There are always a lot of questions surrounding fertility while breastfeeding and the return of your menstrual cycle following birth. This is different for every woman and the range of “normal” can be vast. Some women’s menstrual cycles resume shortly after giving birth, while others may not resume cycling until well beyond the first postpartum year. Many factors can affect this timing. This part of your postpartum journey can be confusing and unfortunately it can be difficult to find answers. Although every woman’s experience will be different, this blog will hopefully give you some insight on the possible timeline, associated factors, and what to expect from your first period following pregnancy.
Studies have shown that ovulation will occur sooner for non-nursing women than nursing women (1). Women can also experience menstruation postpartum without the occurrence of ovulation. This is seen more frequently in non-nursing women (1). Breastfeeding women tend to experience a delay in the return of their periods because prolactin can suppress reproductive hormones (2).
A 2011 systematic review, identified the mean day of first ovulation for non-lactating women ranged from 45 to 94 days postpartum (3). Urine tests were used to determine ovulation and concluded that ovulation occurred before menses in 20-71% of the cases. 0-60% of the ovulations were also fertile. Another study using basal metabolic temperature to measure ovulation, concluded that on average ovulation would occur at 74 days postpartum. 70% of these ovulations were fertile and 30% of first menses were preceded by ovulation (3) . Therefore, ovulation will likely return prior to experiencing your first period following pregnancy.
In comparison, most women who are exclusively breastfeeding their babies will not experience a menstrual period for 3 to 6 months or longer postpartum (4). This is known as lactational amenorrhea. Even when menses returns it is difficult to know if ovulation has occurred and if your cycle will continue as normal. Women are more likely to ovulate and resume a regular menstrual cycle when their baby is 6 months old and/or sleeping for longer periods of time without needing to be fed. Most breastfeeding women will completely resume their periods between 9 and 18 months postpartum. Another study followed 72 women who were exclusively breastfeeding their babies. Almost half of the women experienced some spotting or vaginal bleeding between 6 and 8 weeks postpartum. These women eventually ovulated and menstruated earlier when assessed by hormone analysis (5).
Occasionally women will see menses return before they have fully weaned their babies. It is common to see a drop in milk supply during certain points of your cycle, specifically from mid-cycle to the start of bleeding. La Leche League recommends “a daily dose of 500 to 1,000 mg of calcium and magnesium from the middle of your cycle through the first three days of your period may help minimize any drop in supply” (4).
Your first postpartum menses may be similar or very different when compared to your periods prior to pregnancy. Your body is still recovering, healing, and changing, so be patient with it as it adjusts. Some new menstrual symptoms may include: clotting, heavier flow, cramping, increased pain, irregular cycle length, or inconsistent flow. The additional, and potentially painful cramping may be due to your body needing to shed an increased amount of uterine lining and the hormones associated with breastfeeding. As your cycle continues to regulate, these changes will likely lessen (6). While your body continues to heal, be sure to always fuel it with whole foods that are rich in iron and other micronutrients.
Periods following birth may also improve because of a dilated cervix and/or the hormone relaxin. Women with endometriosis also typically experience less painful periods following birth as a result of increased progesterone from pregnancy. (Unfortunately, painful periods are likely to resume with cases of endometriosis.)
If you happen to experience more painful periods following pregnancy, getting adjusted by a women’s health chiropractor at the beginning of your cycle and taking a magnesium/calcium supplement can be beneficial. It’s a good idea to check in with a pelvic PT as well. Always be sure to follow up with your healthcare provider with any questions.
Sarah Tirimacco, DC
1. Berman ML, Hanson K, Kellman IL. Effect of breast-feeding on postpartum menstruation, ovulation, and pregnancy in Alaskan Eskimos. Am J Obstet Gynecol. 1972 Oct 15;114(4):524-34.
3. Jackson E, Glasier A. Return of ovulation and menses in postpartum nonlactating women: a systematic review. Obstet Gynecol. 2011 Mar;117(3):657-62.
5. Visness CM, Kennedy KI, Gross BA, Parenteau-Carreau S, Flynn AM, Brown JB. Fertility of fully breast-feeding women in the early postpartum period. Obstet Gynecol. 1997 Feb;89(2):164-7.
Blog originally posted at BIRTHFIT.com
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