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Blood on pessary

18 May, 2023


Is blood seen on a pessary considered internal spotting?

My understanding is yes, and based on that I have been niddah three times in the past six weeks.

More details, if relevant:

The pessary has to be taken out and repositioned almost daily. I try to close my eyes and rinse it off before I look at it, but sometimes I look too soon and see blood anyway.

Not wearing the pessary makes it difficult and painful to stand and walk.

I have been able to avoid niddah from external spotting using black underwear, panty liners, not looking at toilet paper. I only do bedika once a day and don’t go very deep if I’m worried, so the cloths do not get stained. Really the only spotting that “counts” is on the pessary ring.

I am on progesterone only birth control, for which regular spotting is a side effect.

I have been on combined hormone pills before with very bad mood disorder reactions including self harm. I am considering switching back to this to reduce spotting but I kind of feel like this would be trading my own health (possibly life) for shalom bayis. I am hoping this is not my only option.

I would prefer to use a barrier method but my husband does not agree– he does not think they are effective enough and does not think we are in a position to handle an unplanned pregnancy right now (we have a 22 month old and a 6 month old, the baby has some health issues we are dealing with).


Thank you for reaching out to us.

We are sorry to hear of your frequent episodes of niddah and of your difficulties on the combined contraceptive pill.

Blood on a pessary can sometimes come from irritation to the vaginal wall, in which case it would not make a woman niddah. However, this would need to be confirmed through medical examination, and the use of progesterone-only contraception could limit relying on such an assessment.

In the short term, you might find it helpful to put on dark sunglasses and be in a darkened bathroom when you remove and rinse the pessary, to limit the chances that you will see any color.

Longer term, it might be worthwhile to explore the IUD as a contraceptive option. A pessary can typically be removed for IUD insertion and put back in afterwards. The IUD is often associated with staining over the first cycles of use, but this tends to subside over time. You could also consider a progesterone-secreting IUS. Sometimes there is no bleeding whatsoever on these, but there can also be chronic staining. The IUD and IUS are highly effective. Learn more about them here.

Please be in touch with any further questions.

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