We've all been there before: maybe you've felt a little bit off, perhaps even with a fever and some flu-like symptoms. If you've experienced this while on your period, then the possibility of having toxic shock syndrome may have crossed your mind. I mean, how long are you supposed to keep a tampon in for, anyway?  

What is toxic shock syndrome?

Toxic shock syndrome (TSS) is a rare but serious condition that can happen when certain types of bacteria produce toxins that affect your body's immune response. These toxins can cause everything from a high fever and a rash to organ failure and even death. While toxic shock syndrome is fairly uncommon, there are several different things you can do to help lower your risk and keep yourself from Googling things like, "Can I leave a tampon in overnight?" 

How does toxic shock syndrome develop?

According to the Cleveland Clinic, toxic shock syndrome is usually caused by a type of bacteria called Staphylococcus aureus ("staph" for short) or streptococcus pyogenes (group-A strep). Believe it or not, staph bacteria are pretty common  about one-third of us have them living on our skin or in our noses right now (gross, but true). Normally, though, those bacteria don't cause any problems. But in rare cases, they can release toxins that lead to  you guessed it  TSS. 

Usually, toxic shock syndrome develops when staph bacteria get into a wound or certain types of devices that we use on or inside our bodies, like tampons or menstrual cups. The bacteria may then produce toxins that can quickly spread throughout your body, triggering an intense immune response.  

What are the symptoms of toxic shock syndrome?

While only a few hundred cases of TSS are reported in the U.S. each year, it's still good to know the signs, especially if you regularly use tampons or other internal devices. The symptoms of toxic shock syndrome can vary, but they usually come on very suddenly and can be rather severe. So here are some things to look out for:  

  •  An unusually high fever (usually over 102°F/38.9°C)

  • A sudden drop in blood pressure (which can lead to dizziness or fainting)

  • Vomiting or diarrhea

  • A rash that looks like a sunburn, especially on the palms of your hands or the soles of your feet

  • Muscle aches or weakness

  • Redness or swelling in the eyes, mouth, or throat

  • Confusion or disorientation

With that in mind, it’s important to note that not everyone with toxic shock syndrome will have all of these symptoms. But any combination of these indicators, along with the context of having recently used an internal device like a tampon or menstrual disc is enough of a reason to seek medical attention.   

How to prevent toxic shock syndrome

It's a no-brainer just to say, "Never wear a tampon for more than eight hours at a time." However, protecting yourself from toxic shock syndrome isn't always as simple as that. Here are some helpful tips that can keep you protected against developing TSS while on your period: 

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  • Use low-absorbency tampons. If you use tampons, try using the lowest absorbency option possible. This will help prevent the tampon from staying in too long and reduce the risk of bacterial growth.

  • Change tampons and menstrual cups regularly. Changing your tampon at least every 4-8 hours or more frequently is important if you have a heavier flow. Don't leave a tampon in for longer than 8 hours, even if it isn't completely saturated. Sleeping with a tampon in is okay, but consider setting an alarm to change it if you plan to sleep for more than 8 hours.

  • Alternate between tampons, pads, and menstrual cups or discs. Using pads or other menstrual products in addition to tampons or cups can help reduce your risk of toxic shock syndrome.

  • Wash your hands! Always wash your hands thoroughly before and after inserting or removing a tampon or touching any internal device, like a cup or disc. 

  • Avoid handling a tampon too much. The more a tampon is exposed to your touch, the greater the potential risk for bacteria exposure. Try to make it a habit to only open a tampon when you're ready to insert it, and always make sure your hands are clean first. 

Remember: toxic shock syndrome is rare and something you shouldn't immediately start worrying about. However, as a woman, it's always a good idea to know the signs and symptoms so you can take the proper steps to protect yourself and act quickly if something does seem off. Stay safe out there!   

Jennifer “Jay” Palumbo is a freelance writer, infertility and women’s rights advocate, former stand-up comic, author of the blog, “The 2 Week Wait,” and proud IVF Mom. Her articles have been featured in Time magazine, Huffington Post, and ScaryMommy. She has been interviewed on news outlets such as CNN, NPR, and BBC, where she has demonstrated her ability to make even reproductive issues fun and educational. You can follow her "infertility humor" on Instagram at @jennjaypal.