Postpartum Periods: What to Expect (After You’ve Expected)
Posted by Courtney Mayszak, RDN, LDN
Aug 27, 2019
Periods after pregnancy. Probably not the first thing on the brain after delivering a human, but you may still have questions: when is it coming back? And what will it be like when it does?
We got you, mom / mom-to-be. This article covers:
- When to expect your period to return
- What your first few postpartum periods will be like
- Other important things to know, like when you can get pregnant again, the link between PMS and postpartum depression, and post-baby menstrual hygiene tips
But first, the basics. Periods = no pregnancy. Menstruation happens when there isn’t a fertilized egg to nestle up in the blood-filled uterine lining. Without a fertilized egg, the lining is useless, and leaves the body as a period. When there is a fertilized egg, it needs the lining for oxygen, blood, and nutrients. Hence, no periods during pregnancy.
Periods are a sign you’re able to get pregnant again. And it takes some time after delivery to recover from pregnancy before the uterus is ready to grow the lining it needs to take on a new fertilized egg. And that leaves you…out of menstrual practice. Here’s what to expect while you wait for your cycle to show back up.
When’s my period coming back?
The timing of your first postpartum period depends on whether, and how often, you’re breastfeeding. This is because the hormones the enable milk production shut down the hormones that control your period (in doctor-speak, it’s called ‘lactational amenorrhea’). So, if you’re...
Not breastfeeding at all, or partially breastfeeding
If you’re exclusively formula-feeding your baby, or using a combo of formula and/or solid foods with breastmilk, periods return on average 5-6 weeks after giving birth.1 But this won’t apply to everyone! If you deviate from this norm, it doesn’t necessarily mean something’s wrong, just keep your doc updated on your cycle.
Also note: the more you’re nursing, the longer you can expect your cycle to hold out. So if you’re trying to keep the non-breastmilk nourishment to a minimum, don’t be surprised if takes much longer than 6 weeks for your period to show up.
If 100% of your baby’s diet is your milk—not formula or solid foods—and you’re nursing during the day as well as at night, in theory, you won’t menstruate again until you stop exclusively breastfeeding, or start breastfeeding less often.
But in practice, it doesn’t always work out this way. A round-the-clock nursing schedule may not be necessary if your baby is sleeping longer through the night. But when you start skipping the nighttime feeds, the half-day break in nursing could be enough to turn period hormones back on and cause spotting—sometimes even a full-blown period.1
In one study, a third of new moms menstruated at least once while exclusively breastfeeding. But of the moms who did, their cycles were longer (average 37 days compared to the usual 28). Cycles got shorter over time, but didn’t become regular again until they stopped breastfeeding completely.2
Also note that there are huge variances in when that first post-baby period will arrive for exclusively breastfeeding moms. In one study, the first postpartum period came an average of 48 weeks after giving birth, but varied from 21 weeks to 63 weeks.3 Again, it depends on when you introduce your baby to food or formula, and how much you’re still nursing after you do.
What will my first few postpartum periods be like?
Expect the unexpected. There’s no such thing as a ‘standard’ postpartum period. But chances are, your post-baby periods will be different from your pre-baby periods. Expect your first post-pregnancy cycle to:
Unless you spot or get pre-period symptoms beforehand, you won’t know when that first period is coming. And even spotting and early symptoms can easily be mistaken for a typical post-pregnancy experience: it’s common to bleed non-period blood after delivery, and cramping may be caused from your uterus returning to its normal size, not from menstrual cramps.
Don’t freak out, but do keep menstrual hygiene supplies on or near your person.
Some bleeders’ cycles bounce right back to the typical 28 days after a baby. Others are less predictable. It depends on how long it takes for your hormones to get back into their normal groove. Stress and weight losses/gains are also common for new moms, and these factors can throw your cycle out of whack, too. Don’t be surprised if your first cycle is 27 days, for example, and the next is 34. That’s normal. Things will eventually even out over time.4
Also note that it’s common for post-baby flows to stop and restart, so don’t forgo the pads until you’re certain your period is over.5
Come with worse symptoms than your periods before getting pregnant (but maybe not!)
Again, everyone’s super different! Some new moms find their period is way more manageable post-baby than it was before getting pregnant (a second miracle of childbirth!) Others are not so lucky, and their post-baby periods involve more intense cramps, more blood clots, and a heavier flow.1
Some symptoms may subside after pregnancy while others get worse. You may even get new symptoms you’ve never had before. Whatever your symptom set during those first few postpartum periods, it may become your new normal, even after your cycle becomes regular again.
Don’t panic. If your symptoms worsen, we can help make cramps and PMS two less things you have to worry about. Because if there’s a new human in your household, period problems should be the last thing on your mind.
Note: if you used any form of hormonal contraception (e.g. an IUD, or birth control pills, shots, or implants) before getting pregnant and you’re no longer using it post-pregnancy, expect your period to be heavier and your symptoms more severe. That thing you called a ‘period’ before pregnancy wasn’t your real period; what you’re experiencing now is your natural, unsuppressed cycle.
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Attention birth control users: you know that "period" you get every month? It's not technically a period at all. If you're taking your pills properly, your body won't ovulate (and hence, won't get pregnant). And since true menstruation can't happen without ovulation, you don't actually menstruate. What you're experiencing is withdrawal bleeding from the hormones you're taking. And this isn't totally necessary. So long as your doc gives you the green light, it's fine to skip the placebo pills / simulated "period", and move right into your next pack of pills. #MenstrualHacks #TheMoreYouKnow 📷: @girlsareawesome
And as always, if you suspect your periods are way worse than what is ‘normal’, or they interfere with your ability to function, talk to your doctor.
When can I get pregnant again?
As early as 6 weeks after giving birth if you’re not exclusively breastfeeding, or as early as 6 months if you are.6
You’ll know you’re officially fertile again when you get your period—but there’s a catch! Periods happen about two weeks after ovulation—when an egg is released from the ovary and available to sperm for fertilization. This means you won’t know that you’re fertile again until two weeks after the fact. And if you do get pregnant during that early fertility window and you haven’t had your first post-baby period yet, you might not recognize the lack of menstruation as a sign you’re pregnant.
If you’re not trying to have back-to-back pregnancies, use contraception, even before your first postpartum period. Birth control pills, shots, implants, IUDs, condoms, and internal condoms are all safe to use while breastfeeding, but hold off on using diaphragms and cervical caps until after your first postpartum checkup.7
Why does breastfeeding push back the fertility window? Remember the hormones that enable milk production shut down the hormones that control ovulation. So breastfeeding can actually be a viable means of contraception (a very cool biohack, in our opinion). But it ONLY works if *all* of the following conditions are met:8,9
- You’re nursing at least every 4 hours during the day and every 6 hours at night
- You’re nursing directly from the breast (pumps don’t count!) every time you breastfeed
- You’re feeding your baby nothing but breastmilk
- Your baby is less than 6 months old
- You haven’t gotten your first post-baby period yet
When you do all of the above perfectly, this method is at least a 98% effective means of contraception10—about as good as birth control pills.11 Just be ready to use another birth control method at that 6 month mark, when you reduce the frequency of feeds, introduce food or formula to your baby’s diet, or you get your period. (Though remember, if you got a period, you’ve already been fertile for two weeks, so it’s best not to wait until you menstruate to use an alternative form of contraception.)
Pre-baby PMS could mean more postpartum depression
PMS and postpartum depression (or PPD) are linked. Their symptom profiles overlap (e.g. depression, anxiety, irritability, and mood swings), and researchers think they’re caused, at least in part, by rapid changes in the same hormones: estradiol and progesterone.12
Some people are more vulnerable to fluxes in these hormones than others. Bleeders who get bad PMS fall into a group researchers call ‘hormone-sensitive’.13 (If this sounds like you, we’ve got just the thing.)
Enter pregnancy, a tidal wave of a hormonal shift, and the women in this group are especially vulnerable to PPD. A study involving over 1,300 women found those with more severe PMS symptoms before getting pregnant had significantly worse-off mood swings, irritability, and depression throughout pregnancy and the postpartum period.14
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You’ll bleed right after giving birth—but this isn’t a period!
It’s a vaginal discharge called lochia. It’s totally normal, and happens whether you’ve had a vaginal delivery or Cesarean (though moms who’ve delivered vaginally can expect more of it). It’ll be dark red and clotty for the first 3 days after delivery (again, looks like a period, but is not), watery and pinkish-brown from day 4 to day 10, and yellowish-cream from day 10 on with a stale, musty odor.15 Cute, right?
Discharge usually stops 4-6 weeks after delivery.16 Use pads or period underwear—not tampons or a menstrual cup—to contain lochia, because…
You’ll need to wait until after your 6-week postnatal checkup before using tampons or a cup
The area where the placenta joined the wall of the uterus will still be open and tender, and you might be dealing with cuts and tears in and around your vagina. Open wounds are easy targets for infection, so you won’t be able to insert anything up your vagina until your doc says your wounds have healed.17
This includes tampons and menstrual cups, discs, and sponges. Technically there’s no required waiting period before you can insert penises, fingers, and sex toys, but most practitioners recommend you wait 4-6 weeks to give your body time to heal.18
After those first 6-weeks, it’s time for a shiny new menstrual cup! And maybe different tampons...
Birthing a tiny human is a big stretch for the vaginal canal, and it probably won't completely return to its pre-baby shape.19
Menstrual cup users may need to use a larger cup, otherwise it might leak. Most menstrual cup companies offer post-pregnancy cup sizes to accommodate a slightly wider vagina.
Tampon users may need bigger tampons than they did pre-motherhood, but it depends. If you had vaginal lacerations during delivery, the scar tissue might take up space in the vaginal canal, so you may actually need smaller tampons. And even if you need bigger tampons for a while, things could change back to your pre-baby tampon size as your pelvic floor muscles eventually tone back up. (Pro tip: Kegel exercise speed up this process. Plus you can do them literally anywhere at any time.)20
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Betty speaks the god's honest truth. From menstruation to intercourse to childbirth. From being the most elastic part of the human body, to having 8,000 nerve endings (twice as much as the penis, we may add). Vaginas are a force of nature. What feats has your vagina performed today?
2. Howie, P. W., McNEILLY, A. S., Houston, M. J., Cook, A., & Boyle, H. (1982). Fertility after childbirth: post‐partum ovulation and menstruation in bottle and breast feeding mothers. Clinical endocrinology, 17(4), 323-332.
3. Knauer, M. (1985). Breastfeeding and the return of menstruation in urban Canadian mothers practising" natural mothering".
6. Jackson, E., & Glasier, A. (2011). Return of ovulation and menses in postpartum nonlactating women: a systematic review. Obstetrics & Gynecology, 117(3), 657-662.
8. Vekemans, M. (1997). Postpartum contraception: the lactational amenorrhea method. The European Journal of Contraception & Reproductive Health Care, 2(2), 105-111.
12. Hendrick, V., Altshuler, L. L., & Suri, R. (1998). Hormonal changes in the postpartum and implications for postpartum depression. Psychosomatics, 39(2), 93-101.
13. Schiller, C. E., Meltzer-Brody, S., & Rubinow, D. R. (2015). The role of reproductive hormones in postpartum depression. CNS spectrums, 20(1), 48-59.
14. Sugawara, M., Toda, M. A., Shima, S., Mukai, T., Sakakura, K., & Kitamura, T. (1997). Premenstrual mood changes and maternal mental health in pregnancy and the postpartum period. Journal of clinical psychology, 53(3), 225-232.
15. Sherman, D., Lurie, S., Frenkel, E., Kurzweil, Y., Bukovsky, I., & Arieli, S. (1999). Characteristics of normal lochia. American journal of perinatology, 16(08), 0399-0402.
Cover photo credit: http://vincentferranephotography.com/