No privacy, no water: Gaza women use period-delaying pills amid war

Many Palestinian women have resorted to taking menstruation-delaying pills due to the desperate, unsanitary circumstances they have been forced into as a result of the continuing Israeli offensive in Gaza.

Facing displacement, overcrowded living conditions, and a lack of access to water and menstrual hygiene products such as sanitary napkins and tampons, women have been taking norethisterone tablets – ordinarily prescribed for conditions such as severe menstrual bleeding, endometriosis, and painful periods – to avoid the discomfort and pain of menstruation.According to Dr Walid Abu Hatab, an obstetrics and gynaecology medical consultant at the Nasser Medical Complex in the southern city of Khan Younis, the tablets keep progesterone hormone levels raised to stop the uterus from shedding its lining, thus delaying a period.

The pills may have side effects such as include irregular vaginal bleeding, nausea, changes to the menstrual cycle, dizziness and mood swings, according to medical professionals, but some women like Salma Khaled say they have no choice but to take the risk amid Israel’s relentless bombardment and blockade of Gaza.

‘Most difficult days’

Salma fled her home in Gaza City’s Tel al-Hawa neighbourhood two weeks ago and is staying at a relative’s house in Deir el-Balah refugee camp in central Gaza. The 41-year-old says she has been in a constant state of fear, discomfort and depression, which has taken a toll on her menstrual cycle.

“I am experiencing the most difficult days of my life during this war,” Salma says. “I got my period twice this month so far – which is very irregular for me – and suffered heavy bleeding.”

Salma says there are not enough sanitary pads available in the few shops and pharmacies that have remained open. Meanwhile, sharing a house with dozens of relatives amid a water shortage has made regular hygiene a luxury – if not an impossibility. The use of the bathroom must be rationed, and showering is limited to once every few days.

Pharmacies and stores alike are facing dwindling supplies due to the total siege imposed by Israel following an attack by the armed wing of the Palestinian group Hamas on October 7. In addition, Israel’s bombardment of main roads in the Gaza Strip has made transporting products from medical warehouses to pharmacies an impossible task, according to Abu Hatab.

Without the means to manage her menstruation as she usually would, Salma decided to try to find pills to skip her period.“I asked my daughter to go to the pharmacy and buy pills that delay menstruation,” Salma says. “Perhaps this war will end soon and I will not need to use them more than once,” she added, worried about the possible side effects of the pills on her body.

‘Extreme stress’

More than 1.4 million people have been internally displaced in the Gaza Strip since October 7, living in cramped, unhygienic conditions in United Nations-run schools and in overcrowded spaces with host families or relatives, leaving no room for privacy.

The effects of the Israeli offensive – now in its 25th day – have been devastating. More than 8,500 Palestinians have been killed, the majority of them women and children. Repeated warnings by the Israeli military for residents to leave northern Gaza and Gaza City have seen towns and cities in the centre and south of the territory swell in number, but air attacks have continued to pound the southern Gaza Strip.

According to Nevin Adnan, a psychologist and social worker based in Gaza City, women ordinarily may experience psychological and physical symptoms in the days before and during their periods, such as changes in their mood and lower abdominal and back pain.

These symptoms can worsen during times of stress such as the ongoing war, according to Adnan. “Displacement causes extreme stress and that affects the woman’s body and her hormones,” she explained.

“There can also be an increase of the physical symptoms associated with menstruation, such as abdominal and back pain, constipation and bloating,” she said.

Women may experience insomnia, constant nervousness and extreme tension, Adnan added.

At present, she said more women are open to taking period-delaying pills to avoid embarrassment and shame due to the lack of hygiene, privacy, and available health products.

Still, although she understands the current predicament, Adnan said in normal circumstances consulting a doctor before taking these tablets is important to know what effects these pills and their sustained use might have on a woman’s physical health.