don’t use tampons because it’s too uncomfortable to put them in or because their period is so heavy that a tampon isn’t going to cut it.
Toxic-shock syndrome
Toxic-shock syndrome (TSS) is caused by bacteria and has nothing to do with any kind of chemical that is in the tampon itself. Staphylococcus aureus is a type of bacteria commonly found on the skin, and a particular form can produce a toxin called TSST-1. On entering the bloodstream, this can cause a massive inflammatory reaction, usually characterised by a really high fever, vomiting, skin rashes and aching muscles. But, unhelpfully, it doesn’t always lead to any symptoms ‘down there’ which would make it easier to identify the cause. It can be life-threatening and requires urgent medical attention. It’s also incredibly rare, with only about forty cases per year in the UK, around half of which are thought to be related to tampon use (the other half are seen in children, men and older women, and are typically associated with skin burns and infections).
The ways that tampon use can potentially increase the risk of TSS include:
collecting blood and increasing vaginal pH to create a breeding ground for bacteria
causing tiny little micro-tears in the vaginal wall on insertion and removal, which allow bacteria to enter the bloodstream (it has been suggested that menstrual cups are safer in this regard, although I disagree; there has been a reported case of TSS with menstrual-cup use,6 probably because it too can cause vaginal abrasions and potentially create the right bacterial breeding ground.
On balance, I don’t think there’s any reason for the social media-based frenzy related to tampons, or enough evidence for changing your practices, especially because TSS is so rare.
Pads
Let’s not forget pads now. They might not be the sexy option these days, but they’re still incredibly useful, especially for light days, and a godsend to the many women who don’t like tampons or cups. To be clear, you don’t need the scented ones, which some women find cause irritation to the delicate vulval tissue. Reusable pads, as well as periods pants, with an inbuilt absorbable pad, are also increasingly popular. These are better for the environment, and there’s no difference between them and disposable pads from a health perspective.
THINGS YOU’VE ALWAYS WANTED TO KNOW, BUT WERE TOO AFRAID TO ASK
Should I track my menstrual cycle?
I’m a massive fan of cycle tracking and usually recommend the Clue app (see Resources). It stops you being caught short without pads or tampons and can be really useful in helping you to recognise patterns in symptoms that you might get at particular times of the month. I breathe a sigh of relief when a patient gets her phone out to tell me all about her periods because it makes things so much easier to pinpoint; and if you haven’t been doing it, we will often give you a menstrual-cycle tracking chart to fill in for the next few months.
I started tracking my period as a way of reassuring myself that the pain in my side every month was ovulation pain and not some dreadful case of appendicitis; all doctors are hypochondriacs to some extent. I did my medical-school elective on a tiny island in Fiji, where I had what I now realise was terrible ovulation pain, but at the time I was panicking and planning how I would get airlifted out to get my appendix removed because I didn’t want to undergo surgery in our operating theatre, which was essentially a shed with a bright light. It was the worst twelve hours of my life! (And I’ve also seen the occasional woman arrive at A&E with the same fear.)
What is a fake period?
I’ve heard people referring to periods on the Pill as ‘fake periods’, which can cause a bit of anxiety. What they mean is that the bleeding is due to the hormones in the Pill, unlike a ‘true period’, in which the bleeding is caused by your body making the necessary hormones. When you stop taking your Pill it mimics the last few days in your cycle where the corpus luteum is dying away, so the levels of synthetic hormones from the Pill are dropping, which causes the lining to fall away.
I’m often asked: ‘If it’s a fake period, does that mean I could still be pregnant?’ And the answer is, ‘No’. If you have a bleed on the Pill when you have your week-long break, then you are not pregnant.
Are organic tampons better?
Many concerned women have contacted me asking if they’re harming themselves by using conventional tampons, which, if you believe the hype, contain bleach plus cancer- and endometriosis-causing toxins. These claims are entirely unfounded, as very sophisticated lab techniques have failed to pick up any of these compounds in non-organic tampons.7 Dioxins are a type of toxin that seem to get the most attention, but you actually ingest way more of these through your diet than you ever could through a humble tampon.8 At present there is no scientific evidence to show organic tampons are better for health or any less likely to be associated with TSS. But they’re definitely more expensive.
Some people have said they find organic tampons less irritating, and while there’s no specific mechanism for why that might be the case, if you do find you’re not satisfied with your current brand, you have nothing to lose by changing to an organic brand to see if it makes a difference. But my medical (and non-medical) opinion is: if it ain’t broke, don’t try to fix it.
Can I stop my period if I’m going on holiday?
Yes, and there are two ways to do so.
If you’re on the combined oral contraceptive pill (COCP) The COCP is the type you take for twenty-one days and then have a break for seven days, during which you would have your period. If you want to stop your period, it’s OK to take up to three packs in a row without a break. You won’t have a bleed because you maintain a constant hormone level, although some people will find they get some cramping and spotting, especially towards the end of the third pack.
If you’re not on the COCP In this case, your GP can prescribe Norethisterone, a synthetic progestogen tablet that you take three times per day, starting about ten days before your period is due and continuing for the duration of your trip/the time for which you want to stop your period. Your period will usually start about two days after stopping the tablets. Again, they can cause cramping and spotting and your period might be heavier than normal.
There isn’t a ‘non-hormonal’ way of stopping/delaying your period.
THE GYNAE GEEK’S KNOWLEDGE BOMBS
I love a good ol’ period chat. I always find that it’s something everyone wants to talk about, but no one wants to be the first to bring it up, whether in clinic or socially. One of my biggest missions is to help start this conversation, so that you can understand what’s normal and when something might need medical attention. Here are the five key points that I’ve covered in this chapter that I find myself repeating over and over:
A period is what happens when the lining of the uterus falls away, containing blood, mucus and old cells. It’s not your body detoxing itself, it just means you didn’t get pregnant.
Your period blood can be like a rainbow – pinks, reds, browns, blacks; they’re all normal.
It’s common to have irregular, often quite long cycles at the extremes of your menstrual life –
