Starting their period is a big deal for adolescents. It marks a turning point in their lives where puberty becomes the new normal and change is happening all over their body. Undoubtedly, adolescents are going to have questions, and for those about period products, safety is the biggest factor.

Tampons can be super helpful, since they can be worn during swimming or other activities when a pad might not be convenient or possible. Tampons are safe if used properly, but if left in too long can lead to toxic shock syndrome, a rare disease caused by an infection where bacteria release toxins into the body that can lead to organ damage (including kidney, liver and heart failure), shock and even death.

Changes in how tampons are made and education about safe use of tampons have decreased the rates of toxic shock syndrome. Even with these improvements, it is important to follow all directions on the packaging and to wash hands before attempting to use tampons. Tampon users should use the lowest absorbency tampon you need, change them every 4 to 8 hours, and throw them away after each use.

Symptoms to keep an eye out for include fevers or chills, vomiting, diarrhea, headache, sunburn-like rash, confusion and fatigue. If noticed, contact your doctor as soon as you can.

Recently, alternatives to tampons, like menstrual cups, have become more widely available. These products are easy to find and can be used while swimming or playing sports. They are also reusable, which people may like since it can lessen waste and be more friendly to the environment than other menstrual products.

Often, menstrual cups are made with medical-grade silicon, which discourages the growth of bacteria. However, bacteria can still grow on menstrual cups and toxic shock syndrome has been reported in people using these products.

Refer to the specific care guidelines for your menstrual cup, but generally most products recommend washing the menstrual cup after each use with water and soap, boiling the menstrual cup in between periods, and removing the product at least every 12 hours.

Period underwear are a great reusable option and are even easier to use than menstrual cups. Because period underwear is outside your body, it is not a risk for toxic shock syndrome. However, they still should be cleaned or washed as instructed on the packaging.

Tampons and other menstrual products are safe when used properly. As always, talk to your pediatrician about any questions or concerns you have about period products or toxic shock syndrome.

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Jessica Bethel MD, MPH, is a pediatric hospital medicine fellow at the University of Wisconsin and has served as her program's lead advocacy resident. She has been involved in the AAP since medical school including in the Council on Immigrant Child and Family Health, the Section on Minority Health Equity and Inclusion, and Section on Global Health.

Megan Yanny, MD, FAAP, is a board-certified general pediatrician and assistant professor in the Department of Pediatrics at the University of Wisconsin School of Medicine and Public Health. She is involved in medical student and resident education and is a member of the WI AAP and the AAP.

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