Menstrual periods after childbirth – when will they start again?

By (embryologist), (gynecologist) and (biochemist).
Last Update: 08/05/2022

How long does one need to wait for the first menstruation after delivery? Will it be a heavy period? Are there differences if the delivery is natural or by cesarean section? What if choose to breastfeed? These are some of the most common questions asked by pregnant women, especially first-time mothers.

In this article we will resolve these and other common doubts about the first menstrual period after childbirth.

After the birth

After having a baby, the mother's uterus needs about fifteen days to return to normal, both in terms of size and position. Furthermore, the woman will gradually recover her pre-pregnancy state:

  • Abdominal flaccidity disappears
  • The vagina and vulva close
  • The cervix closes

This postpartum recovery period is called puerperium and its duration varies from one woman to another. Nevertheless, it is common for it to last around 40 days, which is why some people call it the fourth trimester.

It is easy to understand that the menstrual cycle also needs some time to become regular again. During pregnancy a woman experiences a strong hormonal imbalance that leads to anovulation and the lack of menstruation.

Despite this, it is possible that the woman may experience slight vaginal leakage or lochia during this postpartum stage.

Lochia is bleeding that occurs during the first two to four weeks after delivery from the wound left by the placenta. Initially it is bright red in color but it gradually fades until it stops altogether.

As well as the small variability between women, there is another fundamental factor that prevents the hormonal cycle from returning to its normal state: breastfeeding. We discuss this in detail below.

Breastfeeding

Choosing to breastfeed the baby is one of the main factors in the continued absence of the menstrual period. Therefore, depending on how the parents choose to feed the newborn, it will take more or less time for the period to return.

Bottle feeding
if the mother chooses to bottle feed her baby, it may take 8 to 10 weeks for her period to become regular again. There is no reason for it to be longer. In fact, it is advisable to consult a specialist if the period does not arrive after two to three months.
Breastfeeding
if the mother decides to breastfeed her child, the return of the menstrual cycle will take longer. This delay may be prolonged for 3 to 6 months, usually due to the hormone prolactin.

Prolactin, produced by the pituitary gland (hypophysis), is the hormone that stimulates breast milk production. Its production can disrupt and paralyze ovarian activity. Therefore, the longer the breastfeeding period, the longer it will take the mother to regain her periods.

Prolactin needs to return to its normal (pre-pregnancy) level for menstrual cycles to become regular again. Therefore, in principle, a woman will not have her period during lactation.

Despite this, there may be cases in which the first menstruation appears during this breastfeeding period, especially if feedings are increasingly spaced out.

As Dr. Nadia Caroppo, a gynecologist specializing in assisted reproduction, tells us:

As breastfeeding feeds are spaced out, the female sexual axis begins to operate again due to the decrease in prolactin, which is the hormone that generates milk, the cycle starts up and menstruation may begin to appear.

Women who are breastfeeding their babies every two hours do not usually ovulate. As these feeds become more spaced out, the female hormnone axis starts to normalise as the levels of prolactin gradually decrease. It generally takes 3 - 6 months for the period to return but in some women it may be as long as 8 months.

However, even though the woman may not have her period she could indeed ovulate and become pregnant. As such she needs to be careful not to fall pregnant again.

For mothers who choose not to breastfeed, the menstrual period usually returns after about 2 months after the birth. About a month after the lochia has ceased.

First menstrual cycle after pregnancy

In addition to the way the child is fed, there are other factors that may influence the return of the menstrual cycle after the birth of the baby. Some examples are:

  • The amount of blood lost during labor (if a lot of blood has been lost, it is likely to take a little longer).
  • Whether or not it is the first vaginal delivery (in first-time mothers it takes longer).
  • Genetic inheritance of the woman.

Although this first period is likely to be anovulatory (no eggs), sometimes this is not the case. Therefore, the use of condoms, preferably latex-free, is recommended to correctly prevent a new pregnancy. In fact, it is advisable to use protection during the entire breastfeeding period, even in the absence of menstruation, since we do not know exactly when the menstrual period will start again.

The first menstrual period after conception is usually quite heavy.

As it is also common for menstrual symptoms to vary during this first menstrual period. Women who suffered from painful periods before becoming mothers may notice a certain improvement in their situation. This is due to the muscular uterus being less than before.

As the situation returns to normal and the uterus returns to its normal state, periods return to the way they were prior to pregnancy. However, there are women whose menstrual cycle changes permanently after pregnancy.

It is advisable to use cotton pads instead of tampons for the first menstrual period after childbirth due to the sensitivity of the area.

FAQs from users

Can I get pregnant after childbirth if I am not menstruating?

By Andrea Rodrigo B.Sc., M.Sc. (embryologist).

It is true that breastfeeding is considered the best supression of ovulation due to the increase in prolactin level. However, as lactation is reduced, the prolactin level returns to its normal state. This is not immediate and, therefore, if pregnancy is not desired, contraceptive protection is recommended.

In addition, we should not forget that, although it is rare, there may be female periods in which there is ovulation but no menstruation.

Therefore, even without menstruation, there is a possibility of pregnancy after childbirth, although it is low.

Is recovery after cesarean section longer than after natural childbirth?

By Andrea Rodrigo B.Sc., M.Sc. (embryologist).

If talking about physical recovery after childbirth, it is true that cesarean delivery is more aggressive and therefore requires more time for the woman's body to return to its normal state. However, in relation to the menstrual cycle, the type of delivery does not have much effect.

Is it normal for postpartum periods to be irregular?

By Andrea Rodrigo B.Sc., M.Sc. (embryologist).

Yes, after childbirth, hormone levels gradually adjust and return to normal, i.e., to the pre-pregnancy state.

Therefore, since the menstrual cycle is regulated by hormones, it is common to have irregular periods after childbirth.

Although there are no major differences in relation to the first menstruation, the woman's physical recovery is different if the delivery was by cesarean section or natural childbirth. In this article we discuss the main differences between one type of delivery and the other: Natural birth vs C-sections.

We have also talked about the variation in the time it takes for the first period after the birth of the baby depending on whether you choose bottle or breastfeeding. If you would like to learn more about these feeding methods then please read our article: Breastfeeding or bottle feeding?

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References

Authors and contributors

 Andrea Rodrigo
Andrea Rodrigo
B.Sc., M.Sc.
Embryologist
Bachelor's Degree in Biotechnology from the Polytechnic University of Valencia. Master's Degree in Biotechnology of Human Assisted Reproduction from the University of Valencia along with the Valencian Infertility Institute (IVI). Postgraduate course in Medical Genetics. More information about Andrea Rodrigo
 Nadia Caroppo
Nadia Caroppo
M.D.
Gynecologist
Bachelor's Degree in Medicine by the University of Buenos Aires, with specialization in Obstetrics & Gynecology. Large experience working as an OB/GYN at several Spanish and international hospitals. Experience as the Supervisor of Female Genital Tract Pathology & Colposcopy Unit. More information about Nadia Caroppo
License: 460844481
Adapted into english by:
 Michelle Lorraine Embleton
Michelle Lorraine Embleton
B.Sc. Ph.D.
Biochemist
PhD in Biochemistry, University of Bristol, UK, specialising in DNA : protein intereactions. BSc honours degree in Molecular Biology, Univerisity of Bristol. Translation and editing of scientific and medical literature.
More information about Michelle Lorraine Embleton

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