Women managed menstruation for thousands of years before the modern tampon arrived in the 1930s, using everything from softened plant fibers to folded linen rags to specially designed belts and aprons. The methods varied widely by era and culture, but the basic challenge was always the same: absorb or contain menstrual blood with whatever materials were available.
Ancient Plant-Based Absorbents
The earliest known menstrual products were made from plants. In ancient Egypt, women used softened papyrus, a grass-like aquatic plant, shaped into an absorbent insert that functioned much like a primitive tampon. Indigenous women in North America used dried moss, which was also a common diapering material, or pieces of cloth that became widely available through trade networks by the 18th century. Across cultures, the pattern was similar: whatever soft, absorbent plant material grew locally became the go-to option.
The Era of Rags and “Bleeding on Clothes”
For much of European history, menstrual management was far simpler than most people assume. Historian Sara Read has concluded that during the medieval period, most women just bled onto their clothing. Rags placed between the thighs or attached to clothing were also used, but dedicated menstrual products were not universal. Many women, especially those doing physical labor, simply wore dark skirts and washed them later.
The word “on the rag,” still sometimes used as slang, traces directly back to this practice. Women who did use cloth typically folded linen into a rectangular pad and fastened it to a cord tied around the waist. A 1911 German medical manual included step-by-step illustrations showing exactly how to fold fabric into a menstrual pad and secure it with a waistband, suggesting this method persisted well into the early 20th century. These cloth pads needed to be washed and fully dried between uses, a task that carried its own social weight. Even today, research in rural communities shows deep stigma around the visible drying of menstrual cloths, and harmful washing practices persist despite educational efforts.
Victorian Belts and Sanitary Aprons
The 19th century brought the first commercially marketed menstrual products, though they look nothing like what exists today. Manufacturers developed a market for specialized menstrual clothing, including belts that held fabric pads in place and “sanitary aprons,” which were rubberized garments worn over the buttocks to prevent leakage onto chairs and clothing when sitting down. These aprons were practical responses to a real problem: women participating in public life, attending church, visiting, or working outside the home needed protection that rags alone couldn’t reliably offer.
The belt-and-pad system became the dominant approach for decades. A fabric pad clipped onto an elastic belt worn around the hips, holding the absorbent material in place without pinning it to undergarments. Women who came of age before the 1970s often remember these belts vividly, as they remained common even after adhesive-backed pads were introduced.
World War I Changed Everything
The leap to disposable products came from an unexpected place: battlefield medicine. During World War I, manufacturers developed cellucotton, a wood pulp product with a cotton-like texture, for use in surgical bandages. Nurses at the front quickly realized the material worked well for menstrual absorption too. After the war ended, Kimberly-Clark repurposed the technology and launched Kotex in 1921, the first commercially available disposable sanitary pad. It used the same cellucotton wrapped in a gauze sheath that had been designed for wartime wounds.
Kotex pads were a revolution, but adoption was slow. Buying them required asking a pharmacist, which many women found mortifying. Stores eventually set up self-service displays where customers could leave money in a box and take the product without speaking to anyone.
The First Modern Tampon
The internal tampon as we know it came from Dr. Earle Haas, who filed a patent for an applicator-style tampon on November 19, 1931, and received it by 1933. He then sold the patent to businesswoman Gertrude Tendrich for $32,000. Tendrich started by sewing tampons at home before scaling up production and creating Tampax, the first commercial tampon brand. Internal menstrual products existed in concept long before Haas (the Egyptian papyrus inserts being one example), but his design, with its cardboard applicator tube, was the version that went mainstream.
Menstrual Seclusion as Cultural Practice
Managing the physical blood was only part of the picture. In many cultures, menstruation came with social rules that shaped women’s entire routines. Among Cherokee, Creek, Choctaw, and Chickasaw nations in the American Southeast, women practiced menstrual seclusion, retreating to small huts built at a distance from the main community. British trader James Adair described these as “small huts, at considerable distance from their dwelling-houses.”
During seclusion, women did not cook for others, work in gardens or fields, or take fire from the community hearth. Some used specific utensils for eating and drinking. At the end of their period, they washed themselves before returning to shared spaces. This wasn’t necessarily punitive. The practice also encompassed looser forms of separation that allowed women to travel while maintaining the core elements of the tradition, like avoiding food preparation for others or using distinct material markers to signal their status.
Similar seclusion practices existed in cultures across the world, from Nepal’s now-banned chhaupadi tradition to menstrual taboos documented across parts of Africa and South Asia. The common thread was the belief that menstrual blood carried spiritual or physical power that needed to be contained, not just for hygiene but for cultural reasons that went far deeper.
The Health Costs of Improvisation
Without access to purpose-made products, women throughout history faced real health consequences. Poorly cleaned rags, damp cloth that wasn’t fully dried, and makeshift materials all raised the risk of reproductive and urinary tract infections. This isn’t just a historical problem. In parts of the world today where commercial products remain unaffordable, people still use newspapers, leaves, breadcrumbs, rags, or other improvised absorbents, and the infection risks remain the same as they were centuries ago.
Beyond physical health, the shame and secrecy surrounding menstruation created its own damage. Research consistently links poor menstrual hygiene to negative mental health outcomes, with people internalizing the stigma and associating their cycle with feelings of disgust or failure. The long history of hiding menstrual cloths, washing them in secret, and avoiding any public acknowledgment of periods created patterns of silence that modern advocates are still working to undo.