Tampon Safety and Regulations

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Tampons are one of the options you can use to absorb menstrual bleeding when you have your period. In general, they are very safe, but there are some precautions you need to take.

There have also been a number of widespread concerns about the materials used in tampons and their manufacturing process. The United States Food and Drug Administration's (FDA) Center for Devices and Radiological Health has been regulating and providing consumer information about the safety and efficacy of medical devices produced and sold in the US, including tampons.

Most young women start out by using pads and then may begin to use tampons, either sometimes or all the time. Proper use is essential for preventing complications of tampon use.

Safety Tips When Using Tampons

If you are going to use tampons, you should know that they are safe when used properly. But, some side effects, as well as serious complications, can occur as a result of tampon use. There are a few things to keep in mind to prevent problems.

  • Change your tampon every four to eight hours: Often, because tampons are not obvious when you use the toilet, you can forget to change them. However, they need to be changed about every four hours, and they should not be left in for longer than 8 hours. Bacteria can grow on a tampon that is left in for too long, increasing the risk of vaginal or bladder infections, as well as a serious blood infection called toxic shock syndrome (TSS).
  • Change your tampons after you have a bowel movement: After a bowel movement, bacteria-laden feces can contaminate the string that hangs out if the tampon, exposing you to potential vaginal or urinary tract infections.
  • Don't use a more absorbent tampon than you need: If some days of your period are light, an excessively absorbent tampon can increase your risk of vaginal dryness because it can absorb the normal protective lubrication of the vagina. And even more importantly, tampons that are too absorbent have been shown to increase the risk of TSS. Tampon sizes are standardized across brands in the U.S. by a method that labels all tampon products as regular, super, super plus, or junior to describe the range of tampon absorbency.
  • Don't use a tampon when you don't have your period: If you are not sure if you might get your period, it is best to use a pad or a pantyliner. Leaving a tampon in when you don't have your period causes vaginal dryness and increases the risk of TSS.

Preventing Toxic Shock Syndrome

Toxic shock syndrome (TSS) is a rare condition that can occur if a tampon is left in for too long. It is more common among young women or women who have decreased immune function. But leaving a tampon in for too long is considered one of the most significant risk factors for TSS, even for otherwise healthy women who have used tampons before.

Symptoms

Symptoms of TSS include fever, vomiting, lightheadedness, and a rash. The condition can advance rapidly, and may even result in death. The FDA requires all tampon manufacturers to provide packaging information on all tampons sold in the U.S. describing the symptoms of TSS and how to reduce your risk.

Causes

TSS is not caused by the tampons themselves, but rather by a bacterial infection of either Staphylococcus aureus or Streptococcus pyogenes bacteria. These bacteria already live on the surface of your skin, and they protect your skin from other infections. However, they can invade the body's bloodstream, causing a life-threatening infection.

Prevention

Changing your tampon within four to eight hours and choosing a tampon with the proper size and absorbency for your flow are the most effective ways of preventing TSS. If you anticipate that you or your daughter cannot have access to changing a tampon frequently enough (for example, on a long ride or a long shift at work), then use a pad instead.

Concerns About Tampons

There are several widespread concerns about tampons, and the FDA's official consumer page addresses many of these issues.

  • There have been claims that that asbestos is used in tampons to increase manufacturers' profits, causing excessive bleeding. According to the FDA, tampons are made of cotton and rayon, or a combination of these materials. Asbestos is not approved for use in making tampons, and factories that manufacture tampons are subject to inspection to ensure that required manufacturing standards are being met.
  • There are concerns that dioxin, a pollutant found in the environment, could be present in the cotton or rayon used in tampons, potentially causing endometriosis. Major U.S. tampon manufacturers tested their products for dioxin levels using an analytical method provided by the FDA. The results showed that dioxin levels ranged from non-detectable to one 1 part in 3 trillion, and the FDA has determined that dioxin at this extremely low level does not pose a health risk.
  • A bleaching process is required to purify wood pulp and retrieve the cellulose fibers which make rayon. There have been consumer concerns raised about the use of chlorine in the bleaching process. Use of chlorine can lead to a dioxin byproduct, so tampons sold in the US are required to use a chlorine-free bleaching process.
  • There are warnings that rayon fibers cause TSS. The materials used in tampons don't cause TSS, but high absorbency tampons are associated with an increased risk of TSS, and women are advised to avoid using a higher absorbency tampon than needed.

A Word From Verywell

Tampons are a convenient option for many women. They tend not to cause an odor, they don't show under tight clothes, and they are practical when swimming or participating in other sports. The regulations regarding tampon materials and production provide reassurance that the tampons sold in stores in the US are safe to use.

Sources:

Jacquemond I, Muggeo A, Lamblin G, et al. Complex ecological interactions of Staphylococcus aureus in tampons during menstruation. Sci Rep. 2018 Jul 2;8(1):9942. doi: 10.1038/s41598-018-28116-3.

US Department of Health and Human Services, For Consumers, The Facts on Tampons and How to Use Them Safely

Vostral S. Toxic shock syndrome, tampons and laboratory standard-setting. CMAJ. 2017 May 23;189(20):E726-E728. doi: 10.1503/cmaj.161479.

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