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About menstruation after childbirth | Clinic.kg

Menstruation after childbirth

30 June 2019

A healthy pregnancy and delivery of a healthy baby is a reason for a woman to be proud of herself and her health. An important topic that worries many women after childbirth is menstruation: when to expect it, why the cycle is irregular, is it possible to get pregnant while breastfeeding, and much more. We will analyze the main issues in our article.

Postpartum discharge

Postpartum profuse discharge in a woman has nothing to do with menstruation - these are lochia, which from bloody become sanious, and then transparent, completely disappearing. After about two months, the uterus and ovaries return to their physiological state and size, which means that the onset of menstrual cycles with the maturation of eggs and menstruation is quite possible. Thus, a woman can expect her first menstruation from the 2-3rd month after childbirth.

When should my period start after childbirth?

This period depends on the type of feeding of the child: natural or artificial. Breast milk is produced under the influence of the pituitary hormone prolactin. The level of estrogen does not increase, therefore, when breastfeeding, menstruation begins, on average, 2 months after childbirth, more often when feeding “by the hour”. But there are times when some nursing women do not have periods for a year, and for some, they can recover in a month and a half after childbirth. On average, the onset of menstruation with breastfeeding varies from 3 months to six months.

How long do periods last after childbirth?

Often the first menstruation is quite heavy. There may be strong discharge, menstruation with blood clots. If you have to change the pad every hour, you should seek help from a doctor: this may be a symptom of bleeding that has begun. Subsequent periods usually become normal. In other cases, in the first months, women have irregular spotting. This is typical for breastfeeding, when prolactin synthesis gradually decreases.

Reasons for the slow recovery of the regular cycle

Each woman has her own individual period for the restoration of the menstrual cycle. This is determined by the activity of the production of hormones of the sex glands, the pituitary gland, the state of the immune and reproductive systems as a whole. There are a number of reasons for this that affect the body in the postpartum period:

• features of the individual hormonal background;
• hereditary factors;
• the nature of the birth process;
• features of the restoration of the uterus.

What to do if the menstrual cycle has become irregular:

• In the first months of the postpartum recovery period, do not panic. In most cases, this is the norm. For each woman, the normalization of the cycle occurs individually, usually during the first months of the resumption of menstrual bleeding. Irregularity is more common in nursing mothers.

• It takes about 2 months to restore the normal function of all organs and systems. Balance in the endocrine system comes later, especially if breastfeeding is used. Therefore, a woman can feel completely healthy, but she will not have a period.

• Notice the irregular cycle only after 3 cycles. This may be due to an inflammatory process, endometriosis or a tumor of the genital organs. A delay in the second period is not dangerous, unless it is associated with a second pregnancy.

Menstruation after caesarean section

Menstruation after caesarean section is restored in the same way as after normal delivery. During lactation, periods do not come for six months. Against the background of artificial feeding from the maternity hospital due to the lack of nipple stimulation (which activates the synthesis of oxytocin, which contracts the uterus), recovery may be somewhat slower, plus there is still a scar on the uterus. Therefore, the restoration of menstrual function may occur a little later, for several weeks.

Cycle after a pathological course of pregnancy or childbirth

After termination of a miscarriage or abortion, the first menstruation occurs within 45 days. If this does not happen, the woman should seek help from a gynecologist. To exclude such causes of amenorrhea as the remaining part of the fetal egg in the uterus or inflammation, 10 days after the termination of a frozen or normal pregnancy, an ultrasound scan is necessary.

Pathologies of menstruation, what to pay attention to and immediately contact a specialist:

• Sudden cessation of postpartum discharge is a sign of a bending of the uterus or endometritis, accumulation of lochia in the uterine cavity - lochiometers.
• Scanty periods for 3 or more cycles. Perhaps they are a symptom of hormonal disorders, Sheehan's syndrome or endometritis.
• Irregularity of menstruation six months after its restoration, a break between bloody discharge for more than 3 months. Most often associated with ovarian pathology.
• Excessive bleeding for 2 or more cycles, especially after a surgical delivery or abortion. They are often caused by the tissues of the membranes remaining on the walls of the uterus.
• The duration of menstruation is more than a week, which is accompanied by weakness, dizziness.
• Abdominal pain, fever, foul smell, discoloration of vaginal discharge - a sign of a tumor or infection.
• Spotting before and after menstruation is a likely symptom of endometriosis or an inflammatory disease.
• Itching in the vagina, an admixture of curdled discharge is a sign of thrush.
• Bleeding twice a month for more than 3 cycles.

Is it possible to get pregnant?

The most common myth is that a woman cannot get pregnant if she is breastfeeding a baby. The fact is that the process of ovulation - the first after childbirth, is formed before the onset of the first spotting, and it is she who, with unprotected intercourse, can lead to an unplanned pregnancy, and a woman will give birth to the weather. If a woman does not feed, it is necessary to think about protection after childbirth immediately, from the very first sexual contact, since the dynamics of the restoration of reproductive functions is different for everyone, after 6-8 weeks from the moment of birth, the first ovulation is possible.

Remember that a long delay in menstruation after childbirth or a cycle failure are not always symptoms of dangerous disorders, but in any case it is undesirable to self-medicate. For any questions and problems that arise with the reproductive system, please contact our specialists for advice.

When menstruation starts after childbirth: how long after the birth of the child does menstruation

When does menstruation begin after childbirth

In women who do not breastfeed, the first menstruation occurs 7-8 weeks after childbirth. For the vast majority of breastfeeding mothers, the menstrual cycle is restored later than ³ . If the child is transferred to artificial feeding, ovulation can be observed already 27 days after the last breastfeeding ³ .

Let's figure out why this happens and what changes are observed in the uterus and ovaries during this period.

Menstruation after childbirth

The uterus, the weight of which during pregnancy, excluding the fetus, increased to a kilogram, and the length - up to 39 cm, begins to decrease ² . Her muscle fibers contract and undergo physiological decay and rebirth ² . By the end of the postpartum period, it becomes the same as before conception - weighing about 50 g and 8-9 cm long ¹ .

The inner surface of the uterus, to which the placenta was attached, gradually heals.

It is believed that the inner layer of the uterus (endometrium) is completely restored by 6-8 weeks and "freezes" in anticipation of the first menstrual cycle after childbirth ^1.2 .

Active changes are also taking place in the ovaries. The follicles begin to mature in them. The accompanying hormonal changes lead to the resumption of menstruation ³ .

What determines the onset of menstruation after childbirth

The process of restoring the menstrual cycle is primarily affected by lactation - the formation of milk in the mammary glands ³ . The hormone prolactin, which is responsible for this process, inhibits the onset of cyclic processes in the ovaries ^3.4 .

Breastfeeding an infant supports lactation and prolactin release. Therefore, if a mother breastfeeds her baby exclusively and at least 6-10 times a day (with an interval of 4 hours during the day and 6 at night), postpartum lactational amenorrhea is usually observed, that is, the absence of menstruation ^3.4 .

According to some reports, in lactating women, the first menstruation is observed on average 4.5 months after childbirth. Some do not have them until the end of lactation ³ .

How long after childbirth does menstruation begin if the woman had a caesarean section?

If milk is scarce and the woman is not breastfeeding, her first period may start as early as 4 weeks after the caesarean section ³ . This is 2-4 weeks earlier than after natural childbirth ³ . Preservation and enhancement of lactation postpones the start of the cycle indefinitely ³ .

How the cycle and nature of menstruation can change after childbirth

The body needs time to return all organs and functions to the state that it was before pregnancy. Therefore, the restoration of ovarian function may be delayed ⁴ .

In 40% of women, a new egg matures already in the first menstrual cycle after the birth of a child ⁴ . However, more often at the beginning of the postpartum period, ovulation - the release of a mature egg from the follicle - does not occur. Such cycles are called anovulatory. Their typical manifestation is irregular periods ⁴ . The duration of anovulatory cycles can be from 1.5 to 6 months ⁵ .

How long do periods last after childbirth if there is no ovulation?

Menstruation occurring during anovulatory cycles is called dysfunctional uterine bleeding. They are plentiful and sometimes last more than 10 days ⁵ . As soon as ovulation is restored, the cycle becomes what it was before the conception of the child ³ .

When to see a doctor

In the postpartum period, a woman should be especially attentive to her health. The slightest disturbances in well-being and the appearance of suspicious symptoms are a reason for contacting an obstetrician-gynecologist.

Below we describe in which cases a doctor's consultation is urgently needed.

Postpartum hemorrhage

In the first months after childbirth, attention should be paid to the amount of discharge. Abundant discharge of blood or its impurities in the lochia - signs of postpartum hemorrhage ² .

Bleeding in the late postpartum period, that is, after 24 hours and within 6 weeks after delivery ⁶ , occurs much less frequently than on the first day after the birth of a child - in 0.2-3% of cases ⁷ .

They may be caused by ⁶ :

• pieces of placenta in the uterus;
• too slow recovery of the size of the uterus;
• penetration into the uterine cavity of pathogens causing inflammation;
• bleeding disorder ⁶ .

Postpartum endometritis

According to statistics, postpartum endometritis is diagnosed in 4-5% of women who gave birth spontaneously, and after caesarean section, endometritis is detected in 10-15% ⁹ .

After the birth of a child, the inner surface of the uterus resembles an open wound, so pathogens from the vagina, penetrating into the uterine cavity, can easily cause inflammation ⁸ .

Signs of postpartum endometritis or inflammation of the lining of the uterus include:

• purulent lochia;
• fever;
• lower abdominal pain ¹ .

What is important to know?

Not only the inner surface of the uterus, but also cracks, abrasions on the surface of the soft tissues of the cervix, vagina and perineum can become the entrance gate for infection to enter the body ² . Therefore, in the postpartum period, it is extremely important to observe special rules of intimate hygiene.

During the first 8 weeks it is better to use special postpartum sanitary napkins. When menstruation returns after childbirth, you can replace the pads with tampons, for example, o.b.® ExtraDefence ¹⁰ . With soft, bi-directional SilkTouch® wings, these tampons adapt to your body shape and provide reliable protection during your period, day and night ¹⁰ .

The processes of restoring the reproductive system after childbirth can proceed in different ways. They are influenced by the individual characteristics of the body, the course of pregnancy and childbirth, the nature of lactation and feeding the baby ^2.3 . For example, after a caesarean section, recovery is 3 times slower than after a natural birth ³ . If the mother is breastfeeding, the uterus returns to normal faster ¹ . Proper postpartum hygiene is an important part of caring for the female body.

The information in this article is for reference only and does not replace professional medical advice. For diagnosis and treatment, contact a qualified specialist.

Literature

1. Zanko S. N., Radetskaya L. E., Zhukova N. P. Obstetrics / Vitebsk. - 2017. - 383 p. / ISBN 978-985-466-891-8
2. Tayupova I. M., Sakhautdinova I. V., Kuleshova T. P. Physiology and pathology of the postpartum period // Ufa: BashNIPIneft. - 2014. - 59 p.
3. Khaskhanova L. Kh., Musaeva Ya. V. Physiological and pathological postpartum period // Grozny: Chechen State University Publishing House, 2016. – 96 p.
4. Nazarova NM, Prilepskaya VN, Nekrasova ME Postpartum contraception: efficiency and safety // Gynecology. – 2018. - 20(2). - P. 5-8.
   DOI: 10.26442/2079-5696_2018.2.5-8
5. Zaidieva Ya. Z. Dysfunctional uterine bleeding in the age aspect // Medical Council / №3. - 2012. - S. 78-83. Belousova A. A., Aryutin D. G., Toktar L. R. Late postpartum hemorrhage // Obstetrics and gynecology: opinion news, training.

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