Shalom, Rabbi Halperin
Professor Avraham referred me to you regarding a medical Sheila I have.
What is the halachik definition of endometriosis, dam niddus or dam makka?
And does it depend where the endometriosis is?
Thank you in advance,
Endometriosis is a condition in which cells from the uterine lining appear in other parts of the female reproductive system, including the tubes and ovaries, or even in the abdominal cavity. Because the cells are the same as those of the uterine lining, they are often affected by the menstrual hormones.
Although physiologically the cells are uterine cells, the law of dam niddah is limited to cells within the uterus. However, cells found beyond the uterus would not be considered as dam niddah, but as other internal bleeding.
Therefore, if it were possible to ascertain that the blood is only from regions beyond the uterus, the bleeding would not render the women a niddah. However, in practice, bleeding from the endometriosis is usually accompanied by uterine bleeding, so that the woman would usually be treated as a niddah.
There is another, somewhat similar, condition called cervical ectropion, in which cells from the cervical (not the uterine) lining extend outwards beyond the cervix outside the canal. These cells are fragile and are liable to bleed upon contact, such as when a woman does a deep internal bedikah. This is considered as dam makka and is a condition possible to verify by a gynecologist or a bodeket tahara, a gynecological nurse trained by Machon Puah. In this case a rav should be consulted.