Are Feminine Products HSA Eligible? Menstrual Items and Cramp Meds

Feminine hygiene products used for menstruation are HSA eligible. The CARES Act of 2020 permanently added tampons, pads, liners, cups, sponges, and similar menstrual care products to the federal definition of qualified medical expenses, so you can pay for them with pre-tax HSA dollars for any purchase made on or after January 1, 2020.¹ The change is not temporary, and it applies to Flexible Spending Accounts and Health Reimbursement Arrangements as well.

Which Menstrual Products Qualify

The IRS describes the eligible category as “tampons, pads, liners, cups, sponges, or other similar products.”¹ In practice, that covers both disposable and reusable options:

Tampons of any absorbency or applicator type, adhesive pads, and panty liners.
Menstrual cups, menstrual discs, and reusable period sponges.
Period underwear with built-in absorbent layers designed for menstrual use. The IRS has not issued a specific ruling on period underwear, but most HSA administrators treat it as eligible under the “other similar products” language in the statute.

The working test is purpose. A product designed and marketed to manage menstruation qualifies. A general undergarment that happens to be absorbent does not.

Feminine Care Items That Are Not Eligible

Plenty of things sold in the same aisle fall outside the definition. General hygiene and personal care items stay ineligible even when they’re branded for women or shelved next to menstrual products:

Feminine washes, wipes, and sprays are classified as personal hygiene, not menstrual care.
Deodorants and body powders are general toiletries regardless of branding.
Daily multivitamins and general PMS supplements taken for overall wellness don’t qualify. A supplement a doctor prescribes to treat a diagnosed medical condition may qualify with documentation of medical necessity.

Spending HSA money on an ineligible item has real consequences. The amount is added to your taxable income for the year, and you owe an additional 20 percent penalty tax on top of that.² The penalty stops applying at age 65 or if you become disabled. When a product is a close call, pay out of pocket.

Pain Relievers for Cramps

The CARES Act also removed the prescription requirement for over-the-counter medications bought with HSA, FSA, or HRA funds.¹ Ibuprofen, acetaminophen, naproxen, and combination products like Midol can be purchased with HSA dollars without a doctor’s note. If cramp relief is a monthly expense for you, it comes from the same tax-advantaged account as the products themselves.

How to Pay and What to Keep

You have two ways to use HSA funds. You can pay directly with your HSA debit card at checkout; many pharmacies and large retailers have systems that flag eligible items automatically. If a retailer’s system doesn’t recognize the product, the card may be declined even though the item qualifies. That’s a retailer limitation, not an IRS one.

The alternative is to pay out of pocket and reimburse yourself later through your HSA administrator’s website or app. There is no deadline for that reimbursement. You can pay today and reimburse yourself months or years later, as long as the expense was incurred after you opened the HSA.³

Whichever method you use, the IRS requires you to keep records showing every distribution went to a qualified medical expense.³ Save itemized receipts that show:

The merchant name and date of purchase.
A product description specific enough to identify the item (for example, “tampons” or “menstrual cups”), not a generic line like “pharmacy item.”
The amount paid, including sales tax.

You don’t submit these with your return. You need to produce them if the IRS audits you or your administrator asks for verification. The general retention period is three years after you file the return for the year the distribution was made.⁴ Photographing receipts into a folder organized by tax year is enough.

FSAs and HRAs Work the Same Way

The CARES Act change wasn’t limited to HSAs. Menstrual care products and over-the-counter medications are reimbursable from Health FSAs and HRAs on the same terms.¹ The key difference is that FSAs generally follow a use-it-or-lose-it rule. If you have FSA dollars left near the end of the plan year, stocking up on menstrual products is a straightforward way to spend them before they expire. HSA balances, by contrast, roll over indefinitely.

1
Internal Revenue Service. IRS Outlines Changes to Health Care Spending Available Under CARES Act
2
Office of the Law Revision Counsel. 26 U.S. Code 223 – Health Savings Accounts
3
Internal Revenue Service. Publication 969 (2025), Health Savings Accounts and Other Tax-Favored Health Plans
4
Internal Revenue Service. How Long Should I Keep Records