Use of hormonal pills to delay periods in Ramadan

In short: Periods can be delayed in Ramadan with norethisterone tablets started a few days before the expected period, two to three times a day, or by taking the combined contraceptive pill without a break. Minor effects include breast tenderness, headache and spotting. They are not suitable for women prone to blood clots or with migraine with aura, so ask the doctor before starting.

Women delay periods during Ramadan so they can fast the entire month.

It can be done medically but should be done under the direct supervision of a gynecologist.

Hormonal pills are used for this purpose; the safest option is chosen based on patient assessment.

Why are women not allowed to fast during menstruation?

During the menstrual cycle the body experiences hormonal changes and blood loss which result in:

• Fatigue
• Pain
• Headache
• Dizziness
• Low energy levels

And that’s why they are not allowed to fast, in order not to put more physical strain on their body.

**norethisterone pills:

• Sold under the name primulot nor or aminor
• It is a progesterone
• Started about 3 days before the expected start of the period
• Taken 2-3 times per day
• The period usually starts 2-3 days after stopping the pills
• It is not a contraception, it only works on the endometrium

**combined birth control pills:

• They contain both hormones estrogen and progesterone
• They also prevent ovulation and hence pregnancy
• The pills are taken daily and continuously (skip the placebo week and start the next pack immediately)
• Period usually starts 2-4 days after stopping the active pills
• Examples are: Yasmin, yaz, microgynon, marvelon

**side effects include:

• Breast tenderness
• Bloating
• Mild headache that responds to simple analgesia
• Mood swings
• Irregular spotting

Who shouldn’t take these pills?

• History of blood clots (thrombosis) or a known clotting tendency — this applies to both combined pills and high-dose norethisterone
• Migraine with aura
• Liver disease
• Breast cancer
• Uncontrolled high blood pressure

Smokers aged 35 or over, women with a history of stroke or heart disease, or recent major surgery with immobility (for combined pills)

From Islamic point of view, is it okay to delay periods in order to fast the whole month of Ramadan?

Yes, it is halal as long as it doesn’t impose any harm on health.

What if the woman can’t take hormonal pills, are there any alternatives?

There are no reliable alternatives but the can try taking tranexamic acid which decreases the amount of menstrual blood hence shortening the duration of the cycle and the number of days during which she doesn’t fast.

It is out of God’s mercy to His servants that He allows women to break their fast during the blessed month of Ramadan on the days of menstruation, because menstruation itself exhausts a woman’s body and she needs all her energy to be able to care for and feed her fasting family members, and she is rewarded for providing this care.

Dr Najeeb Layyous F.R.C.O.G

Consultant Obstetrician, Gynecologist and Infertility Specialist