Ask an Expert: Why did my period change after having a baby?
After a pregnancy, it can take several months or even a year in the case of breastfeeding moms to have their cycle resume. But what about if your cycle isn’t as it used to be?
In this article, Dr. Erica Nikiforuk, Naturopathic Doctor, breaks down the common reasons for menstrual cycle changes after having a baby.
When your period comes back after pregnancy, you may not know what to expect. For some women it will pick right back up as it was; and other women may notice postpartum period changes. This article outlines what those changes may mean, and when you may want to consider reaching out to your medical doctor or naturopath.
What happens in a normal menstrual cycle?
A normal menstrual cycle does not necessarily have to be 28 days; technically a cycle length between 23-35 days, with a bleeding length between 3-7 days can be considered ok. Each cycle consists of two distinct phases: the follicular phase, and the luteal phase, which are separated by ovulation.
The follicular phase begins on day 1 of your period and ends with ovulation. The second phase of the cycle, or the luteal phase, begins from ovulation and continues to the start of the next period. What marks each of these phases is quite distinct. At the start of the cycle, the pituitary gland releases follicle stimulating hormone (FSH), which, as the name suggests, stimulates the growth of follicles on the ovary. A small group of follicles matures together, and they release estrogen in preparation for ovulation. Once the level of estrogen is sufficient, this triggers a rapid rise in luteinizing hormone (LH). This surge of LH causes ovulation (meaning that a mature follicle ruptures and releases it’s egg); which is the key event that causes the cycle to move forward.
What changes occur in pregnancy and postpartum?
In pregnancy, levels of estrogen and progesterone climb, but there is a significant drop off in both of these hormones as soon as a woman gives birth. Similarly, prolactin levels increase 10-fold during pregnancy, and they will remain elevated during the postpartum period while breastfeeding. Prolactin suppresses the reproductive hormones, which usually halts ovulation and the menstrual cycle along with it.
The timing at which the first menstrual cycle will resume is influenced by multiple factors, including how frequently during the day (and night!) an infant is nursing, whether or not the mother is pumping instead of exclusively having the baby at the breast for feeds, whether the baby is given any bottle feeds or has been introduced to solids yet, and whether the mother is going an entire night without nursing. The more often a baby is at the breast, the more prolactin is produced, and the less likely that ovulation will occur.
When a woman does have her first postpartum cycle, there may be a longer gap until her second period. By the third cycle, a pattern should start being established – although many factors may continue to interrupt this pattern, including irregular eating patterns, stress or lack of sleep, intense exercise, and continued elevations in prolactin levels.
What do postpartum period changes mean?
Anovulation (not ovulating) and amenorrhea (not having a period) during the first 6 or more months postpartum while breastfeeding is normal. A lengthier or unexplained delay in the return of a regular period should be investigated. The length of time it can take for ovulation to begin after having your baby depends on many factors including how you feed your baby, endocrine conditions such high prolactin levels independent of nursing, PCOS, or thyroid disorders.
A short follicular phase occurs when a woman ovulates before day 11 or 12. This can occur temporarily with the resumption of the period postpartum. Ovulating early in the cycle can also occur for women in their late 30’s, in times of stress, with diet changes, as well as with significant changes in weight.
A short luteal phase occurs when the corpus luteum breaks down too soon and results in not enough progesterone being produced. Stress is a common culprit here, although this can also arise from poor follicle development.
Changes in the level of pain or heavier flow is not overly uncommon for those first few cycles when your period resumes after your baby is born. However, if this change remains significant, it is best to rule out any additional causes of heavier, more painful cycles, such as infection, fibroids, or endometriosis. Fibroids can increase in size during pregnancy, so if you’re noticing that your cycle has become much heavier than it was before your baby was born, it’s time to ask your doctor for an ultrasound.
Deciphering postpartum period changes involves a thorough workup. At Oona, our dedicated team of Naturopathic Doctors can help you understand the changes in your body and map out a detailed approach to care.
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About Dr. Erica Nikiforuk, BSc, ND, RAc
Dr. Erica Nikiforuk is a Naturopathic Doctor and Registered Acupuncturist with a focus on fertility, wellness throughout pregnancy and pediatric health. With over 11 years in clinical practice, Dr. Erica is passionate about helping couples complete their families, and nurturing the health of the next generation.
You can read more about Dr. Erica here.
References
Li W, Qiu Y. Relation of supplementary feeding to resumptions of menstruation and ovulation in lactating postpartum women. Chin Med J (Engl). 2007 May 20;120(10):868-70.
Kovacs CS & Deal CL. Postpartum Lactational Amenorrhea and Recovery of Reproductive Function and Normal Ovulatory Menstruation in Maternal-Fetal and Neonatal Endocrinology, Academic Press. 2020: 207-214.
