In the '70s and '80s, toxic shock syndrome (TSS) struck thousands of women. The crisis peaked in 1980 with 814 cases of TSS, of which 38 women died, most due to extended use of the high-absorbency Rely tampon. Today, women still get TSS, though cases are rarely publicized.

Yet tampon safety is once again a national issue, in part due to the efforts of Rep. Carolyn Maloney, D-N.Y., who introduced a bill to address the health problems associated with tampon use. The Robin Danielson Act (HR 360) is named after a 44-year-old woman who died in 1998 from TSS because she didn't recognize her symptoms. The bill directs the National Institutes of Health to conduct reliable, independent research to determine the health risks posed by the presence of synthetic fibers, dioxin and other additives in tampons.

What causes Toxic Shock Syndrome?

TSS is caused when staph or strep bacteria grow in the vagina, usually encouraged by the presence of a higher absorbency tampon or one that has been inserted more than eight hours. The bacteria produce toxins that are absorbed into the bloodstream, which can cause a severe drop in blood pressure (shock) and/or organ failure, especially of the liver and kidneys.

In some cases, TSS is fatal. Its symptoms are similar to the flu, including a high fever, vomiting and diarrhea, muscle aches, dizziness or fainting, a red rash, headaches, bloodshot eyes and sore throat.

"Highly absorbent tampons, especially those containing synthetic fibers, increase the amounts of toxin present in the vagina," says Tierno.

In the mid-'70s, synthetic fibers were used in tampons because manufacturers wanted to produce more absorbent, leak-resistant products. Since then, three of the four problematic synthetics have been eliminated from tampons. "The only one left is viscose rayon," Tierno says.

How to reduce your risk of TSS

To minimize your risk of contracting TSS, choose a tampon made of 100 percent cotton, preferably organic. "You're at the lowest risk possible with cotton," says Tierno. "In my research, every synthetic fiber amplified toxin development, whereas cotton did not."

Most precautions for guarding against TSS are simple, says holistic nurse practitioner Pam Chandler, a specialist in women's health care. Wear a tampon for a maximum of six to eight hours to avoid bacterial growth. However, she recommends leaving it in for at least two hours.

"If you remove a tampon too soon, it won't be saturated," she says. "Then you risk scraping the dry, fragmented cotton across the vaginal mucosa, irritating it and setting the scenario for infection." Also, using a tampon overnight, when planning to sleep longer than eight hours, is risky. At night, consider wearing a pad instead, she advises.

Choosing a tampon with proper absorbency is crucial to preventing TSS. "At the beginning of your period, if your flow is heavy, you may need Super Absorbency so you don't have to change tampons too often," says Chandler. When the flow slows, however, don't be tempted to continue with a Super because it's more convenient. Switch to a lower absorbency tampon instead. Also, use tampons only during menstruation.