What is toxic shock syndrome (TSS)?

What actually happens in TSS

Some people carry bacteria like Staphylococcus aureus on their skin or in the vagina without any trouble. Under certain conditions those bacteria release toxins into the bloodstream. In a small number of people the immune system overreacts to these toxins, blood pressure drops and organs can start to fail. That's why TSS moves quickly and needs hospital treatment, usually fluids and antibiotics.

TSS isn't only a period problem. It can also follow skin wounds, burns, surgery or childbirth, and it can affect anyone, including men and children. But the link with periods is the one most people hear about, because of tampons.

Symptoms of toxic shock syndrome

The FDA and NHS list these signs. They often look like a bad flu at first, which is why the timing (during or just after your period, with a tampon or cup in) matters so much.

• A sudden high fever, usually 102°F (38.9°C) or higher, or feeling hot, cold and shivery
• Vomiting or diarrhea
• Dizziness, or fainting or nearly fainting when you stand up
• A rash that looks like sunburn, often on the palms and soles
• Muscle aches, confusion, or skin or lips turning pale, blue or blotchy
• Peeling skin on the hands and feet, usually a week or two later

How tampons and cups are linked to TSS

Tampons don't contain the bacteria, but a high-absorbency tampon left in for a long time creates conditions where toxins build up more easily. Since super-absorbent materials were removed from the market in the 1980s and labels became standardized, tampon-related TSS has become much rarer. A large review of menstrual cups found only five reported cases of TSS linked to cups, though the true rate can't be calculated.

How to lower your risk

• Wash your hands before and after inserting a tampon, cup or disc.
• Pick the lowest absorbency you need, and lower it on lighter days. See how often to change a tampon.
• Alternate tampons with pads on light days or at night. See how often to change a pad and menstrual cup vs tampon.
• Don't use tampons for discharge between periods.
• If you've had TSS before, ask your doctor whether you should avoid tampons and cups entirely.

Knowing when your flow tends to be heavy or light makes this easier. If you track your period, you can plan which product and absorbency to use on which day, instead of guessing. It also helps to know your normal: if your periods are very heavy, that's worth a separate chat with a doctor.