Cosmetics & Personal Care Products and Women’s Health: A Closer Look at Menstruation, Fibroids, Endometriosis, and Reproductive Health

Hormones play important roles in every stage of women’s lives, affecting our maturation and how our reproductive system works. The way hormones function, as they travel around your body via the endocrine system, is harmed by exposure to “endocrine-disrupting chemicals” (EDCs). Toxic chemicals and EDCs interfere with the endocrine system’s functioning and include chemicals like Bisphenol A (BPA), phthalates, per- and polyfluoroalkyl substances (PFAS), polychlorinated biphenyls (PCBs), and dioxins.1 EDCs are found in food and food packaging; in the environment, in water and soil; and in personal care products like cosmetics, hair products, and lotions. 

Exposure to EDCs can disrupt a person’s hormone balance and contribute to a variety of health problems. For women, these include early puberty, menstrual irregularities, endometriosis, fibroids, and other health problems. Scientists suspect that prenatal exposures to phthalates and other toxic chemicals may set the stage for gynecological disorders and make women more sensitive to other chemicals that impair fertility. 

In 2013, the American College of Obstetricians and Gynecologists’ (ACOG) Committee on Health Care for Underserved Women, and the American Society for Reproductive Medicine’s (ASRM) Practice Committee, released a committee opinion highlighting emerging clinical and scientific advances from the previous 15 years. The document described that “preconception and prenatal exposure to toxic environmental agents can have a profound and lasting effect on reproductive health across the life course.” 2 The opinion urged clinicians to identify and reduce patients’ exposure to toxic environmental chemicals, based on “sufficiently robust” evidence linking them to adverse reproductive and developmental health outcomes. 3

This report highlights the research on EDCs and toxic chemicals in cosmetics and other personal care products, and describes the negative impact these products may have on women’s health. It also emphasizes the ways in which Black women are at increased risk of exposure to EDCs and associated health problems, including uterine fibroids. 

Any proposal to address the health disparities and negative outcomes experienced by women, and Black women specifically, must consider exposure to EDCs and toxic chemicals from cosmetics and personal care products. 

Sources of EDCs and Toxic Chemicals

Cosmetics, hair products, and intimate care products are loaded with toxic chemicals, including EDCs. Black women use larger amounts of cosmetics and personal care products than white women do, because of structural racism and its long-lasting influence on societal and cultural norms and beauty standards. For example, Eurocentric beauty standards often place value on straight hair styles, and discriminate against natural hair styles in workplaces and educational settings. In turn, this contributes to Black women’s increased use of hair products, including straighteners. In addition, myths and stereotypes that are rooted in racism about Black women’s bodies affect their product consumption. Twice as many Black women douche and deodorize compared to white women.4

Hair products and intimate care products are loaded with toxic chemicals, including EDCs. Hair products marketed to Black women and girls often contain harsh and harmful chemicals including EDCs, carcinogens, neurotoxins, and allergens. These products include, for example, oils, conditioners, shampoos, relaxers and other hair straighteners (perms) that chemically alter hair’s texture. Lye-based relaxers contain sodium hydroxide, while “no-lye” relaxers contain calcium hydroxide and guanidine carbonate.5

The use of these products has been linked with greater body burden of chemicals for women in general, and Black women in particular. For example, a George Washington University study found that, compared to white women, Black women had higher exposures to specific phthalates because they used vaginal douches more often.6 This study found that vaginal douching may increase exposure to DEP and contribute to racial/ethnic disparities in DEP exposure. Another study found that Black women have significantly higher levels of phthalates than white women—a whopping 48 percent higher.7

A study analyzing data from the National Health and Nutrition Examination Survey (NHANES) found that Black girls aged 6–11 had mono-ethyl phthalate levels twice those of children of other racial/ethnic groups.8 Another study found that American and African-Caribbean women were more likely to be exposed to hormonally-active chemicals—like placenta and parabens—in hair products.9 

The Black Women’s Health Study, which surveyed 59,000 pre-menopausal Black women, asked about the use of chemical hair straighteners, including when the woman first used straighteners, how often they used them, how many scalp burns they experienced, and the type of formulas they used.10 Almost all of the women surveyed (94%) reported having used hair relaxers for at least 1 year.11 One-third (32.6%) of the women who reported using hair relaxers did so frequently, seven or more times per year.12 The EDCs in these products appear to impact Black women’s development, and their risk of reproductive problems including fibroids and endometriosis, as described below.

EDCs, Toxic Chemicals, & the Effect on Menarche & Menstruation 

The timing of puberty may have a profound impact on women’s later health. Studies have demonstrated that the timing of puberty is associated with diabetes, cardiovascular disease, the development of fibroids, breast cancer, and other adverse health outcomes in women.13 Menarche—when a young woman gets her first period—is considered one of the defining events of puberty and reflects the onset of sexual maturity.14 In the U.S., the average age of menarche is 13.8 years; however, menarche varies by factors that include race and ethnicity—it can occur as young as 9 or as old as 18. 15 Studies have found that Black girls are more likely to reach menarche earlier than other racial/ethnic groups in the U.S.16

Research also suggests that there may be a link between hair products containing EDCs and the timing of puberty and menarche—and, specifically, between Black girls’ use of hair care products and their earlier onset of puberty.17 In one study, women who reported using hair oil during childhood had a 4 percent increased risk of earlier menarche, adjusting for race/ethnicity and birth year. Hair perm users also had an increased risk for earlier menarche.18 In another study of 300 Black, African-Caribbean, Hispanic, and white women, those who reported using chemical hair oils and perms were 1.4 times more likely to experience early puberty and menarche, after adjusting for race, ethnicity, and birth year.19 Black women were not only more likely to use hair oils and perms but also to have experienced menarche earlier than women from other racial/ethnic groups. 20 Other studies have linked early puberty to Black girls’ use of hair detanglers.21

Exposure to EDCs from hair products may explain some variations in the timing of menarche and puberty, suggesting that use of specific types of hair products may be an important consideration when evaluating earlier age at menarche.22

EDCs, Toxic Chemicals, & the Increased Risk of Uterine Fibroids

Uterine fibroids are solid, non-cancerous tumors that develop inside the uterus.23 These tumors vary in size and shape, and generally grow very slowly. Some women with fibroids are asymptomatic, but others experience extreme discomfort.24 Symptoms include pain, pressure, lengthier menstrual cycles, heavy bleeding, constipation, and problems with urination.25 Over the long-term, fibroids can cause iron-deficiency anemia, infertility, and miscarriage. Complications from uterine fibroids can lead to maternal mortality and morbidity, an ongoing crisis especially for Black women.

In the U.S., an estimated 26 million women have uterine fibroids; more than 80 percent of Black women, and about 70 percent of white women, develop fibroids before menopause. Black women, however, have more severe symptoms and are more likely to develop early-onset uterine fibroids that grow into larger tumors, compared to women of other races/ethnicities.  

A study identified early age at menarche as a risk factor for the development of fibroids. Research that followed more than 23,000 pre-menopausal Black women from 1997 to 2009 suggests that women who got their first period early, before age 10, were also more likely to have uterine fibroids.26

Because fibroid tumors are estrogen-dependent, exposure to phthalates and other EDCs that disrupt the body’s natural estrogen production can potentially spur development of fibroids.27 28 For example, women who use hair relaxers are 1.17 times more likely to have uterine fibroids than those who do not.29 Among women who used hair relaxers frequently (7 or more times a year), the risk of developing fibroids was 1.23 times higher than that of women who used these products less often.30 The Black Women’s Health Study found that hair relaxers expose Black women to EDCs and other toxic chemicals that are absorbed through scalp lesions and/or burns caused by the products. The length of time a woman used hair relaxer treatment and the number of scalp burns she experienced were correlated with developing fibroids.31

Although not all published studies support these conclusions, there is suggestive evidence that phthalates can impact fibroid development and growth. A recent review of human and experimental evidence on EDC exposures and fibroids concluded that multiple EDCs— including certain phthalates, organophosphate esters, and parabens—are associated with fibroid risk and progression, Further, epigenetic processes may play an important role in linking EDCs to fibroid development and growth.32  The link between hair relaxers and increased fibroid risk is an important discovery, and one that may partially explain fibroids’ racial disparities.33

EDCs, Toxic Chemicals, & the Increased Risk of Endometriosis 

Endometriosis occurs when the tissue lining the uterus (endometrial tissue) grows outside of the uterus, such as on the ovaries, fallopian tubes, or intestines. With this condition, the endometrial-like tissue thickens, breaks down, and bleeds with each menstrual cycle, which can cause severe pain. Because the tissue has no way to exit the body, however, it becomes trapped. When endometriosis involves the ovaries, cysts called endometriomas may form. Surrounding tissue can become irritated, eventually developing abnormal bands of fibrous tissue that can cause pelvic tissues and organs to stick to each other (called “adhesions”) and scar tissue. 

Endometriosis may affect more than 11 percent of U.S. women between age 15 and 44.34 It is especially common among women in their 30s and 40s and may complicate efforts to get pregnant. There is a lack of data on Black women and endometriosis, but it appears that Black women are at greater risk for the condition, compared to women of other racial/ethnic groups.35

Like fibroids, endometriosis is estrogen dependent. Because EDCs mimic estrogen, they are thought to increase the risk of endometriosis as well as other reproductive and developmental problems.36 37 For example, diethyl hexyl phthalate (DEHP) is a common EDC that controls viscosity and is widely used in personal care products; stabilizers; lubricants; and softening, emulsifying, and suspending agents. Women are exposed to DEHP through cosmetics, perfumes, food packaging, medicines, and insecticides.38 A 2018 study found that women who had endometriosis had higher DEHP levels, compared to women without the condition. This finding suggests EDCs may play a role in the development of endometriosis.39

Health Problems Among High-Risk Populations 

Studies have shown that workplace exposure to toxic chemicals may impact reproductive health, including increasing the risk of miscarriage, infertility, and difficulty conceiving. As far back as 1975, researchers found that Russian factory workers who were exposed to high levels of phthalate on the job had fewer pregnancies and more miscarriages than women who were not exposed.40

Workers who are at increased risk of exposure to ECDs and subsequent health problems include cosmetologists and hair stylists, many of whom are women. Studies show that an estimated 70 percent of hair stylists will suffer from some form of work-related skin irritation during their career. 41 Long-term problems among women in these professions include higher rates of fibroids, miscarriages, and poor birth outcomes. A study of more than 12,000 women in Norway found that female hairdressers were at an increased risk for fibroids, miscarriage, and poor birth outcomes, compared to women in other professions.42 Hairdressers who worked more than 30 hours a week during their pregnancies were almost twice as likely (1.8 times) to have a low-birth-weight baby, compared to women who worked fewer than 30 hours a week.43

A North Carolina survey found that cosmetologists experienced more miscarriages compared to women who worked in other professions.44 This risk increased among women who worked in salons that used formaldehyde- and alcohol-based disinfectants.45 Another study found that women who were pregnant during cosmetology school had twice the risk of miscarriage compared to women who were not.46 And, compared with women in other professions, hairdressers are more likely to give birth to infants who are small for their age, have major malformations, and have higher rates of infant mortality.47

Policy Solutions 

The NWHN is deeply concerned about the proliferation of harsh and harmful chemicals in women’s personal care products, and the impact of untested, unregulated chemicals on women’s reproductive health. As recommended by the ACOG/ASRM, the NWHN recommends that women moderate their exposure to EDCs and other toxic chemicals that can contribute to health problems, including fibroids and endometriosis.50

Generally, the field of women’s health research is underfunded. To resolve this issue, policymakers must provide funding for studies on the long-term effects of chemicals in personal care products on health. These long-term studies should also examine women’s unique and disproportionate exposures to these products. In July 2020, Senator Kamala Harris (D-CA) introduced a bill to provide new funding for research and education on uterine fibroids.48 Representative Yvette D. Clarke (D-NY), led companion legislation (H.R. 6383) in the U.S. House of Representatives.49 The bill would provide $30 million annually from 2021 to 2025 to the National Institutes of Health (NIH) to expand uterine fibroids research; create a uterine fibroids public education program through the Centers for Disease Control and Prevention (CDC); expand and improve data collection on which groups are affected by uterine fibroids; and more.

In addition to funding, the NWHN is advocating for Congress to pass robust cosmetics regulation legislation. In 2019, Representative Frank Pallone introduced the Cosmetic Safety Enhancement Act (H.R.5279).51

It is imperative that cosmetic legislation address the disproportionate impact of toxic products on Black women. Any such effort will require understanding how systems of racism impact Black women’s exposure to environmental chemicals and responding to those considerations. Model legislation was passed in California in 2020: the Cosmetic Fragrance and Flavor Right to Know Act (SB 312)52 requires companies to report to a state database harmful fragrance chemicals in cosmetics, personal care, and professional salon products. 

Two laudable efforts are currently active in Congress, both supported by the NWHN. First, the Safe Cosmetics and Personal Care Products Act of 2019 (H.R. 4296) was introduced by Representative Jan Schakowsky (D-IL).53 It expands regulation of cosmetics; professional salon products; personal care products, like shampoos and body washes; and intimate care products, like douches, sprays, powders, and wipes. It also creates a grants program to support innovative alternatives to the toxic chemicals that disproportionally impact salon workers and/or communities of color. In addition, it directs the National Institutes for Environmental Health Sciences to create a grants program to support research on the marketing and sale of harmful cosmetics to women and girls of color. 

Second, for over a decade, Representative Carolyn Maloney (D-NY) has re-introduced the Robin Danielson Feminine Hygiene Product Safety Act (H.R. 3865).54 The bill directs NIH to research the impact that ingredients in menstrual products (i.e., pads, tampons, etc.) may have on women’s health. In 2015, the bill was expanded to include intimate care cosmetics, such as douches, sprays, washes, wipes and powders. Chemical exposure from these vaginally applied cosmetics could have significant reproductive health impacts, which should be thoroughly investigated.

The NWHN provides educational resources on the dangers of toxic chemicals in cosmetics to help women and consumers make safe choices.55 We urge women to use other resources, as well. We support the Environmental Working Group’s Skin Deep Database, which allows users to search ingredients, products, and brands in order to assess their safety.56 Similarly, the California Safe Cosmetics Program hosts a cosmetics product database, which discloses any chemicals in cosmetic products that are known to cause cancer or reproductive harms.57

The NWHN is working to broaden the analysis about reproductive health to include an assessment of the way that toxic chemicals in personal care products may result in adverse health outcomes. 

M. Isabelle Chaudry, Esq. is the National Women’s Health Network’s Senior Policy Manager. She thanks Dr. Ami Zota, Associate Professor, Department of Environmental & Occupational Health at the George Washington University Milken School of Public Health for her excellent assistance with this article. In addition, Jamie McConnel, Deputy Director, Women’s Voices for the Earth and Alexandra Gorman, Director of Research and Science, Women’s Voices for the Earth, provided insightful comments on the contents.

REFERENCES:

1 Ahmad, G., Nazir, S., Usman, Z., Imran, M., & Lone, K. (2018). Women diagnosed with endometriosis show high serum levels of diethyl hexyl phthalate. Journal of Human Reproductive Sciences, 11(2), 131.

2 “Exposure to Toxic Environmental Agents.” (2013). The American College of Obstetricians and Gynecologists. 575. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2013/10/exposure-to-toxic-environmental-agents

3 "Exposure to Toxic Environmental Agents.” (2013). The American College of Obstetricians and Gynecologists. 575. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2013/10/exposure-to-toxic-environmental-agents. 

4 Branch, F., Woodruff, T. J., Mitro, S. D., Zota, A. R. (2015). Vaginal Douching and Racial/Ethnic Disparities in Phthalates Exposures Among Reproductive-Aged Women: National Health and Nutrition Examination Survery 2001-2004. Environmental Health, 14(57). https://ehjournal.biomedcentral.com/articles/10.1186/s12940-015-0043-6

5 Helm, Jessica S., et al. "Measurement of endocrine disrupting and asthma-associated chemicals in hair products used by Black women." Environmental research 165 (2018): 448-458.

6 Branch, F., Woodruff, T. J., Mitro, S. D., Zota, A. R. (2015). Vaginal Douching and Racial/Ethnic Disparities in Phthalates Exposures Among Reproductive-Aged Women: National Health and Nutrition Examination Survery 2001-2004. Environmental Health, 14(57). https://ehjournal.biomedcentral.com/articles/10.1186/s12940-015-0043-6

7 Branch, F., Woodruff, T. J., Mitro, S. D., Zota, A. R. (2015). Vaginal Douching and Racial/Ethnic Disparities in Phthalates Exposures Among Reproductive-Aged Women: National Health and Nutrition Examination Survery 2001-2004. Environmental Health, 14(57). https://ehjournal.biomedcentral.com/articles/10.1186/s12940-015-0043-6 

8 James-Todd, T., Terry, M. B., Rich-Edwards, J., Deierlein, A., & Senie, R. (2011). Childhood Hair Product Use and Earlier Age at Menarche in a Racially Diverse Study Population: A Pilot Study. Annals of Epidemiology, 21(6), 461-465. https://doi.org/10.1016/j.annepidem.2011.01.009

9 James-Todd, T., Senie, R., Terry, M.B. (2012). Racial/Ethnic Differences in Hormonally-Active Hair Product Use: a Plausible Risk Factor for Health Disparities. J Immigrant Minor Health, 14(3), 506-11. https://pubmed.ncbi.nlm.nih.gov/21626298/

10 Wise, L. A., Palmer, J. R., Reich, D., Cozier, Y. C., & Rosenberg, L. (2012). Hair Relaxer Use and Risk of Uterine Leiomyomata in African-American Women. American Journal of Epidemiology, 175(5), 432-440. https://doi.org/10.1093/aje/kwr351

11 Wise, L. A., Palmer, J. R., Reich, D., Cozier, Y. C., & Rosenberg, L. (2012). Hair Relaxer Use and Risk of Uterine Leiomyomata in African-American Women. American Journal of Epidemiology, 175(5), 432-440. https://doi.org/10.1093/aje/kwr351

12 Wise, L. A., Palmer, J. R., Reich, D., Cozier, Y. C., & Rosenberg, L. (2012). Hair Relaxer Use and Risk of Uterine Leiomyomata in African-American Women. American Journal of Epidemiology, 175(5), 432-440. https://doi.org/10.1093/aje/kwr351

13 Day, F. R., Elks, C. E., Murray, A., Ong, K. K., Perry, J. R.B. (2015). Puberty timing associated with diabetes, cardiovascular disease and also diverse health outcomes in men and women: the UK Biobank study. Scientific Reports. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4471670/

14 Flaws, J. A., & Hirshfield, A. N. (2000). Environmental Exposures and Women's Reproductive Health. Science Direct. Retrieved July 21, 2020, from https://www.sciencedirect.com/topics/medicine-and-dentistry/menarche

15 James-Todd, T., Terry, M. B., Rich-Edwards, J., Deierlein, A., & Senie, R. (2011). Childhood Hair Product Use and Earlier Age at Menarche in a Racially Diverse Study Population: A Pilot Study. Annals of Epidemiology, 21(6), 461-465. https://doi.org/10.1016/j.annepidem.2011.01.009

16 James-Todd, T., Terry, M. B., Rich-Edwards, J., Deierlein, A., & Senie, R. (2011). Childhood Hair Product Use and Earlier Age at Menarche in a Racially Diverse Study Population: A Pilot Study. Annals of Epidemiology, 21(6), 461-465. https://doi.org/10.1016/j.annepidem.2011.01.009

17 James-Todd, T., Terry, M. B., Rich-Edwards, J., Deierlein, A., & Senie, R. (2011). Childhood Hair Product Use and Earlier Age at Menarche in a Racially Diverse Study Population: A Pilot Study. Annals of Epidemiology, 21(6), 461-465. https://doi.org/10.1016/j.annepidem.2011.01.009

18  James-Todd, T., Terry, M. B., Rich-Edwards, J., Deierlein, A., & Senie, R. (2011). Childhood Hair Product Use and Earlier Age at Menarche in a Racially Diverse Study Population: A Pilot Study. Annals of Epidemiology, 21(6), 461-465. https://doi.org/10.1016/j.annepidem.2011.01.009 

19  James-Todd, T., Terry, M. B., Rich-Edwards, J., Deierlein, A., & Senie, R. (2011). Childhood Hair Product Use and Earlier Age at Menarche in a Racially Diverse Study Population: A Pilot Study. Annals of Epidemiology, 21(6), 461-465. https://doi.org/10.1016/j.annepidem.2011.01.009

20 James-Todd, T., Terry, M. B., Rich-Edwards, J., Deierlein, A., & Senie, R. (2011). Childhood Hair Product Use and Earlier Age at Menarche in a Racially Diverse Study Population: A Pilot Study. Annals of Epidemiology, 21(6), 461-465. https://doi.org/10.1016/j.annepidem.2011.01.009

21 Flint, N. N., & Adewumi, T. (2016). Natural Evolutions One Hair Story (M. Merchant & J. Robinson Flint, Eds.). Black Women for Wellness. http://www.bwwla.org/wp-content/uploads/2016/03/One-Hair-Story-Final-small-file-size-3142016.pdf

22 James-Todd, T., Terry, M. B., Rich-Edwards, J., Deierlein, A., & Senie, R. (2011). Childhood Hair Product Use and Earlier Age at Menarche in a Racially Diverse Study Population: A Pilot Study. Annals of Epidemiology, 21(6), 461-465. https://doi.org/10.1016/j.annepidem.2011.01.009

23 Johnson, L. (2016, January 12). Uterine Fibroids vs. Endometriosis. Fibroid Treatment Collective. Retrieved July 6, 2020, from https://fibroids.com/blog/health-information/uterine-fibroids-vs-endometriosis/

24 Johnson, L. (2016, January 12). Uterine Fibroids vs. Endometriosis. Fibroid Treatment Collective. Retrieved July 6, 2020, from https://fibroids.com/blog/health-information/uterine-fibroids-vs-endometriosis/

25 Johnson, L. (2016, January 12). Uterine Fibroids vs. Endometriosis. Fibroid Treatment Collective. Retrieved July 6, 2020, from https://fibroids.com/blog/health-information/uterine-fibroids-vs-endometriosis/

26 Wise, L. A., Palmer, J. R., Reich, D., Cozier, Y. C., & Rosenberg, L. (2012). Hair Relaxer Use and Risk of Uterine Leiomyomata in African-American Women. American Journal of Epidemiology, 175(5), 432-440. https://doi.org/10.1093/aje/kwr351 

27 Ndinge, C. (2019, July 20). Study reveals that Black women who use chemical hair relaxers are at a higher risk of having fibroids! Tendances People Mag. Retrieved July 11, 2020, from https://tendancespeoplemag.com/en/study-reveals-that-black-women-who-use-chemical-hair-relaxers-are-at-a-higher-risk-of-having-fibroids

28 Information about Uterine Fibroids from Acessa Health. (2020, July 8). Acessa Health. Retrieved July 23, 2020, from https://www.easybib.com/mla8/website-citation/eval

29 Wise, L. A., Palmer, J. R., Reich, D., Cozier, Y. C., & Rosenberg, L. (2012). Hair Relaxer Use and Risk of Uterine Leiomyomata in African-American Women. American Journal of Epidemiology, 175(5), 432-440. https://doi.org/10.1093/aje/kwr351

30 Wise, L. A., Palmer, J. R., Reich, D., Cozier, Y. C., & Rosenberg, L. (2012). Hair Relaxer Use and Risk of Uterine Leiomyomata in African-American Women. American Journal of Epidemiology, 175(5), 432-440. https://doi.org/10.1093/aje/kwr351

31 Wise, L. A., Palmer, J. R., Reich, D., Cozier, Y. C., & Rosenberg, L. (2012). Hair Relaxer Use and Risk of Uterine Leiomyomata in African-American Women. American Journal of Epidemiology, 175(5), 432-440. https://doi.org/10.1093/aje/kwr351

32 Zota, A.R., Geller, R.J., VanNoy, B.N., Marfori, C.Q., Tabbara, S., Hu, L.Y., Baccarelli, A.A., Moawad, G.N. (2020). Phthalate Exposures and MicroRNA Expression in Uterine Fibroids: The FORGE Study. Environmental and Nutritional Epigenetics, 13. https://journals.sagepub.com/doi/full/10.1177/2516865720904057; Zota, A.R., Geller, R.J., Calafat, A.M., Marfori, C.Q., Baccarelli, A.A., Moawad, G.N. (2018). Phthalates Exposure and Uterine Fibroid Burden Among Women Undergoing Surgical Treatment for Fibroids: a Preliminary Study. Retrieved October 7, 2020 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6321778/

33 Ndinge, C. (2019, July 20). Study reveals that Black women who use chemical hair relaxers are at a higher risk of having fibroids! Tendances People Mag. Retrieved July 11, 2020, from https://tendancespeoplemag.com/en/study-reveals-that-black-women-who-use-chemical-hair-relaxers-are-at-a-higher-risk-of-having-fibroids

34 “Endometriosis." Office on Women’s Health, U.S. Department of Health and Human Services. Page last updated April 1, 2019. https://www.womenshealth.gov/a-z-topics/endometriosis 

35 Shade, G.H., Lane, M. & Diamond, M.P. Endometriosis in the African American woman—racially, a different entity?. (2012). Gynecol Surg 9, 59–62. https://link.springer.com/article/10.1007/s10397-011-0685-5. 

36 Oransay, S. (2018, September 25). Cosmetics and some household products could be responsible for worsening endometriosis. EndoNews. Retrieved July 11, 2020, from https://www.endonews.com/cosmetics-and-some-household-products-could-be-responsible-for-worsening-endometriosis

37 Ribeiro, M. A., & Scarano, W. R. (2016). Endocrine Disruptors in Endometriosis. Global Journal of Medical Research, 16(3). https://globaljournals.org/GJMR_Volume16/4-Endocrine-Disruptors-in-Endometriosis.pdf

38 Ahmad, G., Nazir, S., Usman, Z., Imran, M., & Lone, K. (2018). Women diagnosed with endometriosis show high serum levels of diethyl hexyl phthalate. Journal of Human Reproductive Sciences, 11(2), 131. https://doi.org/10.4103/jhrs.JHRS_137_17

39 Ahmad, G., Nazir, S., Usman, Z., Imran, M., & Lone, K. (2018). Women diagnosed with endometriosis show high serum levels of diethyl hexyl phthalate. Journal of Human Reproductive Sciences, 11(2), 131. https://doi.org/10.4103/jhrs.JHRS_137_17

40 Davis, B.J., Maronpot, R.R., Heindel, J.J. Di-(2-ethylhexyl) phthalate suppresses estradiol and ovulation in cycling rats. Toxicology Applied Pharmacology, 128(2), 216-23. https://pubmed.ncbi.nlm.nih.gov/7940536/. 

41 Flint, N. N., & Adewumi, T. (2016). Natural Evolutions One Hair Story (M. Merchant & J. Robinson Flint, Eds.). Black Women for Wellness. http://www.bwwla.org/wp-content/uploads/2016/03/One-Hair-Story-Final-small-file-size-3142016.pdf

42 Flint, N. N., & Adewumi, T. (2016). Natural Evolutions One Hair Story (M. Merchant & J. Robinson Flint, Eds.). Black Women for Wellness. http://www.bwwla.org/wp-content/uploads/2016/03/One-Hair-Story-Final-small-file-size-3142016.pdf

43 Flint, N. N., & Adewumi, T. (2016). Natural Evolutions One Hair Story (M. Merchant & J. Robinson Flint, Eds.). Black Women for Wellness. http://www.bwwla.org/wp-content/uploads/2016/03/One-Hair-Story-Final-small-file-size-3142016.pdf

44 Flint, N. N., & Adewumi, T. (2016). Natural Evolutions One Hair Story (M. Merchant & J. Robinson Flint, Eds.). Black Women for Wellness. http://www.bwwla.org/wp-content/uploads/2016/03/One-Hair-Story-Final-small-file-size-3142016.pdf

45 John, E. M., Savitz, D. A., & Shy, C. M. (1994). Spontaneous Abortions among Cosmetologists. Epidemiology, 5(2), 147-155. https://doi.org/10.1097/00001648-199403000-00004. 

46 Flint, N. N., & Adewumi, T. (2016). Natural Evolutions One Hair Story (M. Merchant & J. Robinson Flint, Eds.). Black Women for Wellness. http://www.bwwla.org/wp-content/uploads/2016/03/One-Hair-Story-Final-small-file-size-3142016.pdf

47 Flint, N. N., & Adewumi, T. (2016). Natural Evolutions One Hair Story (M. Merchant & J. Robinson Flint, Eds.). Black Women for Wellness. http://www.bwwla.org/wp-content/uploads/2016/03/One-Hair-Story-Final-small-file-size-3142016.pdf

48 Kamala D. Harris, U.S. Senator for California. (2020). Harris Introduces Legislation to Support Uterine Fibroids Research and Education. https://www.harris.senate.gov/news/press-releases/harris-introduces-legislation-to-support-uterine-fibroids-research-and-education  

49 H.R. 6383-Uterine Fibroid Research and Education Act of 2020. https://www.congress.gov/bill/116th-congress/house-bill/6383/text 

50 Kamala D. Harris, U.S. Senator for California. (2020). Harris Introduces Legislation to Support Uterine Fibroids Research and Education. https://www.harris.senate.gov/news/press-releases/harris-introduces-legislation-to-support-uterine-fibroids-research-and-education  

51 H.R. 5279-Cosmetic Safety Enhancement Act of 2019. https://www.congress.gov/bill/116th-congress/house-bill/5279/text 

52 SB-312-Cosmetic Fragrance and Flavor Ingredient Right to Know Act of 2020. https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200SB312

53 H.R. 4296-Safe Cosmetics and Personal Care Products Act of 2019. https://www.congress.gov/bill/116th-congress/house-bill/4296/text?r=203&s=1 

54 H.R. 4296-Safe Cosmetics and Personal Care Products Act of 2019. https://www.congress.gov/bill/116th-congress/house-bill/3865

55 Toxic Cosmetics and Personal Care Products. The National Women’s Health Network. https://nwhn.org/unsafe-cosmetics-2/ 

56  EGW's Skin Deep Cosmetics Database. https://www.ewg.org/skindeep/

57 California Safe Cosmetics Program Product Database. https://cscpsearch.cdph.ca.gov/search/publicsearch