Toxic Shock Syndrome: What You Need to Know

Dr. Jolene BrightenPublished: Last Reviewed: Menstrual Cycle Leave a Comment

If you were taught never to leave your tampon in for too long, it's because of toxic shock syndrome (TSS). Toxic shock is a bacterial infection that can be life-threatening. It's linked to period products, although it can happen for other reasons too.

Even though it's rare, understanding why TSS happens is important, and I think more education is needed. Think of it as part of the overall foundation for learning all about your menstrual cycle.

Here I'll give you all the information you need on toxic shock syndrome: what it is, why it happens, how it's linked to your period, and most importantly, what you can do to reduce the risk it can happen to you.

What Is Toxic Shock Syndrome?

Toxic shock syndrome (TSS) is a rare, life-threatening infection caused by Staphylococcus (staph) bacteria, most commonly Staphylococcus aureus . On average, it's estimated that only about 1 to 3 people per 100,000 in the US are diagnosed with TSS each year.

Another similar health crisis can occur due to Streptococcus pyogenes (strep) bacteria, in which case it's technically called toxic shock like syndrome (TSLS) or Streptococcus toxic shock syndrome (STSS). Here, I'll use the term toxic shock syndrome interchangeably for both types because they're very similar in their causes and symptoms.

Many people have staph and other bacteria living on their bodies in places like the skin, nose, mouth, and vagina and never get sick from it. But given the right environment where staph or strep can grow and multiply and enter the bloodstream, it can become a problem. Once present in the bloodstream, the bacteria can release toxins that cause illness.

The connection between toxic shock and menstrual products blew up in the early 1980s when a super-absorbent tampon was introduced on the market that used synthetic materials not previously used in tampons. Toxic shock syndrome rates suddenly jumped, and it was later found that most of those getting sick were menstruating. Turns out the material used created the perfect breeding ground for bacteria in the vagina.

Luckily, the tampons were recalled, but this unfortunate situation helped us better understand that keeping tampons in too long is not great for anyone, especially when it comes to toxic shock risk.

How Does Toxic Shock Syndrome Happen?

This syndrome happens when staph or strep bacteria enter the bloodstream and release toxins that act like poison. 

Unfortunately, beyond that, there's not a whole lot of research or understanding on exactly why toxic shock happens or who may be more predisposed to get sick.

The main factors are that the bacteria need to replicate and enter the bloodstream. Once in the blood, the toxins stimulate an overproduction of inflammatory chemicals in your body that cause symptoms like fevers, rashes, and, if not treated, organ failure (more on symptoms below).

So, if a tampon or other menstrual product is left in the vagina for too long, it can cultivate bacterial growth that could possibly enter the bloodstream via tiny, microscopic tears on the vaginal wall. And a super-absorbent tampon makes a happy hub for bacteria to grow while also drying the vagina, which increases the chance of skin irritation or cuts.

Toxic shock syndrome doesn't only happen with menstrual products but can also be caused by open wounds, surgery, or burns (basically anything that gives the bacteria access to the bloodstream). And while we usually hear warnings about TSS and tampons, it's also associated with IUDs and menstrual cups.

Having staph or other bacteria on the skin doesn't automatically mean someone will experience toxic shock, but those with known staph infections are at an increased risk, as are immunocompromised people.

@drjolenebrighten Tampons + TSS = bacteria making toxins 🤢 #drjolenebrighten #learnontiktok #tiktokpartner #tampon #tamponchallenge ♬ Dirty Harry – Gorillaz

Toxic Shock Syndrome Symptoms

Toxic shock progresses really fast and, if not treated, can be fatal. Since symptoms can look like many other conditions or infections, it's helpful to be aware, especially if you start feeling bad quickly and are using period products.

Symptoms include:

  • Headache
  • Fatigue
  • Sore throat
  • High fever
  • Diarrhea or vomiting
  • Dizziness
  • Chills
  • Rash that resembles a sunburn on extremities
  • Body pain
  • Low blood pressure

If the condition isn't treated, it can progress to seizures, organ failure, loss of consciousness, and even death.

What about the prognosis? It turns out that streptococcal (strep) toxic shock syndrome, or STSS, can have a case fatality rate of over 50%, while non-streptococcal toxic shock syndrome (caused by staph) typically has a death rate of less than 3% per case.

However, people who have toxic shock caused by staph often get it more than once — likely because the factors that predisposed them initially still remain in place.

In both types of TSS cases, early treatment is extremely helpful in reducing the chance of death or serious lasting harm.

How to Treat Toxic Shock Syndrome

I'm not writing all of this to scare you (remember that toxic shock is super rare!), but I do want you to take it seriously. If you are even the slightest bit worried, get help immediately.

The treatment for toxic shock is powerful antibiotics to combat the bacteria, which you have to get from a physician. Fluids and other supportive care are also given to support symptoms like low blood pressure or pain.

Toxic shock syndrome is treatable if caught early, although as I mentioned, once you have TSS, you are more likely to have it again.

Once home, you can aid your healing with nutritious food and supplements to support your immune system. But this is one of those cases where antibiotics are lifesaving and necessary.

How to Prevent Toxic Shock Syndrome

Given what we know about bacterial growth and toxic shock syndrome risk, good preventive hygiene and immune support top the list for preventing TSS in the same way you would try to avoid any infection.

Here are some steps to always take when you have your period and use menstrual products to stay healthy:

Regularly Change Your Tampon or Menstrual Cup

Toxic shock risk goes up the longer you keep your tampon in because it can give the bacteria a chance to multiply. Generally, you should change your tampon every 4 to 8 hours. Keeping a tampon in longer than 8 hours increases the risk of toxic shock syndrome.

Never, ever wear a single tampon for more than 8 hours at a time.

And just like tampons, please be mindful of how long you keep your menstrual cup in. While apparently much more rare (with only one or two known cases reported in scientific journals), anything left in the vagina too long increases the risk for TSS, so be strict about limiting usage to 8 hours at the absolute most (or preferably less!) before changing and cleaning the cup.

@drjolenebrighten Are they safe? #drjolenebrighten #menstrualcup #period ♬ Hold On – Moguai,Cheat Codes

You can read more about the pros and cons of menstrual cups and my recommendations on using them here.

Use the Lowest Absorbency Tampon You Can

Use the lowest absorbency tampon that you need according to your period flow. If you can wear a single tampon for eight hours without changing it, the absorbency may be too high and you can consider going with a less absorbent product.

Try to avoid super or super plus tampons, especially overnight. If you're worried about leaking, period underwear is an option to keep your clothes and sheets clean.

Clean Your Menstrual Cup

Your menstrual cup should have clear instructions on keeping it clean between uses. Really make sure to follow the guidelines for optimal hygiene. Any remaining blood could contribute to bacterial growth and increase the risk of TSS (or other vaginal infections).

Wash Your Hands Before and After Changing Period Products

Good old-fashioned soap and water are some of your best weapons against bacteria.

Wash your hands before handling any menstrual products or touching your vagina. Hands can be a staph carrier or harbor other bacteria that you can unknowingly introduce when changing a menstrual cup or tampon, so it's best to stay on the safe side.

A good rule of thumb is to sing the chorus of your favorite song for 20 seconds while you scrub with warm water and soap.

Get Educated on Period Health

Understanding your period and the details of vaginal health can help you stay healthy and better understand your body. 

For a refresher on staying safe and insightful, holistic health tips for more pleasant and manageable periods, you can also consider taking my course or master class on these topics. 

Which Period Products are Best to Use to Avoid Toxic Shock?

Toxic shock syndrome is most closely linked to tampon use because of what happened in the 80s and because of how prevalent tampons are, but it doesn't mean they aren't safe for you to use or that they are the only way to contract TSS, as I explained earlier.

A good rule of thumb is to look for tampons made with natural materials like cotton. And as I mentioned above, really try to avoid those super tampons. If your period is really heavy and you must use them, try to be really mindful about how long you keep them in.

Are Menstrual Cups Safer Than Tampons?

There's not much actual human data, but recent bacteriological evidence suggests menstrual cups can still cause toxic shock if left in the vagina too long and aren't necessarily safer. The same hygiene factors apply to both tampons or menstrual cups. 

So it would be a mistake to assume you're safer with a cup — the truth is we aren't sure, and no one can afford to gamble on this issue. However, there are other benefits to consider, not least being environmental impact if this is something important to you.

Can You Get Toxic Shock Syndrome from Pads?

Since toxic shock is associated with increased bacteria inside the vagina, pads aren't associated with TSS since they remain outside. You can still consider the hygiene tips listed above, but it's very unlikely that using a pad can give you toxic shock syndrome.

Toxic Shock Syndrome and Menstrual Sponges 

Another option marketed as an environmentally safe alternative to tampons is the sea sponge. Sea sponges can be made synthetically or are actually creatures from the ocean. They are incredibly absorbent and reusable, just like your kitchen sponge.

But I'd wait and hold off on this one. Since sea sponges are so absorbent, they are also tough to clean and may carry old blood. All of this poses a risk for toxic shock syndrome and vaginal infections in general.

I'm all for sustainability, but this trend needs a bit more time before I can consider recommending it.

Does Toxic Shock Affect Your Hormones?

Since toxic shock is a bacterial infection, it's not linked directly to your hormones. However, any time you get really sick, it can stress your body out and affect all the body's functions.

People recovering from severe illness like TSS may notice short-term changes to their cycles like missing a period or other hormone imbalance symptoms, but it should return to normal once you've had a chance to heal.

Who Is Most at Risk for Toxic Shock Syndrome?

Remember toxic shock is rare. It can happen to anyone at any age, so good hygiene and understanding why toxic shock syndrome happens are so important. However, TSS is most commonly seen in the following populations:

  • Young women
  • Women who have just given birth
  • People with compromised immune systems
  • People with underlying health conditions

Regardless of which group you may happen to be in, you can significantly reduce your risk of toxic shock syndrome by following the advice I covered in this article — and if you suspect you may have it or are experiencing the symptoms I mentioned, seek medical attention immediately. Getting seen right away dramatically improves your odds of a healthy and safe outcome.

As with anything that has to do with your period and menstrual cycle, more knowledge is empowering.

Have you already heard about toxic shock, or is this the first time you've learned about it? Share your comments below — I love to hear your stories.

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  4. Balayla J, et al.. Streptococcal Toxic Shock Syndrome After Insertion of a Levonorgestrel Intrauterine Device. Journal of Obstetrics and Gynaecology Canada. 2019. 41(12). 1772-1774.
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About The Author

Dr. Jolene Brighten

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Dr. Jolene Brighten, NMD, is a women’s hormone expert and prominent leader in women’s medicine. As a licensed naturopathic physician who is board certified in naturopathic endocrinology, she takes an integrative approach in her clinical practice. A fierce patient advocate and completely dedicated to uncovering the root cause of hormonal imbalances, Dr. Brighten empowers women worldwide to take control of their health and their hormones. She is the best selling author of Beyond the Pill and Healing Your Body Naturally After Childbirth. Dr. Brighten is an international speaker, clinical educator, medical advisor within the tech community, and considered a leading authority on women’s health. She is a member of the MindBodyGreen Collective and a faculty member for the American Academy of Anti Aging Medicine. Her work has been featured in the New York Post, Forbes, Cosmopolitan, Huffington Post, Bustle, The Guardian, Sports Illustrated, Elle, and ABC News. Read more about me here.