As if pregnancy was not physically and emotionally transformative enough on its own, the postpartum aftermath is a white-knuckle roller coaster. Hormones are surging and plummeting, nipples are leaking, vaginas are bleeding-healing-itching, night sweats are blazing, c-section scars are tender, hormonal changes are raging—and if you’ve been gifted with a healthy pregnancy and baby, there’s also a very little (how are they so little?!) human to keep alive. No big deal, right?
In the midst of this mayhem, Mother Nature has one peace offering: a pause on your period. It’s a kind gesture to let the hormonal dust settle—but if you’re wondering when you can expect your menstrual cycle to regulate and the red tide to rise again, read on for the expert explanation from Dr. Caitlin O’Connor, a Naturopathic Doctor (and Perelel panelist) who specializes in holistic treatment for women.
How soon after pregnancy and childbirth should I expect to get my period?
“This is extremely variable and depends on multiple factors,” Dr. O’Connor says. “For folks who don't breastfeed, they will likely get cycles back within three months. With breastfeeding, some folks won't experience menstruation at all until they wean completely. Other folks will get their periods back once the baby goes eight to ten hours without nursing (often overnight). For some, they will get their periods back in the first four to six months even when nursing around the clock! And it is typical for some people to have irregular cycles for the duration of breastfeeding.”
What exactly are my hormones doing during this time?
To put it mildly: Your hormones are doing a lot. Immediately after birth, your estrogen and progesterone levels decrease back to their pre-pregnancy levels—which is often what contributes to the “baby blues.” Meanwhile, the “bonding” hormone oxytocin increases, as does prolactin—the hormone responsible for lactation and breast milk production.
This swirling hormone cocktail contributes to symptoms like cramping, hot flashes, mood swings, and—you guessed it—menstrual irregularity, especially if you’re breastfeeding. (Prolactin can suppress the hormones responsible for ovulation.
Is it possible to confuse postpartum bleeding with my period in the first six weeks?
“Typically not. While folks can get a period in the first four weeks, it is more typically six to 12 weeks if someone isn't breastfeeding,” Dr. O’Connor explains. “By two to four weeks postpartum, bleeding should be pretty wrapped up and typically have transitioned to spotting and darker blood.”
On the other hand, “onset of a heavier and more red flow would be an indication of menstrual flow. It is always good to check in with your care provider with questions regarding bleeding, especially bleeding that seems to be getting heavier in the first six weeks. Some folks will have some extended spotting, and there can be many variations of normal—but postpartum bleeding that is still consistent or heavy should be evaluated at the six-week visit to make sure healing is going well,” Dr. O’Connor suggests. If you’re passing a lot of blood clots, it’s a good idea to check in with your physician as well.
Should I expect my first period after baby to be the same as it used to be? If not, in what ways might it be different?
“I consider pregnancy and birth to be like shaking the snow globe of the menstrual cycle and things can settle in to be much different than they were before. Most typically, the first postpartum period will be heavier and possibly last longer than prior to pregnancy. Often mood changes will be more intense as well. It can take three to six cycles to settle into the new normal,” Dr. O’Connor explains. In other words, you might experience irregular periods for several months.
Which postpartum period variations are normal—and which are cause for concern?
“It’s very normal to have a heavier flow, but typically having to change a super pad or tampon more frequently than every one to two hours for longer than six hours, soaking or bleeding through menstrual products, experiencing ‘gushing,’ or passing large clots while standing are all reasons to check in with your provider,” Dr. O’Connor suggests.
“Most of the time this is just a normal variation secondary to the hormonal shifts of postpartum, but it is never a bad idea to check in and discuss options for management if heavy bleeding becomes a trend,” she adds. Iron deficiency is already more common during postpartum and heavy menstruation can exacerbate the issue. Anyone with heavy flows should have their ferritin checked in addition to the more common CBC. Anything under 30 is considered iron deficiency and a good goal is 50-70 or even higher in some folks.”
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Are women really more fertile right after they give birth? We’ve heard about some women getting pregnant in the first cycle after birth and never getting their period.
“I don't think folks are necessarily more fertile, I think it is just the element of surprise!” Dr. O’Connor says. “Ovulation almost always precludes the menstrual flow, so an egg will be released typically 10-14 days before the first flow. Release of that egg is pretty hard to predict for folks who aren't tracking markers like cervical discharge and body temperature—and even then the disrupted sleep, lifestyle changes, and hormonal shifts that are typical of postpartum can make for very erratic ovulatory patterns,” she explains. For these reasons, “it’s very easy for a rogue egg to be released and get fertilized before the first menstrual flow has started.”
Most experts recommend waiting several weeks to start any hormonal birth control, and longer if you’re breastfeeding. (For what it’s worth, it’s usually not safe to have sex until roughly six weeks postpartum.) Your physician can answer specific questions about sexual activity and contraception.
Looking for more support in your postpartum journey? Our Mom Multi Support Pack was developed specifically for the needs of new moms—and in a clinical trial, 70% of participants who took Mom Multi Support Pack had more energy and overall mood improvements.1
1Based on an 8-week independent study of 30 women, ages 25+ who have at least one child under the age of 5 years old.