Tampon Safety: Toxic Shock Syndrome : Part 2

by Food and Drug Administration (FDA)

(Page 2 of 2)

Though TSS is extremely rare, tampon users should still be aware of it, says Richter. "All tampons are associated with the risk of TSS, and it's important for women to know the signs," she says. "If a woman becomes ill or has any concerns at all about TSS, she should remove her tampon immediately and contact her doctor."

Today, tampon manufacturers in this country produce tampons made of rayon, cotton, or a blend of the two. Cotton is commonly referred to as "natural," while rayon is considered "synthetic." But consumers shouldn't assume that "synthetic" means bad and "natural" means safer, says Jay Gooch, Ph.D., a toxicologist and senior scientist at Proctor and Gamble. Rayon is made from cellulose fibers derived from wood pulp. "Technically speaking, rayon is synthetic, but it's more like natural cellulose than it is different," Gooch says. "There is a lot of confusion out there about what rayon is and a lot of unsupported allegations about the safety of the two fibers." Previous CDC studies have found no increased risk with rayon versus cotton for the same absorbency and brand of tampon.

Other Tampon Ingredients

John McKeegan, spokesman for Johnson and Johnson, makers of O.B. tampons, says his company tells women who call with questions about the presence of cancer-causing dioxin in tampons that the company uses elemental chlorine-free bleaching, which does not produce dioxin.

Chlorine gas, which can produce a small amount of dioxin, used to be the bleaching agent for rayon used in tampons, says Gooch. "But elemental chlorine-free bleaching uses a chlorine dioxide agent. Chlorine dioxide may sound like chlorine gas, but they are two very different things," he says. Bleaching is necessary because all fibers have impurities associated with them that will inhibit absorbency. "Bleaching cleans and purifies raw material, but it does not leave toxins," he explains. And unlike what some people think, he adds, the white color of tampons is a consequence of the purification process, not an appearance goal.

Using a method approved by the Environmental Protection Agency, major tampon manufacturers have tested their products for dioxin. Data show that dioxin levels in tampons range from undetectable to 1 part in 3 trillion, far below the level that occurs through daily environmental exposure and considerably below the level FDA believes would put consumers at risk, Stratmeyer says.

"That doesn't mean that dioxin couldn't get there from another source," he adds. "You could end up with dioxin in rayon or cotton simply because of decades of pollution." It can be found in air, water or the ground before the wood pulp or the cotton is produced. "But what we know today is that you will find more dioxin already in your body than in any tampon," he says.

Many experts say the proof of tampon safety lies in its long history. But others want more research into diseases other than toxic shock syndrome. Rep. Carolyn Maloney (D-N.Y.) introduced the Tampon Safety and Research Act in 1997 and again in March 1999. The bill, which was referred to the Subcommittee on Health and Environment, proposes to provide NIH with research support to determine the extent to which dioxin, synthetic fibers, and other additives in tampons pose health risks such as cancer, endometriosis, infertility, and pelvic inflammatory disease.

But from FDA's perspective, there is no indication right now that such research is necessary, Stratmeyer says. "We are not aware of evidence that would call for a large-scale study on tampons' relation to these diseases."

TSS Warning Signs

Symptoms of toxic shock syndrome can be hard to recognize because they mimic the flu. If you experience sudden high fever, vomiting, diarrhea, dizziness, fainting, or a rash that looks like a sunburn during your period or a few days after, contact your doctor right away. Also, if you're wearing a tampon, remove it immediately. One or two weeks after initial symptoms begin, flaking and peeling of the skin occurs, mainly on the palms and soles. If your doctor determines that your symptoms are TSS, you will probably be sent to a hospital for treatment. With proper treatment, patients usually get well in two to three weeks.

Women under 30, especially teenagers, are at a higher risk for TSS, because some females that age may not yet have antibodies to the toxin. Using any kind of tampon — cotton or rayon of any absorbency — puts a woman at greater risk for TSS than using menstrual pads.

Understanding Absorbency

Absorbency — the rate at which a tampon absorbs or soaks up menstrual blood — is measured in grams of fluid. Research suggests that the risk of toxic shock syndrome may increase with tampon absorbency. But that doesn't mean you have to steer clear of higher absorbency tampons completely, according to Colin Pollard, chief of FDA's obstetrics and gynecology branch. "You should match absorbency to your flow," he says. For a lighter flow, use regular or junior absorbency. If your tampon absorbs as much as it can and has to be changed before four hours, you may want to try a higher absorbency. There's usually less need for higher absorbency when your period is ending.

When you shop, you'll find these absorbency terms and ranges on all tampon packages:

• Junior absorbency: 6 grams and under
• Regular absorbency: 6 to 9 grams
• Super absorbency: 9 to 12 grams
• Super plus absorbency: 12 to 15 grams

According to the American College of Obstetricians and Gynecologists, your tampon is probably too absorbent if the tampon is hard to remove, you experience vaginal dryness, if a tampon shreds, or if it doesn't need to be changed after several hours. Vaginal dryness and ulcerations may occur when a tampon is too absorbent for your flow.

Tips to Avoid Tampon Trouble

The strategy had worked for years, says Tracy, 28. She always inserted a small tampon on the morning she expected her period. But a few years ago, her period started one day late. "By the time it came, I had forgotten about the first tampon," she says. "The bleeding was so heavy that I figured I must not have had one in. So I put another one in."

All day she changed her tampon every few hours like she normally does. Then on one trip to the bathroom that night, she noticed a second string. When she finally removed the first tampon, the mild cramps she had experienced all day worsened. The pain became so intense she couldn't walk. Severe cramps and heavy bleeding ultimately landed her in the emergency room.

Putting in a tampon and forgetting about it is rare, but it does happen, says Gerald Joseph, M.D., former chairman of the department of obstetrics and gynecology at the Ochsner Medical Foundation. Joseph says he sees such cases — mostly among women under 30 — a few times each year. Joanne, 44, says she forgot once and didn't realize the tampon was still there until six days later when she went to her doctor complaining of foul odor and vaginal discharge.

FDA recommends the following tips to help avoid tampon problems:

• Follow package directions for insertion.
• Choose the lowest absorbency for your flow.
• Change your tampon at least every 4 to 8 hours.
• Consider alternating pads with tampons.
• Know the warning signs of toxic shock syndrome.
• Don't use tampons between periods.

About the Author

www.fda.gov
FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.