Nishmat's Women’s Health and HalachaIn memory of Chaya Mirel bat R' Avraham

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Progesterone to avoid chuppat niddah

25 June, 2012

Question:

Hi,

I am starting to teach kallot before their weddings and I would like to become more familiar with the use of a progesterone-only pill to delay a woman's period. I know many girls today are using these pills to avoid a chuppat niddah and to avoid using the traditional oral contraceptive pills (progesterone and estrogen). Can you please explain the benefits of this pill over the traditional method (aside from only using it for a couple of days)? Can you also explain when a kallah would start using it (at what point in her last period before the wedding), and stop using after her wedding?

Thank you very much.


Answer:

When a kallah needs cycle control to prevent chuppat niddah (not every kallah does), the main advantages of progesterone over combination hormonal contraceptives are that: it can be taken for a short period of time, it does not have a lasting contraceptive effect (such that the bride can conceive immediately following use), and it does not include estrogen, which sometimes is medically contraindicated for a given woman.  The major disadvantage is that it involves a large progesterone dosage, which can lead to nausea, bloating and other side effects.  Also, the bleeding that occurs when stopping the medication is usually heavier than a regular period and brides should be aware of that.

Progesterone is typically given five days prior to the anticipated menses and continued for roughly five to seven days in order to delay menstruation.  Breakthrough bleeding may occur if progesterone is used for longer than ten days, so larger cycle adjustments are best made with smaller doses over a couple of months.  The proper timing depends on the bride's anticipated menstrual timing and wedding date.  Typically, the bride should be instructed to stop taking it once the marriage is consummated and to expect bleeding to start two to four days later.  The exact strategy, dosage and timing should be worked out together with a health care provider. 

The progesterone generally used for the delay of menses is different from the progesterone only pill used for contraception. Both contain progesterone, but at different dosages and sometimes with different formulations. These medications should be prescribed only by a health care provider after seeing the woman, taking her medical history, menstrual history, and wedding date into account. The kallah teacher's role is to assure that the health care provider understands both that the kallah should not be bleeding  at the time of her wedding and that any bleeding or spotting needs to stop at least a week beforehand.

Please feel free to write back with any further questions.


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