What’s the Deal with Postpartum Periods?
Postpartum periods are an aspect of postpartum recovery that every new parent will eventually face after enjoying a much-needed break from their menstrual cycle during pregnancy. This return to regular menstrual cycles can be a bit of a mixed bag, varying significantly from person to person, depending on factors like breastfeeding, overall health, and individual hormonal responses.
Postpartum menstrual cycles are often influenced by various factors, including the state of the reproductive system, hormonal changes, and whether or not the individual is breastfeeding. The key takeaway is that postpartum periods are unique for each person, just like pregnancy, and are not governed by a one-size-fits-all approach.
Understanding Lochia vs. Menstruation
To understand postpartum periods, it’s essential to distinguish between lochia and menstruation. Lochia is the vaginal discharge containing blood, mucus, and tissue that was part of the uterine lining during pregnancy. It typically appears right after childbirth, lasting for around six weeks or longer in some cases.
- Lochia’s stages: Lochia starts as a heavy, red discharge in the first few days after birth. This might seem like a regular period at first but is typically much heavier. Over the next week, lochia gradually transitions to a lighter, pinkish or brown color. Around two weeks postpartum, the discharge lightens to a light brown or yellow hue. Though the volume generally decreases over time, some fluctuations in the flow can occur, particularly if you engage in physical activities that strain the pelvic muscles.
Lochia is entirely separate from menstruation and is not influenced by ovulation. It’s the body’s natural way of clearing out the uterus after childbirth. Once lochia ends, the body gradually readjusts to its pre-pregnancy state, and eventually, menstruation resumes.
The Big Question: When Will Your Menstrual Cycle Return?
One of the most common postpartum questions is, “When will my period return?” Unfortunately, there’s no definitive answer, as it varies based on a host of factors, including breastfeeding and the individual’s unique hormonal profile.
- Non-breastfeeding individuals: For those who aren’t breastfeeding, the menstrual cycle often returns sooner. Many will experience the return of their period within six to eight weeks postpartum, though it could take longer depending on factors like how quickly the body adjusts and heals from childbirth.
- Breastfeeding individuals: On the other hand, those who breastfeed may not see their period for several months or even longer. Breastfeeding can delay the return of the menstrual cycle due to a hormone called prolactin, which is responsible for milk production and also suppresses ovulation. However, this is not a guarantee; some breastfeeding parents experience irregular spotting or occasional periods even while nursing.
A 2018 study published in the Journal of Women’s Health indicated that for some women who exclusively breastfeed, periods may stay away for six months to a year. This extended break from menstruation is known as lactational amenorrhea, and it occurs because prolactin keeps estrogen levels low, which prevents ovulation.
However, it’s important to note that while breastfeeding might delay ovulation and menstruation, it is not a reliable form of birth control unless you follow the lactational amenorrhea method (LAM) strictly. Even in breastfeeding individuals, ovulation can still occur unpredictably, so if you’re not ready for another pregnancy, it’s essential to use contraception once you resume sexual activity.
What to Expect When Your Period Returns
When your period finally returns postpartum, it might not look or feel the same as it did pre-pregnancy. Many people find that their postpartum periods are:
- Heavier or lighter than usual: Some people experience heavier bleeding and longer periods, while others notice a much lighter flow. This could be due to the body readjusting to its pre-pregnancy hormonal state or uterine changes that took place during childbirth. Studies have shown that postpartum menstrual changes are common, but they usually stabilize after a few cycles.
- Irregular: Postpartum periods can be unpredictable, with cycles being longer or shorter than before. Irregular periods are common as the body attempts to re-establish its ovulation pattern. It can take several months for the cycle to regularize, even if you’re not breastfeeding.
- Accompanied by stronger cramps: Some report experiencing more intense menstrual cramps postpartum, while others may feel little to no discomfort. The intensity of cramps often depends on changes in the uterus and pelvic muscles after delivery.
In general, it’s important to allow your body the time it needs to adjust to menstruating again. If you have concerns about excessively heavy periods or irregularities lasting more than six months, a healthcare provider can assess for potential issues, such as thyroid disorders or hormonal imbalances that could be contributing to the changes.
Breastfeeding and the Return of Periods
One of the most significant factors affecting the return of your menstrual cycle postpartum is breastfeeding. Research shows that individuals who exclusively breastfeed often experience a longer delay in the return of their menstrual cycles.
Here’s how breastfeeding impacts the return of your periods:
- Prolactin: When you breastfeed, your body produces higher levels of prolactin, which helps stimulate milk production. Prolactin also suppresses ovulation, which prevents the release of eggs and delays menstruation. The more frequently you breastfeed, the more prolactin your body produces.
- Demand-driven cycles: Those who feed on-demand or nurse frequently throughout the day and night are more likely to experience a longer delay in their periods. However, as babies grow and begin to breastfeed less frequently, prolactin levels naturally decrease, leading to the eventual return of ovulation and menstruation.
- Combination feeding: If you combine breastfeeding with formula or solid foods, your period may return sooner than someone who exclusively breastfeeds. Introducing solids or supplementing with formula often reduces the frequency of nursing sessions, leading to lower prolactin levels and a quicker return to regular menstrual cycles.
Lochia and Returning Periods: Can You Tell the Difference?
Many new parents worry about distinguishing lochia from their first postpartum period, especially since both involve vaginal bleeding. Here’s how to tell the difference:
- Lochia typically appears as bright red, heavy bleeding right after delivery, lasting for several weeks. As it tapers off, the color changes to pink, brown, or yellow. Lochia discharge will reduce over time, although physical exertion might cause a temporary increase in bleeding.
- Menstruation is more likely to be cyclic, arriving once the body resumes ovulation. Your first postpartum period will resemble your pre-pregnancy menstrual flow in color, consistency, and duration.
It’s essential to be aware of signs of abnormal bleeding or postpartum hemorrhage. If you experience large clots, unusually heavy bleeding (soaking through a pad every hour), or bleeding that resumes suddenly after tapering off, contact your healthcare provider.
Postpartum Periods and Contraception
When your period returns, ovulation precedes menstruation, meaning you could be fertile before noticing any menstrual bleeding. For those who aren’t ready to conceive again, it’s important to discuss contraception options with your healthcare provider. While breastfeeding provides some natural suppression of ovulation, it’s not 100% effective. Options include:
- Barrier methods: Condoms or diaphragms are safe, hormone-free options that can be used postpartum.
- Hormonal contraception: If you’re breastfeeding, your provider may suggest progestin-only birth control pills, a hormonal IUD, or an implant, which are less likely to interfere with milk supply.
- Non-hormonal IUDs: Copper IUDs offer long-term contraception without affecting breastfeeding or hormones.
Painful Periods Postpartum: What’s Normal?
After childbirth, it’s not uncommon for postpartum periods to come with more intense cramps and discomfort, especially during the first few cycles. However, certain issues like endometriosis or adenomyosis, which can worsen with pregnancy, might contribute to more severe pain.
If you experience abnormally heavy or painful periods for more than a few months postpartum, a healthcare provider can evaluate for conditions like uterine fibroids, pelvic inflammatory disease, or other underlying issues.
What to Do When Sex is Painful After Childbirth?
Painful sex after childbirth, known as dyspareunia, is an issue faced by many postpartum individuals. Studies suggest that 50-60% of women report painful sex 6-7 weeks postpartum, and up to 30% continue to experience discomfort at six months postpartum. The rate is similar for both vaginal and cesarean births.
Why Does Sex Hurt After Childbirth?
There are several reasons why sex may be uncomfortable after childbirth:
- Tissue Healing: If you experienced a vaginal tear, episiotomy, or any trauma during birth, it can take weeks or even months for tissue to heal completely. This can cause pain or sensitivity during intercourse.
- Hormonal Changes: Postpartum hormonal fluctuations, particularly reduced estrogen levels, can lead to vaginal dryness, especially if you’re breastfeeding. The hormone oxytocin, which is elevated during breastfeeding, suppresses estrogen, leading to less lubrication and thinner vaginal tissues.
- Pelvic Floor Weakness: Pregnancy and childbirth can weaken the pelvic floor muscles, which may contribute to discomfort or pain during sex.
What You Can Do to Alleviate Painful Sex
Here are some steps you can take to ease discomfort:
- Communication: Openly communicate with your partner about what feels comfortable and take it slow. It’s important to go at your own pace.
- Use Lubricants: Water-based lubricants are essential for reducing friction and easing vaginal dryness, especially during breastfeeding.
- Pelvic Floor Therapy: A pelvic floor therapist can help strengthen and rehabilitate the muscles, reducing pain and improving sexual function.
- Check with Your Healthcare Provider: Don’t hesitate to talk to your provider if pain persists. They can assess any lingering trauma or offer solutions like estrogen creams to help with dryness.
Conclusion
The return of your postpartum period and experiences like painful sex are complex and highly individualized. Whether your cycle resumes soon after childbirth or remains absent for several months, your body is unique, and it’s important to be patient with yourself. Similarly, if sex is uncomfortable, know that you’re not alone and help is available.
The postpartum experience is a journey of both physical and emotional healing. Understanding what to expect and knowing when to seek support can help you navigate this transition with confidence and care.
