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Please visit www.jewishwomenshealth.org for a wide range of articles and case studies on the topic of women's health and Jewish Law. This website is designed to assist medical practitioners in providing optimal care to their observant Jewish patients. |
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Hormonal Cycle Manipulation for Brides Abstract: Physical contact between husband and wife is prohibited while the wife is niddah. Brides may request to hormonally manipulate their menstrual cycle to prevent niddah status at the time of the wedding. While standard methods of hormonal manipulation (i.e., hormonal contraceptives or progesterone) can be used, this request extends beyond simply preventing menstruation on the wedding night. All bleeding, even minor spotting that will be found only on internal self examination, must cease at least one week prior to the wedding. For a virginal bride, the first episode of intercourse will also bring on the niddah status. Therefore, she is likely to want her withdrawal bleeding to start soon after wedding so the two time periods of niddah can overlap. Discussion: Physical contact between husband and wife is prohibited while the wife is niddah. Therefore, a halacha observant bride will want to schedule her wedding for a date when she will not be niddah. She may turn to her health care provider for assistance in assuring that the timing is correct. This is not merely a request to avoid menstruation on her wedding night. All bleeding needs to have ceased at least one week before the wedding, allowing her enough time to count seven clean days and then immerse in the mikveh before she gets married. The rules of hymenal bleeding are another factor in planning the wedding date. After first intercourse, a woman with an intact hymen follows the same rules of physical separation as a niddah due to presumed hymenal bleeding - whether it is actually observed or not. Therefore, she will often want to schedule the wedding shortly before she expects her next menses, so that her period closely follows this initial separation. On the other hand, because some couples do not achieve intercourse on their wedding night due to fatigue or inexperience, it is wise to leave a margin of a few days before the menses are due. There are two basic medical approaches. One is to use combination hormonal contraceptives to control her cycle. The other is to use progesterone to delay expected menses. In either case, it is important to remember that the bride wants to avoid being niddah at her wedding, not just to avoid her period. Spotting and breakthrough bleeding lead to the niddah status and it is important to minimize the chance of their occurrence. When using combination hormonal contraceptives, it is best to begin a few months in advance to minimize the possibility of breakthrough bleeding that is common in the first cycle or two. It is also best that she not continue taking hormones for many extra days without allowing a withdrawal bleed, as this also increases the likelihood of breakthrough bleeding. With progesterone alone, use for over ten days is likely to lead to spotting. Please see our article on Hormonal Cycle Manipulation for more detailed information on these medical approaches and their halachic implications. Some physicians may feel uncomfortable using medical intervention for religious indications. However, it is accepted to use medications to improve a patient's quality of life and this is such an example. This should not be viewed as more invasive than the use of hormonal contraceptives for assistance in control of acne. Implications for Patient Care: A bride may request hormonal manipulation of her cycle to prevent niddah status at the time of her wedding. This is an important quality of life issue in this patient population. Proper manipulation means that all bleeding and spotting will have ceased at least one week prior to the wedding. Users of Internet filtering services: This site discusses sensitive subjects that some services filter without visual indication. A page that appears 100% complete might actually be missing critical Jewish-law or medical information. To ensure that you view the pages accurately, ask the filtering service to whitelist all pages under jewishwomenshealth.org. This material is intended for general information purposes only. The patient's individual circumstances should be considered when making specific treatment decisions. Reproduction of the contents of this article for other than personal use |