Endometriosis affects 5-10% of all women in their reproductive years. There are challenges for all these patients. However, observant Jewish patients have a few more difficulties to consider when treating.

Despite how common endometriosis is, the diagnosis is still difficult to confirm. In fact women often are not clinically diagnosed for many years. This is because the symptoms and severity of the symptoms vary from patient to patient. It is also unknown why some women develop endometriosis and others do not, but it does run in families.

There is no cure for endometriosis, but treatment can help with the symptoms. The treatment plan would depend on the goal of the patient. For example, the goal could be pain relief or a more regular menstrual cycle. On the other hand, the patient may be trying to conceive.

Observant Jewish patients trying to conceive need a specialist familiar with their unique challenges.

In a recent article published on JewishLink.news, Dr. Alexander Kotlyar tackles this sensitive subject.

“When considering how to treat endometriosis, the issue of conception must be considered with careful incorporation of essential halacha. Since the pattern of menstrual bleeding will affect whether a woman is niddah, any irregular or prolonged bleeding due to endometriosis can drastically affect a couple’s chance to be together and try to conceive. If the niddah status and mikvah immersion are prolonged and delayed, respectively, due to an irregular bleeding pattern this could force the couple to miss being together during the optimal conception window, that is shortly before ovulation. Numerous treatments could address the issue. We can use low doses of estrogen at the start of the cycle to both shorten the bleeding time and delay ovulation. Ovulation can also be delayed using a short course of Clomiphene Citrate (aka Clomid).

It should also be noted that surgery could also play a beneficial role and increase the time span during which a couple could have relations and try to conceive. By excising any visible endometriosis and potentially reducing the level and duration of pain experienced prior to menses, or hargasha, this could reduce the time a couple should abstain while the woman is observing an onat perishah (period of separation).”

Click here to read the full article, Endometriosis: A Primer On an Enigmatic Disease