18. Birth Control Pills and IUDs

Birth control pills are meant to be taken orally every day. The pills contain hormones that either prevent ovulation or prevent the implantation of the egg in the uterus. It is also possible for these hormones to be delivered through a patch, which is effective for a week, or via a vaginal hormonal ring, which is effective for three weeks. There are several advantages to the hormonal methods of contraception. They are user-friendly; they can be used for just a month or for years; and prolonged use can significantly lengthen the time during which a woman is ritually pure, since she does not menstruate as long as she continues to take the hormones. Thus, if the duration of a woman’s ritually pure time is generally two to three weeks of each menstrual cycle, by taking the pill it is possible to extend this time to a month and a half or longer. The couple can also control when the woman will be a nidda and plan it based on their convenience. Nevertheless, the hormones should not be taken for extended periods of time without medical approval.

The downside of hormonal treatments is that they often have side effects, such as moodiness, weight gain, and loss of libido. However, there are many types of birth control pills. A woman, under her doctor’s supervision, can switch to a different pill until she finds the best one for her, thus reducing the side effects. Some people are concerned that hormonal treatments are carcinogenic, but the general consensus among doctors today is that the risk is minimal and not a cause for concern. Some even claim that the hormones reduce the risk of certain diseases. One more disadvantage is that sometimes the hormones lead to breakthrough bleeding, which may render the woman a nidda. Switching to a different pill usually solves this problem.

Nursing mothers need to take special birth control pills that do not adversely affect nursing. The problem is that these pills are more likely to lead to spotting and staining. Usually, taking an additional half pill a day stops the bleeding, but if it continues, an alternate solution must be found (see n. 17 above).

An IUD is inserted into the uterus by a doctor and prevents the egg from implanting in the uterine lining, although exactly how it works is something of a mystery. The advantages of the IUD are that it has neither the side effects of hormones nor the medical concerns. Additionally, a woman does not need to remember to take it every day as with the pill. Therefore, many women prefer to use an IUD instead of hormonal contraception.

The disadvantages of an IUD are that it is relatively expensive and must be inserted by a doctor. It is therefore normally used for a year or more at a time. Another major drawback is that the IUD can cause bleeding for an extended time following its insertion. Even after that, it can lengthen normal menstrual bleeding by one to three days, thereby reducing the number of days that a woman is pure. Additionally, if an IUD is inserted incorrectly, it can cause bleeding until it is replaced.[18]


[18]. If a woman has finished her period and then sees blood that, in the doctors’ assessment, was caused by the IUD, poskim disagree about her status. Some are lenient. Since she is presumed to be finished with her period, then the status of this blood is that of the blood of a wound, since it was caused by the IUD (Taharat Ha-bayit 1:5:10; Dibrot Eliyahu 6:36). Others are stringent, because it may in fact be menstrual blood (Shi’urei Shevet Ha-Levi 187:5 toward the end). Additionally, the claim can be made that any blood that comes from the uterus causes impurity. Still others see her status as uncertain, but are prepared to be lenient if there are additional grounds to justify a leniency (Be-ohala Shel Torah 1:24). It would seem that this blood should be considered a stain (ketem), which does not render her impure if it is found on a nonwhite substrate or is less than the size of a gris (approximately 19mm in diameter). If the IUD is the type that secretes hormones, we cannot be lenient, as it is possible that the hormones triggered a type of menstrual bleeding.

In cases in which an IUD causes a woman’s period to last longer than usual, we cannot be lenient. Even though it is clear that the IUD is responsible, it is too difficult to distinguish between menstrual blood and the blood caused by the IUD.

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