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Toxic shock syndrome is extremely rare, but it's one reason some women choose organic tampons and alternative methods like menstrual cups for their periods. However, a new study suggests that the type of tampon may not make any difference to the risk of menstrual-related toxic shock syndrome (TSS) — while menstrual cups, which are believed to be safer than tampons, may pose slightly more danger of the potentially fatal bacterial infection.
The new research, published Friday in Applied and Environmental Microbiology, was partly sparked by recent reports of TSS in women who had been using menstrual cups, according to Dr. Gerard Lina, the study's coauthor and professor of microbiology at the University Claude Bernard in Lyon, France.
Menstrual cups are made from soft flexible material and instead of absorbing blood like a tampon, they simply collect it.
“I would say that the menstrual cup is not protective and similar precautions of usage should be advised,” Lina said. That includes: hand washing; less than 6 hours of use; sterilization between uses; and avoiding use overnight when sleeping.
TSS occurs when the certain types of bacteria suddenly start to proliferate and spew out deadly toxins. Often the syndrome results from toxins produced by Staphylococcus aureus (staph) bacteria, but group A streptococcus (strep) bacteria can also be a cause.
The new study, which looked at 11 types of tampons and 4 types of menstrual cups, found that the kind of material — organic or regular cotton, rayon or blend — made no difference when it came to the growth rate of bacteria.
The illness first became widely known in 1980s, when super-absorbent tampons were blamed for hundreds of deaths. Attention eventually turned to the amount of time the tampon was in the body. Since then, cases have declined. TSS occurs in about 1 in 100,000 menstruating women, no matter what product is used. Model Lauren Wasser developed TSS in 2012 while on her period, eventually losing both legs to the excruciatingly painful infection.
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Dr. Angela Chaudhari welcomed the new study.
“The menstrual cup is becoming really popular among the college age female population,” said Chaudhari, an assistant professor in the division of minimally invasive gynecology at Northwestern University’s Feinberg School of Medicine. “That’s because unlike tampons you don’t have to throw it out. You can just wash it.”
There’s been an assumption that the menstrual cup is safer, but the new study suggests that’s not true, Chaudhari said.
The study also underscores the need to follow precautions when using tampons:
- Don’t wear them overnight
- Don’t keep one in for more than four to six hours
- Don’t use more than one at a time
- Always use the lightest absorbency possible
Beyond that, women might be alert for signs of the start of TSS, said Dr. Richard Beigi, an ob-gyn and infectious disease specialist at the University of Pittsburgh Medical Center and chief medical officer at UPMC’s Magee-Womens Hospital.
Early symptoms, Beigi said, can include:
- a sensation that your heart is racing
- a lightheaded feeling
- Later on you might develop a rash
“Most women with TSS, if they are treated early, live,” Beigi said. “It’s a pretty severe infection, but it is responsive to antibiotics.”