Introduction

Endometrial cancer (EC), a type of cancer that originates in the epithelial lining of the uterus, is the most common gynecological cancer affecting American women (Crosbie et al., 2022). In 2023, over 66,000 cases were predicted, and 13,000 deaths occurred from endometrial cancer (Mahdy et al., 2024). As a significant contributor to mortality in American women, endometrial cancer must be further researched to determine causal factors and develop preventative measures. Endometrial cancer typically manifests as postmenopausal bleeding, especially at early stages (Crosbie et al., 2022). Additionally, pelvic pain and uterine enlargement are common symptoms. Known risk factors include obesity, excess estrogen exposure, sedentary lifestyle, and insulin resistance (Raglan et al., 2019). Obesity is the most significant underlying cause of increased endometrial cancer in high-income countries such as the United States (Crosbie et al., 2022). However, though risk factors have been identified, the exact cause of endometrial cancer is unknown (Saso et al., 2011).

Interestingly, recent studies have found volatile organic compounds (VOCs) in female menstrual products (Ding et al., 2022). VOCs are found in a wide variety of everyday products, and their health effects are largely unknown, but recent evidence suggests that VOCs may cause respiratory issues, irritation, and cancer (Rumchev et al., 2007). Additionally, it was found that menstrual product usage may be a potential source of VOC exposure (Ding et al., 2022). Pads and tampons are directly placed on vaginal tissues, which are more vulnerable than exposed skin to toxic chemicals. Chemicals can permeate into the body due to the abundant network of blood and lymphatic vessels in the vaginal walls and general tissue structure of vaginal and vulvar tissues (Ding et al., 2022; Woo et al., 2019). Therefore, the usage of menstrual products on highly permeable vaginal tissues may be an especially potent source of consistent VOC exposure in women with possible carcinogenic effects.

One demographic particularly susceptible to VOC exposure via menstrual products is females with low educational attainment, specifically those without a bachelor’s degree. In the context of this study, low education is defined as the status of lacking a bachelor’s degree. Evidence shows a negative correlation between educational level and use of scented menstrual products, indicating that educational attainment may indirectly be a risk factor for VOC intake through high scented product usage (Zota et al., 2023).

Additionally, low education in females has been identified as a causal risk factor for endometrial cancer, specifically for EC with endometrioid histology (Wang et al., 2022). This study aims to identify how low education is linked to a higher risk of endometrial cancer by examining scented menstrual product usage in this population. Low educational attainment is correlated with increased rates of obesity and diabetes, risk factors for endometrial cancer, which may partially explain why low education is a causal risk factor for EC (Wang et al., 2022). This study identifies VOC absorption via scented menstrual product usage as another possible explanatory factor contributing to the high risk of endometrial cancer seen in low-educated women. Ethylbenzene and styrene, contained at higher rates in scented menstrual products, are potential carcinogens that may be linked to endometrial cancer via vaginal tissue absorption. Since the cause of endometrial cancer is not clear, this paper evaluates scented menstrual product usage as a risk factor for EC, given the strong correlations between scented menstrual product usage and low education, as well as endometrial cancer and low education (Zota et al., 2023; Wang et al., 2022).

Methods

This literature review utilizes the data derived from peer-reviewed studies on PubMed relevant to endometrial cancer risk, scented menstrual product usage, volatile organic compounds, and educational level. We specifically examined the correlations between scented menstrual product usage and educational level, as well as endometrial cancer risk and educational level. We also identified specific VOCs found in scented menstrual products that may contribute to endometrial cancer risk. Only sources published in English and focused on American populations were considered. Search keywords consisted of variations of the following terms: “low education,” “scented menstrual products,” “volatile organic compounds,” and “endometrial cancer.”

Due to the limited research on the topic, only a few peer-reviewed journal articles met the criteria and were considered relevant to the research question. We analyzed the findings of these studies to determine and report the correlations and patterns in the data within the current literature.

VOCs in Menstrual Products

Of the VOCs found in menstrual products, ethylbenzene and styrene were specifically found at significantly higher rates in scented pads and tampons than in non-scented products (Lin et al., 2020). Ethylbenzene is considered a possible Group 2B carcinogen (Huff et al., 2010). Some studies on Ethylbenzene exposure via inhalation and digestion in rats have linked it to an increased prevalence of tumors in the testicles, kidneys, and head (Huff et al., 2010). Humans can absorb ethylbenzene via skin contact with consumer products, though no studies on humans or animals have been conducted regarding possible health effects via vaginal exposure (Vermont Department of Health, 2018; National Library of Medicine, n.d.). Styrene is a possible Group 2A carcinogen and can also be absorbed through skin contact (Centers for Disease Control and Prevention, 2023; National Institute of Environmental Health Sciences, 2025). No research exists examining vaginal absorption due to the lack of funding for research on women’s reproductive and gynecologic health (Sciences et al., 2024). It has been mainly found to be associated with lymphohematopoietic cancers, though evidence is limited (National Institute of Environmental Health Sciences, 2025). Although there is limited research on ethylbenzene and styrene causing endometrial cancer specifically, styrene is absorbed via skin contact, supporting our hypothesis that permeable vaginal tissues may have increased susceptibility to these VOCs. Furthermore, we attribute ethylbenzene and styrene, found at higher concentrations in scented menstrual products, to endometrial cancer specifically due to the high incidence of endometrial cancer in low-educated women and the fact that low-educated women use scented products at higher rates.

Endometrial Cancer Risk

A 2022 study found a causal relationship between educational attainment and the development of endometrial cancer via genetic evidence. Specifically, a 4.2-year increase in educational attainment is correlated with a 38% decrease in endometrial cancer risk (Wang et al., 2022). This correlation was found by examining genetic variants that are statistically associated with higher educational attainment, and it was found that genetic predisposition to more years of education resulted in lower risk for endometrial cancer (Wang et al., 2022). Genetic variants associated with higher educational levels were also found to be correlated with lower risk of obesity and diabetes, as well as high waist-to-hip ratio, factors which may contribute to the correlation between educational level and endometrial cancer (Wang et al., 2022). Since low-educated females have increased endometrial cancer risk, this specific demographic is of interest in our study.

Scented Menstrual Product Usage

Interestingly, the low-educated female population also has higher rates of scented menstrual product usage than women with higher levels of education. A 2023 study examined differences in rates of scented and unscented menstrual product utilization amongst women of different races and educational backgrounds (Zota et al., 2023). We focused specifically on analyzing the rates of scented versus non-scented product usage in relation to educational attainment status, as low-educated females are our population of interest, given their high endometrial cancer risk. The education levels consisted of the following: 1) high school diploma or less (N = 130), 2) some college, technical school, or associate degree (N = 226), and 3) bachelor’s degree or greater (N = 297). Their data demonstrated a negative correlation between education level and scented menstrual product usage. Regarding scented pad utilization, women who achieved a high school diploma or less reported the highest rates of use at 17.7%, followed by women with an associate degree or some college at 11.1%, with women who have a Bachelor’s degree or greater in last place at 6.4%. Similarly, the usage rates of scented tampons followed the same order of education levels, with 7.7%, 4.9%, and 3.0% usages (Zota et al., 2023). The data therefore suggests that a correlation between lower educational attainment and use of scented menstrual products may exist.

Since low-educated females use scented menstrual products at higher rates than those with higher educational levels and have a high risk of endometrial cancer, there may be a potential correlation between scented product use and endometrial cancer risk in the low-educated female demographic. Additionally, given that ethylbenzene and styrene are potential carcinogens that can be absorbed via scented menstrual products, we have strong evidence to support our proposed correlation.

Discussion

The recent discovery of VOCs in menstrual products, with high concentrations in the fragrance of scented products, is a concerning development in the field of women’s reproductive health. The finding that these chemicals may be absorbed in female vaginal tissues at rates that exceed health thresholds is concerning, especially due to ethylbenzene and styrene being carcinogenic (Zota et al., 2023). As the most common gynecological malignancy in American women, endometrial cancer must be further researched to determine its precise cause and increase preventative measures. Although some risk factors have been identified for endometrial cancer, scented pad usage is another potential factor that has not yet been considered. Due to the possible positive correlation between the use of scented menstrual products and the increased prevalence of endometrial cancer in low-educated women, scented menstrual products could feasibly be considered a potential risk factor for endometrial cancer.

Regarding limitations, there are other factors associated with low-educated individuals that are also established risk factors of endometrial cancer, such as obesity, diabetes, and high waist-to-hip ratio (Wang et al., 2022). The correlations that form the basis of our study are largely underresearched, with few journal articles found to support the correlations between scented menstrual product usage, low educational attainment, and endometrial cancer risk. Furthermore, the lack of studies also prevents any ability to cross-compare data and methodology across literature, and look for consistent results amongst similar papers. Thus, the review’s conclusions are not drawn from a well-established research base, so more studies are needed to support these correlations and consequently strengthen our argument that the use of scented menstrual products in low-educated females contributes to their high risk of endometrial cancer. Additionally, no research exists regarding the rates of absorption of ethylbenzene and styrene through female human reproductive tissue. Any conclusions regarding the potential carcinogenic effects of the chemical compounds were through inhalation, dermal contact, and ingestion in animals and humans (Huff et al., 2010; Vermont Department of Health, 2018; National Institute of Environmental Health Sciences, 2025). Therefore, it remains unclear the specific effects of the chemical on human health via vaginal absorption, and even less so if the chemicals could be a causal factor for endometrial cancer, so more research is needed to more definitively draw these conclusions.

Conclusion

By synthesizing the correlations between educational attainment and endometrial cancer risk as well as educational attainment and scented menstrual product usage, we have found a potential correlation between scented menstrual product use and endometrial cancer risk in low-educated women. Our argument can be supported by the fact that scented menstrual products contain high levels of ethylbenzene and styrene, potential carcinogens that can be absorbed at high rates by highly permeable vaginal tissue via menstrual product utilization. However, the current research is insufficient to prove our proposed correlation between the two factors.

Future studies should examine the effects of specific VOCs such as ethylbenzene and styrene on female human reproductive health, with a focus on absorption rates via menstrual product usage. Additionally, future research must identify if VOCs have significant carcinogenic effects at the levels absorbed via dermal contact. Determining the precise effects of VOCs on women’s health will provide insight into the extent to which scented menstrual products are contributing to endometrial cancer in low-educated women, who most commonly use these products. Determining if scented menstrual product usage is a risk factor for EC is an important step towards determining the cause of endometrial cancer and identifying more preventative measures to decrease EC rates. Future research should also focus on other demographics beyond low-educated women in order to decrease the prevalence of known confounding factors, such as obesity and diabetes, that are established causal factors to EC and are highly associated with low education (Wang et al., 2022). This approach could more clearly determine whether scented menstrual product usage independently could lead to EC development, which is a necessity before implementing preventative interventions, especially in low-educated women with a genetic predisposition for the disease. Therefore, an increased focus on women’s reproductive health and public health research in the United States is required to develop effective preventative measures and treatments for endometrial cancer. The results can lead to a greater focus on creating safety standards that regulate the presence of VOCs in consumer products to safe levels.