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May 28, 2004/Sivan 8 5764, Vol. 56, No. 36
The halachic method of treating menstrual problems
DR. STEVEN WININGER
Special to Jewish News
I have been privileged to treat many Jewish women from throughout Phoenix. Some are Orthodox and very observant, some fall in the middle and others are non-observant. Some of my patients are also very interested in discussing whether various procedures are in conflict with Jewish laws, rituals and customs. This is especially true when dealing with issues surrounding birth, menstruation and contraception.
When a patient asks me about Jewish laws, I always suggest that she first consult her rabbi since the interpretation and application of Jewish laws and rituals (halacha) can vary significantly. In some cases, the rebbetzin (rabbi's wife) can also provide useful information without the embarrassment that talking to a male rabbi might generate.
For Jewish women who observe the laws of Tahrat HaMishpacha (the laws of separation), menstruation plays an important role within the marriage. A husband and wife must not engage in sexual relations during the wife's menstrual period. The separation usually lasts about 12 to 14 days beginning at the first sign of blood and ending the evening after the woman's seventh "clean day." As soon as possible after this seventh day, the woman must immerse herself in a kosher mikvah, a ritual bath. According to Jewish law, a husband and wife should engage in marital relations following immersion in the mikvah. Torah identifies, teaches and reunites the couple at the exact time a Jewish woman is most fertile - the onset of ovulation.
Throughout the ages, rabbis and other experts have also stressed the psychological benefits of this monthly abstention, noting that it forces a couple to build a strong non-sexual bond. It also helps to increase a couple's desire for one another, making intercourse in the remaining two weeks more special. It also gives both partners a chance to rest without feeling any pressure to engage in sex.
Many of my patients are seeking solutions for irregular, heavy or painful periods. Fortunately, relief from heavy, painful or inconvenient periods is an area in which several new treatment options have recently emerged.
Before exploring treatment options, a woman should always undergo a complete exam that includes a pelvic exam, PAP smear and, in some cases, a biopsy of the uterine lining and a pelvic ultrasound to ensure there is no abnormality in the cells that line the womb. Depending on the results of the exam and tests and the patient's preferences, she has several options, including:
- Oral contraceptives - Prescribing a birth control pill or monthly progesterone stabilizes the uterine lining and reduces cramping, as well as the volume and duration of a woman's period. Since the development of oral contraceptives, many observant brides regulate their periods in the months before the wedding to ensure that they will not have their period at the time of their marriage.
- Hyteroscopic resection - This outpatient procedure removes or vaporizes smaller fibroid cysts without affecting normal hormonal function.
- Uterine ablation - For women who have completed childbearing, this non-invasive 90-second outpatient procedure uses precisely measured radio frequency energy to ablate the uterine lining, which significantly reduces or eliminates periods, cramps and PMS symptoms. This procedure, which requires no incisions, can also be performed electively for post-childbearing women with normal menstruation who prefer to avoid the monthly inconvenience caused by their period.
- Mirena Progesterone IUD - Using this intrauterine device may decrease menstrual bleeding, but it can cause irregular bleeding for the first six months after insertion.
- Hysterectomy - After exploring all alternatives, a hysterectomy may be the only remaining option for eliminating heavy bleeding and pain. However, women should be aware that having fibroids is not an automatic indication for a hysterectomy. In fact, this procedure should only be considered after other alternatives have been explored. The exception is when a woman has uterine, endometrial, cervical or ovarian cancer, in which case a hysterectomy can be a life-saving procedure.
Before deciding to have a procedure performed, ob-servant women should always consult with their rabbi because some of these procedures or treatments can interfere with fertility. Having children is so important in Judaism that the very first commandment out of 613 is to be fruitful and multiply (Genesis 1:28).
The best advice I can offer any woman suffering from abnormal bleeding or heavy or painful periods is to select an OB/GYN who is clinically skilled, who listens and responds attentively to his or her patients and who takes the time to explain the risks, benefits and potential problems of all treatment options. For observant Jewish women, it is an advantage to see an OB/GYN who will consult closely with you and your rabbi to ensure that the treatment selected does not conflict with halachic teachings.
Steven J. Wininger, M.D., a board-certified OB/GYN, who is active in the Orthodox Jewish community. He practices at the Arizona Wellness Center for Women, 3811 East Bell Road, Suite 212, Phoenix. Call 602-992-3162 or visit www.AzWellness.com.
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