Exploring the impact of Ramadan fasting on women’s reproductive health: A narrative review

Abstract

Ramadan is the ninth month of the Islamic lunar calendar in which Muslims abstain from consumption of food and drink, smoking, and engaging in sexual activity during daylight hours for the full lunar month, approximately 29–30 days. Beyond its spiritual significance, fasting during this month represents a distinct physiologic and cultural practice that may influence women’s reproductive health. This narrative review integrates findings from published studies to summarize current evidence on the impact of Ramadan fasting (RF) on the menstrual cycle, fertility, polycystic ovary syndrome, pregnancy, and breastfeeding. Relevant literature was identified through PubMed and Embase using keywords related to Ramadan and women’s health, with emphasis on qualitative synthesis and critical interpretation rather than quantitative comparison. Across the literature, RF appears to cause mild and temporary menstrual irregularities without major hormonal changes. Fertility hormones generally remain stable. Among pregnant and breastfeeding women, most studies report no significant differences in maternal or neonatal health between fasting and non-fasting groups, though findings vary by region, nutritional intake, and gestational timing. While immediate birth outcomes appear largely unaffected, long-term effects have been elucidated through recent studies. Collectively, the evidence highlights the physiologic adaptability of women during RF while revealing the need for more comprehensive research on RF’s effect on women’s health. Gaining insight into this area of research contributes to a more inclusive and culturally sensitive approach to healthcare, targeting the unique needs of female Muslim patients. This will allow healthcare providers to leverage this research to establish rapport with their patients and deliver attuned, quality care.

Plain language summary

What do the findings mean? While healthcare providers can use this evidence to offer culturally sensitive guidance to Muslim women during Ramadan, more research is required in Western countries to provide personalized care in different populations. Why was the study done? Ramadan fasting involves abstaining from food, drink, and certain activities during daylight hours for a month. This review looked at how Ramadan fasting affects women’s health, focusing on the menstrual cycle, fertility, polycystic ovary syndrome (PCOS), pregnancy, and breastfeeding. What did the researchers do? The researchers reviewed and summarized studies that analyzed the effects of Ramadan fasting on women’s reproductive health and pregnancy-related factors. What did the researchers find?

• Ramadan fasting may cause irregular menstrual cycles but doesn’t significantly change reproductive hormone levels.

• Fasting does not harm fertility or ovulation.

• Pregnant and breastfeeding women should consult a physician prior to fasting during Ramadan as there is inconclusive and contradictory evidence on safety.

• Fasting during pregnancy or breastfeeding is generally safe when nutrition and hydration are maintained however, early-pregnancy fasting may slightly reduce birth weight if calorie intake is low. Modest long-term associations, such as slightly lower height-for-age and small differences in childhood cognitive performance, have been observed, particularly with first-trimester fasting.

• Breast milk composition and infant growth are mostly unaffected, though some micronutrients may be slightly lower.

Keywords

Ramadan Ramadan fasting PCOS menstrual cycle fertility breastfeeding pregnancy

Introduction

As of 2023, Islam stands as the world’s second-largest religion, embraced by a quarter of the global population.¹ Within Islam, one of the fundamental practices that significantly shapes the lives of Muslims is fasting during the Islamic month of Ramadan. During this sacred lunar month, Muslims abstain from both food and drink from dawn until dusk. Ramadan is a religiously and culturally significant month for Muslims, as during this month many not only feel closer to God and their personal spirituality, but they feel closer to their families and other members of their communities. Millions of Muslims across the world share in this tradition marked by selfless devotion. Muslims who observe Ramadan fasting (RF) may experience a range of benefits, including weight loss, reductions in BMI and waist circumference, as well as mental health improvements such as enhanced willpower, greater self-discipline, increased emotional resilience, and a sense of spiritual renewal through the atonement of past sins.^2,3 Fasting during Ramadan is embedded in the lives of Muslims starting from an early age, as many children are eager to share in the tradition alongside their parents and other community members. Despite busy schedules, families eat their first meals and break their fasts together every day for the entire lunar month. Thus, it is quite easy to see that not participating in such a significant month could feel isolating for many, even if their health exempts them from fasting. In fact, the Qur’an exempts those who are menstruating, pregnant, or ill from fasting during Ramadan, and requires them to make up the missed days later in the year, in addition to full exemptions for children, the elderly, and those who are sick, frail, or mentally or cognitively impaired. Fasting does not look the same for every woman, especially if they have an underlying condition that could affect their health. It is important for these women to know the benefits and risks, if any, of RF given their health conditions.

In addition to these challenges, Muslim women have often faced suboptimal healthcare experiences, particularly in non-Muslim majority countries, despite the significant presence of Muslims in the global population. In fact, Black women and Asian women (two ethnicities that make up a significant percentage of Muslim women) are four and two times more likely, respectively, to die during pregnancy than White women in the United Kingdom.⁴ A qualitative systematic review of Muslim women’s experiences of maternity services in the United Kingdom showed a lack of cultural sensitivity and stereotypical cultural assumptions toward Muslim women by healthcare providers, as well as lack of regard for their decision-making processes.⁴ For example, there is a lack of understanding that a Muslim woman would not want to attend a prenatal class because of the presence of other men and a lack of subsequent privacy. The review found other examples of this too, like Muslim women not being able to follow dietary suggestions given by their healthcare providers because the guidelines did not include Halal (meat that is sacrificed Islamically) options, or not taking proper medications or vitamins because there was no information about the animal products in them. To combat biases toward Muslim women, provide more comfortable, culturally appropriate experiences for them, and increase their quality of healthcare, more research must be done regarding the health of Muslim women and the effect of different religious practices, like Ramadan.

In this review, our primary objective is to investigate the impact of RF on various aspects of women’s reproductive health to facilitate physician–patient discussions on this topic. Our examination begins by exploring the correlation between RF and its effects on women’s menstrual cycles, followed by an analysis of its influence on fertility, polycystic ovary syndrome (PCOS), pregnancy, and breastfeeding. Rather than systematically pooling outcomes, this review adopts a narrative approach to integrate diverse findings across physiology, culture, and geography, with the goal of contextualizing the health of fasting Muslim women beyond statistical measures.

Materials and methods

This narrative review qualitatively summarizes existing evidence on the effects of RF on women’s health. Relevant studies were identified through PubMed and Embase using combinations of the keywords “Ramadan,” “Ramadan fasting,” “menstrual cycle,” “fertility,” “pregnancy,” “breastfeeding,” and “PCOS.” The search prioritized peer-reviewed articles published in English or with available translations.

Because this review was designed to integrate rather than systematically quantify findings, no formal risk-of-bias tool or meta-analytic methods were applied. Instead, methodological quality was evaluated qualitatively. To maintain consistency across heterogeneous study designs, we developed internally defined criteria focusing on five aspects: clarity of study objectives and methodology, adequacy of sample size and participant selection, appropriateness of control or comparison groups, transparency in defining fasting exposure and measured outcomes, and soundness of statistical interpretation. All authors independently reviewed and discussed the included studies to ensure alignment in appraisal and inclusion decisions. Data from included studies were analyzed thematically to identify consistent trends, conflicting results, and contextual factors influencing women’s physiologic responses to fasting. The goal was to generate an interpretive overview that reflects both biomedical and cultural dimensions of RF.

Results

Fasting and menstrual cycle changes

Hormonal shifts are essential for regulating the menstrual cycle and fertility.⁵ Given the precise regulation of hormone levels throughout the menstrual cycle, monitoring any alterations resulting from women’s engagement in RF could prove advantageous.

A total of two articles observed the interplay between RF and its effects on a woman’s menstrual cycle. Yavangi et al. monitored 80 college-aged women for a total duration of 3 months—including the month before and after the observance of Ramadan.⁶ Levels of blood volume were assessed for the daily usage of pads and tampons, commencing from the onset of each participant’s menstrual cycle. Questionnaires were administered to gather information regarding the participants’ menstrual patterns both preceding and after the designated study period. Examination of the collected data found that 30% of the participants experienced irregularities in their menstrual cycles during Ramadan compared to the months outside of Ramadan. Specifically, 13.8% of the women reported instances of oligomenorrhea exclusively during the Ramadan period. This was a significant increase in incidence compared to a 1.3% increase in the 3 months preceding Ramadan and a 2.5% increase in the 3 months following Ramadan. Essentially, a significant increase was observed in the incidence of oligomenorrhea in the month of Ramadan when compared to months when participants were not RF.

A study by Ikhsan et al., observing 85 female teenagers for 4 months, reported similar findings.⁷ Questionnaires were answered by each respondent every month, beginning 3 before Ramadan and concluding 1 month after Ramadan. The researchers defined “menstrual cycle changes” as any deviation in regularity, frequency, duration, or menstrual blood volume. Examination of the findings revealed a notable rise in the average menstrual blood volume among participants prior to RF in contrast to menstrual blood volume after RF. Their findings suggest that fasting during Ramadan is directly correlated with the observed disruptions in the menstrual cycle.

Fasting and fertility

According to Eurostat in 2013, countries in the European Union had a fertility rate of 1.58, while Muslim countries studied had a rate of 3.12, nearly double in comparison.⁸ A more recent article from Pew Research in 2017 shows that Muslims have the highest fertility rates among all studied religious groups.⁹ While Muslim-majority populations tend to exhibit higher fertility rates globally, this pattern is likely multifactorial rather than the direct effects of fasting itself. Nevertheless, exploring the potential hormonal changes induced by RF can deepen our understanding of how spiritual practices intersect with women’s reproductive health. Investigating this relationship offers insight into both the adaptive capacity of the female endocrine system and the broader integration of faith and physiology in women’s lives.

Effects of fasting on hormones relating to fertility

Current research about RF and its effects on female sex hormones and fertility comes to conflicting conclusions. Abnormal levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), and other sex hormones can lead to failure to ovulate, resulting in issues with fertility. Abnormal prolactin (PrL) and progesterone (Pg) levels lead to irregular menses and fertility issues, as well as, at times, failure to ovulate and a higher likelihood of miscarriage. Abnormal estradiol (E2) levels indicate impaired eggs early in the menstrual cycle and are linked to higher miscarriage rates and lower live birth rates.¹⁰ The conclusion reached across several articles was that RF had little to no effect on LH, FSH, dehydroepiandrosterone (DHEA), prolactin, progesterone, estrogen, E2, and gonadotropin-releasing hormone (GnRH) in fertile fasting women compared to a non-fasting group.^11–15 The studies included all feature modest sample sizes, with the largest being 76. Blood samples taken from subjects at various points in one menstrual period all found no significant change in sex hormones as compared to a non-fasting control group.

Effect of fasting on in vitro fertilization

For Muslim women who have issues conceiving, RF may prove advantageous for supporting successful in vitro fertilization, known as IVF. IVF first utilizes hormonal medication, most commonly FSH or gonadotropins, to stimulate the ovaries to produce more mature eggs. These eggs are then surgically retrieved and are combined in a laboratory dish for fertilization. These embryos will culture for 2–6 days before the healthiest are transferred to the woman’s uterus for pregnancy and the rest are cryopreserved. Wahba details the findings of a 2016 study done on how RF affects infertile women undergoing IVF.¹⁶ Wahba followed a group of 600 infertile women, half fasting and half non-fasting, as they underwent their first-ever trials of IVF, with all following the same IVF scheduling for hormone dosing and embryo retrieval. It was found that fasting women required a longer duration and higher dose of hormones during ovulation induction but went on to produce significantly more mature eggs and a greater number of embryos than their non-fasting counterparts. Embryo quality, pregnancy rate, and live birth rate remained similar between both groups. Among successful IVF cases, pregnancy complication rates were higher for the fasting group, with complications like miscarriage, multiple pregnancies, gestational diabetes, and preeclampsia. Despite higher complication rates, anxiety and depression rates were lower in the fasting group compared to the non-fasting group. While other research suggests that fasting on its own has no effect on fertility in infertile women, the effect of RF on IVF remains an area requiring more study.¹⁷

Fasting and PCOS

PCOS impacts approximately 6%–13% of reproductive-aged women.¹⁸ This condition, characterized by an increased LH:FSH ratio, gives rise to a range of symptoms such as irregular menstrual cycles, infertility, excessive hair growth (hirsutism), and weight fluctuations.^19,20 Currently, management of PCOS focuses on addressing symptoms rather than disease course. Weight loss is a common recommendation for PCOS patients, likely due to its role in managing glucometabolic markers like insulin resistance. Prior literature indicates that excess adiposity worsens the outcomes of PCOS patients.²¹ This is due to the peripheral conversion of adipose into a form of estrogen called estrone (E1).²² Of the various weight loss strategies, fasting has gained popularity in recent years. Previous literature indicates RF specifically has been linked to reductions in visceral adiposity and body weight.^23,24 Given this context, our study centers on examining the correlation and impacts of fasting in relation to PCOS.

The effect of RF on hormone levels and weight in PCOS patients

In an article conducted by Zangeneh et al., 40 women with PCOS were divided into two equal RF and non-fasting groups.²⁵ Within both test groups, blood samples were collected both before and after a minimum of 25 days of RF. Post-Ramadan blood tests were centered around evaluating hormone levels in participants. The findings revealed that levels of FSH, LH, and testosterone in the serum showed no significant alterations compared to control participants. Notably, cortisol and noradrenaline levels exhibited a decrease among individuals in the RF group. As of now, this is the singular study observing the effects of RF on hormone changes in women with PCOS.

Safety and potential benefits of fasting during pregnancy and breastfeeding

Certain conditions allow for exemptions from fasting during the 30 days of Ramadan, including pregnancy and breastfeeding. Pregnant women are not under the obligation to fast and are exempt because of obvious nutritional needs for mother and fetus. However, many women choose to fast during pregnancy despite their exempt status. There is scarce quantitative data on how many Muslim women fast during pregnancy. However, one study of Muslim pregnant women living in the Netherlands, a Western country, found that 54% of participants fasted during the month of Ramadan.²⁶ In contrast, a study of 353 pregnant women in Pakistan reported substantially higher fasting rates, with 87.5% fasting during Ramadan.²⁷ While these findings are not representative of RF practices among all pregnant Muslim women globally, they highlight how cultural context and majority versus minority Muslim settings influence fasting behaviors. Notably, across diverse settings, a substantial proportion of pregnant Muslim women continue to choose to fast.

Although many women fast in Ramadan during pregnancy and while breastfeeding, the amount of research done on fetal and maternal outcomes remains scarce. As will be shown throughout the next sections, the majority of studies have found that fasting during Ramadan while pregnant or breastfeeding has no significant impact on fetal or maternal health. However, some studies have shown conflicting results on whether fasting during a specific trimester has effects on maternal and fetal outcomes. (The first trimester of pregnancy lasts from weeks 1–13 and is when the fetus develops and grows its major body systems and obtains a heartbeat; this period also has the highest risk of miscarriage. The second trimester lasts from 14 to 27 weeks, and the third trimester from 28 to 40 weeks. These trimesters are primarily dedicated to the further development and growth of the fetus.) Most studies only examined perinatal birth weight and maternal weight as significant health outcomes.

Effects of fasting on fetal outcomes, particularly birth weight

An area of concern for pregnant women considering RF is the effects of fasting on fetal outcomes, particularly fetal birth weight. Earlier studies done on the topic have elucidated that RF does not significantly alter neonatal growth measures. Researchers in 2004 followed 168 fasting and 156 non-fasting women throughout pregnancy. They found no significant differences in birth weight, gestational age, or Apgar scores between the groups.²⁸

More recent studies have largely confirmed these findings. One study examined fetal birth weights in infants born to 139 fasting versus 252 non-fasting pregnant women.²⁹ The researchers examined birth weights of infants born to women who were classified as “exposed to RF,” or having fasted at least 1 day out of the month. They compared these birth weights to the birth weights of infants born to women who were not exposed to RF. On average, the birth weight of RF-exposed infants and non-RF-exposed infants were not significantly different. They also concluded that the number of days fasted did not affect the birth weights of infants either. Another study³⁰ analyzing fetal birth weights, as well as length, head circumference, and weight of placenta of babies born to 58 fasting versus 168 non-fasting expectant mothers showed no significant difference in these outcomes in the two different groups. A case-controlled, prospective study done compared 123 women who fasted at least 7 days during pregnancy to 92 pregnant women who did not fast.³¹ The study concluded that there were no significant health outcome differences such as preterm delivery, pregnancy-induced hypertension, and gestational diabetes in maternal and fetal outcomes between the two groups.

However, one study comparing neonatal birthweights in 98 fasting versus 207 non-fasting women found that pregnant women who fasted in Ramadan, especially during the first trimester, delivered babies that had significantly lower birth weights than their counterparts who did not fast.³² Additionally, these researchers observed that pregnant, fasting Muslim women who switched to a high-fat diet during non-fasting hours birthed babies with normal weight. These findings were mirrored in a more recent large cross-sectional study, following more than 1300 mother–newborn pairs to observe the relationship between RF, maternal diet, and neonatal outcomes.³³ The investigators found that infants of mothers who fasted during pregnancy had modestly lower birth weights compared to those of non-fasting mothers. Importantly, this association was most pronounced among women who also reported reduced dietary or fluid intake during non-fasting hours, suggesting that nutritional adequacy rather than fasting alone drives differences in fetal growth.

Together, these findings show that the evidence on RF during pregnancy significantly affecting infant birth weight is inconclusive.

Trimester-dependent effects on maternal and fetal health

Some studies have found differing effects of RF on maternal and fetal health based on trimester fasting. For example, a study compared the health of 155 pregnant women who fasted during their second trimester of pregnancy to the health of 146 pregnant women who did not fast.³⁴ The results showed that pregnant women who fasted in their second trimester had beneficial effects on their health compared to the women who did not fast, including a lower risk for gestational diabetes and excessive weight gain. The same study also found that newborn measurements did not differ between the two groups. Similarly, Dikensoy et al. found that fasting during pregnancy at 20 weeks of gestation or later did not adversely affect intrauterine fetal development or well-being.³⁵ They also reported that maternal serum cortisol levels were elevated and the low-density lipoprotein (LDL) to high-density lipoprotein (HDL) ratio was decreased. These findings support the relative safety of fasting during mid-to-late pregnancy when maternal nutrition is adequately maintained.

Taken together with studies^32,33 mentioned in section “Effects of fasting on fetal outcomes, particularly birth weight,” these findings may suggest that quality and timing of maternal nutrition during Ramadan may be critical modifiers of pregnancy outcomes. Therefore, the existing literature on trimester-dependent effects on maternal and fetal health remains inconclusive, though most findings suggest that fasting later in pregnancy is generally well tolerated when maternal nutrition and hydration are maintained.

Beyond these individual studies, a 2024 systematic review and meta-analysis in Human Reproduction Update synthesized over 30 studies—including population-based analyses from the Middle East, Africa, and Europe—to evaluate both short- and long-term offspring outcomes. This review found no significant associations between prenatal RF exposure and birth weight or preterm birth. However, a slight reduction in the proportion of male newborns was observed, suggesting possible sex-specific fetal vulnerability. While immediate birth outcomes appear largely unaffected, subtle long-term effects such as marginally lower height-for-age and small cognitive differences in childhood were identified, particularly when fasting occurred during the first trimester. These findings align with the Developmental Origins of Health and Disease hypothesis, indicating that even modest nutritional or circadian changes during early gestation may influence developmental trajectories later in life.³⁶

Effects of fasting on breastfeeding

One area of concern to Muslim women who fast during Ramadan is whether their breast milk will contain enough nutrients for their infants, given the nutritional deficit they may experience during their fasts. Some studies have shown that the effects of RF on breast milk composition are minimal, while another found significant decreases in certain nutrients in break milk. One study following 26 nursing mothers aged 22–32 found no significant differences in breast milk composition (total fat, protein, lactose, total solids, non-fat solids, triglycerides, and cholesterol) between milk obtained while mothers were fasting, and milk obtained while mothers were not fasting.³⁷ A different study evaluated both the contents of the breast milk—including carbohydrates, protein, and lipid levels—as well as the weight gain of infants in Muslim women exclusively breastfeeding who fasted and did not fast during Ramadan.³⁸ The results showed that the breast milk composition between the two groups did not differ, and there was no difference in weight gain of infants or mothers from either group. Another study, however, found significant decreases in some nutrients. It found that micronutrients like zinc, magnesium, and potassium were found to be significantly decreased in mothers who fasted during Ramadan.³⁹ This study involved tracking the breast milk composition of 21 breast-feeding fasting mothers during and 2 weeks after Ramadan. Infants were aged 2–5 months. This study found a significant nutritional deficiency in micronutrients in mothers, and most other nutrients besides vitamins A and C and proteins. The study recommends mothers to abstain from fasting while breastfeeding. There is conflicting evidence on the effects of RF on Muslim, breastfeeding women, given the minimal number of studies present.

The above findings are summarized in Figure 1, while Table 1 summarizes the articles discussed in this review.

Figure 1.

Summary of the potential effects of RF on women’s health: RF may lead to irregular menstrual cycles and greater incidence of oligomenorrhea and higher average menstrual blood volume, without substantial alterations in reproductive hormone levels. RF has shown inconclusive evidence on pregnant Muslim women and trimester-related effects on newborn health. Additionally, studies have shown that there is no significant difference in macronutrients between the breast milk of fasting versus non-fasting women, but fasting women may have less micronutrients and vitamins in their breast milk.

Table 1.

Study characteristics.

Author (year)	Design	Country	N	Population	Brief of findings
Menstrual cycle changes
Yavangi et al. (2013)	Analytic cross-sectional study	Iran	80	Female college students	30% of participants experienced irregularities in their menstrual cycles during Ramadan compared to the months outside of Ramadan. A significant increase was observed in the incidence of oligomenorrhea in the month of Ramadan when compared to the other months.
Ikhsan et al. (2017)	Observational study	Indonesia	85	Female high school students	A notable rise was found in the average menstrual blood volume among participants prior to RF in contrast to after RF suggesting that fasting during Ramadan directly correlated with the observed disruptions in the menstrual cycle.
Fertility
Shahabi et al. (2010)	Self-controlled study	Iran	24	Healthy women	In comparison to hormone levels during Ramadan and 2 months after, no significant hormone change was found around ovulation. There were also no changes in ovulation frequency.
El-Migdadi et al. (2004)	Comparative study	Jordan	40	Healthy men and women	When comparing LH and testosterone levels of two populations at different sea levels, the only significant finding was found in between fasting groups.
Çağlayan et al. (2014)	Randomized prospective study	Turkey	30	Healthy women	During RF, the participants had similar LH and testosterone levels found between the two regions compared of Jordan Valley and Ramtha City. However, during RF, fasters in Jordan Valley experienced greater testosterone levels, possibly explained by environmental factors.
Bahreyni et al. (2015)	Prospective cohort study	Iran	58	Healthy pre-menarche women	Researchers found similar changes in the levels of DHEA, progesterone, and E2 in both fasting and non-fasting study groups, and similarly concluded that changes in LH and FSH could be due to other contributing factors.
Yarahmadi et al. (2001)	Quasi-experimental study	Iran	76	Healthy women	Researchers found that changes in FSH, LH, E2, progesterone, and DHEA relating to RF follow the physiologic manner and short-term fasting has no significant effect.
Wahba (2016)	Prospective cohort study	Egypt	600	Infertile women undergoing IVF	While RF did not significantly impact IVF outcomes, it did result in a significant reduction in the anxiety and depression often linked with these procedures.
Al-Chalabi et al. (2019)	Cross-sectional study	Iraq	50	Fertile and infertile women	Fasting on its own has no effect on serum progesterone and prolactin levels in infertile women. However, in fertile women there was a significant increase in serum progesterone levels.
Polycystic ovary syndrome
Zangeneh et al. (2014)	Non-randomized controlled study	Iran	40	Women with PCOS	The findings revealed that levels of FSH, LH, and testosterone in the serum showed no significant alterations compared to control participants. Notably, cortisol and NA levels exhibited a decrease among individuals in the fasting group.
Pregnancy
Azizi et al. (2004)	Prospective cohort study	Iran	155	Pregnant women	Examined fetal growth, amniotic fluid index, and Doppler indices during Ramadan. No significant effect on fetal growth or fetal well-being parameters.
Savitri et al. (2018)	Prospective cohort study	Indonesia	1351	Pregnant women	In participants who fasted during Ramadan for at least 1 day, the weights of their newborns did not show a significant difference compared to those of participants who did not fast.
Safari et al. (2019)	Case-controlled study	Iraq	301	Pregnant women	Pregnant women who fasted in their second trimester had beneficial effects on their health compared to the women who did not fast, including a lower risk for gestational diabetes and excessive weight gain. Newborn measurements did not differ between the groups.
Parveen et al. (2020)	Cross-sectional study	Pakistan	226	Pregnant women	Expectant mothers in Multan, Pakistan found no significant differences in these outcomes between the two groups.
Hossain et al. (2021)	Prospective, case-controlled	Pakistan	215	Pregnant women	The study compared pregnant women who fasted for at least 7 days during pregnancy to those who did not fast. The study assessed newborn measurements and maternal outcomes such as preterm delivery, pregnancy-induced hypertension, and gestational diabetes. It concluded that there were no significant differences in health outcomes between the two groups for both mothers and fetuses.
Pradella et al. (2023)	Cross-sectional survey	Germany	326	Pregnant women and newborns	Pregnant women who fasted during Ramadan, especially in the first trimester, delivered babies with significantly lower birth weights compared to non-fasting counterparts. However, pregnant Muslim women who fasted and switched to a high-fat diet during non-fasting hours gave birth to babies with normal weight.
Dikensoy et al. (2009)	Prospective comparative study	Turkey	65	Women with ⩾20 weeks’ gestation	By the 20th day of Ramadan, maternal serum cortisol levels were elevated and LDL/HDL ratio was decreased in women at 20 or more weeks of gestation, while no effects on fetal growth or well-being were observed.
Kana et al. (2025)	Cross-sectional observational study	Nigeria	1370	Mother–newborn pairs	Fasting mothers delivered infants with slightly lower mean birth weight compared to non-fasters; no change in gestational duration. The association with lower birth weight was strongest among women who also reduced food or fluid intake during non-fasting hours.
Breastfeeding
Başıbüyük et al. (2023)	Comparative observational study	Turkey	48 (21 fasting, 27 non-fasting)	Mothers who only breastfed their babies during Ramadan in 2021	Breast milk composition between the two groups did not differ, and there was no difference between weight gain of infants or mothers from either group.
Bener et al. (2001)	Prospective descriptive study	UAE	26	Healthy nursing mothers	No significant differences were observed in breast milk composition, including total fat, protein, lactose, total solids, non-fat solids, triglycerides, and cholesterol, between fasting and non-fasting periods.
Rakicioğlu et al. (2006)	Prospective observational study	Turkey	21	Breast feeding mothers	This study highlighted significant decreases in breast milk micronutrients such as zinc, magnesium, and potassium.

LH: luteinizing hormone; DHEA: dehydroepiandrosterone; FSH: follicle-stimulating hormone; PCOS: polycystic ovary syndrome; RF: Ramadan fasting; IVF: in vitro fertilization.

Discussion

RF has varying effects on women’s health. The literature indicates that RF may lead to irregular menstrual cycles without substantial alterations in reproductive hormone levels. Fertility remains largely unaffected by RF, with potential benefits for infertile women undergoing IVF. Compared to their non-fasting counterparts, pregnant and breastfeeding Muslim women fasting during Ramadan exhibit no significant differences in their health or newborns’ well-being.

This review highlights the need for more comprehensive research on RF’s effect on women’s health, specifically in countries with sizable Muslim populations where Islam is not the majority religion. While core physiological responses to diurnal fasting are likely similar across populations, contextual modifiers vary substantially across and within countries: day length and climate, baseline nutritional status and dietary patterns at Suhoor/Iftar, and how religious exemptions are applied in practice. These factors may shape both the decision to fast and the physiologic impact of fasting. Consequently, findings observed in Pakistan or Indonesia, for example, may not be directly transferable to Muslim populations in Western settings where minority status, acculturation, food environments, and healthcare systems differ. This heterogeneity emphasizes the need for locally conducted studies in Western contexts, even as cross-regional data provide a useful starting point for hypothesis generation and clinical counseling. Gaining insight into this area of research contributes to a more inclusive and culturally sensitive approach to healthcare, targeting the unique needs of female Muslim patients. This will enable healthcare providers to use this research to build rapport with their patients and provide personalized, high-quality care.

The effects of RF on different aspects of women’s health varies. Regarding menstrual changes, two studies have shown that during Ramadan, women who fast experience a greater incidence of oligomenorrhea, menstrual irregularities, and higher average menstrual blood volume. For Muslim women who already experience irregular periods, this may be something they should consider when RF.

There are few reports on the effects of RF on female sex hormones and fertility. Most studies concluded that fasting had little to no effect on LH, FSH, GnRH, PrL, Pg, DHEA, and E2 in fertile fasting women compared to non-fasting women.^11–15 A similar study with a female study population, and generally more and better research into RF’s effect on female sex hormones and fertility is needed. On IVF, another study showed that RF yielded significantly more mature eggs and a greater number of embryos than non-fasting counterparts, though the fasting women required a longer duration and higher dose of IVF treatment during ovulation induction.¹⁸

Only one research article has investigated the effects of RF on the health of women with PCOS. Although the authors reported no significant difference in serum levels of FSH, LH, and testosterone²⁵ between fasting and non-fasting participants, the article demonstrated some methodological limitations and ranked lower in our quality assessment appraisal. As such, it was included due to absence of alternative studies in this population rather than evidentiary strength, and its findings should be considered preliminary and interpreted with caution.

Although many Muslim women fast during pregnancy and while breastfeeding, research examining maternal and fetal outcomes remains limited and conflicting at times. Most studies to date have found that fasting during Ramadan does not significantly impact fetal birth weight, gestational age, or maternal outcomes when adequate nutrition and hydration are maintained. However, evidence remains mixed regarding trimester-dependent effects. Several studies indicate that fasting in the second or third trimester is generally well tolerated, while fasting in early pregnancy may be associated with a modest reduction in neonatal birth weight.³³ Nutritional adequacy, particularly during non-fasting hours, appears to be a key determinant of these outcomes. However, newer research suggests that while RF may not be associated with neonatal complications, fasting during the first trimester shows subtle long-term complications in childhood.³⁶

Similarly, studies evaluating the impact of fasting on breastfeeding mothers have yielded inconsistent findings. While most research shows that fasting does not significantly alter breast milk composition or infant weight gain, some studies have noted reductions in specific micronutrients such as zinc, magnesium, and potassium. Collectively, existing evidence suggests that RF while pregnant or breastfeeding is risky due to the largely inconclusive outcomes. Women who wish to fast should always consult their healthcare providers to develop individualized plans that safeguard maternal and infant well-being.

Limitations

This literature review highlights several limitations within the existing research on RF among Muslim women. First, there is a dearth of studies examining the health and pathologies of Muslim women during Ramadan, with most research categorizing them as a homogenous group. Although the focus on men in Ramadan studies is often justified by fewer confounding variables such as menstrual cycles, this has resulted in a gap in studies understanding the health of Muslim women. Moreover, the majority of available research originates from Muslim-majority countries or specific geographic regions, limiting their generalizability to more diverse populations. This issue is further compounded by studies often focusing on specific populations, such as students from a single university.

Furthermore, there is a notable lack of longitudinal studies which monitor health changes over several Ramadan periods, which would provide insight on long-term effects and adaptations. Current research emphasizes immediate outcomes, neglecting the cumulative effects of yearly fasting. Addressing these limitations calls for more comprehensive and regionally diverse research, considering the various experiences and backgrounds of Muslim women, and employing longitudinal studies to better understand the long-term health implications of RF.

Advice for physicians

The research presented in this review can be a helpful tool for physicians when speaking with their female Muslim patients. If a female Muslim patient is currently diagnosed with a health condition, particularly a reproductive or gynecological condition, physicians should inquire about her intentions to fast during the month of Ramadan. If the patient intends to fast, it is advisable to schedule follow-up appointments throughout the month to monitor her health and any adverse effects. Physicians should also ask if the patient has fasted before during Ramadan and about her experiences, both in terms of health and familial obligations. For instance, if a patient with PCOS has experienced irregular periods during RF and feels obligated to fast, physicians might advise reconsidering RF, especially since her condition exempts her from fasting. It is also important to discuss the implications this might have on her relationship with her family.

Physicians can also provide guidance on optimal diets for Muslim women (and Muslims in general) who decide to fast during this month. For example, they should advise avoiding fried foods that are popular in some cultures (like samosas and pakoras in Pakistani culture) during Iftar (the meal at dusk). Physicians can also recommend certain foods to eat at Suhoor (the meal at dawn) to provide sufficient energy throughout the day and promote improved metabolic health. These recommendations can include foods high in whole grains and viscous fibers and avoiding rapidly available carbohydrates like those found in sugary cereals.⁴⁰ These suggestions can help physicians offer more culturally aware advice to their Muslim patients.

Future directions

Future research should aim to expand on the current consensus of RF effects, with a specific emphasis on its impacts on women across multiple Ramadan periods. There is a need for in-depth investigations into the mechanisms underlying menstrual irregularities, including oligomenorrhea, observed during RF. Exploration of the hormonal, nutritional, and psychological factors contributing to these changes is necessary to guide interventions to reduce the adverse effects that come with RF. Second, the conflicting results on the relationships between RF and female sex hormones, fertility, and IVF outcomes urge further research. This research is particularly necessary for Muslim women considering IVF as an option. Lastly, despite existing literature hinting at the potential benefits of RF for women with PCOS, the underlying mechanisms of how RF influences hormonal levels are still unclear. Identifying these mechanisms will help clarify the role of RF as a possible management strategy for PCOS symptoms. Addressing these research gaps will not only guide healthcare practices for women observing RF but also develop our understanding of the interplay between fasting, hormones, and reproductive health.

Conclusion

The existing body of literature addressing the effects of RF on women’s health provides insight into its complex nature, examining through the lens of the menstrual cycle, fertility, PCOS, pregnancy, and breastfeeding. Notably, findings suggest that RF may lead to irregular menstrual cycles, particularly oligomenorrhea, yet reproductive hormone levels and fertility were not affected. Moreover, contradicting evidence exists for the effects of RF on pregnant and breastfeeding women, as well as on infant birth weight. While the available research allows us to understand the varied impacts Ramadan has on women’s health, more comprehensive and regionally diverse studies are imperative. This information equips healthcare providers to provide culturally sensitive care for their female Muslim patients participating in RF. Lastly, this review contributes a nuanced perspective, enriching the broader understanding of fasting practices.

Footnotes

Acknowledgements

The authors would like to thank the faculty mentors at the California University of Science and Medicine for their guidance and support throughout the development of this work.

ORCID iDs

Sehar Hussain

Alysha Ali

Hina Mohsin

Ethical considerations

Not applicable.

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Author contributions

Sehar Hussain: Conceptualization; Investigation; Writing – original draft; Methodology; Writing – review & editing; Data curation; Visualization; Validation.

Sana Ahsan: Conceptualization; Investigation; Writing – original draft; Methodology; Validation; Visualization; Writing – review & editing; Data curation.

Alysha Ali: Conceptualization; Writing – original draft; Investigation; Methodology; Validation; Visualization; Writing – review & editing; Data curation.

Hira Khan: Conceptualization; Investigation; Writing – original draft; Methodology; Validation; Visualization; Writing – review & editing; Data curation.

Sedra Tibi: Methodology; Visualization; Supervision; Resources; Conceptualization; Writing – review & editing.

Hina Mohsin: Conceptualization; Funding acquisition; Methodology; Visualization; Writing – review & editing; Supervision; Resources; Project administration.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data availability statement

Not applicable. All data discussed in this narrative review are derived from previously published studies that are publicly available and appropriately cited within the manuscript.

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