Tuesday, February 14, 2012

UPDATED: Menstrual Cycles and the Mikvah

You're a smart cookie, so you already know that the laws of taharat hamishpacha require a married woman to go to the mikvah after a waiting period that comes after the period ends or a certain number of days.

So that means you have to plan your conversion mikvah date equally carefully, right? Not necessarily. You'll probably get little say on what dates are available.

Some batei din hold that you can't immerse for your conversion while there is a flow. I don't know of any batei din who hold that women have to follow the same rules as married women, but who knows.

I know there are other batei din who hold that a woman can immerse for conversion at any time. That doesn't mean they won't discourage you from immersing during that time. They might, or they might even assume you prefer that extra few days or week wait. (And some might assume you're going to make the mikvah gross.) You can always express your desire to dip sooner than later, if that is important to you, and maybe you'll even get your wish.

At some point, you might get the chance to awkwardly (or not) say to the rabbi, "Uhh...what is your ruling about menstrual cycles and the mikvah?" If you suffer from irregular periods, you may want to have a "hypothetically speaking" conversation with the rabbi before you have a date. Best case scenario, they say it doesn't matter and any day will work. 

So what happens if they say the blood matters, you get a mikvah date, and something (usually stress) throws your cycle out of whack and you suddenly have an inconvenient mikvah date? There are a few options, and none is really that pleasant. They may even be dangerous. I recommend staying with options 1 or 2, and if you decide to pursue options 3-5, check with your doctor, preferably your gynecologist.

1) Explain that the date needs to be moved. You don't even have to name the reason, though I'm sure any curious rabbi would ask. If you would prefer to be vague, I think most rabbis won't push it if you say it's health-related. You'll be annoyed that you have to delay your conversion, but it's really not the end of the world.
2) Ask whether the circumstances might make it alright, such as a very light flow or you hope it might stop in time. It's a coin toss what'll happen.
3) If you are not taking birth control/hormonal pills already (or don't at this part of your cycle), you can try re-starting the medication. If you use Nuvaring or other non-daily birth control, you can leave the medication in place longer than you normally would. While this is commonly done by women worldwide who want to delay a period, it is not without its risks. I don't know what the effects might be, and I encourage you to discuss this with your doctor.
4) Take extra birth control medication as soon as you have signs that a period is starting. This is probably terrible for your body, and I can't guarantee that it isn't dangerous. I don't know. And it will hurt terribly (cramps), and you will feel awful for at least a few days. Your doctor can tell you the appropriate number of pills to take if he or she approves this as "not dangerous" in your case. 
5) The Plan B pill. I believe that anyone over 17 can purchase it over the counter (without a prescription, but it may still be behind the counter) in any state. This pill is just a one-pill version of the high-dose birth control in option 3. Just because you can get it without a prescription doesn't mean you should take it lightly. Unlike the target market for Plan B, you have the luxury of at least a few days to research and think about it. This pill creates the same painful cramping and other side effects. 

Again, note that I'm not a doctor. Don't do anything dangerous; halacha forbids risky activity. A few days, a week, or even a month really won't mean anything in the grander scheme of your life, I promise. If you have to delay your conversion, you have to delay it.

UPDATE: I foolishly assumed this was obvious, but I want to state it explicitly: any delay of your period should never be more than a couple of days. Don't try to skip an entire period or move it a week or something! I'm discussing the surprise period or the surprise mikvah date, not shifting your cycle entirely!

Hopefully you won't have to deal with these questions!


  1. Suggestion #4 and 5 are pretty bad for you. I'm also not a huge fan of #3. My suggestion is try #1 and 2. Extra hormones like that are pretty bad for you. Better you be slightly embarassed to mention your period to a beit din and delay it than hurt yourself.

  2. can't you use one of those tampons that go inside the vagina? it may not count as a barrier if it's completely inside the body, but consult your LOR.

  3. I second Jade... beyond normal "vacation packing" with your birth control pills or your Nuva Ring (which means you skip the inactive placebo pills and start a new pack right away/put in a NEW Nuva ring instead of leaving it out for 7 days) I doubt any gyno would recommend taking multiple BCPs or Plan B for the purpose of skipping a period.

    Plus, if your community mikvah doesn't require converts to plan their dip around their cycle, Instead and the Diva Cup are good options if Aunt Flow decides to visit at the time of your mikvah... there's no, shall we say, external evidence unlike with tampons.

    Either way, great post. Definitely a question that I think a lot of converts are nervous to ask about, or maybe wouldn't think about anyway.

  4. To clarify about the Diva Cup or Instead - leniencies exist for items hypothetically seen as barriers that are placed inside an orifice of the body. So definitely still consult your rabbi.

  5. if you use one of those tampons that you can insert in, you can always cut the thread so it won't be seen, and no one will notice that you have anything inside.

  6. Thanks for the note about limiting it to a few days. I thought that was obvious, but that was the danger of assumption. I added some text above.

    As for tampons and the Diva Cup (those totally didn't occur to me!), that depends what the basis of the rabbi's ruling is. Whether it can be seen or not isn't the relevant point. There may be barrier issues for protruding parts (even with the Diva Cup, which I thankfully am familiar with). But if not and the ruling is based on "ewww" reasons, those could help. However, unless the flow is very heavy, there is little to no worry about "dripping" into the water. You're in the mikvah a very short time, and your legs are shut most of the time (you're standing), which will keep low to moderate flows inside your body for the 5-10 minutes.

    All that said, don't make the mikvah your first experience with the Diva Cup or a similar product. You mess it up at least the first few times you use it, which either causes discomfort or spilling. And I think most people freak out getting it out the first few times, so that's not an experience you want on Mikvah Day.

    If your rabbi's ruling is that women can't immerse in the mikvah during a cycle, but not because of "eww" factor, then do not use a tampon or other device to hide your period's presence. That is deceitful, disrespectful, and could even be grounds for your conversion not being valid if you ignore a rabbi's ruling at the moment of entering the Jewish People. You're not THAT desperate for your conversion to be on THAT day, are you?

  7. As a medical student and someone taking BC and skipping periods on it, here's my take.

    If you're on a monophasic/constant-dose oral birth control pill (eg. Alesse, Yasmin) you can take it for up to 3 months consistently. This skips 2 periods. You can take it for longer, but there's less research available supporting this length of use. Sideffects: same as 1 month BC use, plus possible spotting (depends on the person/BC).

    If you're on multiphasic oral birth control (eg. Ortho Tri-Cyclen), this isn't really possible. The fomulation of the pills changes over the month. So don't skip the placebo pills.

    I can't really comment on nuvaring, but the general consensus in medicine is not to leave anything inside your body longer than is recommended. Yucky things can happen (eg. infection, reaction to degradation, etc.).

    Point being, if you need to delay your period and you're a medically uncomplicated person, there is a perfectly safe way: monophasic birth control. You can talk to your doctor to see if this is a good option for you :).

  8. My (Conservative) rabbi asked me directly about how my cycle fell, in order to ensure that the date was planned around it. It was a sort of weird conversation, but whatever. Had to be done!

    There are BC prescriptions (i.e. Seasonale) that reduce your periods to once every three months. I was on it for a while with no adverse side effects that I noticed. If you know your mikvah is coming up in the near future, you could look into getting on this prescription, and it won't be a jury-rigged fix, which won't freak your doctor out. The only downside is that if you've just started using this kind of BC, you're more likely to get spotting or similar the first time out. I didn't have major problems with that, though, so it's entirely possible others won't either.

  9. The conversation is one that you are likely to have again - at your wedding. May as well try it out the first time here.

  10. Halachically, conversions can occur at any time of the month - see yoatzot.org for more info. Along those lines, a tampon or diva cup (i.e. something temporary that can be removed) is considered a chatzitzah / barrier for immersion. That being said, there may be rabbis that will still prefer postponing, even if the woman wanted to go ahead. Another (potentially less awkward) option is to consult with the Mikveh - they may be able to act as a liaison with the rabbi(s).

  11. When I immersed for conversion, my period had just ended. It doesn't really matter, because you're immersing not for purity but for a change in status. If you want to kill two birds with one stone, and do hefsek tahara and stuff, you can. Tampons and the like are probably a chatziza also. I think the most important reason not to immerse during your period is that you may get fluid in the mikvah. Also, I had to sit there talking to the beit din in a bathrobe, which definitely would have gotten stained/drippy otherwise. My opinion: just ask the rabbi or mikvah to change the date if you'll be on your period, for practical reasons. It's way less embarrassing than the alternative, and it doesn't hurt you. Rabbis aren't teenage boys. They deal with this stuff all the time. Isn't the rabbi you pick is mature enough to handle this?

  12. Skylar,

    I'm a little bit shocked at this post. Delaying a menstrual cycle is easily accomplishable, but no one should be relying on the information in this post. They should be consulting their doctor. Furthermore, much of the information in this post is oversimplified or flat-out wrong.

    1. Taking extra birth control pills (multiple at a time) is not an effective way to delay a period and, you're right, it has its sideffects.
    2. Taking birth control to delay a period for a long period of time (weeks/months) is perfectly safe with some birth control formulations, but once again a doctor should be consulted. Perhaps planning well in advance of the mikvah would allow this.
    3. Taking Plan B may actually INDUCE bleeding within 7 days of taking the medication. BAD IDEA if your intention was to stop bleeding.

    You might want to get this post re-written by a medical person, or cut out some of the not-so-accurate suggestions and updates.

    1. If 6 reminders of the importance of discussing these options with your doctor wasn't enough to impress upon someone that "a doctor should be consulted," I don't know what will convince that person.

      Most people get a few days' or hours' notice of a mikvah date. It's possible to get "let's go right now!" but even these suggestions can't help that situation. Planning ahead simply is not always possible.

      But let's discuss the larger issue. You're shocked I'm discussing this. If I had a "medical person" to write this, I'd have had them write it. I don't. And neither do the other people facing this situation (or who may not even know these issues exist until it's too late). The *real* issue here is that this topic needs to be discussed because panicked women send out texts and phone calls to any Sally, Darlene, or Mary to get old wives' tale advice on how to stop or delay a period. Whether it's a good idea or not and the safest ways of accomplishing it should be discussed reasonably and available to people who need it. The benefit of this is that we can pool our knowledge together through this comments section, as we have done. I have never made any claim to infallibility on this blog, and I was doubly certain to highlight my ignorance in the body of this post repeatedly.

      Thank you for your comments on Plan B, though since you remain anonymous and don't reveal your source of medical knowledge, the average person would probably take into account the fact that the medical student above didn't mention that issue. And that person could disregard your comment. Just like how juries in a trial consider the reliability of the witnesses in the case.

      But at least the discussion is happening, and it's not being left to gossip and panic. That was my goal.

    2. Oh, and to address several of your points, I explicitly said none of the suggestions I gave should be for more than a couple of days. I'm discussing the surprise period or the surprise mikvah, not shifting your cycle. Therefore, your comments about 7 days, weeks, and months just appear irrelevant.

    3. Er - medical student from above here.

      Hate to say it, but it looks like this Anonymous is right about the plan B (I was wondering about that too when I read your original post). I just looked it up on Dynamed (a comprehensive medical review site), and I found this under emergency contraception: "if no bleeding, check hCG [the pregnancy hormone] at 10-14 days." The contraception induces bleeding in pregnant patients; it certainly doesn't delay bleeding in a non-pregnant individual.

      I guess none of this advice helps much if you're given a few hours notice! That seems pretty crazy. Would you know that the mikvah phonecall is coming (within weeks/months)?

      It's hard to stop a period once it's started - it could take up to a few days. So maybe it would be worth considering skipping a period or shifting your cycle if you know a mikvah date could be approaching... *insert manditory talk-to-your-doctor disclaimer here*

      FWIW, I don't think you've recommended anything actively dangerous :P.

  13. FWIW if you really feel uncomfortable speaking to your Rabbi directly it's quite easy to go to the Rabbi's wife and have her speak on your behalf. Slightly less embarrassing. And it can be an effective way of communicating about other family purity issues in the future - just make sure you right down all the details for her so that there are no mistakes made in communication. Or email your Rabbi if that makes you feel more comfortable than a face to face discussion

  14. What if you're ill? Would that be seen as contaminating the mikvah: your virus or bacteria?