlled house of representatives shelved a bill that would have made it illegal for authorities to seize menstrual data stored on computers and other devices. Button said the brand would make the data it collects anonymous: “Everyone should have autonomous rights over their data. That’s a red line.” She added that Emm would encrypt users’ data to protect their identities. One of the co-founders of Marlow, a startup based in Canada, wanted to create more comfortable menstrual products, because tampons always hurt to insert. Her doctor once told her to spit on tampons to make them easier to put in, so the team created products that can be dipped in water-based lubricant. “We were shocked and we couldn’t believe that was the only advice the doctor had,” said Nadia Ladak, a co-founder. “We learned that some people were already using lube at home for tampons, but it was such a messy process: it almost feels like arts and crafts in the bathroom stall.” Marlowe’s lube comes in a bottle that coats the tampon with one dip. Marlow has played well on TikTok, where the company has 49,000 followers and regularly posts videos of people answering the type of period questions older generations might have saved for their older sisters. “We’re getting people off of autopilot,” Ladak said, “so they’re not just putting up with the first thing they see on the shelf.” Not every promising period brand gets a happy ending. One UK-based brand, Calla Lily, created Tampliners. That product was exactly what it sounded like: a tampon connected to a pantyliner. Thang Vo-Ta founded the company after learning about the design from a doctor who told him that two-thirds of women wear both tampons and a liner some days to prevent leaks. In 2020, Time magazine called the Tampliner one of the best inventions of the year – shown on the page right next to the Covid vaccine. Vogue dubbed it “one of the best eco-friendly brands worth trying right now”. Cosmopolitan said it was a “gamechanger”. At the time, Calla Lily was selling online in the UK. About 85% of menstrual products are still purchased in a store, so it was crucial that the company get picked up by a major retailer. “I spoke to the heads of femcare at Walmart, Target, CVS, and they all thought it was amazing and wanted to stock it,” Thang said. But every major retailer, including a large pharmacy chain in the UK, declined to sell the product. Thang believes this is because stores did not want to upset the sales of established legacy brands that sold both products. Calla Lily stopped selling its tampliners in 2022. The company now uses the same product model as a way for pregnant women to vaginally insert the hormone progesterone, which is thought to reduce the chance of miscarriage. “We really thought we were going to make it,” Thang said. “We tried to make it work with viral videos, or influencers, but ultimately we just needed to be sold in a major retailer. But I really do hope that more products keep coming out, because there needs to be a hell of a whole lot more innovation in the space, so we can all benefit.”