Why My U.S. Experience With Tampons Made Me Rethink Menstrual Product Taxes
Kana Yamamoto, M.D., Ph.D.
Researcher, Medical Governance Research Institute
In this column, “A Quick Medical Note,” a female physician offers concise commentary on everyday events and news from medical and health perspectives. In this installment, Dr. Kana Yamamoto—an internist at Tetsuikai Navitas Clinic and the Medical Governance Research Institute—shares her insights on “experiences related to menstruation.”
Recently, I was interviewed about “sleep during menstruation.” [※1] According to a survey conducted in connection with “World Sleep Day”—established by the World Sleep Society to promote accurate knowledge about healthy sleep—more than half of Japanese women experience mental and physical effects during sleep due to anxiety about menstrual leakage. The survey also revealed that women sleep, on average, about two hours less during their period compared with their usual nights.
I had my first period at the age of ten, which means I have lived with menstruation for 26 years now. When I was younger, I often thought, “Menstruation is such a hassle.” But over time, I came to accept it as a natural part of my life. Through the interview, I was given an opportunity to reflect once again on menstruation and menstrual products. In this column, I would like to share some of my personal experiences and thoughts related to my period.
|Severe Menstrual Pain Led Me to Visit a Gynecologist
When I was 20, my menstrual pain became severe enough to interfere with my daily life, and I rushed to see a gynecologist. Following my physician’s recommendation, I began taking a low-dose oral contraceptive pill. Since then, my menstrual cramps have significantly improved, allowing me to live far more comfortably. Although my period still comes every month, my menstrual flow decreased, I used fewer menstrual products, and I rarely stained my underwear, clothing, or bed sheets.
After experiencing many mishaps over the years, I eventually developed habits to prepare for my period—such as carrying menstrual products when I sensed it might start and choosing underwear or clothing that I wouldn’t regret staining.
Even so, despite taking the pill, my menstrual flow tended to increase around the second day. On such days, I would not only use overnight sanitary pads with wings,[※2] but also place a red bath towel over my bedsheet before going to sleep. Because I tend to move around a lot in my sleep, my pad would often shift during the night, leading to stains on my underwear or pajamas. Yet sleeping on a towel came with its own stress—I found myself subconsciously thinking, “I must not move beyond the edge of this towel,” which ultimately made it harder to fall asleep. This was exactly the kind of mental and physical impact on sleep during menstruation described in the survey mentioned earlier.
Three years ago, I switched from the low-dose pill to a contraceptive implant, and since then both the frequency and volume of my periods have decreased even further. In the United States, tampons are far more common than pads, and the variety available is extensive. As I began using tampons, I found that my worries about leakage disappeared almost entirely—day or night. Moreover, I no longer experienced the heat, moisture, or skin irritation associated with pads. Overall, I feel that the discomfort I used to experience during my period has been significantly reduced.
|I Could Never Go Back to Pads Again
Now in my third year of using a contraceptive implant, my menstrual flow and frequency have slightly increased, so I find myself using tampons more often. Even so, I genuinely feel that “I could never go back to pads.” On the rare occasions when I ran out of tampons and had to use a pad as an emergency measure, my body reacted strongly to what used to feel normal—the slight constriction of period underwear and the distinct sensation of heat and moisture from pads. I ended up rushing to the nearest drugstore to buy tampons.
I have never really discussed menstrual products with friends, but if someone were to ask me which product I recommend, I would wholeheartedly say, “Tampons.” Although they are not the mainstream choice in Japan and the options are more limited than for pads, they are available.[※3] Just like pads, tampons come in different types—daytime and overnight, light-flow and heavy-flow—so you can choose according to your needs.
I had purchased and used tampons in Japan before, but I had always assumed they were meant only for heavy-flow days or for occasions like swimming at the pool or beach. Because of that, I typically reached for pads—the products positioned on the main shelves—rather than the tampons stocked on the lower rows.
So when I first visited the menstrual products aisle at a drugstore in the United States, I was astonished by the sheer variety of tampons available—and equally surprised by how few pads were displayed compared with Japan’s stores, where pads dominate the shelves.
|The Cost Gap of Menstrual Products: Japan vs. the United States
Finally, according to data from Soma City in Fukushima Prefecture,[※4] women spend approximately 500 to 1,200 yen per month on menstrual products and other gender-specific hygiene items—amounting to roughly 400,000 yen over a lifetime. Of course, these numbers vary depending on menstrual flow and cycle length, but the monthly cost of products that women must use is undeniably significant.
According to PlushCare,[※5] the average monthly spending on menstrual products in the United States ranges from approximately $8 to $15, although the amount varies depending on the state, how frequently products are used, and the type of products purchased. The New York Post[※6] reports that the price of tampons has risen by about 36% over the past five years due to inflation. It is also estimated that 16.9 million women in the U.S. who menstruate live in poverty, and two-thirds of them cannot afford to purchase essential menstrual products such as pads or tampons.[※7]
Although tax policies vary by state, as of May 2025, 24 states, including California, New York, Massachusetts, Florida, Texas, and Minnesota, have eliminated sales tax on menstrual products, meaning that they are tax-exempt at the time of purchase. (Some counties and municipalities may still impose their own local taxes.)
The shift toward tax exemption has been driven by several social and ethical considerations: growing recognition that menstrual products should be treated as essential goods; increased awareness of “period poverty” as a societal issue; and a reevaluation through the lens of gender equity, given that many necessities (such as groceries and medications) have long been tax-exempt while menstrual products historically were not. In addition, the nationwide “tampon tax repeal” movement has gained significant momentum, helping many states formally classify menstrual products as necessities and adopt tax-exemption measures.
Unfortunately, menstrual products such as pads and tampons in Japan are still subject to a 10% consumption tax. Although a reduced tax rate system was introduced in October 2019, menstrual products were excluded from eligibility. In Japan as well, there are individuals who limit or forgo purchasing menstrual products due to financial constraints—an issue that affects both their health and quality of life. As a result, “period poverty” has increasingly drawn public attention. However, no legislative changes have been made so far, and menstrual products remain taxable.
Of course, tax exemption alone will not solve period poverty. Still, there is no doubt that menstrual products are not luxuries—they are necessities. I sincerely hope that in Japan, too, an environment will soon be established in which everyone who needs menstrual products can access options that are comfortable and appropriate for them.
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This article was originally published in AERA DIGITAL on May 15, 2025.
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