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Menstrual cup and Toxic Shock Syndrome

"Toxic Shock Syndrome is a rare but serious disease that can be fatal"... we've all read this at some time or other on our tampon or sanitary pad packets and (maybe) we've felt a little frightened. What is it exactly? Who is at risk of developing this disease? What precautions do we need to take to avoid it? We're going to bring you up to date with current scientific knowledge:


What is Toxic Shock Syndrome?

Toxic Shock Syndrome (or TSS) is a disease that can be caused by two types of bacteria: Staphylococcus aureus (in most cases) and Group A Streptococci. These bacteria are naturally present on the skin and mucous membranes of about 30 to 40% of the population, and do not pose any problems in the vast majority of cases. Only that sometimes these bacteria find a place that's particularly conducive to their development, and this can trigger TSS.

What makes these breeding grounds? An injury, a scar following a surgical operation or... menstrual blood. About 50% of TSS cases occur in women who are on, or have just had their period, in which case we refer to Menstrual TSS. The other 50% develop in men, women, children, regardless of age or sex (usually from an infected wound).


After a period of development time inside a wound or menstrual blood, the Staphylococcus aureus will release a toxin that will spread in the blood, then around the whole body. This is the TSST-1 toxin. If the body cannot defend itself properly against this toxin, it will trigger an immune chain reaction which is referred to as a superantigen: the TSST-1 toxin will trigger a disproportionate immune response and the body will over-react, which will make the blood vessels porous, causing hypotension and multiple organ failure that can result in death. As soon as the first symptoms appear, quick action is needed by removing your tampon or cup and going to see a doctor urgently.


Right. That was the worst case scenario! But there are plenty of ways to recognise TSS, and most importantly, to avoid it as much as possible.


What are the symptoms of Menstrual Toxic Shock Syndrome?

Symptoms may appear during menstruation or a few days after the end of menstruation.

The symptoms are similar to those of the flu: fever, nausea, vomiting, headache, body aches. You might also have symptoms of shock, such as dizziness or discomfort due to low blood pressure and a rash similar to sunburn. We're repeating ourselves here but it is very important: as soon as the first symptoms appear, quick action is needed by removing your tampon or cup and going to see a doctor urgently.


Statistically, what are the risks of developing menstrual toxic shock syndrome?

The numbers are clear: Out of 14 million women who are old enough to have monthly periods in France, 20 suffer from menstrual TSS a year (all with tampons), equivalent to 0.0001%.


You need to be pretty unlucky to develop TSS. The risks of developing TSS are therefore very low and it would mean that:

  • you are part of the 30% of the population that is naturally a carrier of Staphylococcus aureus
  • And, in addition, you are part of the 4% of the population that carries a strain of Staphylococcus aureus capable of producing TSST-1 (yes, not all of them are!)
  • And, still further, you are part of the 10% of the population that is not able to protect themselves against the TSST-1 toxin.

So statistically speaking, there is a very, very small risk of developing Menstrual Toxic Shock Syndrome. However:


  1. There is currently no test available in pharmacies to know if you carry a Staphylococcus aureus,
  2. Even if there were, just because you are not a carrier at any given moment, doesn't mean that you will not become one later. It is considered that 50% of the population is an intermittent carrier of Staphylococcus aureus.
  3. There is no test available in pharmacies to know if you are immune to the TSST-1 toxin.

It is therefore impossible at the moment to know if you are at risk of having TSS one day, so it is better to take all the precautions explained below. You should find these recommendations on the instructions for the tampon, menstrual cup or any other device that will be inserted into the vagina for a long time (diaphragm, sponge).

What can facilitate the onset of Menstrual Toxic Shock Syndrome?

We began hearing about Menstrual Toxic Shock Syndrome in the 1980s in the US, when a brand of tampon, the Rely brand, caused an outbreak of 772 cases of menstrual TSS, and 38 deaths. This brand of tampons was hyper-super-mega-absorbent, and because nobody knew about menstrual TSS some women kept the same tampon in throughout their period (which is totally inadvisable of course). Rely tampons were super-absorbent thanks to a synthetic material: carboxymethylcellulose, and it has been proven that it this material promoted the growth of Staphylococcus aureus.

Today, this material is no longer used in tampons, and precautions have been added: since this Rely scandal, tampon manufacturers have been indicating absorption levels with small drops, (to avoid inserting unnecessarily absorbent tampons, that promote menstrual TSS) and recommended insertion times have been 4 to 8 hours. Thanks to these measures, the number of menstrual TSS cases has greatly decreased.


A recent scientific study shows that the composition of the tampons or cups currently on sale does not influence the growth of the Staphylococcus aureus (phew!) and we look at this in more detail here and here.

But at the risk of disappointing some of you, the cup does not protect against Menstrual Toxic Shock Syndrome…


Because it is the fact that menstrual blood is retained in the vagina that makes Staphylococcus aureus sometimes develop. After years of being forgotten about, the subject of menstrual TSS has finally begun to be seriously studied, and recent scientific publications on the subject enable us to recommend these important precautions if you want to use a tampon or menstrual cup safely:


Risk factors for menstrual TSS
  • Choose a tampon that is too absorbent or a menstrual cup that is too big


  • re)Introducing Staphylococcus aureus into the vagina during menstruation




  • Leave sufficient development time for the Staphylococcus aureus to produce the TSST-1 toxin


  • An immune system that cannot defend itself against the TSST-1 toxin
What can be done to reduce the risk?



  • Do not use an intra-vaginal device if you have ever had TSS (menstrual or not) or if you are severely immunocompromised.






















It's not so complicated after all! In addition, Claripharm makes your life easier by offering you a Duopack for each size that enables you to change your cup during the day if you are not able to disinfect it: you keep a clean cup in its box, which you take out with you for the day, and after 6 hours you can swap it with the one you've got in!



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