After giving birth, a woman's body changes quite a bit. Her hormones go up and down, her sleep patterns change, and she feels more stressed. It's like being on a roller coaster ride – sometimes it's exciting and rewarding, but other times it's tough.
On top of that, returning to everyday life also poses its challenges, especially when it comes to her menstrual cycle after giving birth. Will it be early? Late? Lighter or heavier than before?
This can leave you with many questions, but rest assured, we have the answers. We asked Dr. Zachary Ferraro, OB-GYN (MD, Ph.D.), to shed light on various postpartum period concerns, including the reasons why the first period after baby is longer than seven days, how the postpartum period differs from a regular period, and the impact of breastfeeding and bottle-feeding on your menstrual cycle.
Every woman's menstrual cycle is different. Some may experience heavy and painful periods, while others may have a lighter and shorter flow. However, it's important to note that your postpartum period differs from a pre-pregnancy cycle, as a 2021 article published by the UT Southwestern Medical Center states that a postpartum period tends to be much heavier and lasts up to two to three weeks following vaginal birth or cesarean section (C-section) delivery.
According to Dr. Ferraro, this is due to the presence of lochia, a combination of blood and uterine tissue that sheds after childbirth.
"Lochia is specific to the postpartum period and is the shedding of the uterine lining of pregnancy in the postpartum period as the uterus contracts, decreases in size, and sheds the endometrium that supported the placenta and the baby," he tells Today's Parent. "It can be confused with the first period postpartum, but it is different."
Dr. Ferraro explains that lochia usually consists of bright red blood and can continue for several weeks, becoming lighter and turning into slight spotting during the first four to six weeks after childbirth. It's also normal for the color of lochia to shift to pink, brown, or clear as the body eliminates white blood cells, blood, and mucus.
However, Dr. Ferraro warns that lochia may worsen with activities that increase abdominal pressure, such as walking or other physical activities, so taking it easy on your body during this period is essential.
When considering the duration of a postpartum menstrual cycle, it is essential to understand that it varies for each person. Dr. Ferraro explains that most women will experience a period lasting from three to seven days after the return of menses postpartum. However, if you have any concerns about your bleeding or if something seems unusual, it is recommended to speak to your healthcare provider to ensure that this is normal for you.
After giving birth, whether you breastfeed or choose to bottle feed can influence the return of your period. Breastfeeding, for example, can delay the return of your period due to elevated levels of prolactin, the hormone that suppresses periods. "This is known as 'lactational amenorrhea' and can surprisingly be effective as a form of contraception for up to six months postpartum if you exclusively and regularly breastfeed," says Dr. Ferraro.
"However, it's not foolproof, so you'll want to speak with your doctor about contraception during this time and see what might work for your health."
If a mother chooses bottle feeding, the decrease in prolactin levels can stop the suppression of the menstrual cycle, causing it to return earlier, possibly within four to six weeks after childbirth, according to Dr. Ferraro. In this case, these individuals should consider contraception if they wish to avoid pregnancy.
Every woman's body is unique, so each person's postpartum menstrual cycle is different. However, if you experience heavy bleeding that saturates more than one pad per hour for over two hours, intense cramping, or unusually large blood clots (bigger than a golf ball), Dr. Ferraro says it's a good idea to see an OB-GYN or gynecologist.
Dr. Ferraro also advises seeking emergency care if you experience brisk, bright red bleeding immediately postpartum that does not subside and/or if you also experience feeling faint, dizzy, chest pain or palpitations, shortness of breath, or generally feeling unwell. "This is important to rule out the risk of a more serious postpartum infection or bleeding pattern," he says.
Dr. Ferraro states that your initial period following childbirth might differ from your period before pregnancy because of natural postpartum bleeding called lochia, which can continue for up to six weeks as your body adjusts to the postpartum phase. Nevertheless, as women's bodies differ, each person's early postpartum period is unique. "A few women might observe light bleeding, whereas others might have a heavier flow with small blood clots," he adds.
Following your pregnancy, Dr. Ferraro suggests that your postpartum period may be lighter, heavier, or remain the same, as underlying medical conditions and exclusive breastfeeding can influence it. However, it's important to note that when your period returns, it should resemble its pre-pregnancy state in color, flow, and frequency. "This means that if you had regular or irregular periods before pregnancy, you are likely to experience the same patterns again after pregnancy," he says.
Dr. Ferraro suggests that a woman can get pregnant before her first postpartum period, as ovulation and menstruation's return after pregnancy largely depend on lactation. "If you are not breastfeeding, ovulation can take place as early as three to four weeks after delivery," he explains. To prevent another pregnancy, Dr. Ferraro suggests considering hormonal birth control such as progesterone-only pills, injections, and intrauterine devices (IUDs), as these methods are effective and do not disrupt the milk supply while breastfeeding.
However, he emphasizes the importance of having a thorough discussion with a prenatal care provider before delivery before starting any birth control methods.
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