Question Regarding Menstruation and Contraceptives


The Question:

Assalaamu ‘alaikum (peace be upon you) Imam Suhaib,

May Allah subhanahu wa ta’ala (exalted is He) reward you for your efforts with this blog, and give you the strength to continue to be of benefit to young people like myself who spend way too much time online. I have a question related to your recent post regarding Ramadan rulings for women. What are the rulings related to a woman who is bleeding while on the pill (combined oral contraceptive pill)? Does the bleeding take the status of hayd (menstruation) or istihaadah (non-menstrual bleeding)?

Technically speaking, the pill interferes with and interrupts the menstrual cycle such that the woman no longer goes through the natural menstrual cycle. As such, even though there is a regular pattern of bleeding for seven days, it is not a menstrual period per say but what is referred to as a “withdrawal bleed.”That is, there is no shedding of the uterine lining as would normally occur. Most of the online fatwa (legal verdict) I could find regarding this assume that the bleeding is a menstrual period – I am not sure if this assumption has a shar’i justification or if it simply stems from a common misconception about the effect of the pill. Please let me know the majority opinion on this matter. A short post on this issue would also be of great assistance, not only to myself but also to others the since use of the pill is fairly common these days and this issue relates to important matters of worship and intimacy as well.

May Allah (swt) reward you and grant you forgiveness in this blessed month.

The Answer:

Imam al-Dardir says in Sharh al-Saghir regarding the conditions of menstruation that it should “flow on its own (natural process).” In addition he says that “it is yellow or brownish.” Thus, if the person is certain that this is not menstrual blood, then this blood is considered istihaada (prolonged non-menstrual bleeding). The presence of menstrual blood is what prohibits certain acts of worship and its absence makes them permissible. Thus, since the certainty is based on the absence of menstrual blood, the sister is allowed to worship with no restrictions.

*In addition: This answer should not be taken as a general one. The questioner clearly stated that the blood flow was not that of menses. Thus, if that is clearly established, then the ruling takes that of istihaadah. However, if one takes the pill and continues to have a menstrual cycle then the above does not apply.

Allah (swt) knows best.

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15 Comments

  1. A Sister says:

    Salaam Alaikum,

    I’m a little bit confused by this post. Does this question and anwser imply that any sister on “the Pill” never gets a “normal” menstrual cycle and thus should not stop praying and fasting? It is my understanding there are different types of pills that function in different ways. I have been on the pill for over a year and have always had a normal cycle. The blood that comes is the same as it always was before I started on the pill. The only change is that they are shorter. Please clarify.

    JazakAllahuKhair

  2. Suhaib Webb says:

    Asalamu alaykum,

    This answer should not be taken as a general one. The questioner clearly stated that the blood flow was not that of menses. Thus, if that is clearly established, then the ruling takes that of Istihadah. However, if one takes the pill and continues to have a menstrual cycle then the above does not apply.

    SDW

  3. Another sister says:

    Assalamo elikuim
    Also on the same note, is it permissible to take pill to delay menses so that one can fast without any break ? Sometimes its hard to keep the missed fast later.

    Jazak Allah khair

  4. Umm Bilal says:

    Scholars have said that it is permissible to take medicine to delay menstruation, as long as it does not effect the woman’s health.

    You can read the following for more information:

    http://www.islamonline.net/servlet/Satellite?pagename=IslamOnline-English-Ask_Scholar/FatwaE/FatwaE&cid=1158658480937

  5. tl says:

    Salaam,
    If you are in the process of memorizing the whole quran, i memorize half a page a day, is it permissable to continue while on your period if you use a quran which also has the translation in it?

  6. L says:

    The question states:

    “As such, even though there is a regular pattern of bleeding for seven days, it is not a menstrual period per say but what is referred to as a “withdrawal bleed.”That is, there is no shedding of the uterine lining as would normally occur”

    Has a qualified health expert been consulted on this issue? Because the way it was explained to me is that when starting certain contraceptive types (such as IUDs and progesterone–or in my case a progesterone-containing IUD) the effect of these is to thin out the uterine lining until it is very, very thin. This results in having lighter and less frequent periods. This would mean that the “withdrawal bleed” (I have not heard this term before and I am uncertain as to exactly what it means) when first starting these types of contraceptives IS shedding of the uterine lining.

    However, I thought this would be considered immaterial as I always have applied the rules of 10 days maximum for a period, 15 days minimum of ritual cleanliness between periods. Unfortunately this does get confusing when first starting contraceptives that cause you to have prolonged or frequent periods in the first few months. It is not really apparent which “one” of the bleeding episodes is your “period” per se, so by relying on those guidelines you may end up actually praying and fasting during what looks like a “period” but is actually something which becomes prolonged excessive bleeding if you’re having a month-long “period” or multiple “periods” due to the medication.

    Jazaakumu l-laahu khayran.

  7. sarah says:

    Salam alaikum wa rahmatallah –

    Br Suhaib please allow me to suggest that the question may have been misunderstood? I don’t think she was asking about spotting between periods. As a Nurse Practitioner specializing in women’s health, I understood this sister’s question to be a general one about whether women in general should consider the artificially-induced “periods” while on the pill to be equivalent to a natural period….

    For ANY woman who is taking the pill properly, she does not go through the usual menstrual cycle: she will not release an egg, her uterine lining doesn’t develop for possible pregnancy, and she won’t bleed or shed that lining UNTIL she stops the artificial hormones.

    Thus the bleeding that a woman on the pill has each month happens only because the last 7 pills in each pack are placebo, with no hormones in them.

    That’s why one could say a pill period is not a “normal” menses in the sense above. Physiologically it is a withdrawal bleeding from the sudden lack of hormones. In fact it is a feature engineered by the pill manufacturer; since women are used to bleeding monthly, they designed their product to mimic women’s usual pattern.

    A pill period may look similar to menses but is shorter and usually significantly lighter due to the effect of the pills. But it has no regular pattern except according to the usage of the pills: this bleeding would happen every week if she stopped the pills every week. It would happen every year if she stopped them only once a year. It would happen irregularly if she took/stopped them at whim.

    So Sh. Suhaib, would you be able to give some more background about the fiqh rulings on menstruation as it relates to the use of artificial hormones? Are pill periods equivalent to natural periods or does it depend on how the pills are used?

    Jazakum Allah khairun for your attention to this issue!

  8. Arif says:

    Asalamu alaikum,

    I do agree that the matter requires a little further analysis along with some medical consultation. However, I would like to explain why I believe the bleeding that occurs while using oral contraceptive medication is essentially the SAME bleeding that occurs with normal menstruation.

    PROCESS OF NORMAL MENSTRUATION:
    1. GnRH hormone stimulates release of FSH and LH
    2. FSH stimulates follicle development
    3. LH and FSH stimulate follicular release of estrogen
    4. Estrogen DEVELOPS THE ENDOMETRIAL LINING (this is the same lining that will slough off later during menses)
    5. Estrogen is normally feeding back negatively to GnRH to decrease LH and FSH (this is the balance Allah created in the human body) so that not too much estrogen is produced
    6. However, there is a treshold that estrogen reaches where it switches and STIMULATES LH release, this is called the “LH surge.”
    7. The LH surges and stimulate the follicle to rupture and release the ovum (“egg”)
    8. The left over follicle is now called the Corpus Luteum. This Corpus is producing progesterone.
    9. Progesterone helps STABILIZE the already developed ENDOMETRIAL LINING and increases its vascularity in preparation for implantation.
    10. If no implantation occurs (i.e. no pregnancy)* then estrogen and progesterone work synergistically in inhibiting FSH and LH. This decrease in FSH causes a decrease in estrogen and progesterone release by the corpus luteum
    11. The estrogen and progesterone now reach such a low level that they can no longer maintain the ENDOMETRIAL LINING and at the time of menstruation the ENDOMETRIAL lining sloughs off which results in the subsequent bleeding.

    *if there is implantatation then the newly implanted placenta produces bHCG which takes over the job of the Corpus Luteum in producing Estrogen and Progesterone for maintainance of the endometrium.

    EFFECT OF ORAL CONTRACEPTIVES:
    Firstly, I’d like to say that there are many types of contraceptives and their mechanisms are slightly different.

    There are two main types of Oral Contraceptives in the US
    1. Progestin-only (progesterone)
    2. Combination (estrogen and progestin)

    In regards to the Combination pills (the most commonly used pills)
    1. Exogenous estrogen and progestin (the pills) inhibit the bodies natural production of FSH and LH leading to an inhibition of internal production of estrogen and progestin.
    2. The descreased level of natural estrogen prevents the body from reach the threshold level of esttrogen needed for the “LH surge” mentioned in #6 above.
    3. The lack of an LH surge leads to NO RUPTURE OF THE FOLLICLE AND NO OVUM PRODUCTION.
    4. HOWEVER, the exogenous estrogen and progestin STILL work the same on the ENDOMETRIAL LINING and still develop that lining.
    5. on the white pill days (the 7 placebo days) there is a cessation of both estrogen and progesterone, so the hormones are no longer maintaining the ENDOMETRIAL LINING and you have menstruation like NORMAL.

    In regards to Progestin only medications
    1. Since you don’t have exogenous estrogen, and you are inhibiting internal estrogenic production you will not have endometrial development. You will stop having menses all together. Particularly with the injection of progestin there is a 50% chance you will have PERMANENT cessation of menstruation.

    SO…..Sorry for the long science lesson but the following conclusions can be made:
    1. The bleeding you have with combination pills is the SAME bleeding you would have without the pills. And therefore the bleeding you have on those 5-7 days (placebo pill days) would be the same as your period bleeding. I believe that would indicate the same ahkaam of menstruation during those days.

    2. Bleeding with progestin-only pills/injection is questionable and requires further analysis.

    salam,
    Dr. Arif Hussain

  9. Arif says:

    correction: with progestin-only injections, 50% will have cessation of menstruation by the end of the 1 year. However, if you stop taking the injection you can have a return to normal menstruation.

  10. maryam says:

    Salam Alaykum sisters i am actually taking Depo Provera Injection and my body is not good i used to get normal Menstraution but i used to always get unessary bleeding. and im worried if i can pray or enter mosque or read Quran ? please sisters help i want to do write thing but im confused and now i didnt get any Menstraution but my nurse told me its all part of the Depo Provera but i dont what i should do about prayer, Quran and going to Mosque

  11. Gooney says:

    Is it permissible to go for Follicular scanning when fasting in Ramzaan . Please reply as soon as possible . Thank you .
    Jazakallah Khair.

  12. shaheda says:

    OK I have often heard of people running pill packs together or missing out the placebo ones to avoid a bleed to for example not miss fasing or go on hajj etc… if it’s not considered a real period then that wouldn’t be necessary? You would be bleeding for 7 days and worshipping as usual…

  13. Green says:

    So if I’m on the pill and I get breakthrough bleeding in between my “periods” does it count as istahadah? The blood is dark but it is just spotting, not very heavy, only need to wear a panty liner. Also can I have sex whilst bleeding in between periods? Sorry for too much info.

  14. Umm Maryam says:

    I took the ‘Morning after Pill’ and one of the side effects is Menstrual Changes, which will cause some bleeding, which is want I am suffering from. I am unsure whether I am able to continue during the duration of bleeding or is it regarded as ‘impure’ bleeding/Period. The bleeding is light but continous. As I am unsure I have been washing thoroughly and refreshing my wudu for each salah.

    Can you advise if i am impure and should not be praying or to continue on as normal. I also wanted to perform some voluntary fasts – as my logic is, if i can pray and should be able to fast too???

    Jzk

  15. Umm Maryam says:

    oops…. “I am unsure whether I am able to continue PRAYING during the duration of bleedingf….”

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