When you’re pregnant, your body may feel like it’s on a bit of a hormonal roller coaster, experiencing different symptoms in every trimester of pregnancy. You may be left wondering – what happens after birth? While your body goes through a major transformation during pregnancy, it undergoes an equally major one after labour and delivery. There’s plenty of information out there about pregnancy hormones and your body’s transformation during pregnancy, but the details of what happens to your health and body after birth often gets overlooked. In this article, we will address some of the hormonal changes you experience post birth. We also offer a free on-demand class to help you understand your Postpartum Hormones.
How Estrogen Can Affect Hair Growth and Hair Loss
In pregnancy, estrogen levels rise dramatically and especially before birth, reaching levels over a thousand times their baseline values. These levels end up dropping after delivery back to a pre-pregnancy baseline. Estrogen has a big effect during pregnancy, and because of this, it’s important to understand how this in turn affects your postpartum body. One of the most common questions we get is about what happens to your hair during pregnancy and then postpartum.
During pregnancy, you likely noticed that your hair was the best it had ever been in your entire life – the reason is because estrogen helps to keep the hair follicles in their active growth phase. Once estrogen levels drop after giving birth, hair follicles that were supposed to enter their resting phase end up doing so and that’s when you’ll find that you experience some hair loss. You can expect hair loss around four months postpartum and sometimes as early as three months. Hair loss is a very common occurrence.
There are three stages in the life cycle of the hair follicle:
Stage 1 – Antigen. During pregnancy, estrogen is very high so it keeps hair follicles in the antigen/growth phase.
Stage 2 – Catagen. After childbirth estrogen levels decline, moving the hair follicles to a transition phase.
Stage 3 – Telogen. Hair follicles transition to the telogen which is the resting phase. In this phase, you might start to experience that hair loss. It’s important to remember that this is normal and temporary.
Normally, we would expect to see that lost hair grow back. However, there are a few other factors that can affect hair loss such as your ferritin levels, which is your iron storage from protein. If you find that the hair you lost postpartum is not growing back, it’s worth getting your ferritin levels tested through lab work done with your medical doctor or your naturopathic doctor. Ideally your ferritin levels should be greater than 50 for hair growth but ideally it should be between 60 to 90.
Other factors that can affect hair growth or hair loss
- Hypothyroidism is another factor that can affect hair growth. You can get your thyroid tested with your medical or your naturopathic doctor.
- Low-carbohydrate diet or protein deficiency can also affect hair growth or loss.
- Sometimes a history of polycystic ovary syndrome can affect hair loss as well and this is where a higher total testosterone levels can affect hair loss but in more of a male pattern which would be the top of your head, the frontal areas or even top of your head.
After childbirth, progesterone levels drop back to pre-pregnancy levels. Your body will unlikely be creating large amounts of progesterone until you start ovulating again. If there is any placental tissue that’s retained after birth, this could secrete progesterone and cause a drop in prolactin levels that may affect either breastfeeding or chest feeding.
Prolactin essentially suppresses progesterone production which prevents ovulation, so while you are breastfeeding or chest feeding, you might not experience a period for a few months. Your period can take anywhere between six weeks to 18 months to return. Sometimes it could be quicker than that and sometimes it might be longer than that.
Once you get your postpartum period, you might notice that your period is heavier and may involve symptoms such as PMS – headaches, breast tenderness, lower back pain, cramping. There aren’t any blood tests to actually determine if you have PMS so if this is of a concern to you because you’ve never actually experienced it before, be sure to track your symptoms. You can use a period tracker or you can write them down.
Prolactin is known as the “mothering hormone” and it’s best known as the major hormone of milk production. It also helps to support conception in early pregnancy, balance immune function, and optimize postpartum maternal adaptations including maternal behaviors attachment.
Following birth, milk production increases slowly in people who are breastfeeding or chest bleeding, with milk usually coming in around 30 to 40 hours postpartum. This timing is related to the postpartum decline in progesterone which often inhibits prolactin’s lactogenic effects. According to one study, maternal prolactin levels are maxed in people who breastfeed or chest feed about two to four days after birth.
Low Milk Supply and Low Milk Production
There are three phases of milk production:
- Lactogenesis 1 which occurs during pregnancy. This is the phase where colostrum is produced.
- Lactogenesis 2 which begins once your placenta has been delivered
- Lactogenesis 3 which is when the milk supply is maintained by the removal of milk. Suckling and night feeds will often stimulate higher levels of prolactin and removal in the early days.
Suckling and feeding should generally happen every three to four hours, however, you should follow your baby’s cues. If you have any questions or concerns with milk supply, we recommend that you book an appointment with a Lactation Consultant.
There are two common reasons for low milk supply and low milk production.
#1 – The baby is not at the breast or chest often enough. Perhaps feeds are too short, or the intervals between feeds are too long. This can happen if baby’s feeds are tightly scheduled, rather than feeding on demand, and can also happen if night feeds have stopped.
#2 – Poor latch mechanics, resulting in poor milk transfer, or the baby not fully emptying the breast during feeds. If you’re concerned about milk supply, definitely contact a lactation consultant. We have many wonderful Lactation Consultants here at Oona that would be very happy to help you and help determine you know what can get your production going.
Postpartum Hormones Affecting Milk Production
Hormonal difficulties can also affect milk production. Sometimes it’s due to high progesterone. Postpartum thyroiditis can be a factor as well and you can get tested for this with your medical or naturopathic doctor.
Insulin resistance can be an issue and this may have arisen from gestational diabetes or from the conditioned polycystic ovary syndrome. A couple other tests that we can look at is fasting insulin and fasting glucose. These are often done on the same day.
Other Stressors Affecting Milk Supply
Stress can also impact milk production. Once you’ve been assessed by a lactation consultant to make sure that any potential latch issues have been addressed, you may want to consider herbs to increase your milk supply.
Some people may develop postpartum thyroiditis after birth. This is a fluctuation between hyperthyroidism which is an overactive thyroid and hypothyroidism which is an underactive thyroid.
Hyperthyroidism may occur about one to four months after delivery while hypothyroidism may occur four to eight months after delivery. Risk factors include previous postpartum thyroid condition, a history of hypothyroidism prior to pregnancy, elevated TPO antibodies during preconception or during pregnancy, other autoimmune conditions like type 1 diabetes, and previous or current postpartum depression. With hyperthyroidism, there’s a multitude of symptoms and signs such as anxiety, heart palpitation, insomnia, irritability, sensitivity to heat, shortness of breath, increased sweating, fast heart rate, fine brittle hair or thinning skin.
Signs and symptoms of Hypothyroidism may include fatigue or low energy, unexplained weight gain or difficulty losing weight, pain stiffness or swelling in the joints, infertility, decreased libido, reduced resting body temperature, slow heart rate, hair loss, brittle nails, dry skin, or irregular menstrual periods.
There are several different tests that we can use to test for any thyroid condition which your naturopathic doctor can run for you. If you feel that you might have hyperthyroidism or hypothyroidism, please book an appointment with one of our Naturopathic Doctors in Toronto or Newmarket.
Oxytocin is known as the cuddle hormone. After birth, oxytocin is elevated from skin to skin contact which helps to turn on maternal adaptation behavior that promotes bonding and lactation. It can also help to reduce postpartum hemorrhage as well. We can naturally raise oxytocin in a few ways:
- getting a massage
- hugging others
- physical intimacy
- cooking aromatic foods (and enjoying them after 🙂)
- physical activity and exercise
- community and social involvement
There are three main stress hormones in the body: epinephrine, norepinephrine and cortisol. In general, a certain amount of stress is normal and beneficial.
Epinephrine and norepinephrine mediate the like fight or flight stress response so they’re released with perceived danger. Studies have shown that this promotes safety for labouring females in the wild through human evolution by slowing or stopping labour, giving time for fight or flight, and then redistributing blood to the heart, lungs and major muscle groups and away from the uterus and baby. Epinephrine levels drop rapidly after birth which may be important to optimize uterine contractions and prevent hemorrhage.
Cortisol levels are elevated in the new mother for several days following birth. Not only is it a stress hormone, cortisol is also associated with romantic attachment. Postpartum Mood Disorders
After birth, mood disorders may develop. This can include baby blues, postpartum depression, postpartum anxiety, and postpartum psychosis. Baby blues are experienced by up to 85 percent of postpartum people, and is normal and expected. This typically starts around days three to four after delivery and lasts for about a week or maybe a bit longer. It usually happens because estrogen and progesterone decreased to their normal levels and you may notice symptoms such as sadness, irritability or mildly depressive state.
Postpartum depression is experienced by 10 to 20 percent of women in developed countries. If symptoms of baby blues last for more than two weeks or if they only begin more than two weeks after delivery, this may actually be postpartum depression and can actually happen up until 12 months after delivery. Symptoms may be more intense than those of baby blues, and can include crying, lethargy, depressed appetite, guilt, shame, and lack of interest in taking care of yourself or your baby.
In terms of managing postpartum depression, you can consider vitamin D, omega-3 fatty acids, iron, and magnesium. Psychotherapy and cognitive behavioral therapy can be great as well. We have a wonderful mental health team here at Oona which can certainly be of support to you during the postpartum period.
Postpartum anxiety can include panic disorders, obsessive compulsive disorder (OCD) and generalized anxiety disorders. You might notice symptoms like hyperventilation which is increased breathing, excessive worry, restless sleep, and panic attacks. Symptoms can range from very mild to very severe.
Postpartum psychosis is characterized by thoughts of harming yourself and your baby. Symptoms include hallucinations, cognitive impairments and delusions. Although this condition is rare, it must be taken seriously and is considered a psychiatric emergency.
General Postpartum Recommendations
- If you are breastfeeding or chestfeeding, we recommend that you continue to take your prenatal vitamins because your baby’s going to continue to use your stored minerals and nutrients.
- We also recommend maintaining blood sugar by eating small frequent meals throughout the day, making sure that those meals are protein rich if you’re breastfeeding or chest feeding. You’re trying to aim for an extra 25 grams of protein during the day. Obviously that can be really hard to track so just make sure that whenever you’re having meals that there is a good component of protein in there.
- Return to exercising (clear this with your pelvic floor physiotherapist first).
- Around six weeks postpartum, you may want to consider getting some lab work done with either your medical doctor or your naturopathic doctor. Depending on your concerns or symptoms, we can take a look at thyroid panel testing, your ferritin levels, vitamin D, fasting glucose and fasting insulin.
There isn’t really any clear guideline on how long after birth the postpartum period lasts, but once you’ve given birth you’re permanently postpartum. If you need any help or support, all of us here at Oona are happy to help you thrive in what we call the fourth trimester and this transition into being a parent. Please feel free to send us an email at [email protected], call us or book an appointment with one of our practitioners.
Sign Up for Our Free Postpartum Hormones 101 Class
For a more detailed look at postpartum hormones, consider taking our free on-demand Postpartum Hormones 101 class.