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U.S. Food and Drug Administration |
This article originally appeared in the October 1991 FDA Consumer and contains revisions made in September 1997 and January 1999. |
Women taking the necessary measures to prevent menstrually-related toxic shock syndrome (TSS) can be credited with much of the reduction in the number of cases in recent years. In 1997, there were only five confirmed menstrually-related TSS cases and no deaths.
TSS is a rare but potentially fatal disease that, when related to menstruation, occurs most frequently in young women aged 15 to 24, usually in association with tampon use.
The number of confirmed menstrually-related TSS cases peaked in 1980 at 814, with 38 deaths. At that time, the national Centers for Disease Control found that 71 percent of women who developed the condition had been using Rely, a brand of highly absorbent tampons that had recently come on the market. These tampons were removed from the market, and the Food and Drug Administration and tampon manufacturers developed product labeling to help women avoid the life-threatening condition.
The incidence of menstrually-related TSS was reduced to 470, with 13 deaths, in 1981 and has continued to fall steadily since then.
TSS was first identified as a distinct disease in 1978 and also affects people who don't use tampons. It occurs in children, men, and non-menstruating women, most frequently in connection with wounds. Though scientists know there is a relationship between the development of TSS and the use of tampons, especially high-absorbency tampons, the exact connection remains unclear.
Scientists think that in order for the disease to develop, bacteria called Staphylococcus aureus must be present. These bacteria release one or more toxins (poisons) into the bloodstream. S. aureus bacteria commonly live in body areas such as the nose, skin or vagina and usually cause no problem. But the bacteria also can lead to serious infection after a deep wound or surgery or, for reasons not fully understood, during tampon use.
Keeping Your Risk Low
If you've ever had TSS, get medical advice before using tampons.
You can reduce your risk of TSS by not using tampons or by alternating between tampons and pads. Whether the benefits of using tampons--particularly high-absorbency ones--are worth the increased risk of TSS is an individual decision.
Because the TSS risk increases with tampon absorbency, if you use tampons, you should use products with the lowest absorbency that meets your needs. There's usually less need for high absorbency at the end of a menstrual period. You can find what's best for you by experimenting with different sizes and different brands, beginning with the least absorbent.
To help women compare absorbency from brand to brand, FDA requires that manufacturers use a standard test to measure absorbency and that the absorbency be stated on the label using standard terminology. When shopping for tampons, look on the packages for the following absorbency terms and ranges and then compare brands before you make your selection.
| If the package says: | The absorbency range is: |
|---|---|
| Junior Absorbency | 6 grams and under |
| Regular Absorbency | 6 to 9 grams |
| Super Absorbency | 9 to 12 grams |
| Super Plus Absorbency | 12 to 15 grams |
It also helps to:
Symptoms may not appear until the first few days after the end of your period. Be sure to explain to your doctor what your symptoms are, when your period began, and whether you've ever had TSS before. If you use tampons, mention what absorbency you use.
TSS symptoms appear quickly and are often severe. Not all cases are exactly alike, and you may not have all the symptoms. You may have aching muscles, bloodshot eyes, or a sore throat, making it seem like the flu. The sunburn-like rash may not develop until you're very ill; it may go unnoticed if it's only on a small area. Later, the skin on your palms and soles may flake or peel. A first episode may be so mild that you don't connect the symptoms with TSS, but the next time, the symptoms may be severe. Once you've had TSS, you're more likely to get it than someone who never has had it.
Deaths, though rare, tend to happen during the first week of illness. The danger lies in a sudden drop in blood pressure, which could lead to shock if not treated in time.
TSS is usually treated with antibiotics, and drugs to lower temperature, and large amounts of fluids and electrolytes (essential body chemicals) to raise lowered blood pressure. Blood and other specimens from the body are analyzed in a laboratory to identify bacteria. Antibiotics are given to help prevent recurrence. Patients often are hospitalized, and severe cases require intensive care. With proper treatment, patients generally recover within three weeks.
While TSS is rare, it's an important health concern for menstruating women, and especially young women. Knowing how to prevent it and recognizing its symptoms can do much to reduce its dangers and continue to keep its incidence low.
Dixie Farley is a staff writer for FDA Consumer. Judith Levine Willis also contributed to this article.
Early diagnosis and speedy treatment are crucial to avoiding the most serious effects of TSS.
Publication No. (FDA) 98-1196
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