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

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Endometriosis


Endometriosis is a condition in which endometrial tissue spreads outside the uterus. Both the symptoms and treatment of endometriosis can have halachic implications.


This page is sponsored by Sara Tesler

The lining of the uterus is known as the endometrium. Endometriosis is a condition in which endometrial tissue spreads outside the uterus. Symptoms can include heavy menses, irregular bleeding, pain with menses and/or during intercourse, gastrointestinal symptoms, and difficulty conceiving. It can also be emotionally challenging to live with these symptoms.

Endometriosis is underdiagnosed, since many symptoms overlap with those of other conditions. Early diagnosis is beneficial to treatment, so girls and women should discuss any symptoms with their physician. For example, women who regularly experience severe menstrual pain should be screened for endometriosis.

A range of treatments are available for endometriosis, including hormonal therapy, complementary medicine, and surgical intervention.

Both the symptoms and treatment of endometriosis can have halachic implications:

Uterine Bleeding

Long periods and irregular bleeding can make a woman niddah more often, or make it difficult to get to the mikveh. A woman can sometimes avoid becoming niddah from staining associated with endometriosis by taking precautions based on the laws of stains. We discuss these here.

A woman experiencing bleeding during the shivah neki’im should ask a specific halachic question about reducing the number of bedikot that she performs, and the possibility of additional leniencies.

If a woman can determine that her bleeding is from a source outside the uterus, such a lesion on the outer cervix or in the vaginal canal, it is dam makkah (blood from a wound) and not dam niddah. The status of endocervical bleeding (inside the cervix) is subject to debate.

Dam makkah does not make a woman niddah. However, since bleeding from outside the uterus often coincides with menstrual bleeding from inside the uterus, it can be complicated to apply leniencies based on dam makkah.

Bleeding after Relations

Endometriosis in the vagina or vaginal cervix can also lead to bleeding after relations. Women with endometriosis should be especially careful about the following precautions, which are advisable for all couples:

  • Use only colored sheets or towels.
  • After relations, both husband and wife should wipe themselves only with disposable tissues or colored towels. The husband should wipe himself before looking, to avoid seeing blood on his body.
  • Husband and wife should wait a minute or two from the end of relations before looking at anything or wiping themselves.

Pain

A woman experiencing pain associated with endometriosis may not wish to have relations. It is fully permissible for a couple to forgo relations when they would lead to discomfort.

Hormonal Therapy

Some forms of hormonal therapy can lead to breakthrough bleeding. A woman should discuss this in advance with her physician. She should also consult with a halachic authority to avoid unnecessarily becoming niddah or interrupting the clean days.

Gynecological Procedures

A woman with endometriosis may undergo various diagnostic or therapeutic medical procedures. We discuss considerations of niddah and scheduling for these procedures here.

Fertility

Endometriosis can affect fertility. Yoatzot Halacha Fertility Counselors provide free personal consultations to help couples address this or other fertility challenges.


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All health and health-related information contained within Nishmat's Women's Health & Halacha Web site is intended to be general in nature and should not be used as a substitute for consulting with your health care professional. The advice is intended to offer a basis for individuals to discuss their medical condition with their health care provider but not individual advice. Although every effort is made to ensure that the material within Nishmat's Women's Health & Halacha Web site is accurate and timely, it is provided for the convenience of the Web site user but should not be considered official. Advice for actual medical practice should be obtained from a licensed health care professional.