Postpartum Periods and Breastfeeding: What to Expect
Postpartum is an emotional time. From bonding with your baby and feeling an overwhelming sense of love and responsibility, to adjusting to a new family dynamic and experiencing significant physical and hormonal changes. It can be a lot to process.
While recovering from birth, you experience lochia. Lochia is the name given to normal postpartum bleeding, or discharge coming from the uterus at the site where the placenta detached. Lochia typically starts with bright red discharge in the first week postpartum. It then becomes lighter (more brownish) and eventually more yellowish-white over a period of about 3–4 weeks.
If you choose to breastfeed, you’ll likely go through a period without any monthly cycle once lochia tapers off. While some women enjoy a break from the monthly bleed, others wish for their cycle to return for peace of mind or because of a desire to try for another baby.
So what’s the deal with getting your period back postpartum (or while breastfeeding)? Why does your body sometimes skip the cycle? Can you get pregnant while breastfeeding? When will your period come back? Will it affect your milk supply? And (if desired), can you do anything to help it return? Let’s dig in.
Why You Don’t Get a Period While Breastfeeding
For many (but not all) women, breastfeeding naturally suppresses menstruation for a period of time during the postpartum phase. Anthropologists have described it as a natural contraception. It’s as if your body knows that you’re still nourishing another baby so it pauses your natural reproduction function in order to allow your body to heal and care for itself and your baby.
This “natural contraception” is thanks to the hormones at play while breastfeeding – namely prolactin and oxytocin. When your baby breastfeeds, they stimulate the nerves in and around your nipples to send a message to your brain to make (prolactin) and release (oxytocin) milk. Prolactin is responsible for production, and too much can actually suppress menstruation longer. Oxytocin is responsible for your let-down reflex (the tingly feeling that comes just before your milk lets down while nursing). Oxytocin also helps prevent ovulation by sending signals to the brain that tell it to suppress the main hormone that stimulates ovulation.
Note that expressing milk with a pump doesn’t cause the same effect, so these effects, and a lack of period, may be reduced in pumping mamas.
Can You Get Pregnant While Breastfeeding?
It’s important to note that a lack of a period while breastfeeding is only considered effective birth control (referred to as the lactational amenorrhea method) if three criteria are met:
- Your baby is under 6 months and getting all nutrition from breastfeeding, none from formula or food.
- You are amenorrheic (not getting a period).
- You practice exclusive breastfeeding on demand, day and night (no stretch longer than 4 hours during the day or 6 hours at night without nursing).
Note: most research does not consider pumping as effective at controlling birth as breastfeeding. As mentioned previously, it is the act of a baby suckling on a nipple (and oxytocin release) that helps release hormones to suppress ovulation. So even if your baby is fed exclusively breast milk, do not consider pumping and bottle feeding as effective birth control, even if you meet all of the other criteria.
When all of these criteria are met, the lactational amenorrhea method is considered to be 98% - 99% effective.
When Will Your Period Come Back?
There is a wide range of normal when it comes to the return of your period, especially if you are exclusively breastfeeding.
If you’re not breastfeeding, the range tends to be a little tighter, and your period may return starting around 4 months postpartum.
If you are exclusively breastfeeding, you may still see the return of a monthly bleed beginning around 4 months, especially if your little one starts sleeping longer stretches at night at an early age. But more commonly, women get their periods back anywhere between 8 - 18 months postpartum. When you get your period back doesn’t indicate anything of concern about your body or breastfeeding relationship. The reality is, every woman is different, and every pregnancy and postpartum are different. Your experience will be different from other women you interact with, and it will likely even be different for your own pregnancies if you experience more than one.
It’s also important to note that it is entirely safe and normal to not get your period back while breastfeeding at all, and some women will not get a period back until a month or two after fully weaning. If you breastfeed into toddler years, this could mean you are 2+ years postpartum!
If your cycle doesn’t return after 3 months from fully weaning, mention it to your provider. They may recommend running some tests to investigate what may be causing the delay. If they don’t seem responsive, ask about a DUTCH test to get a comprehensive look at your hormones, as well as a full thyroid panel to rule out postpartum thyroid complications that may impact fertility.
Will My Milk Supply Decrease When My Period Returns?
Many women fear that the return of their cycle will come with a dip in milk supply. This can certainly happen due to hormonal changes. But more commonly women will notice a drop in supply at certain points in their cycle, often from mid-cycle to around the time of your period. It can also be less comfortable to nurse at this time.
In their book, Womanly Art of Breastfeeding, the lactation experts at La Leche League recommend a daily dose of 500 to 1,000mg combined of a Calcium and Magnesium supplement from the middle of your cycle through the first three days of your period to minimize any drop in supply. If you are taking our Prenatal Multi Powder, you’ll get a combined 800mg, or 400mg each of Calcium and Magnesium. If you’re taking our Prenatal Multi Capsules, you’ll be getting half of this amount, which is a great start to meeting your needs.
It’s also important to remember that the return of your cycle often comes at a time when there is also a decrease in demand from your baby for breast milk (as they get older and rely on food for some nourishment), and sometimes other changes, like mama going back to work and starting to pump and bottle feed. The dip in milk supply you may see could be due to other factors like these, or a combination of factors. Correlation does not mean causation!
Can I Ovulate Without a Period?
The short answer is yes. While not always the case, there is often a phased return to fertility:
- Follicular activity with no ovulation or period: Some breastfeeding mothers report cyclical cramping or PMS-type symptoms in the weeks or months leading up to the return of their period which may be due to this activity.
- Ovulation without luteal competence: An egg is released, and fertilization may even take place, but during the luteal phase, the uterine lining is not adequately prepared for implantation and so implantation may be unsuccessful. This is why some women do not get pregnant during their first few cycles following the return of their period.
- Full fertility: Breastfeeding no longer has any effect on your chance of pregnancy.
In addition, remember that you ovulate before you bleed, so even if you haven’t seen a period yet, this may be the cycle that you begin to ovulate, and a pregnancy may occur. This is more likely the longer you’ve been without a period, but if you are looking to prevent pregnancy, it is important to keep in mind.
How Can I Help My Period Come Back?
Maybe you’re the type who likes the consistency and reassurance of a monthly cycle, or maybe you’re ready to grow your family again and start trying for another baby. Many women are eager to know how to encourage the return of their period.
The herb vitex, or chasteberry, can help to stimulate and support ovulation and is often used to help bring the return of your cycle postpartum. It can work as quickly as 1-3 cycles and is recommended to take in the morning as that’s when the pituitary is most responsive to vitex’s prolactin-lowering effect.
Note that it can affect milk production, but in general staying at or under 5 mL or 220mg/day should help to avoid any milk supply issues. We recommend confirming all herbal supplement dosing with your doctor, midwife, or licensed provider.
In addition, remember to ensure that you are eating enough calories and getting enough nutrients to meet the needs of both you and baby. Breastfeeding in any amount increases caloric needs, and some mamas struggle to meet these needs when otherwise busy with a baby. Some mamas also feel pressure to lose weight postpartum and purposely restrict foods or calories, but restricting both macro (protein, carbs, and fat) and micronutrients (vitamins + minerals) and calories can influence your hormones and cycles.
Our Omega-3, Collagen Protein, and Prenatal Multi can help you conveniently meet these needs while juggling all of the other demands of motherhood. Plus, if you are looking to try for another baby, we always recommend nourishing yourself straight through nursing and into preconception with a balanced diet and comprehensive prenatal vitamin, omega-3, and probiotic, especially as we know that the health of your microbiome impacts fertility. Pregnancy and postpartum are depleting, and ensuring proper nourishment throughout preconception, pregnancy, and postpartum will help ensure that it isn’t too soon for another baby.
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Every woman’s postpartum experience is different, but all women have a shared experience of significant physical and emotional changes. Remember to take care of yourself, give yourself grace as you adjust to your new life as a mama, and know that your body will return to its natural cycles. Of course, you know your body best, so if something feels off with your hormones or cycles, trust your instincts and reach out for support.
We appreciate as always the inspiration and information from Dr. Aviva Romm on this topic.
trusted education is needed.