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Dr. Laura Pipher

Dr. Laura Pipher

Why your postpartum period may be a raging b****

Everyone is always worried about that first postpartum period.

When will it come?

Will it be heavy?

What if I’m breastfeeding?

Can I still get pregnant if I don’t have my period?

Well this all depends on a few factors

  1. Whether or not you are breastfeeding 
  2. Whether or not you are ovulating 

Prolactin, the hormone that is secreted when you breastfeed will prevent your body from ovulating, and subsequently prevents pregnancy. If you are exclusively breastfeeding, then you probably won’t ovulate (or have your first period) for a while. In fact, in lactating women, ovulation is significantly delayed: only 20% will have ovulated by 6 months and only 64% ovulate by 12 months (1). This is why it is so common to not get a period for such a long time when you are breastfeeding. 

In women who are NOT breastfeeding, ovulation can occur as early as 25 days postpartum but usually occurs between 45 to 94 days postpartum (1).

Many women will not ovulate before their first period. Did you know? Having a period does NOT mean you ovulate. If you are trying to avoid pregnancy, exclusive breastfeeding does not guarantee you do not ovulate ( so you should still be using protection with intercourse). 

Tracking your cycle during breastfeeding 

Normally, tracking your cycle requires monitoring symptoms throughout your cycle to determine when you are most fertile. This can include evaluating cervical mucous and taking your temperature [Click HERE to grab your free EBOOK with more information].  Due to the hormonal changes during the breastfeeding transition, cervical mucus changes often do not coincide with hormonal variations, or with ovulation, which can be deceiving for tracking (1). Temperature measurements may also not be accurate in the first cycles after the return of menses and have been associated with a low predictive value of ovulation (1). 

 One study has actually suggested that breastfeeding women who tracked their cycle using cycle monitoring techniques after their period returned had a higher unintended pregnancy rate than those not lactating (1).  Another study found 33% of first menses were preceded by ovulation and 70% of these were potentially fertile (2). The good news is that tracking your cycle becomes more accurate after SIX months postpartum so as long as you can use some form of birth control before that time period, you should be okay to resume regular cycle tracking to prevent pregnancy going forward (2). 

The reasons your period may come back with a vengeance 

You are having anovulatory cycles

Research has shown that in women who menstruated before six months postpartum, there was a high proportion of those who did not ovulate (2). In fact, the average lag between the first period and subsequent ovulation in these women was 15.7 weeks (that’s potentially 4 menstrual cycles without ovulating) (2). So what does this mean? When you ovulate, your body makes progesterone, but when we skip this step, our progesterone levels will be low relative to our estrogen. If we look at this from a cycle perspective, your estrogen is mainly responsible for building up the thickness of your lining, and progesterone is our “pro-gest” hormone that keeps the lining intact waiting for implantation. If this implantation ends up NOT happening, the lining keeps on building until you experience what is known as “breakthrough bleeding”. You may experience this in the form of spotting between periods, or you may experience painful or heavy periods. 

You are extremely stressed 

Motherhood can be overwhelming, and stress in the postpartum period can be higher than normal. When our body is experiencing higher the normal levels of stress we focus on making stress hormone as a protective mechanism. When our body is focused on stress, it is certainly not focused on reproducing, so as a result our reproductive hormones end up suffering. Stress can also reduce your milk supply ! 

You may have a thyroid issue 

Postpartum thyroiditis is an autoimmune thyroid condition that impacts women after they have a baby. A thyroid concern can lead to periods that are heavier or lighter than usual. Other symptoms of a thyroid issue can include

  • Anxiety/depression
  • Trouble losing weight 
  • hair loss
  • dry skin
  • constipation or diarrhea 
  • muscle or joint pain
  • general fatigue 

You have estrogen dominance 

Estrogen dominance does not mean you have extra estrogen, rather it can mean that your progesterone levels are not high enough relative to your estrogen, leading to an imbalance of your hormones & many symptoms including:

  • painful & heavy periods 
  • spotting between periods
  • PMS, breast tenderness & acne 
  • Irritability and mood swings 
  • Clots in your period 
  • Missed/irregular periods 

 

The good news……. 

Research has shown that after six months postpartum, the proportion of women experiencing anovulation declined to 22 percent, and the lag between anovular first menses and ovulation was 7.3 weeks (2). This means that if you didn’t have a period until 6 months postpartum, you would be more likely to ovulate, making your periods less horrible, and even if you didn’t ovulate you may only need to wait 2 months before ovulation resumed. 

Take home points … 

If your periods before you got pregnant were “normal” [Regular, not heavy, no pain, pms acne or breast tenderness] and you didn’t have issues becoming pregnant, then it is likely that your periods will resume to normal in about 6 months after you have your baby. If you are breastfeeding this may take longer, but it is likely that if your period comes 6 months or later after giving birth then they will return to normal faster. If your periods were problematic before you got pregnant OR they are causing you issues 6 months or longer after giving birth, it’s time for further evaluations . 

 

Book your discovery call today to find out how we can work together !

are you more than 6 months postpartum and still have trouble with your periods? Save your spot on the period passport online program

 

references

  1. https://www.jabfm.org/content/26/1/35.long
  2. https://www.ncbi.nlm.nih.gov/pubmed/21343770 . 

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Are you suffering with your monthly cycle?

You are not alone!

Coming soon: our online program The Period Passport that’s designed to take you on a journey to a  healthier period.

Excited to start this journey with you, Dr.Laura Pipher