Your Fourth Trimester Flow: How Your Period Changes After Childbirth

Photo: Malin Alia

The wild and amazing experience of pregnancy comes with quite a few changes – some emotional, some physical, and some just downright mysterious! One glorious change you’ve probably enjoyed is going 10 months without having a period. So, when can you expect its return?

Read more: Painful Periods: When to See a Doctor

Let’s walk through the various postpartum phases and see what differences you may experience moving forward (especially in case you haven’t learned about the “fourth trimester” – a phase often left out of prenatal visit discussions!).

Immediately Postpartum

Congratulations! You made it through labor and delivery, which is no picnic, and have a precious little one. Now begins the “fourth trimester” – a new phase for both you and your baby to navigate. Your body will now start shifting into a sort of recovery mode, first shedding some leftover blood and tissue from your uterus so it can start shrinking back to normal size.

It will start out pretty bright red and may have clumps of tissue, but should get lighter in color and lessen in volume after a few weeks. This “shrinking and shedding” may also cause some mild cramping, but if the pain is severe and accompanied by nausea or heavy bleeding (more than a normal period), call your healthcare provider right away.

If you aren’t breastfeeding, you can expect your period to return in about 6-8 weeks. If you are breastfeeding, it will likely take several months, but you should talk to your doctor about birth control options, because the absence of a period each month doesn’t necessarily mean you aren’t fertile. In an act of what can only be considered deft trickery, Mother Nature has allowed you to still ovulate even if you aren’t getting a period.

While Breastfeeding

You made it through the first few months with baby. You probably feel like you’re starting to get into a routine—nursing doesn’t make you want to cry out in pain anymore, and you may even have a freezer stash of breastmilk ready for mom’s nights out.

What does this mean for your menstrual cycle? Chances are it will stay away for a little bit longer. For centuries, cultures around the world have used breastfeeding as a form of spacing out births and family planning, since the act of breastfeeding inhibits your body from ovulating. It’s actually pretty amazing.

The act of baby suckling simultaneously stimulates milk production and reduces the hormone that stimulates ovulation. But, as many have found, it’s not entirely reliable when it comes to birth control past a certain point. For the first six months, if you’re not feeding your baby any other food and your period has not returned, the use of breastfeeding as a contraceptive (sometimes called lactational amenorrhea method, or LAM) is thought to be 98% effective against pregnancy.

However, once your baby is going more than a few hours without nursing (like at night) and is six months old, you are more likely to start ovulating. Most breastfeeding mothers can expect their periods to return 9-18 months after having their baby, even if they haven’t completely weaned yet.

Motherhood and Beyond

Now, you’ve weaned your little one, transitioned to milk or formula, and have stashed your pump in a dark corner never to see the light of day again (or, maybe, at least for a couple years). Now begins the waiting game to see when your body kicks back into normal gear. While you might want to continue this blissful existence without your flow, it’s probably best to restock your menstrual supplies and carry a few with you—just in case it returns when you least expect it.

Even once you get your first period, it may take several months for your cycle to normalize. At first, it may fluctuate in terms of length, frequency, or intensity. You may go more than 35 days between cycles or find you only bleed for 4 days instead of 6 (hooray!) – but this variability is totally normal after pregnancy. Most women will eventually find their way back to whatever “normal” was for them prior to becoming pregnant.

Some may even notice that their periods improve, since pregnancy and childbirth have stretched the uterus and dilated the cervix. However, some will unfortunately have heavier or more painful periods after childbirth, which could be due to the larger uterus having more lining to shed. There are plenty of other reasons heavier or more painful periods can develop which have nothing to do with pregnancy or childbirth, so always be sure to check in with your doc.

Not surprisingly, after 9 months of changes to create a new life, your body will take some time to recover from the process and get back to your pre-pregnancy state. In addition to the changes in your cycle, you will likely also experience some physical changes such as uterine cramping, hair loss, and some stretch marks on your skin.

Thanks to the hormones, you might also endure some night sweating and mood changes. Give yourself plenty of patience as you adjust to this new stage (in fact, in China, one might “sit the month” after childbirth in order to recover), and as time goes on your body will get back to the state you remember, or at least very close.

Miscarriage

Loss of pregnancy is more common than we often like to discuss, and we want you to know what to expect should you miscarry. For starters, there is still a high chance of becoming pregnant again and having healthy babies. In fact, 85 to 90 percent of women will get pregnant within a year of having a miscarriage. As with the phenomenal reproductive system that repairs after any big event, your cycle, too, finds its way back to what it was.

Many women’s periods return within 4 to 6 weeks following miscarriage. Similar to the experiences after pregnancy described above, your hormones will take some time to adjust after the loss of a pregnancy and the predictability of your cycle won’t necessarily be immediate. This is another time to be gentle and patient with yourself and your body.

Elix’s herbal blends are not meant to be consumed during pregnancy or breastfeeding. Once these stages are complete see how see how a Personal Herbal Healing Formula from Elix can help to balance hormones and restore your cycle.

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This article was reviewed by Dr. Elizabeth Fine.

Dr. Elizabeth Fine is currently the Dean of Clinical Education at Emperor’s College, the #2 ranked colleges for TCM. She has been practicing Acupuncture and Herbal Medicine for over 20 years, with a specialization in women’s reproductive health.