The easiest way to tell that Liz Grey* has her period is to check out the size of her purse. When Aunt Flo arrives for her brutal, stormy visits, Liz switches to a tote bag to lug around her box of super-plus tampons. For those five days a month, life gets tricky: Her commute causes panic if she gets stuck in traffic, and long meetings have her nipping out to the washroom with her purse for her tampons’ hourly change. “My periods have always been heavy and crampy,” she says. But after two kids, now seven and two, it’s gotten gorier than an episode of The Walking Dead.
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Then there’s Nicole Forrest*, 37. Before she had her baby, her periods were hellish, thanks to endometriosis (a condition that causes uterine cells to grow outside of the uterus), with excruciating pain and violent diarrhea. But when she got her first postpartum period seven months after giving birth, she was delighted to find that the pain had all but vanished. “It’s still heavy, but I have none of the other symptoms. It’s such a huge relief!”
And for Lillian Brown, 37, a mom of two kids ages three and six, trying to track her post-kids period is futile. “Between the spotting and the actual period, I’m seeing some form of blood half of the month.”
So why do some women’s periods worsen, other’s improve, and some just go haywire, after having kids?
In theory, the period you had pre-pregnancy is the period you should have post-pregnancy. If you’re not breastfeeding, you can expect your period to return about 10 weeks postpartum (some women might not get it until much later, though), and at about 20 weeks if you are, though that, too, ranges wildly. The delayed onset of menstruation for breastfeeding moms is thanks to prolactin, a hormone that encourages milk production and can inhibit ovulation. Don’t be alarmed if it takes longer than the 20-week mark—some women’s periods won’t return for a year after they stop breastfeeding. And afterward? Well, all bets are off.
Worse than before
For Lillian and Liz, whose periods changed dramatically post-baby, it’s important to note a common factor: Both women had been on the pill from when they became sexually active teens until they decided to conceive in their 30s. And since the “period” you have when you’re on the pill isn’t a natural period, but rather withdrawal bleeding from the 21 days of synthetic hormones, discovering your real cycle can be a shock. “Any form of hormonal contraception, whether it’s the pill or an intrauterine device (IUD), can cause lighter periods,” says Stephanie Rhone, an OB/GYN at BC’s Women’s Hospital and Health Centre in Vancouver. Your newly heavy period might just be your natural, unsuppressed cycle.
There are other factors than can cause heavy, painful periods that have nothing to do with childbirth, and everything to do with just being a woman, including uterine fibroids or polyps, and weight gain.
“If you put on weight, you produce more of your own estrogen in the fat cells of your body, and this can influence how long and heavy your periods are,” says Doug Black, formerly an OB/GYN in Ottawa who now practises in Doha, Qatar.
Alternative practitioners offer a different perspective than a medical doctor: If your periods have suddenly been brutally heavy and painful since you had a baby, a naturopath might suggest shifting your focus from your uterus to your liver.
“In pregnancy there’s a lot of demand on your body to try and deal with bodily waste—not just your own, but also the baby’s—so your liver and kidneys work extra hard trying to excrete toxins and chemicals,” says Toronto naturopath Pamela Frank. “The liver is mainly tasked with detoxifying excess estrogen as well, so heavy, painful periods might indicate a backup in the liver from the pregnancy.” She recommends a multi-phase liver cleanse under a naturopath’s supervision. If cramping is your woe, you might be deficient in magnesium, which helps muscles to relax. She recommends looking for magnesium glycinate—it doesn’t compete with other minerals to get absorbed and is less likely than other forms to cause diarrhea.
If you’re suddenly plagued by heavy periods, you should see your doctor to rule out anything abnormal, and have her check your hormone levels for an imbalance (excess estrogen that’s not being matched by a similar level of progesterone is usually a suspect). You should also get tested for anemia. Supplementing with iron is a necessary evil for a lot of women, says Frank, although she argues that ferrous fumarate, the kind that is prescribed most frequently, is generally poorly absorbed. Instead, she recommends looking for Ferronyl, a much more easily digested form.
When it comes to treating periods that are just naturally heavy (and aren’t caused by anything abnormal), Black has found that many of his patients seeking the one-two punch of period relief and a solid contraceptive are now benefiting from Mirena, an intrauterine system that also releases progestin and is good for five years (or until you decide you want another baby). “It has changed my practice significantly over the past 15 years,” he says.
If you’re finding that your periods are seriously disrupting your life, there’s also a procedure called endometrial ablation, a minimally invasive, 15-minute surgery that destroys the lining of the uterus. “It’s 80 percent effective,” says Rhone. “It doesn’t regulate your cycle, but it certainly makes it lighter or disappear altogether.” Ablations should only be considered by women who are finished having babies, though, since the lining can’t be replaced once it’s gone. It also doesn’t provide any contraceptive benefits, so you’ll need to use birth control as well, since any pregnancy that occurred would have increased risk of miscarriage and obstetrical complications.
While some women’s cycles bounce right back after baby to a regular 28 days, others, like Lillian’s, can be more erratic. It could be just that their hormones need a little extra time to get in the groove. And factors like stress (it produces prolactin, too), thyroid abnormalities, weight loss or weight gain can all contribute to a wonky cycle. And, of course, if your periods are becoming erratic, it might be simply that you’re in the perimenopause zone, which can start as early as your mid-30s, though it more typically begins in your mid-40s.
For a few lucky women like Nicole, their periods turn from foe to friend post baby. Some endometriosis sufferers in particular see a positive change.
“With endo, there are a lot of structural things that are wrong in the pelvis,” says Frank, “and some of those improve when everything—the ligament, the tissue, the adhesions—relaxes to deliver the baby. Hormonally, too, the very high progesterone state of pregnancy helps to keep the estrogen in check.” (Estrogen causes the extra uterine cells to grow.) And the benefits can last well beyond pregnancy. Some women with endo find their symptoms worsen, of course, with no rhyme or reason; if yours do, speak to your doctor about treatment options, including the pill and Mirena.
When to worry
Your general menstrual health should always be a part of the larger conversation you have with your doctor, but if something feels suddenly different or wrong, don’t wait for your yearly physical. “Anything from a simple polyp or a fibroid or fibroma growing within the wall of the uterus, or something a bit more complicated like adenomyosis [where the uterine lining grows into the muscular wall of the uterus] and endometriosis can influence women’s cycles,” says Black.
And while many women have simply learned to manage their periods, “If your periods interfere with your ability to function,” says Rhone, “talk to your doctor.”
For Liz, her monthly slog has simply become her normal routine. Until she’s decided if she’s finished having babies, she’s reluctant to consider anything like an ablation. The idea, though, is tempting. Imagine, she says wistfully, being able to leave the tote bag at home.
A version of this article appeared in our December 2014 issue with the headline “The Return of Aunt Flo,” p. 33.