Toxic shock syndrome, or TSS, is a rare but serious illness caused by toxins released by certain bacteria, most often Staphylococcus aureus and sometimes group A streptococcus. It became widely known in the late 1970s and early 1980s, when a wave of cases was traced to a specific brand of super-absorbent tampon. That product was pulled from the market, high-absorbency materials were reformulated, and menstrual TSS became much rarer. But it has not disappeared, which is why every tampon box still carries a TSS warning.
Why tampons are part of the story
TSS is not caused by tampons themselves. It is caused by bacteria producing toxins. The connection is that a high-absorbency tampon, especially one left in too long, can create conditions that let those bacteria multiply, particularly if it is more absorbent than your flow requires. The historical cases were tied to super-absorbent synthetic materials, including certain forms of rayon, which is part of why fiber type and absorbency matter. The single biggest lever you control is using the lowest absorbency that handles your flow and changing it on schedule.
Warning signs (act fast)
TSS comes on suddenly and progresses quickly. Per Mayo Clinic and the CDC, watch for:
- A sudden high fever
- A rash that looks like a sunburn, often on the palms and soles
- Vomiting or diarrhea
- Dizziness, fainting, or a drop in blood pressure
- Muscle aches, confusion, or headache
If you have these symptoms while using a tampon, remove the tampon and seek emergency care immediately, and tell the medical team you were using a tampon. TSS can progress to organ failure within hours, so it is not something to wait out.
How to prevent it
The prevention steps are simple and well established by the FDA, CDC, and Mayo Clinic:
- Use the lowest absorbency that manages your flow. If you can wear a tampon for eight hours without it being saturated, you are using one that is too absorbent.
- Change tampons every 4 to 8 hours, and never leave one in longer than 8 hours.
- Alternate tampons with pads or period underwear, for example using pads overnight.
- Wash your hands before insertion, and use the lowest absorbency for lighter days.
These habits, not a specific brand, are what actually lower TSS risk. This is why R3 treats a brand offering a full range of absorbencies as a small positive: it makes it easier to match absorbency to flow, which is the core prevention step.
