Tampons are one method of absorbing menstrual flow during your period. Tampons are designed to be inserted into the vagina with or without an applicator.

You may be surprised to learn that the FDA regulates tampons as medical devices. Tampons cleared by the FDA are meant to be used one time and then thrown away. No tampon should be used more than once.

FDA-cleared tampons are made of cotton, rayon, or a blend of the two. The absorbent fibers used in FDA-cleared tampons sold today are made with a bleaching process that is free from elemental chlorine, which also prevents products from having dangerous levels of dioxin (a type of pollutant found in the environment).

Before any tampons can be legally sold in the U.S., they must go through the FDA’s review to determine whether they are as safe and effective as (substantially equivalent to) legally marketed tampons.

As part of the FDA’s review, manufacturers submit data including the results of testing to evaluate the safety of the materials used to make tampons and applicators (if present); tampon absorbency, strength, and integrity; and whether tampons enhance the growth of certain harmful bacteria or change normal bacteria levels in the vagina.

Reusable tampons may carry additional risks of infections such as yeast, fungal, and bacterial infections.

While you may have heard about reusable tampons, the FDA has not cleared or approved these products. The FDA discourages the use of reusable tampons.

The only tampons cleared or approved by the FDA are designed for single-use.

Toxic shock syndrome (TSS) is rare and is caused by a toxic substance that is produced by certain kinds of bacteria. The toxic substance produced by the bacteria can cause organ damage (including kidney, heart, and liver failure), shock, and even death.

Rates of reported TSS cases associated with tampons have declined significantly over the years. One reason is that the FDA evaluates whether a tampon enhances the growth of the bacteria that causes TSS before the product can be legally marketed. Only tampons that have been cleared by the FDA can be legally marketed in the U.S. In addition, more informative tampon labeling, as well as educational efforts by the FDA and manufacturers, may have contributed to the reduction in TSS cases.

Toxic shock syndrome (TSS) is a rare but sometimes deadly condition caused by bacteria that make toxins or poisons. In 1980, 63 women died from TSS. A certain brand of super absorbency tampons was said to be the cause. These tampons were taken off the market.

Today, most cases of TSS are not caused by using tampons. But, you could be at risk for TSS if you use more absorbent tampons than you need for your bleeding or if you do not change your tampon often enough (at least every four to eight hours). Menstrual cups, cervical caps, sponges, or diaphragms (anything inserted into your vagina) may also increase your risk for TSS if they are left in place for too long (usually 24 hours). Remove sponges within 30 hours and cervical caps within 48 hours.

If you have any symptoms of TSS, take out the tampon, menstrual cup, sponge, or diaphragm, and call 911 or go to the hospital right away.

Symptoms of TSS include:

• Sudden high fever
• Muscle aches
• Vomiting
• Nausea
• Diarrhea
• Rash
• Kidney or other organ failure

You may want to talk with your health care provider about whether tampons are right for you. If you use tampons, consider the following:

1. Follow all labeled directions. Even if you have used tampons before, read the instructions in the package.
2. Wash your hands before and after using a tampon. This will help reduce the spread of bacteria.
3. Only use tampons when you have your period. Tampons are not intended to be used at any other time or for any other reason.
4. Change each tampon every 4 to 8 hours. Never wear a single tampon for more than 8 hours at a time.
5. Use the lowest absorbency tampon needed. If you can wear one tampon up to eight hours without changing it, the absorbency may be too high.
6. Contact your health care provider if you have pain, fever or other unusual symptoms. If you have discomfort, pain or other unexpected symptoms like unusual discharge when trying to insert or wear a tampon, or if you have an allergic reaction, stop using tampons and contact your provider.
7. Know the signs of toxic shock syndrome (TSS) and how to reduce your risk. Symptoms and signs of TSS may include a sudden fever (usually 102°F or more), vomiting, diarrhea, fainting or feeling like you are going to faint when standing up, dizziness, or a rash that looks like a sunburn. If you have any of these symptoms during your period or soon after your period, stop using tampons and seek medical attention immediately. To reduce your risk of TSS, use the lowest absorbency tampon necessary, wear a tampon for no more than 8 hours and then throw it away, and use tampons only when you have your period.