The average woman menstruates about 500 times in her life and uses 11,000 disposable menstrual products. If you calculate your own menstrual footprint, you’ll no doubt find the totals in both dollars and environmental impact absolutely staggering.

Disposables are awash in plastic, especially polyethylene. A typical single-use tampon has a string that’s braided with plastic and absorbent material that also contains a layer of plastic, all tucked inside a plastic applicator. Similarly, a typical disposable pad has a plastic leak-proof base and plastic in its absorbent material. Each individual tampon or pad is further encased in plastic packaging.

All that plastic means single-use menstrual products can take 500 to 800 years to break down in landfill. What doesn’t go to landfill often gets flushed down the toilet and ends up in the ocean, where it breaks down into smaller and smaller pieces called microplastics, which harm aquatic life.

And that’s not the end of the bad news regarding disposables. They often contain nasty chemicals — but most parts of the world don’t require ingredients to be listed on the packaging of menstrual products. That’s why it was such big news when, in 2019, New York became the first state in America to mandate ingredient labels on these products.

All in all, it’s an unfathomable amount of chemical unknowns and plastic waste. But unlike plastic straws, with their heartbreaking but media-friendly symbol of a sea turtle getting a straw removed from its nostril, disposable menstrual products haven’t generated much media attention.

Part of the problem is that menstruation all too often is considered a taboo topic, shrouded in shame and stigma. In the Nepalese practice of chhaupadi, for example, anyone menstruating is considered impure and forced to live in a shed, cave, or menstruation hut for the duration of their period. Though officially outlawed, chhaupadi still takes place in many rural communities.

Similarly, in India, menstruators are often forbidden to enter religious spaces and certain kitchens. A lack of knowledge around menstruation, and supplies to deal with it, leads some rural Indian women to use rags, leaves, or even ashes while menstruating. The film Period. End of Sentence., which won the Academy Award for Best Documentary (Short Subject) in 2019, shines a light on the subject.

Many North Americans also treat the topic as taboo — hiding a tampon up a sleeve on the way to the office bathroom, and using code words such as Aunt Flo, The Curse, and TTOTM (That Time of the Month). The resulting shame and lack of knowledge can lead some menstruators to flush used products down the toilet, causing plumbing mishaps and contributing to sewer blockages known as fatbergs. Menstruators may shun reusable products due to embarrassment at having family members see these products in the laundry, or ignorance regarding the female anatomy and how to use items such as menstrual cups.

Madeleine Shaw, cofounder of Aisle (formerly Lunapads), recalls what it was like when she made her first reusable pads and period underwear, almost 30 years ago. “Nobody wanted to talk about it. People thought I was crazy and that it was gross,” she says. Washing those first handmade products was momentous for Shaw. It forced her to recognize her own internalized period shame and experience a bit of an epiphany about menstruation: “This is something that my body is doing that is actually really cool and fascinating and miraculous.”

Thankfully, the topic is gradually becoming less taboo to others as well, at least in North America. According to Shaw, the conversation around menstruation changed dramatically and garnered mainstream attention in 2015, which various sources have dubbed “the year of the period.”

It was in 2015 that musician Kiran Gandhi ran the London Marathon while free-bleeding, finishing the race with menstrual blood proudly showing on her leggings. Also in 2015, #PeriodsAreNotAnInsult trended on Twitter after presidential candidate Donald Trump said Fox News host Megyn Kelly had “blood coming out of her wherever.” And just a couple of weeks into 2016, YouTube personality Ingrid Nilsen grilled President Barack Obama about the “tampon tax,” which classifies menstrual products as luxury items and taxes them accordingly.

This gradual opening up of the public discourse around menstruation means, among other things, that more people have become aware of the different eco-friendly options available. The simplest and most straightforward choice is the cloth pad. It works the same as a disposable but is made of fabric and has snaps instead of plastic adhesive to hold it in place.

Days for Girls International, a nonprofit with the mission of ending period poverty, has spent 12 years (and gone through 30 iterations) perfecting the reusable pad that they distribute around the world. Jessica Williams, the organization’s chief communications officer, describes the pad as “beautiful, washable, sustainable.” It consists of two parts, both made from cheerful and colorful fabric: a shield with wings that snap around the underwear, and a tri-fold liner that unfolds into a large square, for easy washing and discreet drying. “When you hang it up, it just looks like a washcloth,” Williams says.

Another reusable option is the menstrual cup, which is made of flexible rubber or silicone. The cup is inserted into the vagina, where it collects menstrual blood and can be left in for as long as 12 hours. “But in a lot of cultures, inserting something into the vagina is not acceptable,” Williams says. “They just won’t do it.” Plus, in places that lack clean running water, it can be challenging to wash a cup.

A less well-known reusable option is period underwear, which has a crotch made from absorbent material backed by leak-proof material. From the outside, the briefs, bikinis, and thongs made by Aisle appear no different from any other underwear. On the inside, however, the undies can hold two to four times as much fluid as disposable menstrual products. Shaw explains that Aisle underwear is made ethically in Cambodia using sustainable materials such as organic cotton and recycled polyester.

But, she warns, “Not all period underwear are created equal.” She references a recent report that revealed the presence of highly toxic PFAS chemicals in some brands of period underwear. Even tiny amounts of PFAS chemicals, which never break down in the environment, are linked to health issues such as cancer, liver damage, and thyroid disease. (Aisle products have been tested repeatedly and shown to contain no PFAS chemicals.)

Some reusable menstrual products touted as environmentally friendly are highly problematic in other ways. Sea sponges — which can be used in place of a tampon — don’t contain plastic, but the author of The Vagina Bible, Dr. Jen Gunter, argues that they’re not safe or sanitary because of bacteria and debris. Similarly, she doesn’t recommend reusable tampons (sewn from fabric or crocheted from yarn) because they’re untested and unregulated and could harbor bacteria.

Too often, menstruators become overwhelmed by all the choices and conflicting information and just stick with familiar disposables, even if they’re harmful for the planet. Other reasons for avoiding reusables include the mistaken belief that they’re less reliable, squeamishness about carrying around soiled products to be laundered, and the high initial cost.

That high price tag is a very real concern. Both disposables and reusables are too expensive for many people, according to those fighting on the frontlines against period poverty. Far too many menstruators around the world, including in North America, struggle to obtain the period supplies they need each month, a problem that has only been exacerbated by the closure of stores and other public places during the Covid-19 pandemic. According to the organizers of Menstrual Hygiene Day, the pandemic has disrupted access to the very things that menstruators need most: products, information, and sanitation and washing facilities. Disrupted supply chains have also driven up prices.

Lack of access to menstrual products causes many menstruators to regularly miss school and work. Period poverty disproportionately affects people of color, prisoners, refugees, people with disabilities, homeless people, and transgender people. Prisons and homeless shelters rarely supply free menstrual products, and very few food banks give them out. Shaw describes “the indignity of having to choose, if you can imagine, between buying food and buying menstrual supplies. These products should be provided for free in the way that toilet paper and soap are provided in bathrooms. It’s a matter of basic human dignity.”

Period poverty makes the environmental issue of menstrual products even worse, as disposables are cheaper in the short term for anyone already struggling to afford food or rent. In the long term, however, disposables add up to be far more expensive for individuals — and, of course, for the planet.

As with so many of the issues facing the world today, it’s youth who are blazing the way toward finding solutions. Ally Crays is one such dedicated crusader. She’s the Youth Advisory Council Chair of Period, a nonprofit with the mission of ending both period poverty and period stigma through a combination of education and advocacy. Crays would like to see free menstrual products available in all bathrooms, not just women’s.

Crays discusses the many issues that intersect under the umbrella of menstrual equity and explains her focus on trans and non-binary menstruators, because of the additional challenges and discrimination they face in obtaining products. She also explains why everyone should care about helping all menstruators to achieve their full potential: “We’ve seen over and over again that when people who menstruate are in positions of power, especially of political power, there’s greater equity for all.”

Emmy Hancock is another youth committed to end period poverty. She launched her clothing company, Oluna, in 2020 to raise funds for organizations such as Period and I Support the Girls. For every pair of pants that Oluna sells, the company provides a year’s supply of period products to a menstruator in need. Hancock talks about period poverty as a problem that both genders should focus on: “There’s no reason that just women should carry this on their backs.”

Hancock, who is excited about the menstrual justice movement because it takes aim at such a solvable problem, encourages everyone to get involved in any way they can: “Activism exists on many levels. You really can make a difference in this issue, whether it’s writing a tweet, posting on Instagram, writing to your state representative, or advocating for your school board to include tampons in the bathroom.”

Williams agrees it’s an issue we can solve in our lifetimes. She says, “The solution seems so simple, right? Give a girl a washable pad, give her some education, and boom! You’re on your way.”

Williams, Hancock, Crays, and Shaw all express a similar optimism around the life-changing and world-changing power of sharing reusable menstrual products alongside education about menstruation. Shaw sums it up nicely: “I think we’re in a golden age right now — call it a scarlet age — of progress toward menstrual equity and menstrual justice. Now’s the time to push. Now’s the time to make it happen.”