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

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

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

Study Design: We used data from 11,455 participants across the US from the Apple Women's Health study, an ongoing mobile application-based US cohort, who provided consent, enrolled between 11/2019-1/2024, and responded to relevant surveys. Data included age, race and ethnicity, ancestry, gender identity, socioeconomic status (SES), 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 (CIs) of each product use, overall and by several characteristics. We used Chi-square tests and 95% CIs to compare percentages across categorical characteristics.

Results: Overall, 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 30-39, those aged <20 were more likely to use pads (57% [95% CI: 53-61] vs. 45% [95% CI: 43-46]) and less likely to use cups (12% [95% CI: 10-15] vs 21% [95% CI: 19-22]) or period underwear (17% [95% CI: 14-20] vs 22% [95% CI: 21-23]), and those aged ≥50 were less likely to use regular tampons (32% [95% CI: 28-36] vs. 50% [95% CI: 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% CI: 31-42], 39% [95% CI: 36-43], 31% [95% CI: 27-35] vs. 50% [95% CI: 49-51]); Asian or Hispanic individuals were less likely to use cups (15% [95% CI: 11-18], 15% [95% CI: 13-17] vs. 19% [95% CI: 18-20]). Compared to those with high SES, participants with lower SES used pads more frequently (50% [95% CI: 48-52] vs. 42% [95% CI: 41-44]). Compared to those without any gynecological conditions, those with endometriosis were more likely to use super-absorbent tampons (38% [95% CI: 35-41] vs. 33% [95% CI: 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).

Conclusions: In 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 insight into menstrual products use among US adults, informing discussions between clinicians, policymakers, and patients regarding menstrual management.