Toxic shock syndrome linked to menstruation: symptoms and link with sanitary protection?

Period-related toxic shock syndrome is a rare but serious acute illness caused by the presence of a bacterium called Staphylococcus aureus in the vaginal microbiota of some women. If it is associated with the wearing of hygienic protections, it is more due to their misuse rather than to their composition. We take stock with Dr. Odile Bagot, gynecologist.

It is only recently that toxic shock syndrome (TSS) has started to be talked about. him, with cases reported by the press which caused noise: in 2011, after American model Lauren Wasser had her right leg amputated and 2015, after the death of a teenage girl, Maëlle, in Belgium. But what is it exactly?

Toxic shock syndrome: what is it? When we talk about SCT, we usually talk about the one related to the rules: indeed, as noted by the portal of rare diseases , non-menstrual TSS “can also be seen in men and children” . Period-related toxic shock syndrome, on the other hand, is a “rare but very serious condition, which rather affects young women – between 14 and 20 years ”, explains Dr. Odile Bagot, gynecologist.

What causes? It is linked to the presence of a bacterium, called Staphylococcus aureus or staphylococcus aureus, in the vagina of some women. According to Institut Pasteur , 25 To 50% of the population is a healthy carrier of Staphylococcus aureus, “That is to say that the bacteria is found in the skin or the external mucous membranes, in particular the nasal membranes, without any symptoms being developed” . It is when a certain type of Staphylococcus aureus produces the TSST-1 toxin that it becomes dangerous: this will pass into the blood and cause a toxic shock which, s ” it is not taken care of correctly can progress to generalized infection which can lead to gangrene (tissue necrosis), amputation or even death.

What is the link with hygienic protections? TBS is linked to improper use of hygienic protections: the blood that stagnates in the vagina will promote the proliferation of this bacterium. “This can happen with any type of periodic protection, but it is true that it has been more reported with certain types of ultra-absorbent tampons that were found in the United States , specifies Dr. Bagot. A study also showed that there were a little more risks with menstrual cups: they may be less airtight, and we know that Staphylococcus aureus is an aerobic bacteria – that is, it needs oxygen to live. Finally, we also note a small risk with the copper IUD . ”

Nevertheless, it is important to specify that the toxic shock syndrome is not due to the hygienic protections in themselves: if the tests carried out by the National Agency for Food, Environmental and Occupational Health Safety (ANSES) on menstrual cups and tampons revealed “the presence of chemical substances without exceeding the health thresholds ”, it has “ not demonstrated a direct relationship between the physicochemical properties materials of these intimate protections and a risk of increased toxic shock syndrome. ”

Indeed, TSS is due misuse of hygienic protections, and in particular their prolonged wear. According to a study published in March 2020 in the review eClinicalMedicine conducted by researchers from the International Center for Infectious Disease Research of the National Reference Center for Staphylococci in Lyon, “the risk of toxic shock syndrome is doubled when the tampon wear exceeds six hours, and by three when the tampon is worn overnight (the duration of use can then reach eight hours or more) ”. Moreover, the researchers note that “ failure to read or follow the instructions accompanying the box of tampons is also associated with an increased risk of toxic shock ”.

Advice from our partner Tampax

The composition of tampons is not involved in the appearance of toxic shock syndrome Toxic shock syndrome is a rare but serious disease that can be favored by improper use of tampons in women carrying a bacterium: Staphylococcus aureus. It is not the composition of tampons that is in question but their misuse such as prolonged wear or use in poor hygienic conditions. Therefore, respect the conditions of use of the tampons: wash your hands before and after use, use the tampon adapted to its flow, change it every 4 to 6 hours and never more than 8 hours.

Tampax buffers are safe to use. They are all tested and certified by the independent label Oeko-Tex Standard 50. The latest Tampax innovation is the Tampax Cotton Protection range: tampons with a cotton core 64% organic. They are fragrance-free, dye-free and chlorine-free bleach. They have also been tested under gynecological control and ensure optimal comfort and protection: the plant-based plastic applicator with rounded tip allows easy insertion and the LeakGuard anti-leak braid guarantees additional protection against leaks.

Is it common? Fortunately, toxic shock syndrome is rare. In 2004, the number of cases of toxic shock syndrome identified was 5. Around the years 160, there has been a steady slight increase to reach 14 in 2011. Today it stabilizes at 19 per year approximately in France. “This is very little, compared to the number of menstrual cycles a woman has in the year and the number of women who have their periods” , would like to point out the gynecologist. In addition, it is estimated that 19 To 30% of women are carriers of Staphylococcus aureus, and only 1% of them carry the strain that can cause toxic shock syndrome.

To see also

What symptoms? Toxic menstrual shock occurs when you have your periods . The symptoms that should alert are as follows:

a fever that is sudden and greater than 39 ° C, vomitings, feeling unwell with headache, hypotension, diarrhea, a rash looking like a sunburn. What to do in case of toxic shock and what is the treatment? Toxic shock syndrome is a vital emergency: according to National reference center for staphylococci , the death rate ity is of the order of % . The first thing to do is to immediately remove its hygienic protection. Then, it is advisable to consult urgently.

“The treatment consists of treating the infection, especially the state of shock , explains Dr. Bagot. Hospitalization – often in intensive care – is necessary, as well as taking antibiotics. ”

A few simple rules can limit the risks of toxic shock syndrome, namely:

change periodic protection every 4 hours to 6 hours, for the night, favor the wearing of period panties or a sanitary napkin, use hygienic protection only during menstruation and choose protection adapted to your flow, wash your hands well before changing your hygienic protection, carefully read and follow the instructions on the boxes or packages before use. On this last point, however, the General Directorate for Competition, Consumption and Fraud Control (DGCCRF) warns: in a press release published in May 2015, she denounces information for users on the conditions of use of menstrual cups “Generally insufficient, even erroneous, which can generate a serious risk of toxic shock.” However, she states that “ the educational information provided by the investigators during the checks quickly bore fruit: instructions and packaging were changed, sometimes even before a warning was sent to the professionals ”.

Finally, Dr. Bagot wishes to reassure: “TBS is very rare. Young women should not deprive themselves of the comfort and freedom that a tampon or menstrual cup offers because of this. ”


1-Constitution of the World Health Organization
2- NHS UK conditions