Postpartum Periods: Menstruation After Giving Birth
After a menstrual holiday of about year (longer if you breastfeed), there comes a time when your periods arrive again. And these postpartum periods can be a bit different than before giving birth…
The return of the period
The big question is of course: when will it start again? This mainly depends on whether you’re breastfeeding or not. If you don’t breastfeed your baby, your menstruation can return between five and eight weeks after giving birth. The bleeding you experience in the weeks directly after giving birth (postpartum bleeding), isn’t menstruation. It’s lochia, a combination of blood, mucus and uterine tissue, and should be managed with maternity pads instead of tampons to prevent bacterial infections.
More nursing = longer without menstruation
If you do breastfeed, you’ll get a longer menstrual holiday. That’s because during breastfeeding the hormone prolactin is made which suppresses the thickening of the uterine lining and ovulation. The duration and frequency of the feeds, if you also nurse at night (when prolactin levels are highest) and if your baby only gets breast milk or also other food all decide when your period will start. Also other factors like your age, diet, fitness, stress levels and the physical closeness of your baby, play a role. Some women get their menstruation despite frequent breastfeeding, whereas for others the periods don’t start until they’ve completely stopped nursing.
Menstruating after giving birth: the numbers
- Between 9 and 30% of women get their period within three months after giving birth.
- 19-53% of women don’t menstruate in the first half year.
- A small percentage get their monthly bleeding already between 6 and 12 weeks and another part only get it when they’ve completely stopped breastfeeding.
- The majority of women don’t menstruate in the first six months after giving birth.
- On average, the menstruation returns again by itself between 7 and 13-14 months after giving birth.
Not like clockwork
Just so you know: the very first postpartum period can be a bit heavier than before you got pregnant – many women experience more cramps and small blood cloths. It takes time for your cycle to get back to normal. Hormones are all over the place when you’ve just had a baby, so in the beginning your pattern may be irregular. If you used to menstruate every 28 days exactly like clockwork, well, don’t count on it just yet. You may skip a month, especially when you’re still breastfeeding, menstruate more or less frequent, notice changes in flow, or experience spotting instead of a real bleeding. Be patient: after nine months of pregnancy and giving birth to a tiny human, your body needs to adjust again to menstruation.
It can get worse…
For some women, postpartum periods are slightly heavier and more painful than what they’re used to pre-pregnancy. This might be caused by having a larger uterine cavity. Because the inside of the uterus has expanded with the growing of the baby, there is more uterine lining that needs to get shed during menstruation. Usually, the discomfort will decrease over time. However, it can take a whole year before you’re back to your usual menstruation pattern. If your periods have gotten extremely painful and /or you have to change your tampon or pad every hour, then it’s time to see a doctor.
..but it can also get better
Good news: many women who had painful periods before have less trouble with their menstruation after giving birth. This might be because pregnancy and giving birth have stretched the uterus and dilated the cervix, which can lead to less pain and cramping. Another possible theory is that childbirth removes some of the prostaglandin receptors in the uterus. Prostaglandins are hormones that trigger uterine contractions. They don’t only do this during labour, but also, on a much smaller level, during menstruation to expel the uterine lining, causing the famous menstrual cramps.
Fertile before your first period
After childbirth, your period will return. But if it’s heavier, lighter or exactly the same as before, is different for every woman. And of course, everything might change again if you have a second child. Be aware if you don’t want this to happen too soon: use contraception (when breastfeeding, check with your GP which contraceptives are OK to use when nursing). Not menstruating yet doesn’t mean you can’t get pregnant again. Ovulation happens before menstruation, so you’re already fertile two weeks before you’ve gotten your first postpartum period.