Delayed menstruation after stopping breastfeeding

Zhanna Fedotova

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December 27, 2018

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One of the most important questions that women ask about their health after pregnancy and childbirth is the establishment of the menstrual cycle, because menstruation is perhaps the main indicator of women's health.

After the birth of a child, against the background of renewal of processes occurring in general in a woman’s body, changes occur in her menstrual cycle.

Your periods may be delayed, irregular, or even disappear for a while. But you don't need to panic because this is all natural and normal. The speed of restoration and establishment of a woman’s menstrual cycle after childbirth depends on her physiological parameters, hormonal levels, the presence or absence of breastfeeding, stress, etc. In our article we will discuss menstruation after childbirth - irregular cycle, delay, features.

Why don't I get my period?

The absence of menstruation during lactation is influenced by the hormone prolactin, which promotes increased production of breast milk and suppresses another hormone, progesterone, which is responsible for the maturation of the egg and preparation for fertilization. In medical language, this phenomenon is called “lactation amenorrhea,” when the production of progesterone is temporarily suppressed, as well as the maturation of the egg. New conception and pregnancy are impossible for nursing mothers, but there are no periods during lactation.

But as the lactation period ends, prolactin levels will slowly decline. Progesterone, on the contrary, will begin to be intensively produced, which means preparing the woman’s body and genitals for possible conception again. Physiologically, it is normal for menstruation to not occur during lactation, as well as for menstruation to occur again after breastfeeding has ended.

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Reasons for prolonged absence of menstruation after breastfeeding

It is unlikely that anyone will be able to accurately answer the question of when your regular cycle will be restored after weaning your baby. Menstruation is a multi-level process that involves all systems of your body. And if any of them have still not returned to normal after pregnancy and breastfeeding, this will certainly affect the cycle. In 80% of women, their first menstruation begins within 6 weeks after completion of breastfeeding. Experts recommend consulting a doctor if menstruation still has not returned three months after weaning your baby.

Consultation is also necessary if, after the third or fourth cycle, menstruation lasts less than 3 or more than 5 days, the discharge is very scanty (less than 50 ml) or there are large clots in it.

A long delay in menstruation after cessation of lactation can be caused by a number of serious reasons:

• hormonal imbalances in which the release of estrogen is insufficient;
• cystic changes in the ovaries;
• infectious diseases;
• general exhaustion of the body;
• tumors in the uterus and ovaries;
• inflammatory processes of the genital organs.

However, first of all, you need to exclude the possibility of a new pregnancy. It is important not to forget that fertilization occurs during ovulation, which on average occurs 2 weeks before the start of menstruation. Therefore, regardless of whether your menstrual cycle has returned and how regular it is, use protection if you are not ready for a new pregnancy.

In case of prolonged absence of menstruation, the first thing to do is to exclude the possibility of a new pregnancy.

If the pregnancy test is negative and your period does not start, go to the doctor as soon as possible.

Reasons for the onset of menstruation

We often hear from women that the so-called replacement of menstruation with produced milk during the period of feeding the baby does not work. During lactation, menstruation comes early. An unexpected restoration of the cycle during breastfeeding is not uncommon when a woman is surprised to find out that she is pregnant again, while regularly breastfeeding her baby.

The main reasons for the onset of menstruation:

• mother’s failure to comply with the frequency of feedings;
• introduction of new complementary foods;
• transferring the baby to mixed feeding;
• lack of feedings at night;
• decreased production of prolactin;
• taking hormonal drugs.

REFERENCE! Lactation and menstruation are compatible concepts; the main thing is to prevent bleeding and be able to distinguish it from menstruation in time. If your period comes ahead of schedule, even if it is long and heavy, then this is only a sign of a gradual restoration of hormonal levels and a decrease in the production of the hormone prolactin. The menstrual cycle should return to normal 2-3 months after the end of the lactation period. If, after this period, the cycle still does not become regular or bleeding appears after the first month after the end of lactation, then this is a reason to see a gynecologist and undergo an examination.

Probability of delay during breastfeeding

Lactation is a natural process, the average duration of which is 10-12 months. The final period of complete restoration of the cycle also depends on the duration of the breastfeeding stage.

The sooner a woman finishes feeding, the sooner her period will begin. The time of arrival of the first menstruation in the postpartum period depends on several factors :

• hormonal status of the woman in labor;
• changes in the reproductive system;
• how the birth took place (caesarean section or natural way);
• what type of feeding is practiced.

In non-breastfeeding mothers, the cycle is restored after 11-15 weeks. If a woman continues to breastfeed, this period becomes longer. The delay is explained by the restructuring of processes in the body :

1. prolactin levels increase;
2. milk is actively produced;
3. the formation of a new egg is inhibited.

Amenorrhea (delay) during lactation can last from 1 to 16 months.

IMPORTANT : Delay is also a symptom of a serious hormonal imbalance or the onset of an inflammatory process. The normal period for full recovery is 2-3 months after stopping breastfeeding. If critical days do not occur, an examination by a gynecologist is required.

See the reasons for delayed menstruation after childbirth during breastfeeding:

When should critical days occur?

In fact, critical days should occur immediately after the end of the lactation period, i.e. closer to 1 year after the birth of the child. But it happens that the menstrual cycle is restored early - 3-4 months after childbirth. An incentive for rapid recovery can be Lactagel or complementary foods during menstruation, introduced by mothers into the infant’s diet from 6-7 months.

The onset of menstrual periods directly depends on hormonal levels and the degree of prolactin production. The less often the mother begins to put the baby to the baby’s breast, the faster the need for the production of this hormone will gradually decrease. In particular, transferring the baby to mixed, artificial feeding will lead to insufficient stimulation of the hormone. Even the usual supplementation of water with water for the baby can affect the speed of restoration of the menstrual cycle and the arrival of menstruation ahead of schedule.

It is normal for the cycle to resume after 3-4 months from the moment the lactation period approaches the end. But every woman’s body is individual. It is not considered a deviation if menstruation starts a little earlier or later. But mothers who switched their baby to artificial formula immediately after birth should not be surprised if menstruation begins 2 months after birth. This period is quite sufficient to restore the cycle and hormonal levels.

On a note! The method of delivery does not affect menstruation, even phenomena such as lochia. Even after a cesarean section, lochia recedes in the first 2-3 weeks, however, these are by no means critical days, but a period of healing of the injured uterine cavity after surgery, releasing residual dead endometrial particles. Critical days can only be affected by lactation, namely the degree of prolactin production.

When do they start?

The answer to the question depends on the individual structural features of the body. When some young mothers can begin menstruation after 3 months, others have a menstrual cycle that does not begin until breastfeeding is completed, but only after it ends. In the first month after childbirth, thick bleeding is observed . They are not menstruation and soon end.

The onset of menstruation is influenced by the volume of milk produced and the duration of daily feedings. If you introduce complementary foods at 5 months, you can expect your period until the 8th month. Due to changes in hormonal levels, critical days may be absent for up to a year.

If menstruation does begin during lactation, it is distinguished by shorter duration and scarcity of discharge.

Will they be expected soon if there was a caesarean section?

Caesarean section has virtually no effect on the onset of menstruation . The period of the onset of menstruation depends on how gestation took place, as well as on age, lifestyle and quality of lactation.

1. With a combined type of menstruation, you need to wait 3-5 months after cesarean.
2. If mommy does not breastfeed, you can wait 2-3 months for menstruation.
3. With prolonged lactation after cesarean section, the cycle will be restored within a year.

Should I continue to feed if they have already arrived?

Continuing breastfeeding is a beneficial and mandatory action in such a situation. The arrival of menstruation does not in any way affect the taste or consistency of the milk; all nutritional properties are retained.

The effect of menstruation on lactation

After childbirth, increased production of prolactin begins, and milk flows through the milk ducts. At the same time, stimulation and production of other hormones stops. Ovulation and egg maturation do not occur.

Previously, women exclusively breastfed their children for a long time, so the replacement process was observed until about 1 year after birth. Today, with the appearance of many different mixtures on store shelves, many mothers, for one reason or another, transfer their infants to mixed or artificial feeding. Therefore, you should not be surprised if your period comes 4-5 months after giving birth.

Many mothers deliberately replace breastfeeding with artificial feeding or simply do not follow feeding schedules or deny the baby food at night. In this case, of course, milk production will be disrupted, and the level of the hormone prolactin will quickly decline.

On a note! Many doctors are unanimous in their opinion that breast milk is the best nutrition for a newborn. There is nothing wrong if feeding is carried out until the baby is 1, 5 or even 2 years old. This will only help strengthen its immunity and protect the body from damage by various kinds of viruses and bacteria. It is extremely important to maintain equal intervals between feedings (no more than 4 hours). Apply to the breast even at night.

As prolactin production decreases, the amount of milk produced will decrease sharply, which means that menstruation is likely to occur 6-7 months after birth.

Menstruation is directly influenced by hormonal levels. As long as prolactin is produced in abundance, progesterone, on the contrary, arrives in small quantities. Menstruation should return after 2-3 cycles and only after breastfeeding has been completely stopped.

REFERENCE! Menstruation does not affect the taste, quality, color and composition of milk. Their onset only indicates an increase in the hormone progesterone and a significant suppression of prolactin levels. Menstruation should not become a reason for weaning a child or introducing new complementary foods. Even the increased content of hormones in breast milk will only benefit the baby. Critical days are the same natural phenomenon as breastfeeding. Moreover, their arrival during lactation is not considered a pathology. It's all about the hormonal background and the timing of the restoration of menstruation is purely individual. The main thing is that they do not become protracted.

When does your period come after breastfeeding?

After breastfeeding, periods can be restored in different ways. Sometimes they come immediately after the woman has finished breastfeeding, sometimes only after 1-2 months. This is due to the fact that for some time the hormone prolactin can be produced in fairly large quantities, so to speak, by inertia.

If the child refuses the breast on his own, menstruation will begin earlier, since this usually happens gradually - the baby eats less and less, and in the end does not ask for more breast. The body reacts sensitively to this and the amount of prolactin and milk also gradually decreases, which means that the restoration of the cycle is not delayed.

If the child had to be weaned for external reasons, then after breastfeeding is discontinued, in this case, menstruation may be delayed. It will take time for the body to understand that milk is no longer needed. Normally, such a delay lasts a month or two.

It also happens the other way around - breastfeeding continues, but the cycle has already been restored. This is usually associated with the introduction of complementary foods and the abandonment of night feedings. The child eats less milk during the day and does not stimulate prolactin at night, so the cycle is restored earlier. Read a detailed article about periods while breastfeeding.

Many women believe that they are unable to become pregnant before their first period. But you should understand that before your period, as a rule, ovulation occurs - and if the “stars align”, then it is absolutely enough to get pregnant and not wait for your period. And become the mother of charming weather.

However, the restoration process does not end there. After lactation, periods may differ significantly from the usual picture for some time.

Disruptions in the cycle during the feeding period

Failure of the menstrual cycle, delay of menstruation during lactation or after its completion is quite normal. It's all about an imbalance between hormones, an increase in prolactin, a sharp decrease in progesterone. Restoring menstruation takes some time. However, such a duration should not exceed 3 months.

The protracted nature of the cycle recovery should be a reason to consult a doctor. It may indicate the development of an inflammatory course in the body or other gynecological diseases. But in 2-3% of cases, menstruation during breastfeeding can lead to another pregnancy. This is why doctors try to reassure women that lactation cannot be compared with an effective method of contraception. Hormonal levels are unstable and pregnancy is quite real, even if a woman breastfeeds constantly, in compliance with the rules and feeding regimen.

Peculiarities of the arrival date of menstruation in women who have recently given birth

Often the moment when critical days come during breastfeeding is unexpected for a woman, because it is impossible to accurately predict their onset. The main influence on the cycle is how you feed your baby . If a mother breastfeeds at the first request, her period should be expected after 10-12 months.

In women who feed according to a schedule, the cycle is restored after 8-10 months. With a mixed type (milk, formula), the arrival time of menstruation is 3-5 months. On IV you will get your period in 1-2 months.

Among the features of the arrival of menstruation are hereditary predisposition, the mood and health of the mother. The cycle can change the duration, degree and volume of discharge. Menstruation with breastfeeding after childbirth can be irregular - so the first menstruation is not indicative, because a clear cycle is formed only after 1-2 repetitions.

But heavy discharge or a duration of more than 1 week is a reason to consult a doctor.

When should you see a doctor?

Only timely restoration of the menstrual cycle in medical terms is considered one of the main indicators of women's health. But you should immediately contact a doctor if:

• absence of menstruation after 2-3 months from the end of the lactation period;
• the appearance of scanty (heavy) discharge after completion of lactation;
• the passage of painful menstruation, when such a phenomenon was not observed before;
• the appearance of a mother’s period during breastfeeding, without introducing complementary feeding or supplementary feeding into the child’s diet;
• abrupt cessation of the menstrual cycle after complete recovery.

Attention! You should be wary if your periods appeared immediately after the cessation of lactation, and then suddenly stopped. This is similar to hormonal imbalance or the onset of a new pregnancy. In particular, you need to consult a doctor if your period begins while breastfeeding, carried out according to all the rules. If, in addition to bloody discharge, other unpleasant symptoms appear: itching and burning in the vagina, discharge of blood with pus, fever, then there is a high probability of infection in the uterine cavity. Re-cleaning may be required.

Is the delay normal or not?

Delay or amenorrhea is a normal physiological condition for a woman who has undergone childbirth. If the absence of critical days continues after the end of lactation, this is an alarming sign. The reason for the delay may be a number of diseases :

1. ovarian cyst;
2. inflammation;
3. tumor of the ovaries or uterus.

ADVICE : If there is a delay, it is important to exclude a second pregnancy. If the test shows a negative result and the gynecologist does not find any pathologies, the woman needs to see an endocrinologist. Amenorrhea is one of the symptoms of Sheehan syndrome, in which the pituitary gland is damaged.

Should you see a doctor?

During the postpartum period, a young mother should regularly visit a gynecologist to minimize the risk of developing various complications. Mandatory consultation with a specialist is also necessary in the following situations :

• No periods after 6-8 months.
• The regularity of the menstrual cycle does not stabilize for a long time.
• Menstruation has begun, but the discharge feels uncomfortable or painful.

Consultation with a gynecologist is also necessary for advice on contraceptive methods after childbirth.

Results

The arrival of menstruation during lactation often becomes a frightening factor for women. After all, it is generally accepted that this should not happen until breastfeeding is completed. Some mothers assume that a new pregnancy has begun, and their periods are heavy, painful and different than before. The cause may be a bending of the uterus, which is a common occurrence in primiparous women, although after childbirth the defect should be eliminated.

The period of restoration of the menstrual cycle after childbirth is different for each woman. Normal if it settles 2 months after stopping breastfeeding. Otherwise, it is better to immediately consult a doctor if your periods are protracted, which should alert you. There may be 2 reasons - a new pregnancy or a gynecological disease. The second case is a reason when, of course, one cannot delay in undergoing an examination or prescribing a course of treatment.

Restoration of the menstrual cycle

In order to correctly assess the course of the postpartum period in the presence of normal lactation, it is necessary to become familiar with the characteristic features of discharge in the early and subsequent postpartum periods of time.

During the first or second days after the birth of the child, vaginal discharge is bloody and dark brown in color. This is normal, since a large area of ​​the endometrium has been damaged, many small vessels may continue to bleed for some time after childbirth. This is not bleeding, but normal, physiological discharge. They are called lochia.

After three to four days, lochia begins to look like a slightly bloody, spotting discharge. There should no longer be any clots or excessive presence of blood. This course of the early period after the birth of a child indicates a good rate of uterine involution. Simultaneously with this process, milk begins to arrive at the mammary glands. Thus, we can conclude that the hormonal background is adjusted correctly for normal lactation and uterine contractions. If a woman begins to breastfeed her baby, especially immediately after birth, putting it to the breast, then this is an additional stimulator for contractile movements of the uterus and the production of oxytocin.

Over the next two weeks, the discharge is completely cleared of bloody impurities, becomes transparent, and its quantity gradually decreases. This is the period of establishing active lactation. Breastfeeding after childbirth is necessary not only for the child to develop normal digestion and immunity, but also for the mother herself in order to naturally stimulate the establishment of the menstrual cycle.

Two weeks after birth and until the end of the first month of this period, normal lochia are absolutely transparent, mucous, odorless. By the end of the fourth week of the postpartum period, they should practically stop. A different nature of the postpartum interval should alert the woman and force her to see a doctor.

Causes

Thus, to determine whether problems with the menstrual cycle continue for too long or whether this is normal, the following main factors should be taken into account:

• difficult or complicated childbirth by pathologies, as a result of which the body is extremely weakened;
• a large number of births - if this is the third or more pregnancy, recovery may be delayed;
• age – the first birth at the age of over 30 years is more difficult;
• non-compliance with the postpartum period;
• poor and irregular nutrition;
• stress, fatigue or postpartum depression.

It is these conditions that often delay menstruation.

What are the signs of menstrual irregularities? Read the article about the physiology of the female body and symptoms of cycle disorders, types and causes of disruption, treatment methods and the use of traditional medicine.

How to treat menstrual irregularities? Details here.

What happens after childbirth

Immediately after the birth of the baby, the process of uterine involution begins in the young mother’s body. During this period, the uterus is restored to its pre-pregnancy state. Usually this period does not take much time and the organ returns to its original state after 2 months.

These changes affect not only the uterus itself, but also the entire birth canal. The cervix is ​​restored and the internal os is closed. Upon completion of the process of restoration of internal organs after childbirth, the menstrual cycle should resume.

However, your period does not always come by the end of the 8th week. For many women, the recovery period is delayed. This does not always indicate the presence of abnormalities or pathologies. According to gynecologists, about 70% of women in labor experience a delay in the return of menstruation after childbirth.

Read also:

How to treat sore throat while breastfeeding and not confuse it with other throat diseases

First menstruation

Many women complain that when their first periods appear after childbirth, they are especially painful. These complaints are not always adequate. Most often, experts attribute this reaction of young mothers to the fact that they simply forgot their feelings during menstruation.

However, the first periods after the birth of the baby can differ significantly from the usual menstruation. The duration of bleeding, the intensity of discharge and general sensations may change. The second period may come earlier or, on the contrary, late. This shouldn't cause much concern. The normal cycle is restored within 3 months after the first menstruation.

In order for the process of resumption of menstrual periodicity to proceed as naturally as possible, gynecologists recommend abandoning contraceptives for a while and using condoms until complete recovery. In this case, you can clearly track the entire process of the recovery period and notice dangerous deviations in time.

Contact your doctor if:

• After the start of menstruation, there was a delay that lasted more than 4 months.
• When menstruation lasts longer than 8–9 days.
• Menstruation is accompanied by severe pain in the lower abdomen.
• There is an unpleasant odor in the discharge.

These symptoms may indicate the presence of inflammatory processes, postpartum complications, and infectious diseases.

Why do crashes happen?

The functioning of the body, mood and well-being, including menstrual function, directly depend on the hormonal levels at a given moment in a woman’s life. How is it changing?

Hyperprolactinemia

After childbirth, the body of every new mother adjusts to milk production in order to feed the newborn baby. The hormone produced by the pituitary gland of the brain, prolactin, is responsible for this. For its function it is often called “milk”. The production of prolactin inhibits the formation of other hormones, in particular follicle-stimulating hormone (FSH, responsible for the growth and formation of the dominant follicle) and luteinizing hormone (LH, the proper functioning of the corpus luteum depends on it).

As a result, the ovaries are in a “dormant” state, in medicine this concept is called physiological amenorrhea, when menstruation may not normally occur. The balance between all these hormones, as well as estrogens and androgens, determines when a woman’s menstrual function will be restored after childbirth and whether disruptions will occur.

The amount of prolactin begins to increase in a woman’s blood at the end of pregnancy, in the third trimester. Clinically, this manifests itself in the appearance of droplets of colostrum (a colorless, odorless liquid) when pressing on the areola. Further, the level of this hormone will directly depend on the intensity of nipple stimulation and milk suction. The more actively this happens, the more prolactin is produced. And vice versa. Therefore, if a woman does not put the baby to the breast on the first day, and also refuses to express milk, the amount of milk will soon decrease until the end of lactation, and soon after the postpartum period menstruation will come.

The peak of prolactin formation occurs in the early morning, so in order for the formation of the hormone to increase, night feeding is important. The more often a woman feeds her baby at night, the lower her likelihood of menstruation and, accordingly, ovulation.

Extra pounds as a result of excess estrogen

The excess weight that women gain during pregnancy also matters. And many “become kinder” before our eyes even after giving birth. Adipose tissue is a source of estrogen in the body. The more there are, the higher the likelihood of cycle disruption.

Diseases associated with dysfunction of the pituitary gland

At the end of pregnancy and during childbirth, a woman’s body experiences maximum stress on all organ systems. Disruption of the blood supply to the pituitary gland can cause the death of its cells in whole or in part. Risk factors for such conditions are the following complications during pregnancy and childbirth:

• moderate and severe gestosis;
• massive blood loss during natural childbirth, as well as during cesarean section;
• development of DIC syndrome during this period.

As a result, a woman acquires postpartum hypopituitarism (Sheehan syndrome) of varying severity, which depends on the percentage of pituitary necrosis. This disease is characterized by a deficiency of hormones that regulate the ovaries and uterus, the thyroid gland, and metabolism in the body. Clinically, Sheehan syndrome manifests itself in the form of absence of menstruation, loss of body weight, the appearance of edema throughout the body, decreased blood pressure, and hypothyroidism occurs.

The diagnosis can be established by passing the necessary hormonal panel, performing a CT or MRI of the area where the pituitary gland is located and an X-ray examination of the sella turcica.

There is only one treatment for Sheehan syndrome - taking all the necessary hormones for life: the thyroid gland, estrogens and some others to regulate metabolism.

Thyroid dysfunction

If after childbirth the menstrual cycle is disrupted, then the reason may be hidden in a disruption of the thyroid gland, the functioning of which is closely related to the genitals. Hypothyroidism, in addition to menstrual irregularities, will lead to excess body weight, dry skin and hair, brittle nails and some other manifestations.

Stress and psycho-emotional stress

Mental stress after childbirth accompanies almost every woman. Lack of support from loved ones during this period can aggravate the condition, even to the point of severe depression. All this affects a woman’s menstrual function and leads to constant disruptions.

Additional surgical interventions during caesarean section

Sometimes during a caesarean section the scope of the operation can be expanded according to indications. If manipulations affect the ovary, this can lead to cycle disruptions later. Such disorders are temporary and disappear after a standard treatment regimen. But sometimes ovarian exhaustion may occur. The risk group includes older primiparous and multiparous women, multiparous women, as well as those who have previously had ovarian surgery. The periods of such girls can radically change their character after childbirth. As a rule, they become very scarce, and soon run out completely.