A concern for 8 out of 10 women who have recently given birth, postpartum menstruation can make the new mom worried, whether because it is excessively heavy or absent for several months1. But know that it is more common and normal than you might think not to menstruate or to have light bleeding or spotting for several weeks. After childbirth, menstruation does return, but sometimes it is not the same as it was before pregnancy. During pregnancy, women get used to not bleeding at all. With the full return of bleeding and hormones to their proper levels, some questions may arise, such as resuming your sex life and the risk of pregnancy during postpartum recovery.
Endometrium vs. Pregnancy
During pregnancy, the endometrium, which is shed during menstruation, acts as a “nest” for the baby until the placenta forms. This endometrium grows stimulated by estrogen and is maintained by progesterone. If there is no fertilization and the embryo does not implant, the lining sheds and causes menstrual bleeding. Some women after childbirth may not have this stimulation for endometrial growth, and therefore will not have normal menstruation as before. If the mother breastfeeds, these hormones are even less stimulated, as prolactin, the breastfeeding hormone, dominates at this stage2.
Theoretically, postpartum menstruation would only return once a woman stops breastfeeding. However, there are cases where it can return in smaller amounts or with a different color than pre-pregnancy ovulatory menstruation. Women who breastfeed may experience complete absence of menstruation for more than a year after giving birth.
Getting Pregnant During Postpartum Recovery?
It is possible to become pregnant even before your period returns. The safest period to avoid pregnancy is up to 2 months after delivery. Therefore, 40 days after birth, a woman should begin using contraception to avoid an unplanned pregnancy. The ideal birth control pill after childbirth contains only progesterone.
These protect against pregnancy if the woman becomes fertile before ending exclusive breastfeeding. Women who do not breastfeed can resume ovulatory cycles more quickly. That is why postpartum menstruation may return to normal earlier than the expected 6, 7, or 8 months. If your baby is not breastfeeding with you by one month old, your period will return soon.
Hormonal changes directly affect postpartum menstruation. So, if you have already menstruated even while breastfeeding, pay extra attention if you are not yet using contraceptives. In the beginning, postpartum menstruation can be irregular with spotting and a darker or brownish color. But for most women, the period becomes regular again over time. If it does not return to normal within 6 months without breastfeeding, it is advisable to consult a gynecologist to check if hormone tests are needed and better understand what is happening.
Libido After Childbirth
There are cases where libido disappears after childbirth. This is quite common and, again, is due to hormonal changes—with treatment available as well. Just talk to your doctor, and with the appropriate medication, things can get back on track. On the other hand, while some women lose sexual desire after childbirth, others go through a long postpartum period eager to have sex3. In these cases, you should try your best to avoid having sex too soon.
Here is a recommendation for when you get through the postpartum recovery time and your doctor has cleared you for intimacy. The first sexual relations after delivery can be accompanied by vaginal dryness, which can cause some discomfort. This happens because of ongoing hormonal changes, causing imbalances. The tip is to use lubricating gels to improve vaginal moisture and increase pleasure. For example, FamiGel, which is water-based and helps control vaginal pH.
Readers’ Questions:
Withdrawal Method During Recovery
My baby is 20 days old, and I had sex with my husband using withdrawal without a condom. Can I get pregnant even though my postpartum period hasn’t returned yet?
Usually, right after giving birth, the first month is protected and women are unlikely to get pregnant. However, it is recommended to start using birth control before resuming sexual activity, even during postpartum recovery.
Breastfeeding and Menstruation
Does breastfeeding guarantee 100% that I will not get pregnant?
No. After the 40 days of sexual abstinence recommended by doctors, a woman should seek a contraceptive method.
My period is different after giving birth, even now a year later. I’m not menstruating as I used to. Is that normal?
Yes, it is normal. Until your hormones “settle,” irregular periods and unusual colors are to be expected. This happens due to increases in some hormones and drops in others in the body.
Is it possible to get pregnant two months after giving birth?
Yes. After the postpartum recovery period, your chances of getting pregnant are not high, but you still should not take risks. Your body needs full recovery from childbirth and all the changes it has gone through. The best recommendation is the use of contraceptives and condoms for protection.
Is it normal to bleed for more than 40 days?
Normally, postpartum bleeding lasts about 10 days and can last up to 40 days, but no longer. What can happen is that bleeding lasts for a few days, stops, and then comes back after a few days. Because of this, a woman may feel like she is bleeding the whole time. If bleeding is still heavy even after 40 days, especially with large clots or foul odor, seek medical attention.
When does menstruation return to normal after childbirth?
The timing for your period’s return is not a rule and depends on many factors. Women who breastfeed tend to go longer without menstruating, anywhere from 3 to 8 months if exclusively breastfeeding. For those who are not breastfeeding, periods can return to normal after 2 to 3 months.
Author’s Note:
I had 3 cesarean deliveries, and the recovery for each was different. My period returned 3 or 4 months after childbirth and was very heavy. Even a year after giving birth, my flow was very intense. After the first year, it always decreased significantly. The last time, I resumed my sex life using contraception and felt my libido returning to normal more quickly than before. I have no regrets about starting contraception before finishing the 40-day recovery period—it took unnecessary worry off my mind when returning to sexual activity. I recommend you do the same.
Remember: every body reacts differently after childbirth. If you have any doubts about your physical or hormonal recovery, you should consult the obstetrician who delivered your baby or who followed your prenatal care for better guidance. Important Tip: Women who breastfeed need to have all their vitamins up to date to provide good milk and to stay healthy themselves. For this reason, a multivitamin is recommended at this stage. FamiGesta contains everything a breastfeeding mother needs, and also has Methylfolate in the formulation. You can find FamiGesta here.
