FAQ About Premenstrual Syndrome (PMS) and Toxic Shock Syndrome (TSS)

What is PMS?
Many women have cramps along with their periods. The pain can range from mild to very painful, and it can vary from month to month how much they hurt and how long they last. Many—but not all—women also experience PMS (premenstrual syndrome). PMS is the name of the group of symptoms that start around 7 to 14 days before your period begins and usually stop very soon after your period starts. No one knows for sure what causes PMS, but it seems to be linked to the changes in hormone levels that happen during your menstrual cycle. If you experience PMS, you may experience one, some, or many different symptoms. Some months your PMS may be worse than others or you may have no PMS symptoms at all.

What are the possible symptoms of PMS?

• Acne
• Feeling anxious
• Bloated (swollen) stomach
• Headaches
• Constipation
• Joint pain
• Crying spells
• Mood swings
• Depression
• Tender breasts
• Fast heartbeat
• Hard time focusing
• Hunger
• Trouble sleeping
• Feeling tense
• Swollen hands, feet
• Feeling crabby
• Weight gain
• Being tired
• Hard time handling stress

What can I do to minimize PMS?

• You may have heard that vitamins and other pills such as vitamin B6, vitamin E, magnesium, manganese and tryptophan can help relieve PMS. There has not been enough research done on these vitamins to know if they really help, and they may even hurt you. Talk to your doctor if you are thinking about trying any of these.

Every woman is different when it comes to PMS. But here are some tips that may help:

• Eat complex carbohydrates (found in whole grain breads, pasta and cereals), fiber and protein
• Eat less sugar and fat
• Stay away from salt the few days before your period (to reduce bloating)
• Drink less caffeine (found in soda, tea and coffee) to feel less crabby and help ease breast soreness
• Eat small frequent meals each day rather than big ones
• Make sure you are getting the exercise teens need: 30 minutes of exercise, 4 to 6 times a week
• Make sure to get about 8 hours of sleep at night
• Keep a regular schedule for exercise, meals, and bedtime

What is Toxic Shock Syndrome (TSS) and who is susceptible?
TSS is a rare disease believed to be caused by some forms of the bacterium called Staphylococcus aureus. This bacterium can be found normally in the vagina of some women. Without this bacterium, tampons alone have not been found to cause TSS. However, there are studies that have indicated tampons, in the presence of this bacterium, are associated with an increased risk of menstrual TSS.

By using tampons you increase your risk of getting menstrual TSS. It has been estimated that each year 1-17 of every 100,000 menstruating women and girls will get TSS. TSS occurs most often in menstruating females using tampons, in particular women under thirty years of age, and especially teenage girls. TSS also occurs, however, among men, children, and non-menstruating women.

What are the warning signs of TSS?
Warning signs of TSS include: sudden high fever (usually 102ºF or more) accompanied by vomiting and/or diarrhea, fainting or near-fainting when standing up and dizziness or a sunburn-like rash. These symptoms usually appear very quickly and are often severe. Not all TSS cases are alike, and all symptoms are not always present. Other signs might be aching of muscles and joints, redness of the eyes, sore throat and weakness.

What should I do if I think I might have TSS?
If you have a sudden high fever and one or more of the other TSS symptoms during your period, remove your tampon at once, discontinue using tampons, and contact your doctor right away or seek emergency medical care. You might need emergency medical care. Tell the doctor that you are menstruating and you were wearing a tampon.

How does tampon absorbency affect the risk of TSS?
There are studies that suggest that higher absorbency tampons are associated with an increased risk of menstrual TSS. Therefore, you should use a tampon with the lowest absorbency that meets your menstrual flow needs to reduce your risk of getting menstrual TSS. Tampons are available in four absorbency ranges: regular absorbency for light flow (6-9 g); super absorbency for moderate flow (9-12 g); super plus absorbency for heavy flow (12-15 g); and ultra for very heavy flow (15-18 g). Under this absorbency rating system adopted by all tampon manufacturers, tampons within a given range have the same absorbency label.

Wasn't it higher absorbency tampons that caused the TSS scare back in the late 1970's and early '80's?
As stated in the FDA website dated July 23, 1999 on the topic regarding tampons and TSS: "Although scientists have recognized an association between TSS and tampon use, the exact connection remains unclear. Research conducted by the CDC suggested that use of some high absorbency tampons increased the risk of TSS in menstruating women. A few specific tampon designs and high absorbency tampon materials were also found to have some association with increased risk of TSS. These products and materials are no longer used in tampons sold in the U.S." Because of this we recommend using the tampon with the lowest absorbency that meets your menstrual flow needs.