In today’s page of Talmud the rabbis wonder about the meaning of the verse in chapter four of the Book of Esther:
מגילה טו, א
״וַתִּתְחַלְחַל הַמַּלְכָּה״. מַאי ״וַתִּתְחַלְחַל״? אָמַר רַב: שֶׁפֵּירְסָה נִדָּה, וְרַבִּי יִרְמְיָה אָמַר: שֶׁהוּצְרְכָה לִנְקָבֶיהָ
The verse states: “Then the queen was exceedingly distressed” [vatithalhal] (Esther 4:4). The Gemara asks: What is the meaning of vatithalhal? Rav said: This means that she began to menstruate out of fear, as the cavities, ḥalalim, of her body opened. And Rabbi Yirmeya said: Her bowels were loosened, also understanding the verse as referring to her bodily cavities.
So today we will discuss Rav’s statement that because of Esther’s tremendous stress, she menstruated.
The effect of Stress on the Menstrual Cycle
There has of course been a great deal of scientific work investigating the effect of the menstrual cycle on a women's mood. But there has been less examination of the effect of mood (or stress) on the cycle. Elsewhere, Rabbi Meir says the very opposite of Rav. He claims that fear (or stress) prevents menstruation.
נדה ט,א
רבי מאיר אומר אם היתה במחבא והגיע שעת וסתה ולא בדקה טהורה שחרדה מסלקת את הדמים
Rabbi Meir says: If a woman was in hiding from danger, and the time of her fixed menstrual cycle came and she did not examine herself, nevertheless she is ritually pure, [as it may be assumed that she did not experience bleeding] because fear dispels the flow of menstrual blood.
In a third place in the Talmud these contradictory opinions are resolved:
סוטה כ, א
למימרא דבעיתותא מרפיא אין דכתיב ותתחלחל המלכה מאד ואמר רב שפירסה נדה והא אנן תנן חרדה מסלקת דמים פחדא צמית ביעתותא מרפיא
Does fright loosen the womb [and causes a woman to menstruate]? Yes, as the verse states (Esther 4:4) "...and the Queen [Esther] became very afraid" about which Rav explained:" she began to menstruate."
But haven't we learned elsewhere in a Mishnah (Niddah 39a) that fear suspends the discharge of menstrual blood? In fact, fear that is not sudden contracts [the womb and prevents bleeding], but sudden fear loosens [the womb and causes early menstrual bleeding].
Here are some of the things that the rabbis of the Talmud believed could induce menstruation:
Carrying a heavy load (Tosefta Niddah 9:1)
Jumping (ibid)
Sudden fright (Niddah 71a, and Niddah 39a)
Yearning for intercourse (Niddah 20b)
Garlic, onions and peppers (Niddah 63b)
OK, but these beliefs aside, which of the two opinions, that or Rav or that of Rabbi Meir, are best supported by the science?
“Data from both animal and human research indicate that psychological stress is associated with altered menstrual function.”
The Effect of Stress on Menstrual Function
In a review from the Department of Biological Sciences at Ohio University, researchers acknowledged that stress is difficult to define. However, one final common pathway of stressors is the low availability of dietary energy. Ovulation - which is the first part of the cascade that leads to menstruation - has been blocked in hamsters "by food restriction, pharmacological blockers of carbohydrate and fat metabolism, insulin administration (which shunts metabolic fuels into storage), and cold exposure (which consumes metabolic fuels in thermogenesis)." Women athletes frequently experience a lack of menstruation, which is found in up to 65% of competitive young runners. But what about psychogenic causes of a disturbed menstrual cycle - after all, Rabbi Meir taught fear prevents menstruation? While not adressing this directly, the Ohio University researchers had this to say about the relationship between psychological stressors and amenorrhea (the lack of menstruation. Remember that word - it will come up again):
Associations between psychological disturbances and amenorrhea or infertility have long been interpreted as a causal relationship, but prospective studies demonstrating that psychogenic factors contribute to reproductive dysfunction in women are almost completely lacking . Early psychoanalytic conclusions that psychological conditions underlie involuntary infertility in women have been criticized recently on several grounds: first, the same psychological conditions have been found in analyses of fertile women; second, other women with very serious psychic problems conceive with ease; and third, couples with an unfulfilled desire for a child do not show psychological disorders any more frequently than do couples without fertility disorders. Even the direction of causality is questionable, because there are grounds for believing that infertility and its medical treatment cause the depression and anxiety observed in some infertility patients. These findings have led to the recommendation that the term ‘psychogenic infertility’ should be withdrawn from use because it is simplistic and anachronistic.
Menstruation and Incarceration
There is some other evidence we could consider: a 2007 paper published in Women's Health Issues which addressed the influence of stress on the menstrual cycle among newly incarcerated women. Researchers analyzed 446 non-pregnant women who answered a number of detailed questions about their menstrual cycles. They found that 9% reported amenorrhea (I told you what that meant two paragraphs ago) and that a third reported menstrual irregularities.
“Incarcerated women have high rates of amenorrhea and menstrual irregularity and the prevalence may be associated with certain stresses. Further research on the causes and consequences of menstrual dysfunction in this underserved population is needed.”
As might be expected, the stressors of the incarcerated women in this study included drug and alcohol problems and sexual abuse. And it supports the assertion by Rabbi Meir that stress - in the form of incarceration, is causally linked to amenorrhea.
A Longitudinal Study of Psychological Stress and Menstruation
The final study we will review comes from a cohort of predominantly white, well educated married women of whom 505 were "invited to participate join a special survey focusing on midlife and menopause." Rather than ask about stress and current menstruation, the researchers performed a two-year analysis. Here's what they found:
In analyzing stress levels and cycle characteristics across 2 years...women with marked increases in their level of stress (n =30) are shown to have decreased length (0.2 days/cycle) of menstrual cycle intervals and decreased duration of bleed (0.1 day/cycle) compared with increases in these measures (2.9 days/cycle for cycle interval; 0.3 days/cycle for duration of bleed) among women with no marked change in stress level (n=103); t-tests indicate that these differences are significant (p < .05).
Some of the differences that the researchers found in this group were really small - "0.3 days/cycle for duration of bleeding" but if you are into statistics this difference can be significant (that's what those t-tests are all about). But these statistical associations were not powerful, and the researchers concluded that "the results of this investigation...suggest that, in the long term, stressful life events have little relationship to the length of menstrual cycle intervals and the duration of menstrual bleeding in perimenopausal women."
The three studies we've reviewed (even that last one with its weak findings) all suggest that there is indeed a relationship between psychological stress and menstruation. Generally, the effect of stress is to increase the length of the menstrual cycle which may result in amenorrhea. Rabbi Meir, the great sage of the Mishnah, was certainly onto something when he noted just the same effect almost two thousand years ago. And as for Rav, well, perhaps he should have asked a woman. They generally are the experts in these matters.
