Home

ISLAMIC MEDICAL EDUCATION RESOURCES-04

0710-Menstruation

Background material for Year 3 PPSD session on 25th October 2007

PHYSIOLOGY

Menarche, is a sign of adulthood. The minimum legal age at menarche is 9 years; there is no maximum set by the Law. The physiological events of the menstrual cycle are tightly controlled and coordinated by the hypothalamus-pituitary-ovary axis. The menstrual cycle is one lunar month on the average. The length of the cycle varies from woman to woman and even varies in the same woman from month to month. The Law sets 1 day as the minimum duration of the menstrual flow. If the menstrual flow is less than 24 hours, prayers missed in that time have to be repeated because that flow is not recognized as menstruation. For purposes of the Law, the usual length of the flow for a particular woman is considered her period, ‘aadat. However if the length of the flow is less than the usual period, she bathes, prays, and fasts without waiting for completion of the usual duration. The minimal interval of purity, inter-menstrual period, recognized by the Law is 15 days.

 

NORMAL MENSTRUATION

Menstruation is natural and is not a disease. A menstruating woman carries on her normal life with minimal restrictions. She can enter the ka ’aba and walk through the mosque but not sit down. She can do anything with her husband except vaginal coitus. Coitus is forbidden during the period between cessation of the menstrual flow and ritual bathing. Menstruation is a distress. A menstruating woman is exempted from obligatory prayers and saum. She makes up missed saum bot not missed salat. She attends eid salat but does not pray. She cannot touch or read the Qur 'an but she can listen to it with no obligation to make sujuud al tilawat. She is allowed to read or recite dua and other writings that contain Qur’anic verses as long as the intention is not reciting the Qur’an itself. The use of hormones to regulate the menstrual period in order to be able to complete the rituals of pilgrimage is widely used. A menstruating woman cannot perform circumbulation, tawaaf, or the trotting, sa’ay, between safa and marwa. A bath, ghusl, is required at the end of the menstrual flow. This bath has both hygienic and ritual aspects and tayammum can be sufficient when no water is available. The menstrual cycle is used to determine the length of the post-divorce waiting period, iddat al talaaq, as well as the waiting period after death of a husband, iddat al maut. There are disputes among the jurists whether the period is 3 months, three menstruations, or three inter-menstrual periods, quruu/tahuuraat.

 

PRE-MENSTRUAL SYNDROME (PMS)

PMS has been implicated as a factor in mental disorders, irritability, child abuse, alcohol abuse, and depression. Salat may not be possible in severe forms of PMS but must be made up later. PMS can be used as a court defense in mitigation of crimes committed while in an irritable and tense mental state. It is also used as an argument for diminished legal competence, ahliyyat, in civil transactions by women. Loss of interest in sex may create stress in marital relations. This is one additional justification for prohibition of divorce during menstruation.

 

MENOPAUSE, ya’isu mina al haidh

Climacteric changes are related to ageing and estrogen depletion. The climacteric is a period of transition and is associated with problems and complications. Menopause is permanent cessation of menses and is considered part of the climacteric. The age at menopause has been rising in countries and societies where nutrition and health have been improving. Among the manifestations of menopause are: vasomotor flushes, osteoporosis, genito-urinary atrophy (vagina, urethra, and bladder), and cardiovascular disorders (MI, CVA). The postmenopausal syndrome is due to deficiency of estrogen. It is a cause of distress, anxiety, behavioral, and physical disorders. Problems of the menopause include bleeding disorders and mood changes. Early menopause can be induced medically or surgically if there is a dharuurat. Artificial delay of menopause to prolong reproductive life or strengthen marriage is praiseworthy. It is offensive if done for purposes of appearing young to the general society. Estrogen replacement therapy (ERT) can alleviate virtually all menopausal symptoms. ERT has serious side effects that have to be considered under the two principles of benefit and harm.

 

MENSTRUAL DISORDERS

The Qur’an describes menstruation as an annoyance, adha. It is associated with impaired immunity, susceptibility to vaginal infection, and psychological stress. Menorrhaghia is excessive menstrual flow that requires extra care with hygiene if mosque entry is contemplated. The Law considers 15 days the maximum duration of the menstrual flow. Salat and other acts of ibadat are resumed if the flow continues beyond 15 days. Prolonged bleeding, istihaadhat, is not considered menstruation. Intermittent vaginal discharge is not a problem. DUB does not stop the woman from salat or fasting. It is treated as urinary incontinence. The woman washes her vagina and perineum, pads herself, makes wudhu and prays immediately to try to avoid being caught by more bleeding. Sexual relations are allowed in DUB unless there is a medical contra-indication. The severe pain of dysmenorrhoea may interfere with ibadat and civil obligations.

Professor Omar Hasan Kasule, Sr. October, 2007