Heavy periods after c section

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Your Pregnancy Matters

October 12, 2021

Your Pregnancy Matters

Shivani Patel, M. D. Obstetrics and Gynecology

Childbirth changes most new moms’ menstrual cycles – but it varies for everyone.

Many new moms are surprised by how much they bleed after having a baby. For two to three weeks after a vaginal or cesarean section (C-section) delivery, they experience what looks like a heavy period. This is called lochia, a mix of blood and uterine tissue the body doesn’t need after pregnancy.

Like a period, it typically starts heavy and becomes lighter over time, eventually ending with some spotting. The color will transition from dark red to brownish-pink to off-white. However, you are not ovulating regularly yet – releasing eggs from your ovaries – so lochia isn’t a true menstrual period.

Cramping further blurs the line between lochia and menstrual bleeding. Your uterus expands several times its size to keep up with the growth of your baby; after birth, it shrinks back down. The muscle contractions from this process feel similar to period cramps.

Caring for a newborn will consume most of your attention, but be sure to monitor the amount of blood you’re losing during the first few weeks after delivery. Up to 5% of patients experience uncontrolled bleeding, or postpartum hemorrhage, a condition accompanied by symptoms such as low blood pressure, pale skin, and nausea.

If your blood loss seems excessive, see your provider right away. After lochia ends, the timing, flow, and duration of every woman’s period varies, but enough similarities exist to answer common questions about postpartum menstruation.

When should I expect my first period after pregnancy?

Your first period can come anytime between two and 12 weeks after delivery. For most women, it happens between six and 12 weeks.

If you exclusively breastfeed, your period will likely be delayed until you give your baby solid food and other forms of milk. As your levels of prolactin – the hormone that helps your body produce milk – increase, your levels of estrogen and progesterone decrease. These hormones help regulate your period; lower levels reduce the likelihood of ovulation and menstruation.

While you are experiencing lochia, your flow will act like a typical period: starting heavier, then gradually getting lighter. However, if the amount of blood increases after a few lighter days, consider slowing down your activity level for a few days so your body can rest and heal from childbirth.

Related reading: The ‘fourth trimester’: Why women need health care after delivery

Will my period look or feel different?

Most women can expect their first couple of periods after giving birth to be heavier than those they experienced before pregnancy. Menstrual blood should look like you expect: a bright red that fades into a darker, brownish red. You may see small clots the first time but should not see large clots (the size of a plum or golf ball). If you do, alert your provider.

Some research has shown that C-section scarring can increase period pain as well as flow. In general, postpartum period symptoms will be similar to pre-pregnancy symptoms, so if you used to have cramps, they likely will resume. However, some patients say their period pain improves after pregnancy.

Related reading: What’s going on with my uterus? 3 conditions related to pelvic pain and bleeding

How regular will my menstrual cycle be?

Your period can take up to a year to become regular, no matter how consistent it was before pregnancy. To develop, grow, and deliver a baby, your body experiences several hormonal changes, and it needs time to return to normal.

Breastfeeding moms are even more likely to have an irregular menstrual cycle. When you breastfeed, you have lower levels of estrogen in your body – a hormone that fluctuates with your period. Without normal estrogen fluctuation, you won’t have normal periods.

Whether or not you breastfeed, don’t be alarmed if your second period is late – unless you’ve recently had unprotected sex.

You may associate post-traumatic stress disorder with survivors of assault, war, or natural disasters. But as maternal-fetal specialist Dr. Shivani Patel will tell you, symptoms of PTSD can weigh heavy on moms who had complex pregnancies. She knows from personal experience.

Learn more

Preventing postpartum pregnancy

If you have sex without a reliable form of birth control, you can get pregnant – even in the first few weeks after giving birth. The majority of pregnancies that occur less than a year after a previous birth are unplanned.

You will start ovulating between delivery and your first period – up to six weeks after birth, which is typically the same amount of time we recommend you wait to have sex.

Related reading: Birth control after childbirth: Long-term options for new moms

Research-based recommendations suggest spacing pregnancies by at least 12 to 18 months. Postpartum pregnancy can prevent your body from fully healing from childbirth and put your baby at risk of premature birth and infant mortality. A CDC study also found that a shorter time period between births is linked to autism spectrum disorder.

Risks vary based on your age. So, if you want to get pregnant again soon after giving birth, work with your doctor to develop a safe plan that is specific to your situation.

Postpartum bleeding can be confusing. We’re here to provide clarity. To visit with an Ob/Gyn, call 214-645-8300 or request an appointment online.

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After my c section, the last thing on my mind was getting a period. I had to navigate adult diapers, Tucks pads, belly binders, and incision pain. All things I never prepared for because I didn’t expect to have a c section.

So when I ~~mostly~~ recovered from my cesarean, returned back to work, and navigated the journey of pumping and breastfeeding, my period hit me like a ton of brick at just 3 months postpartum.

The cramps made my eyes roll back. The flow was so heavy that my husband wanted to take me to the ER.

I never want another mom to feel this fear or this intense confusion.

When should I expect my period after a c section?

Before we continue, let me note that every BODY is different.

Typically, women should expect their cycle to return between 6-8 weeks postpartum if they are not breastfeeding. The combination of pumping and breastfeeding might delay the start of a cycle, and exclusive breastfeeding could push the start date further.

If you are exclusively breastfeeding, it could be six months or more before you pull the tampons out of your cabinet again.

But every body is different.

I pumped while at work, nursing my baby at lunch and in the evenings and weekends. My first period came when my son was 3 months old, just weeks after returning to work and regularly pumping.

My coworker went 10 months exclusively pumping before her cycle returned.

So be prepared for your first period, but be flexible on when it arrives. Don’t stress too much about it. Your body knows what to do.

Is your period painful after pregnancy?

For me, my period cramps are much more intense after pregnancy and birth than they were before. Part of me wonders if it’s a mindset problem since now I know the pain of unmedicated contractions.

So I went researching . . .

Related: You Might Have Prenatal Anxiety…Do You Want to Know For Sure?

There’s more uterine lining to get rid of.

Think of how much dust would collect inside a bowl if you left it out on the counter, untouched, for TEN months. Gross! Well, your uterus hasn’t “dusted” its lining in 10 months, or even longer depending on when your first postpartum period arrives. There’s layers it needs to dust, sweep up, and wipe down.

I get sweaty and tired when I’m cleaning my house with my entire body, so imagine being one muscle and doing it all yourself! Our poor uteruses.

Because your uterus is a muscle, working harder than it has in the past, it gets sore. Your period cramps are a reflection of this.

Your uterine capacity is larger

. . . after being stretched, worked, and housing a beautiful baby for close to a year.

There’s not only a backstock of uterine lining to shed, but there’s more of it due to a greater surface area! There’s more work for your uterus to do, creating greater pain for you.

Also, your cycle is getting back to normal.

Increased period pain can be a result of the irregularity of your cycle. Hormones rise exponentially during pregnancy. With the birth of a baby, though, your hormone levels suddenly drop.

The body stopped making these hormones when you aren’t pregnant, and the remaining ones fumble around and bump into each other with no real purpose.

Add breastfeeding to the mix and there’s an intense game of hormonal pinball inside your body!

Your body is constantly rewiring itself and adjusting to these changing levels of hormones. It can take up to a year for your cycle to regulate, so be patient, Mama!

It’s a transformation, but it’s temporary.

What my period cramps after a caesarean section are like:

Most intense cramping lasts the first 1-2 days consistently then becomes occasional during the final days
The initial start day of my period is always the most painful
Breathtaking (if you want to put it positively)
Writhing on the couch during the first day

I’ve always had awful period cramps, but cramps after my c-section really threw me for a loop!

Heavy period after c section?

The uterus is larger and dustier as we mentioned before.

There’s so much uterine lining to get rid of!

Blood clots and an irregular, or a heavier, flow postpartum are completely normal. Honestly, it was the weight of my flow that caught me off guard.

I’m not sure why, but I expected periods to be painful after pregnancy. Those afterbirth pains were horrendous! What I didn’t expect was how heavy my flow would be.

There’s one day that sticks out to me where I had to change my tampon once every two hours because I was soaking through it. I couldn’t keep up.

And this was at 9 months postpartum.

Expect your period to be significantly heavier. Stock up on tampons and pads because you might need to use both (I did!). And prepare to be patient as it regulates, taking months to a year to do so.

How long does it last?

Your cycle is still regulating itself so how many days your period lasts and how many days between each period could differ each month.

Mine have been lasting 4-5 days with consistent flow and little spotting towards the end. So usually I “know” when my period has ended instead of guessing and continuing to spot.

That being said, your period after a cesarean can last between 3-10 days, usually hovering around the 5 day mark.

Does breastfeeding affect my period?

Yes!

Breastfeeding affects your period in a number of ways. The most common one being when your period returns.

Breastfeeding affects:

When your period returns

The hormones involved with breastfeeding can impact when your period comes back after childbirth. It can be 6 months or even a year before your menstrual cycle starts again.

How inconsistent your cycle is

Depending on hormone fluctuations and patterns in your breastfeeding journey, your cycle may be inconsistent or irregular when it returns.

Painful cramps

During nursing sessions, I notice I cramp more intensely. The hormone of breastfeeding, oxytocin, creates uterine contractions. While these contractions are more intense right after giving birth, they are still present after several months postpartum.

How to cope with period pain after childbirth

There’s pain in pregnancy, childbirth, and the dreaded periods after. Geez, thanks, Eve!

But we have so many ways to handle this pain after childbirth even if you’re breastfeeding!

1. Take a pain reliever

Tylenol, Advil, and Midol are all safe to use even when you’re nursing. That being said, I am NOT a healthcare professional. Please consult your doctor about what medicines work best for you.

2. Sit in a warm bath

It’s optional to add Epsom salts or Bath and Body Works bubbles!

Related: 15 Time-Saving Tips for Self Care (in under 15 min!)

3. Use a heating pad

4. Seek out your doctor for underlying gynecological and endocrine issues

It’s possible that your period after caesarean delivery is too heavy, soaking through a tampon each hour or passing blood clots. If your flow seems too heavy or your pain is too severe while cramping, reach out to your doctor. These symptoms could be signs of a greater issue.

5. Reflect on your diet and lifestyle choices

What has helped you with your periods after pregnancy? Share with us in the comments below!

Painful periods – NEO-Сlinic Tyumen

Painful menstruation (algomenorrhea, dysmenorrhea, algomenorrhea) is a manifestation of pain syndrome of varying intensity, which has a clear dependence on the timing of the onset of menstruation. About 40-50% of female representatives who are of reproductive age note abundant and painful periods of varying degrees of intensity. A severe form of algomenorrhea, up to complete disability, affects about 10% of all women who have painful menstruation. nine0005

Today, primary, secondary and unspecified dysmenorrhea or algomenorrhea are distinguished.

Primary dysmenorrhea

Primary dysmenorrhea is thought to be due to elevated levels of prostaglandin in the endometrium of the uterus, the inner layer of the uterus that is responsible for providing a medium for a fertilized egg.

The full mechanism of pain formation in high prostaglandin levels is difficult to describe and understand, but can be explained in simple terms. It has been noted that with increased prostaglandin, the frequency of uterine contractions increases by 2-2.5 times compared with a healthy value. Prostaglandins themselves do not cause pain, but can provoke pain by acting on pain mediators. As a result, pain occurs due to high contractions, uterine ischemia and high tissue sensitivity to pain mediators irritated by prostaglandin. nine0005

Secondary form of dysmenorrhea

Despite the fact that the secondary form of painful periods is more dangerous than the primary one, it is much easier to identify its true causes. In most cases, the culprit is one or another disease of the girl's reproductive system, of varying severity:

- endometriosis - growth of the endometrium, the inner layer of the uterine wall;
- fibroids and ovarian tumors;
- inflammatory process;
- adhesive process; nine0023 - defects of the genital organs, congenital or acquired, in which the outflow of menstrual blood is disturbed;
- intrauterine contraception.

Treatment of women with secondary dysmenorrhea is always based on the treatment of the underlying disease that caused this condition.

Painful menstruation after childbirth

Quite often young mothers complain of painful periods after childbirth. In most cases, natural childbirth causes a sharp development of the above causes. Both the primary form and the secondary form of dysmenorrhea can occur, for example against the background of endometriosis. nine0005

In addition, pain is observed when feeding a child, especially during menstruation. When breastfeeding, a reflex reaction occurs, and the uterus contracts, causing discomfort or pain during menstruation. If the birth was difficult, and there were no injuries or ruptures, then menstruation can also cause additional pain until the body is fully restored. The same applies to girls who have had a caesarean section.

Symptoms of painful menstruation

Despite the different causes of “problematic” periods, the symptoms in both cases are quite similar, and it will not be possible to immediately determine the form of dysmenorrhea from them:

- severe pain in the lower abdomen, with a different nature - aching, cutting, stabbing , jerking and giving to the lower back;
- emotional and mental disorder - insomnia, irritability, depression, drowsiness, intolerance to smells, change in taste;
- vegetative disorders - nausea, hiccups, belching, false sensation of heat, hyperthermia,
- increased urination, bloating, diarrhea or constipation, excessive sweating;
– vascular disorders – headache, dizziness, syncope, tachycardia, heart pain,
- a feeling of chills or numbness of the hands, swelling of the face;
- endocrine disorders - severe weakness, itchy skin, swelling throughout the body, polyuria, "cotton" legs and vomiting.

Why should painful periods be treated?

Given the above, it should be understood that the natural physiological function - menstruation, should not cause significant general malaise in a woman, depriving her of working capacity. In order to reduce the pain of menstruation, treatment should not consist in pain relief, but in eliminating the cause of this phenomenon. Of course, it is possible to hope that this will change, for example, with the birth of a child, but if this does not happen, especially if painful periods occur in a woman after the birth of children, you should contact a gynecologist to find out the cause of pain during menstruation. nine0005

To endure pain is not only physically difficult, but also very harmful to the nervous system, and the regular use of NSAIDs and analgesics does not eliminate the cause of painful periods, moreover, the body gets used to them and painkillers have a number of side effects.

Diagnosis

In order to prescribe effective treatment, it is necessary to correctly identify the cause of pain during menstruation. Diagnosis may include the following research methods:

– examination on a gynecological chair;
– general blood and urine tests;
- smears for microflora;
– Ultrasound of the pelvic organs;
– laparoscopic examination;
Dopplerography of blood vessels in case of suspected varicose veins.

Methods of treatment

If painful periods are caused by primary algomenorrhea, therapy most often involves eliminating stress factors, increasing physical activity and getting rid of bad habits. In the second half of the cycle, doctors recommend refraining from active sexual intercourse and lifting weights. Often, after pregnancy and childbirth, pain due to primary algomenorrhea completely disappears, so it is recommended not to interrupt the first pregnancy for women with a similar diagnosis. nine0005

Depending on the causes of algomenorrhea, treatment can be prescribed with or without medication. If algomenorrhea is caused by adhesive processes or neoplasms in the genital organs, then surgical intervention may be indicated.

Prevention

In order to prevent the development of dysmenorrhea, the following rules should be followed:

- develop a correct daily routine, in which there is time for work, sleep and rest; nine0023 - choose a balanced diet, during menstruation eat easily digestible foods that are rich in vitamins;
- control body weight, prevent obesity, but also do not exhaust yourself with strict diets;
- regularly take vitamins;
- do not get carried away with tea or caffeinated drinks;
- avoid stressful situations;
- go for walks in the fresh air more often;
- pay special attention to physical activity, be sure to do exercises and select sports hobbies in accordance with age and general health. nine0005

In addition to preventive measures, a timely consultation with a gynecologist is necessary, which will help to find out the causes of the disease and prescribe the right treatment.

Causes of heavy periods after childbirth

Pregnancy and childbirth are a period of significant changes in a woman's life. These periods cause a real hormonal storm in the body, and often lead to changes in familiar areas such as the menstrual cycle.

Please remember that the body after childbirth requires special attention. Take care of yourself and in case of any doubt, consult a doctor. nine0005

First of all, let's talk about the difference between postpartum hemorrhage (lochia) and menstruation.

What are lochia?

Lochia should be distinguished from heavy first menstruation after childbirth. Lochia is profuse bleeding from the vagina that begins immediately after childbirth. During them, the vagina gets rid of the thick layer of endometrium formed during pregnancy. They are usually dark red in color and abound in blood clots. Lochia is NOT menstruation, they should be considered as a sign of recovery of the body after childbirth. Usually they last 24-36 days, ie. 3-5 weeks. Over time, they become less abundant and change color: they become pink or transparent. Despite the similarity with menstruation, they should be distinguished. During lochia, there are also cramps, as well as during menstruation, because the uterus contracts, returning to its normal size and getting rid of excess endometrium. Lochia differs from menstruation in that it becomes lighter over time, while menstrual blood tends to darken towards the end of the cycle. nine0005

What to do when lochia comes?

Bleeding is usually very heavy at first, and in the hospital you will most likely need special gynecological pads or panties for adults. As soon as the bleeding subsides, you can start using the usual sanitary pads.

The body is weakened at this time, so it is especially important to monitor hygiene and change pads in time so as not to infect. nine0005

Do not use tampons unless your doctor tells you to. When the lochia is completely weakened and brightened, you can switch to daily pads and wait for the first menstruation after childbirth.

What to expect from menstruation after childbirth?

If you are not breastfeeding, your period is likely to start 1-3 months after giving birth, but if you are breastfeeding only, your period may not return for the entire period of breastfeeding. However, for many breastfeeding women, menstruation also returns after a couple of months. This is due to the hormone prolactin, which is responsible for the production of breast milk. It can suppress other sex hormones, thereby preventing ovulation and thus menstruation. But most often in women who are breastfeeding, the menstrual cycle is restored 6 months after childbirth. nine0005

If menstruation returned quickly, and the birth was vaginal (not caesarean section), then you should not use tampons for the first time, because the body is still recovering, and give preference to gaskets.

Often after childbirth, the very nature of menstruation changes: in some women it becomes more abundant, and in others it is easier. Often, the cycle is unstable for some time, but eventually returns to normal. Unfortunately, there is no way to predict what changes await a woman after childbirth in this regard. nine0005

Childbirth is a huge burden for the body, and it will take some time to recover. There is no gold standard for the postpartum recovery period; it is individual for each woman. If you are in any doubt, it is always best to consult a doctor.

Why do periods change after childbirth?

Uterus should return to normal size
Breastfeeding affects the cycle and hormones
Hormonal imbalance

How can menstruation change after childbirth?

Pain in the lower abdomen may become worse or vice versa less
Blood clots may appear
Unstable menstrual cycle
Abrupt onset and end of bleeding
More profuse periods

Why are the first periods after childbirth heavy and what is heavy menstruation?

Very often the very first menstruation after pregnancy and childbirth is more abundant than usual. Heavy periods - such periods when a woman has to use one pad or tampon per hour for several hours in a row (more than 80 ml of fluid per cycle) and / or which last more than 7 days, they are also called "menorrhagia". On the other hand, bleeding in women is different, and what is normal and normal for one is unusual and strange for another, so you should focus on what kind of menstruation is typical for you. nine0005

Often, the first menstruation is characterized by increased soreness, because the mucous membrane of the uterus, even after childbirth, is still thicker than its usual state before menstruation.

Most likely, over time, everything will return to normal, but some discomfort is possible in the first months due to the amount of discharge. To avoid trouble with leakage during heavy periods with clots, you can use night panty liners Kotex Ultra Night. They quickly absorb even the heaviest of secretions thanks to their unique 3D center, while special elastic grooves along the pad give it flexibility and provide additional protection against back leaks. Adjustable inner layer adapts perfectly to body shape and posture. Suitable for this occasion Kotex Natural Night: They have the same benefits as Kotex Ultra Night, and are ideal for women with sensitive skin. You can buy these pads in stores and pharmacies, as well as order on the Internet. nine0005

What symptoms should I look out for?

Although many cycle changes after childbirth are normal, some symptoms still require medical attention:

Unexpected heat and high temperature
Very heavy periods (you have to change pads with maximum absorption more than once an hour, such intense bleeding lasts longer than 2 hours)
Menstruation lasts longer than 7 days
Difficulties with breathing
Severe headaches
Very large blood clots (larger than a ping-pong ball)
Sharp, sharp pain at the onset of bleeding

Please remember that heavy bleeding can lead to anemia and weakness, women with heavy periods need to monitor the level of iron and ferritin in the blood. nine0005

What methods of correction of heavy periods can doctors suggest?

Unfortunately, sometimes heavy periods after childbirth do not return to normal and begin to interfere with normal life. In such cases, doctors can help you choose the right method for correcting this condition, depending on your state of health, the cause that causes them and personal preferences.

Here are some of them:

An intrauterine device is a small device containing the hormone progesterone that a doctor places inside the uterus.
Non-hormonal drugs - a doctor may suggest non-steroidal anti-inflammatory drugs and drugs based on tranexamic acid
Hormonal preparations such as combined oral contraceptives or progesterone tablets
nine0153
Surgical operations correcting the cause of abnormal heavy periods (curettage of the uterine cavity, removal of fibrosis, etc. )

How can you help yourself at home if you have heavy periods?

Yes, there is little pleasure in heavy menstruation, especially if they are painful, but this does not mean that it is impossible to help yourself during this period.

Try using a heating pad. Heat can relieve acute cramps in the lower abdomen and reduce pain. This method works because the heat helps relax the muscles that cause uterine contractions. If you don't have a heating pad, you can pour warm water into an empty plastic bottle. Try not to pour too hot water or wrap a heating pad in a towel so as not to burn yourself. nine0005
At night you can use special Kotex night panties. Sleeping in them is much more comfortable than with a pad, they fit perfectly to the body in any position and protect against leaks from all sides. After all, after giving birth, most women have more important things to do than spend time worrying about stains on their underwear.
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