Islamic tradition has never shied away from discussing important matters, especially when those matters are connected to taharah. Purification, cleanliness, and hygiene, all hold an important place in our way of life as Muslims, yet for some reason we still tend to stigmatize open discussions of how to go about maintaining these aspects, especially when they relate to women.
Menstruation specifically is still one topic considered taboo to discuss by many, despite open and clear mentions of it in the Quran, the hadith of the Prophet Muhammad, peace and blessings be upon him, and in documented statements of the early companions. Because of this, many Muslim women grow up not fully understanding their menses, how to manage it, or how to know when something is wrong.
To try and clear the air about menstrual hygiene, I held a candid conversation with Dr. Naglaa Rizk, MD, FACOG, MHA, a New Jersey-based Board Certified Gynecologist with over 20 years of experience who practices Minimally Invasive Gynecology and specializes in Pelvic Pain and Menstrual Disorders.
Together, we discussed many aspects relating to menstruation that can be used as a guide to help educate Muslim women and girls. Here is what Dr. Naglaa had to say.
Content Warning: This conversation includes detailed descriptions of various aspects of menstruation-related practices and beliefs. Imagery has also been included to help readers get a better understanding of their menses and what they may be experiencing. It can be used as a guide for educational purposes or to help open up conversations between mothers and daughters. Please use your judgment when sharing this guide with young girls.
On Knowing What a Typical Period Looks Like
Q: What are the green flags that a period is a-okay? H3 Header
A-okay is when you get a period, and it starts a little light, then gets a little bit heavier. A normal flow lasts between 3 to 5 days total and you're using no more than 3 or 4 regular absorption pads during the day. You're not soaking them through and you're not having clots that are bigger than the size of a cherry.
Q: What does the start of a period look like versus the end? I know this can cause a lot of confusion for both women and girls.
The cycle starts with a period. After your period ends, you know it’s over when there's a white discharge. Most women have a few days of white followed by a few days of nothing. Then discharge can get yellowish and it may get sticky or mucousy; that's ovulation. Then it will go backward to yellowish, followed by a few days of nothing, to days of white. Then you get your period.
Some women can also get a brownish discharge right before their period without any white in between and that can be part of their normal period.
Q: What about women who have the experience of their period seemingly starting, then stopping for a day or two, and then coming back?
That's not normal.
Q: And if a woman is spotting? Sometimes spotting can last for days, extending the total period time to 8, 9, 10, or more days.
That may be her normal period because it’s what she is used to but, medically speaking, the generally normal time for a period is 3-5 days. Maybe 7 if she has more light or spotting days. Anything beyond that, you should definitely see a physician who specializes in menstrual disorders.
On Being Aware of Menstruation Red Flags
Q: So what are some of the signs that a woman might take note of with her menstrual hygiene or experience during menstruation in general that could signal a larger issue?
The first red flag is too much blood, and by too much, I mean:
- if you're soaking a regular absorption pad in less than 2 hours and/or having to change more often than every 4 hours (changing out of necessity not personal preference)
- if you're passing clots that are bigger than a cherry size
- if you're feeling dizzy or overly fatigued
- if you're anemic, and you're not bleeding from anything else so you know it’s your period, that's a problem
- if you have to get up and change your overnight pad during the middle of the night
- if you're bleeding through your clothes or over the sides of the pad
- if you have to use more than one pad at a time
- if you're using overnight absorption pads regularly during the daytime
There are a lot of flags, and I see patients who experience these things on a regular basis and don’t realize that they have a problem.
Q: That is a lot! Are there any other red flags?
Pain. Any kind of pain pelvic, back pain, or hip pain. Breast tenderness is normal. But any other kind of pain that lasts more than 36 hours and beyond a little discomfort is abnormal.
Q: What about the heavy cramping or abdominal pain many women feel that keeps them in bed?
That’s abnormal. Any pain that starts more than 1 day before your period is abnormal. Any pain that lasts more than 36 hours is abnormal, even if you're not taking medication for it.
Anything that is more than a 4 out of 10 on the visual analog scale is abnormal. Some women feel like, “I can handle it” and won’t take medication because they don’t like pills. But when we ask them about their pain they're like “I spent the whole day in bed with a hot pack and I slept and I drank hot tea.”
Okay, you're not taking medication but your pain is so bad that you're living a useless day.
Allah would not give half of the population a week of nothingness, of not being able to be part of the community. That makes no sense. Allah is not unreasonable.
Q: Can you talk more about fatigue? Menstrual fatigue can also be a sign of PMS, right?
Yes, it can. But PMS symptoms that prevent you from being an active, functional part of your family or emotional disturbances that are affecting your relationships at home is not normal thing.
Our male counterparts in society have convinced us that it's okay, that it's normal, that it's just part of your cycle, and no it's not actually. That is a hormonal problem that is associated with certain disease processes.
So is bloating that comes before your period, nausea or vomiting that comes with your period, or loose bowel movements. Not everybody gets this stuff.
Q: That one is surprising because bloating is usually touted as completely normal or that a woman on her period might even gain a few pounds of water weight and let it go afterward. Can you elaborate on that?
Water weight is one thing, bloating is another. Just because society has linked them doesn't make them the same. Water weight is when your fingers expand and your rings don't fit so well. Bloating is when your pants don't fit well and your belly blows up. They’re two different things.
There’s a whole gamut of things that can happen with your period that shouldn’t but we’ve been gaslit. Male physicians and writers have convinced us that “it’s because of your period, and it’s okay.” Well, yes, it is because of your period, but it’s not okay. And that’s how certain diseases in women have gone undiagnosed and underdiagnosed because they were just written off.
Q: So you’re saying that a lot of what we are taught as just part of the nature of being a menstruating woman is actually abnormal, and could signal a larger issue that needs to be investigated by a doctor?
Yes. And unfortunately, not all gynecologists have been properly taught either. A lot of these flags are linked to Endometriosis [when endometrial tissue grows outside the uterus] and Adenomyosis [when endometrial tissue grows into the muscular wall of the uterus] and you would need to speak to someone who specializes in menstrual disorders.
Women can have an issue they don’t realize is an issue because for their whole life they’ve been told that “Yeah, period pain is normal. I had period pain, your mother had period pain, your sister had period pain, your cousins had period pain, too.”
But that’s all because Endometriosis runs in a family.
On Keeping Things Clean During Menstruation
Q: What are the major things to consider hygiene-wise during menstruation?
Water, water, water. Use plenty of water every time you go in to change or go to the bathroom.
I realize that is a challenge for college students and school-age girls who may be in public schools, but you can carry your own flushable wipes or a squirt bottle if you have a big enough purse. Water is the way you're going to clean out all the germs.
Also, keeping your pubic hair out of the picture, however, you want to do that, because hair is great for clumping dry blood which is then fabulous for bacteria.
Water is really the easiest and best way to keep clean.
Q: Is there anything else pertaining to menstrual hygiene?
We are always taught to wash our hands after going to the bathroom. I’m going to make the pitch that you wash your hands before going to the bathroom as well. It’s even more important during your period because you’re going to be touching and cleansing an area where there is a higher chance of your hands depositing bacteria.
It's not that your hands are going to pick up blood and become dirty, it's that whatever is already on your hands is going to stay in that area. You don't know what's on your hands. What were you playing with three hours ago? How many doorknobs have you touched since the last time you washed your hands?
Whatever it is that you've been touching is on your hands so when you go to clean yourself, you’re essentially cleaning with a dirty towel. Always wash your hands before changing any of your period products or before visiting down there for any reason.
Virgins can stick to cleaning their external portions. Women who are married can clean the internal portions gently with a clean finger if they like but we need to clarify a few things first:
- Using water and/or taking showers does not stop your menses.
- Don't use anything that forcibly squirts water inside the vagina.
- Additional vaginal cleaning products, such as douches, are not needed.
Vaginal discharge itself is a liquid that is pushed out from the vaginal walls as a form of cleaning out what's inside. The vagina has its own integral combination of bacteria and yeast that are normal and have their own very delicate balance. When a woman uses other products [to clean internally], she disturbs that delicate balance. When you disturb the balance, either you kill off the bacteria that are necessary or the yeast that are necessary, and whichever one you kill, the other overgrows and it can lead to infection.
You also want to make sure that you're as dry as you can be before you get out of the bathroom. Leaving excess moisture can increase the risk of yeast infections.
On the Hygiene Pros and Cons of Different Period Products
If you’re using Pads (regular absorption):
Hygiene Pros: You can see how much blood there is.
Depending on how often you use the restroom, a lot of women will change their pads every time. It's okay not to, but I would not recommend staying with the same pad all day. It should be changed about every 4 hours.
When you dispose of your pad, I highly recommend wrapping it up. Don't just chuck it. It's not hygienic. Firstly, because of odor and bacteria. Bacteria love to feed on blood. It’s also not hygienic when sharing a bathroom with someone else because somebody might throw something away in the same trash can and accidentally touch it or your kids may get inquisitive; you just never know.
Hygiene Cons: The smell. The feeling of wetness.
If you’re using the same pad over and over, there are women who get irritated which can lead to vulvar sensitivity from the pad itself.
Q: Everything you’ve mentioned is for regular absorption pads. Yet the markets are filled with pads and other products that target women with much heavier flows.
Yeah, but they don't tell you that it’s abnormal. Like if those products are a requirement in your life, you probably have something wrong.
They just adapt these products and have made it seem like heavy menses is a normal thing. I see patients who wear diapers because the pads are not absorbing enough!
If you [consistently] have to use something beyond a regular absorbency, then there’s a problem.
If you’re using Tampons (regular absorption):
Hygiene Pros: They’re mess-free. You can flush them.
Tampons are easy to dispose of without a bloody mess unless you are overflowing the tampon. I have some patients who need to use both a pad and a tampon at the same time. If you need to do this, or you are soaking through the tampon in under 3 hours, it’s too much bleeding and you should go to a gynecologist.
Also, be careful of how you dispose of the applicator. If it’s a paper applicator and you can flush it, then do that. If it’s a plastic one, do not flush them. It’s easiest to dispose of the applicator by just putting it back in the paper it came in and into the trash.
Hygiene Cons: You can forget about them. You can insert them incorrectly.
Tampons can be forgotten about which can lead to problems.
Sometimes women can have a hard time putting them in because they forget that the vagina is parallel to the floor when they're sitting down. So the tampon doesn’t get inserted straight up if you are sitting. Inserting the tampon wrong, or not inserting it in far enough can cause pain or discomfort.
Q: What are your thoughts on the idea some hold about tampon usage removing a woman’s virginity?
Certain cultures believe that things like riding a bike, riding a horse, or taking part in gymnastics, can break the hymen [thin tissue at the opening of the vagina]. This is not true. The hymen is well hidden.
The idea of virginity really goes back to a family’s concept of whether virginity is a physical, structural element of an intact hymen or if it is a sexual construct. There are women out there having oral sex and are considered virgins. And there are women who have never touched a male human in their life but they use a tampon and are not considered virgins.
So it really has to go back to the family's concept. Are they talking about the physical, intact hymen? Or are they talking about an introduction to sexuality? As a Muslim medical professional, I go by sexual activity. Because the physical hymen can be manipulated in a non-sexual manner.
In the Middle East, I've done surgery on a girl who slipped on the edge of a pool stair, suffered lacerations in the whole vaginal area, and I had to manipulate the hymen in order to suture and repair. That girl was clearly a virgin before the accident. But I had to provide a letter as a matter of law letting them know it was the physician who altered things. In the United States, I've had to do surgeries for polyps on women who are unmarried where, again, I'm the one altering the hymen, and had to give a letter saying that it was me.
Virginity is about sexual activity and I believe that’s how the Prophet, peace and blessings be upon him, intended it.
Q: Would you recommend tampons for a young girl or unmarried woman in general?
If her family doesn't have a problem with it and there is a reason for it, yes.
Some women or girls can get sensitivity from pads, or they can’t find one that works for them, or maybe there is a sensory issue that tampons could help alleviate.
There are also medical situations where a tampon might be a better choice. I have patients who are girls living with Adenomyosis but the pills cause them problems and the only non-surgical other options are either an IUD (which many don’t want) or using a tampon with their pads because they suffer from heavy bleeding.
If you’re using a Menstrual Cup or Disc:
Hygiene Pros: They’re reusable. You can’t put it in the wrong place.
The cup can be more difficult for younger or unmarried women to use because it is less forgiving. It’s also bigger at the edges so it can be more difficult to put in and take out. The disc may be easier because it's a smaller, more flexible contraption.
Hygiene Cons: You have to wash it. Like tampons, you can also forget about it.
Some people like the reusable option of the cup but you have to wash it often. The menstrual disc supposedly self-empties the blood by tipping forward when you use the restroom. (Author note: reusable menstrual discs, like cups, are made to be worn for a maximum of 12 hours and still need to be removed and washed after that time.)
If you’re using Period Panties:
Hygiene Pros: Useful for light days.
I don’t have a whole lot of experience with these. They’re useful for a bit of urinary incontinence, or maybe as a backup to a tampon if needed. But I don’t see how they would hold a lot of blood. It’s probably best if they're used for lighter or spotting days.
Hygiene Cons: They can make noise. Can also hold onto odor if not washed well.
Some brands can be loud. The second layer can be diaper-like and you can hear it as you walk. Other brands may not be as loud.
I also can't see putting bloody anything in with your regular laundry and with something like this, it’s likely to hold onto staining and odors over time if it’s not washed right away.
On Purity and Menstruation
Q: What would you say to those women who feel that their menstruation makes them dirty or impure?
Allah, The Most High, gave us menstruation every month to clean out the space within the uterus after an egg has not been fertilized. The uterus is cleaning out the bedding that it had prepared for a potential fetus to attach.
It has nothing to do with her or her personality or the rest of her body being unclean. There's no uncleanliness about menstruation. It’s just that the bedding has not been utilized and is now being shed.
If you're missing periods, it's probably because you're not ovulating, so there's nothing inside for your body to shed. Some women think when they don’t have a period because of medication or a hormonal IUD that they are building up dirty blood inside of them and that’s not true.
Menstrual blood does not get stored. And it’s not dirty blood. Menstruation isn’t dirty at all. It’s just the contents of the uterus being released because there’s no need for it since there’s no fetus for it to hold.
The rulings we have as Muslims are about ritual purity, and women bleeding during their menstruation is not the only thing that impacts that.
Menstruation doesn’t have to be a taboo topic. The more we know and understand the bodies that Allah, the Most High, has given us, the better we can maintain and purify them for His sake and then our own good health. If after reading this conversational guide you have any questions or concerns about your menstruation, seek out a Gynecologist who specializes in menstrual disorders.
Melissa Barreto is a home educating mother of five children and the Co-Founder of Wildflower Homeschool Collective, a homeschool organization based in Northern New Jersey.
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