Lactational amenorrhea is a break in the menstrual cycle after pregnancy. Although the absence of menstruation after pregnancy is called lactational, that is, associated with lactation, at first the amenorrhea does not depend on the type of feeding: in the very first month after childbirth, menstruation is not restored. This is a natural break in the reproductive cycle of the female body, given to us by nature in order to have time to recover after bearing and giving birth to a child. But what will happen next? We tell you when you can wait for your period after childbirth, what is considered the norm for the first cycles of menstruation, and when an appointment with a gynecologist is necessary.
The earliest terms of pregnancy: who needs an appointment with a gynecologist?
There are two very common misconceptions. The first is that during breastfeeding, the same lactational amenorrhea perfectly protects against the onset of a new pregnancy. So, while you are breastfeeding and there are no periods, you can not use protection. Such information can also be obtained from an experienced mother, especially from the older generation, on the Internet or from non-professional consultants by phone +7 (499) 519-32-56, and sometimes from some health workers. Sometimes this “secret knowledge” comes with advice to take a pregnancy test every month. That is, pregnancy is, as it were, impossible, but the test must be done. It sounds extremely illogical and causes distrust for such a “method of protection”. And not in vain.
Pregnancy may well occur against the background of breastfeeding, otherwise the number of newborns in the Middle Ages would have been much lower. The ability of the body to conceive depends on the level of prolactin, and its change cannot be immediately noticed without regular blood tests. As a rule, the first clear sign is the resumption of menstruation, but ovulation before the first cycle after childbirth goes unnoticed. If conception occurs at this moment, then menstruation will not come due to a new pregnancy.
The second myth is that in the first months after childbirth, pregnancy is impossible, regardless of the type of feeding. The body is not ready, which means that you can not protect yourself. And it’s not true! The body can recover for quite a long time, and very quickly. And in a fairly large number of women who immediately decide to feed their baby with mixtures, the reproductive system is ready for a new pregnancy after 4-5 weeks.
In most cases, obstetricians are advised to wait at least a month after the birth of a child, or even more, until the onset of sexual activity, depending on well-being and complications in childbirth. And this means that by the time of the first contact, the body can begin to produce eggs. To avoid a new pregnancy, only having managed to be discharged from the hospital, it is necessary to protect yourself. As a rule, the only method of contraception that does not require a doctor’s approval is condoms. To select female barrier methods or hormonal contraceptives, you need an appointment with a gynecologist: at the appointment, the doctor will help determine the appropriate option, taking into account the type of feeding, physiological characteristics of the postpartum period and hormonal changes in the body.
The resumption of menstruation depends on the type of feeding
We figured out the possibility of a new pregnancy: it can occur even before the resumption of menstruation. And when to wait for the arrival of menstruation after childbirth, if the probability of conception is excluded? It all depends on several factors: the individual and hereditary characteristics of a particular woman, her state of health and the characteristics of living conditions and nutrition. But there is also an important factor that affects all expectant mothers. This is the restoration of hormonal balance, depending on the type of feeding the baby.
Breastfeeding is a natural regulatory mechanism that largely dictates the duration of lactational amenorrhea. Lactation is impossible without a certain level of prolactin. It is this hormone that is responsible for the production of breast milk and suppresses ovulation. If there is no ovulation, maturation of the egg in the ovary, then there is no subsequent change in the endometrial layer of the uterus, which means there is no menstruation.
If breastfeeding is not supported, then 1-2 months may pass before the first menstruation after childbirth. Mixed feeding, on average, somewhat lengthens the period of amenorrhea, and it can take from several weeks to several months before the first postpartum menstruation. It is impossible to predict more precisely, since everything depends on the ratio of breast milk and formula, the frequency and time of putting the baby to the breast or expressing milk.
If the child is fully breastfed, eats on demand, including at night, from 4 to 7 in the morning (afternoon feeding), when prolactin is most actively produced in response to nipple stimulation, then, on average, before the first menstruation passes about half a year. Most often, the “trigger” for reducing the amount of prolactin is the introduction of complementary foods into the baby’s diet: he begins to receive new foods, eats more, and requires less breast for nutrition. But you need to know that the absence of menstruation during the entire period of lactation, regardless of complementary foods, is also the norm.
Features of the first menstruation after childbirth
Pregnancy and childbirth also affect the characteristics of menstruation in the postpartum period. The first few periods are the time of recovery and adaptation of the body. The menstrual cycle can begin immediately with a certain number of days of bleeding and breaks between them, or it can be “floating”, as in adolescence. The duration, soreness, volume of discharge can be completely different from the usual menstruation. It is also possible the onset of premenstrual syndrome or, conversely, its disappearance. What does it depend on?
Most often, those who used hormonal contraceptives in any form before pregnancy complain of more abundant and painful menstruation after childbirth. Two more important factors are a caesarean section in childbirth (the sooner menstruation begins after the operation, the higher the likelihood that they will be very painful) and multiple pregnancy.
Normal doctors consider about a six-month adaptation period for the restoration of the menstrual cycle. In the first 6 months after the return of menstruation, there may be fluctuations in the number of days of the cycle, and they can be either plus or minus 10 days. And if breastfeeding continues, then the intervals between periods can be delayed due to fluctuations in prolactin levels.
When do you need an appointment with a gynecologist? If menstruation has begun, there is no breastfeeding or there is a mixed, “supportive” form, and the period is not restored within 3 months, or menstruation came once and disappeared again. If the discharge lasts longer than 5-7 days, if there are abundant clots, inclusions, severe pain, severe premenstrual syndrome — all this is a reason for consultation and examination with a doctor.
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Obstetrics / Ed. Savelieva G.M. — 2000
Positive effect of the vaginal hormonal system on the control of the menstrual cycle / Dobrokhotova I.Yu., Ilyina I.Yu. // Issues of gynecology, obstetrics and perinatology — 2010 — T. 9 No. 5