Scanty periods after childbirth: how to distinguish normal from pathology

Hypomenorrhea (scanty periods) is a disorder of the menstrual cycle, which is manifested by a decrease in the volume of bleeding less than physiological in 50 milliliters. Scanty periods after childbirth are one of the common phenomena.

In general terms, the menstrual cycle is characterized by: monthly regularity, volume and nature of discharge (their color, smell, consistency), intensity of bleeding, pain during menstruation, the presence and course of premenstrual syndrome.

Sometimes a decrease in the amount of discharge during menstruation is a physiological norm (for example, after childbirth), in other cases it can become a manifestation of various diseases and cause serious complications.

Norm and pathology

In order to identify the failure of menstruation (including in the form of hypomenorrhea), it is first necessary to distinguish between normal and pathological menstrual cycles.

The correct menstrual cycle looks like this: periods are painless or there is little pain, the duration of discharge is from 3 to 5 days, the normal interval varies from woman to woman and should be in the range of 21-35 days, the volume of discharge of each period is from 50 to 150 milliliters.

A woman who monitors her health must know exactly the duration of her cycle, the nature, the approximate abundance of discharge, and the course of the premenstrual period.

Violation of any of the characteristics of menstruation is an indicator of a possible disruption of the menstrual cycle, which affects both the general health of the woman and the desire to become pregnant in the future.

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Lochia

After the baby's place comes out, the uterine mucosa looks like a continuous wound, its regeneration lasts 9-10 days and ends at 6-7 weeks. Where the placental site is located, regeneration ends at 8 weeks after delivery. During this period, lochia are secreted, which vary depending on the stage.

So, at first they contain a lot of blood, on the third or fourth day they look like serous-serous discharge of a pinkish-yellow color. On the tenth day - transparent, without impurities, but liquid. Their number is decreasing. From the third week they will already be scanty, but will stop completely only at 5-6 weeks.

Read also: Which suppositories should you use to ease stool after childbirth?

After the end of lochia and before the start of the first menstruation, at least 14 days should pass.

Causes of hypomenorrhea

Postpartum hypomenorrhea can occur for reasons directly related to pregnancy and the postpartum period itself - changes in hormonal balance. It happens when you want to lose excess weight that appeared after pregnancy, due to excessive physical activity. The birth of a child, especially the first birth, is stressful in itself.

Scanty menstruation is caused by various factors, but also directly or indirectly dependent on pregnancy and childbirth:

rapid and obvious weight loss, sudden weight loss during fasting, exhaustion;
various postpartum infections and those occurring regardless of childbirth, associated intoxication;
past stress or mental disorders;
hormonal imbalance and endocrine diseases;
taking hormonal medications;
scarcity during breastfeeding;
damage to the genital organs by various infections, for example tuberculosis;
exposure to harmful factors (radiation, chemicals);
tumors of the genitourinary system, pelvic diseases;
sexual infections.

Although hypomenorrhea can be physiological, it is usually a pathological symptom.

Reasons for slow recovery of a regular cycle

The timing of the return of monthly hormonal fluctuations to the previous schedule varies for all women. There are a number of reasons for this that affect the body in the postpartum period:

features of individual hormonal levels;
hereditary factors;
the nature of the birth process;
features of uterine restoration.

Restoring the former periodicity of menstruation while breastfeeding a baby is very individual for all women. This is determined by the activity of the production of hormones by the sex glands, pituitary gland, and the state of the immune and reproductive systems as a whole.

With the birth of a child, mechanisms begin to work that restore the size and condition of the mucous membrane, muscular lining of the uterus and the birth canal. This is necessary in order to prevent bleeding from the uterus. If it is not in the appropriate tone, then the vessels damaged by the passage of the placenta will continue to bleed. This development of events is fraught with extensive blood loss and the most dire consequences. It is for this reason that the early postpartum period is under the close attention of doctors. The process of involution of the uterus, that is, the return of its size to the physiological age norm, is especially carefully monitored.

The birth canal: the cervix and vagina also require quite a long time for their recovery. After all, they are exposed to traumatic effects. Cervical and vaginal ruptures often occur, requiring surgical correction and follow-up. A certain period is required for systematic and complete healing. This also does not contribute to the early onset of menstrual bleeding.

Restoring the size of the uterus - involution - occurs individually in all women. In addition to returning to prenatal size, it is necessary to restore the previous muscle tone. Otherwise, the onset of menstruation can be fatal.

Associated individual characteristics of the postpartum period and breastfeeding are determined by the following factors:

presence of complications during childbirth;
immune system status;
the presence of psychological complications of the postpartum period;
poor quality diet for a postpartum mother;
a large number of births in the anamnesis.

All of the above factors lead to a delay in the restoration of the menstrual cycle after the birth of a child. The waiting period for the onset of regular menstruation is prolonged and if a woman is concerned about this, she should consult a doctor.

Signs of hypomenorrhea

Normal menstruation gives way to scanty bleeding: spotting marks, drops and spots of blood. The color of the discharge changes to light or dark brown, and painful periods appear.

At the same time, the duration of menstruation may also decrease. The woman’s well-being also changes. Additional symptoms may be added: spotting in the middle of the cycle, headache, general weakness, nausea, lower back pain, chest discomfort, constipation, pain in the lower abdomen.

Also, one of the symptoms of hypomenorrhea is nosebleeds. If the secretion of estrogen hormones is disrupted, a woman’s sex drive may decrease.

Symptoms

Often, periods after childbirth change greatly and manifestations may occur that were not there before. Critical days can have different duration, intensity, character and sensations during this period.

Most often a woman is worried about:

pain in the lower abdomen;
nausea and vomiting;
nosebleeds;
dizziness;
weakness;
lumbar pain;
breast swelling and pain;
bloating;
diarrhea or constipation;
increased appetite or lack thereof.

Menstruation after childbirth while breastfeeding should not resume until the end of lactation. If the mother, for certain reasons, stopped feeding the baby or switched him to an artificial method from the first days, you can expect the first discharge after 2 months or even less. In this case, pathologies are often observed: the discharge can be extremely scanty or quite abundant, large clots may be present or the color may change.

Physiological hypomenorrhea after childbirth

With regular breastfeeding, when breastfeeding occurs without delays and lactation continues, menstruation stops for this entire period.

However, if for some reason breastfeeding becomes irregular, the woman does not want to feed herself or has to take a forced break, then scanty periods may appear.

This is typical during the introduction of complementary foods to a child. During this period, the mother begins to breastfeed less frequently and skips one of the feedings. As a result, periods may resume, but at first they are scanty.

As the mother’s body is rebuilt, hormonal levels are normalized, menstruation returns to normal within several cycles - this condition is considered physiological.

If the cycle does not return to normal for a long time or, after normalization, its discharge again becomes scarce, this may indicate a serious malfunction in the woman’s body and the development of any gynecological disorders, which is a direct indication for contacting a doctor.

Prolonged postpartum hypomenorrhea can be caused by endometriosis, endocrine diseases and metabolic disorders. Consultation with a specialist is necessary to prevent serious consequences, for example, the development of infertility in the future.

Physiological features of menstruation during breastfeeding

If a woman breastfeeds regularly, she does not have menstruation during the entire lactation period. But if she has to pause feeding or transfer the baby to complementary foods or artificial nutrition, menstruation resumes, but becomes very scanty. Gradually, the body is rebuilt, the hormonal balance returns to normal, and hypomenorrhea goes away without additional treatment.

If the recovery process is very long and this causes concern, you should definitely visit a gynecologist. Such a deviation from the norm may indicate a hormonal disorder, an infectious disease or a dangerous gynecological pathology.

After an abortion

Abortion is both a serious stress for a woman’s nervous system and a “shake-up” for the body’s hormonal system.

During an abortion, trauma is caused: the inner layer of the uterus is scraped out, the pregnancy is interrupted and a sharp hormonal change occurs. All this certainly leads to cycle disruption, one of which is hypomenorrhea.

The consequences of hormonal imbalance lead to the fact that as the body recovers, normal periods can be restored up to six months. It happens that menstruation resumes earlier after an abortion. It all depends on the type of abortion, the correct execution of the procedure, and the stage of pregnancy.

Scanty menstruation is sometimes observed after an abortion and lasts up to 7 days as a reaction of the uterus to the procedure. They are also often observed after a medical abortion in the form of spotting that lasts from 1 to 3 days and recurs at intervals of a week.

If, along with the described course of the period after the abortion, pain appears in the left side or on both sides, pain in the lower abdomen, and the discharge has an unpleasant odor, then an examination by a gynecologist is necessary.

When do they start?

The first menstruation during breastfeeding can begin immediately after childbirth, but for some this process is delayed. Everything is individual, so it is impossible to calculate the exact time when your period will begin during breastfeeding. Irregular menstruation during lactation is a normal process.

It normalizes during a strong sexual constitution with a delay of 2-3 months after childbirth, and the time varies from 6 to 12 months. After childbirth, spotting may occur, but this should not be confused with menstruation, as this is lochia.

See about the timing of menstruation after childbirth:

After a miscarriage

After an unsuccessful pregnancy, hypomenorrhea is a common manifestation. In this case, particles of the fetus, membranes of the amniotic sac, and blood from the vessels of the endometrium of the uterus are released.

Also, the discharge may become scanty due to adhesions and scars that sometimes form after a miscarriage.

A suddenly terminated pregnancy is manifested by a sudden hormonal disruption, which causes temporary disruption of the menstrual cycle.

As a rule, the cycle should return to normal within about 2 months. If this does not happen, then prolonged scanty periods after a miscarriage may be symptoms of hormonal pathology or infection, which requires consultation with a doctor.

Heavy periods - is this normal?

Six to eight weeks is the time of cleansing and contraction of the uterus from the moment of labor. At this time, bloody and mucous discharge is possible.

In medical terminology, they are called lochia, they are not classified as menstrual discharge! After a while they will become light and stop.

Persistent, bright red discharge may be a sign of hormonal imbalance, bleeding, or another disorder. In this case, a visit to a specialist doctor is mandatory.

As soon as postpartum discharge ends, a new conception is more than possible, therefore breastfeeding and a delay in restoring the cycle is not at all a way to protect against unwanted pregnancy. To be safe, use more reliable means of protection.

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Treatment

Treatment should begin with a search for the underlying cause that caused hypomenorrhea. It is necessary to normalize nutrition, bring weight back to normal (gain or get rid of excess).

They recommend taking vitamins, increasing physical activity, and iron supplements. Avoid or treat stress whenever possible. It is recommended to contact a psychologist or psychotherapist.

In case of inflammatory processes, absorbable antibiotics and antihistamines are prescribed to relieve inflammation and pain. For hypomenorrhea caused by hormonal imbalance, hormonal drugs are prescribed to normalize the functioning of the ovaries.

Various physiotherapy methods are also used. Among folk remedies, herbal decoctions and teas (calendula, motherwort) are used.

Menstrual cycle disorders

Some differences in the course of 2–3 month cycles after childbirth from those to which a woman is accustomed (slightly more painful, longer, etc.) are not pathology. Although, if you have any concerns, it is still better to consult a gynecologist.

This is interesting. If there is heavy bleeding and unbearable pain, there can be no other options: the woman definitely needs urgent help.

There are also a number of violations that indicate pathological conditions and require specialist consultation.

How to normalize the menstrual cycle

To prevent the development of adverse events after childbirth , we strongly recommend that young mothers adhere to the following recommendations:

In order for the body to recover faster from stress and strain, it is necessary to develop the correct diet, which will be enriched with plant-based foods, for example, whole grains, fruits, herbs, vegetables and plenty of purified water. The menu of a nursing mother should include a large amount of dairy and fermented milk products, as well as meat. In addition, it is strongly recommended that you allow yourself plenty of rest, spend plenty of time outdoors, and also allow yourself some minor exercise to keep your body in good shape.
Soon after childbirth, doctors strongly do not recommend using birth control pills as contraception, which have a direct effect on hormonal levels. It is recommended to use barrier contraceptives or non-hormonal methods as protection.
If your newborn baby grows up restless and whiny, in need of constant attention, do not refuse the help of your family and friends who will be able to share household responsibilities and help you. The key to a quick recovery is a stable psychological and emotional state, a woman’s good mood and proper rest.
If before pregnancy a woman was diagnosed with chronic diseases, for example, pathologies of the thyroid gland, anemia, diabetes, then she should definitely visit specialists after the birth of the child in order to correctly adjust the therapeutic course.

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