What Is It?
It is a rare but life-threatening condition where bacteria that usually lives on the skin, nose or mouth go deeper into the body. They spread around the body and cause infection in places far away from where they initially penetrated. This is why you need to know about it, respect the symptoms but also not be unnecessarily scared of it. Knowledge is power.
How Often Does It Happen?
It is rare, very rare. Numbers vary between 0.8 and 3.4 of 100 000 people using menstrual cups compared to 6 to 12 people using high absorbency tampons in 19801. This number does not give extra information as to how long the cups were left in nor if some of these TSS patients had other health conditions which could make the number of cases even smaller.
How Is It Linked To Menstrual Products?
Although TSS can affect non-menstruating adults and children, a lot of people have heard about Toxic Shock Syndrome in the context of menstrual products. Specifically, high absorbency tampons which when they first came out led to a series of TSS cases. The high absorbency tampons which were behind these cases have been removed from sale. All recent studies have come to the same conclusions, that although both tampons and menstrual cups can cause TSS, they are safe products2.
How to reduce risk of TSS when using a period cup
- Wash your hands thoroughly before and after handling your menstrual cup
- Empty your menstrual cup at least every 8h.
- Keep your nails clean and short to avoid damaging your vagina walls when you insert your cup.
- Rinse the cup well inside and out every time you empty it (take a small bottle of water with you into the stall if you are in a public bathroom without individual sinks).
- Disinfect your menstrual cup after every period.
- Don’t use intravaginal menstrual products if you have had previous TSS.
- Do not use menstrual cups for vaginal discharge, or any other reason, between menstrual cycles.
- Do not use menstrual cups if you have a skin infection near your genitals.
- Wash your storage bag regularly.
When To See A Doctor
The signs and symptoms of TSS are not linked to the area where the infection may have started in your vagina. They are more general signs in other places of your body. The important point to remember is that they appear suddenly, and you quickly start to feel very unwell. You need to contact your doctor straight away even if it is in the middle of the night or go to your hospital emergency service. Do not wait to see if it will get better on its own.
- A sudden high temperature
- A sunburn-like rash all over your body
- Flu-like symptoms: sore throat, headache, cough, general aches
- Confusion, dizziness or fainting
- Difficulty breathing
Take out any menstrual products straight away.
Remember it is very rare but should you have any symptoms, don’t sit at home wondering if you may or may not have it, pick up the phone and get a medical doctor to decide if you need extra investigations. Always mention that you have been using an intravaginal menstrual product and if you have any cuts or boils in the vaginal area.
How Do You Treat TSS?
The main treatment for TSS is to monitor you and give support to your body to fight the infection. It involves giving you medications through your veins which can be antibiotics, fluids and even the purified defenses or antibodies of other people. This is always done in a hospital and sometimes in intensive care to be able to help the team looking after you be close to you and adjust the medications at all times. Extreme cases may lead to amputations, but these are the exception rather than the norm even for people who end up in a hospital.
We hope this has given you knowledge and perspective on both the low risk but also seriousness of TSS. If you have more questions concerning TSS and menstrual cups please contact us at firstname.lastname@example.org
Date last reviewed: April 2020
Written by Dr Alice Byram Bsc Med & Surg UMA MA Hons MML Cantab
Dr Alice Byram was born in England to a French-British family. Following on from a degree in Spanish from the University of Cambridge, she went to Spain to study medicine. On her return to the UK, she worked in Emergency Medicine for several years before recently returning to Barcelona.
1Hajjeh RA, Reingold A, Weil A, Shutt K, Schuchat A, Perkins BA. Toxic shock syndrome in the United States: Surveillance update, 1979- 1996. Emerg Infect Dis. 1999;
2van Eijk AM, Zulaika G, Lenchner M, Mason L, Sivakami M, Nyothach E, et al. Menstrual cup use, leakage, acceptability, safety, and availability: a systematic review and meta-analysis. Lancet Public Heal. 2019 Aug;4(8):e376–93.