Key Points
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If you sleep with a tampon, you risk getting Toxic Shock Syndrome, a rare but deadly infection.
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Other options for sleeping while menstruating include menstrual underwear, pads, and cups.
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Unless your doctor advises, don't sleep with a tampon to stop a nosebleed.
Talk with a few women about feminine hygiene, and you'll likely hear various opinions — including whether it's OK to sleep with a tampon. Some women follow a strict rule of no tampons at night, while others have been doing it for years and have never had a problem. Is there anything to worry about?
You're taking a small risk if you sleep with a tampon. It's rare — though deadly. You must decide how to manage the risks; if you don't want to risk it, there are other options for menstruation. This article also addresses sleeping with a tampon in another location prone to bleeding — the nose.
Why Do Tampons Have a Time Limit?
If you look at the instructions on any box of tampons, one line is universal: Don't leave it in for more than eight hours. If you leave a tampon in too long, you risk over-saturation and leakage, but is there any actual danger?
It turns out that there is, and it's Toxic Shock Syndrome (TSS). TSS is an umbrella term for an illness that results from a few different kinds of bacteria, but the symptoms are essentially the same: a mysterious skin rash, fever, low blood pressure, and mental fog. The scary thing about TSS is that it rapidly progresses, and if not treated promptly, it can cause coma, organ failure, or even death.
The excellent news about TSS is that it's relatively unusual — between one and three cases per 100,000 Americans yearly. Not all of those cases even come from tampons; the bacteria sometimes breed in injuries and other infections.
So if you leave a tampon in too long by accident, don't panic — just look out for the symptoms described above and see a doctor promptly if you have concerns. Nonetheless, TSS is dangerous, and prevention is the best strategy.
How Does a Tampon Cause an Infection?
Have you heard of a microbiome? If you're into healthy eating, you've probably heard of the microbiome in your digestive tract, which is full of friendly bacteria that help you digest food. Well, there are other microbiomes all over your body, including in your reproductive system.
The bacteria in your vagina, like those in your gut, are mostly harmless, but keeping the residue of the uterine lining inside of it for very long is an unnatural thing to do — and that's precisely what tampons do. The tampon allows bacteria like Staphylococcus and Streptococcus to breed until they overwhelm the immune system's defenses.
Not every type of tampon is equally dangerous. When researchers first discovered the link between tampon use and TSS, they learned it from a superabsorbent type of tampon that hit the market in the 1970s. That tampon is no longer for sale, but high-absorbency tampons are still more likely to cause TSS.
Therefore, while it's tempting to err toward absorbancy to avoid mess, doctors recommend against it.
"I always recommend inserting a tampon that fits your flow," said Cleveland Clinic gynecologist Stacie Jhaveri. "If you use the most absorbent tampon for a very light flow, chances are, you'll think about changing it less often. You'll also run the risk of drying out your vaginal mucus, allowing room for more bacteria to enter the body."
Do Materials Matter?
The discovery of the tampon-TSS link in 1980 not only led to the removal of that particular brand of the superabsorbent tampon from the market but also to the government banning certain materials used to make it, like polyester foam and carboxymethylcellulose.
However, some manufacturers still blend artificial fibers like rayon and viscose with the cotton that forms the base of all tampons, which has proven divisive.
On the one hand, a significant faction believes all-cotton tampons are safer, especially organic ones. Among that group is New York University microbiology professor Philip Tierno, one of the researchers who discovered the TSS-tampon link, who went so far as to say, "The bottom line is that you can get TSS with synthetic tampons but not with an all-cotton tampon."
To be clear, Tierno still advises changing cotton tampons at least every eight hours.
However, not all studies have supported Tierno's research. Some have found no difference in the risk, and a 2018 French study suggested that cotton tampons might be more likely to sprout dangerous bacteria.
Why the conflicting results? A likely culprit is study design: Because it's too dangerous to try to induce TSS in human subjects, researchers have to reproduce the conditions of a typical vagina in the lab and see what the germs do in there.
It's challenging to get such a complex system precisely correct, but the hazy results suggest that, at the very least, there isn't a sharp and compelling difference between the different types of tampons in terms of TSS risk.
Can You Sleep With a Tampon In?
If you've heard warnings against sleeping with a tampon in, that's entirely because of the time issue. Eight hours is the recommended sleeping length for adults, but it's easy to run over, especially when you're tired. That's why it's best to avoid sleeping with tampons as a precautionary measure.
With that said, the appeal of sleeping with tampons is obvious, especially if your periods are heavy. If you're willing to try it, here are some tips for doing it safely.
Choose the Right Absorbency
Picking the right size of tampon isn't always easy. Unless you've been comparing some unusually intimate notes with your friends, how do you know what "regular" or "heavy" flow is?
The best way to understand is to pick a tampon size — usually best to start with light or medium — and take it out after about four hours and examine it. If there's still plenty of white space on it, it's more absorbent than you need for your current flow. You want something more absorbent if it's completely soaked down to and including the string.
To avoid TSS, and not just at night, try the smallest tampon you can get away with using. If you're concerned about leaks, use pantyliners or absorbent period underwear as a backup. Don't use tampons at all if you're just spotting — use pantyliners or period underwear.
Put a New One in Right Before Bed
To minimize the time you use a single tampon, put a fresh one in before hitting the hay, even if the current one isn't soaked through yet. Replace your tampon as soon as you get up in the morning. Make sure you're well stocked so you don't run out!
Set Your Alarm
Set your alarm for no more than eight hours after inserting the last tampon. If that's not enough time to get quality sleep, consider alternatives. Don't shorten your natural sleep cycles just by using a tampon — sleep is essential for your health!
Alternatives To Sleeping With a Tampon
Tampons are an old standby in feminine hygiene, and maybe you've used them ever since your mother taught you how and never gave them a second thought. If you're concerned about the risks of sleeping with a tampon, try a safe alternative.
There's no perfect solution to the problem, but here's a rundown of options currently available.
Period Underwear
Absorbent underwear designed especially for menstruation has taken the market by storm over the last decade. They're reusable, comfortable, and less prone to leaking than other period products. Their main drawback is that they don't absorb as much as the most robust tampons and pads, so if your flow is heavy, you'll need to use them in combination with other products.
Period underwear is also more expensive than regular underwear and often smells terrible at night's end, even by underwear standards.
Sanitary Pads
Sanitary napkins or pads are an old standby, and they carry minimal risk of TSS because they allow your vagina to empty as usual. The largest of them is highly absorbent, so they're indispensable for heavy bleeders — very heavy bleeders may want to combine them with other products.
The primary health concern around them is that many contain phthalates, which some folks are trying to restrict or ban because some research indicates that high exposure causes various long-term health problems. The evidence is inconclusive, but organic pads don't have phthalates or other possibly harmful chemicals if you're trying to avoid phthalates.
From a cleanliness standpoint, the chief issue with pads is that they're prone to leaking around the edges. Combining them with period underwear is an excellent solution to this issue.
Cups
Silicone menstrual cups are the one alternative to tampons you wear on the inside, so they're the best option if you're only comfortable going commando in bed. They keep the blood and tissue inside your vagina, but the silicone surface is much less friendly to breeding bacteria than fabric.
Still, it's not impossible to get TSS with cups. The aforementioned French study also studied cups and found that the relevant bacteria can grow in them. However, only a handful of TSS cases have ties to menstrual cups. Given how rare TSS is, you're taking a more significant risk when you get in your car than using a cup.
Can You Sleep With a Tampon in Your Nose?
Tampons' absorbent properties have also made them popular for stanching other kinds of bleeding — especially nosebleeds. There are even nasal tampons on the market made for that purpose.
So if you have a persistent nosebleed, is it safe to sleep with one, or do you also risk getting TSS? No current data explicitly ties nasal tampons to TSS. Still, any breakages in the skin can be a vector for the bacteria, especially in people with weakened immune systems.
Doctors typically use nasal tampons on patients after nasal surgery. Still, concerns about the risks of nasal tampons have mainly led to cutting the recommended time for using them. Historically, plastic surgeons left the nose packed for a week or two after a nose job, but now it's more likely to be just a few days or hours. Surgeons also use nasal tampons less frequently due to newer guidelines and alternative methods of controlling bleeding.
Physicians also generally recommend against stuffing tampons — or anything else — up your nose at home to stop nosebleeds. Doing so might tear the delicate mucous membrane inside your nose and increase the bleeding. At most, use a cotton ball, but don't squeeze it up too far.
The correct way to stop a nosebleed:
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Stay upright or lean forward slightly; don't lie down or tilt your head back.
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Use a decongestant nasal spray (oxymetazoline or phenylephrine) to shrink the blood vessels.
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Apply pressure by pinching the sides of the nose — not the bridge. Hold for about 10 minutes.
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If you're still bleeding after 10 minutes, apply an ice pack.
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If you have taken all these steps and are still bleeding after 30 minutes, it's time to see a doctor.
Sleep Safely No Matter What You Use
Sleeping with a tampon carries a small risk with potentially grave consequences. Only you can decide what chance you're willing to take. If your immune system is weak, especially if you've had a severe bacterial infection, the risk of TSS is higher, and you're better off seeking alternative methods.
However, the risk is minor for most people, so go ahead and sleep with a tampon so long as you don't spend too long in bed. Just don't put it up your nose!
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