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Background material by Professor Omar Hasan Kasule for Year 3 Semester 1 medical PPSD session on 09th August 2008
MENSTRUATION AS AN ANNOYANCE
Menstruation is a discomfort. The discomfort is reflected in 3 ways. Immunity is impaired during menstruation. Changes in the vaginal bacterial flora occur increasing susceptibility to infection. It is also a period of psychosocial stress.
AMENORRHOEA
Amenorrhea occurs in anorexia nervosa when gonadotropic secretion fails. Primary amenorrhea is failure to start menstruation by the age of 16. Secondary amenorrhea occurs after a period of normal menstruation. Amenorrhea in anorexia nervosa and in women engaged in strenuous physical activity may be due to reduction of the fat mass causing inability to metabolize estrogens. Psychogenic amenorrhea or hypothalamic amenorrhea is due to hypothalamic under-activity from cerebral impulses (fear, emotional shock, anxiety), infections, neoplasms, or traumatic injuries. Amenorrhea may be ovarian in origin. Amenorrhea may be due to imperforate vagina.
MENORRHAGHIA AND METRORRHAGHIA
Menorrhaghia is excessive menstrual flow. There are no special rulings on this. Extra care must be taken with hygiene especially if mosque entry is contemplated.
OLIGOMENORHOEA
Oligomenorrhea is defined as prolonged intervals between menstruations. It may be psychological, hormonal, or structural.
PROLONGED MENSTRUATION
The menstrual flow may be prolonged in association with menorrhaghia and without it. The Law considers 15 days the maximum duration of the menstrual flow. Salat and puasa are suspended during this time. Salat and other acts of ibadat are resumed if the flow continues beyond 15 days.
DYSFUNCTIONAL UTERINE BLEEDING, DUB
Dysfunctional uterine bleeding occurs around adolescence or around the menopause. Menstrual flows are irregular and ovulation is absent. It is due to poor LH response to rising estrogen levels in girls and low estrogen rise in menopausal women. It is treated using estrogen-progesterone hormone combinations.
Prolonged bleeding, istihaadhat, is not considered menstruation[1]. Intermittent vaginal discharge is also not a problem[2]. 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[3].
DYSMENORRHOEA
Dysmenorrhea refers to painful uterine contractions before or during the menstrual flow. Uterine contractions to expel the menstrual flow may be painful especially in young women who have not been pregnant before. The severe pain of dysmenorrhea may interfere with ibadat and civil obligations. The pain of primary dysmenorrhea may be due to uterine prostaglandin release that increases the strength of uterine contractions and constricts blood vessels. Secondary dysmenorrhea is caused by genital obstruction, infections, or neoplasms.
FALSE PREGNANCY, PSEUDOCYESIS
This is a psychological disorder in which cerebral impulses are generated to stimulate the hypothalamus with consequent increase in secretion of LH and prolactin. This leads to appearance of typical symptoms of pregnancy.