Ovulation after childbirth

Return of ovulation and menses in postpartum nonlactating women: a systematic review

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Review

. 2011 Mar;117(3):657-662.

doi: 10.1097/AOG.0b013e31820ce18c.

Emily Jackson¹, Anna Glasier

Affiliations

Affiliation

¹ From the World Health Organization, Geneva, Switzerland.

PMID: 21343770
DOI: 10.1097/AOG.0b013e31820ce18c

Review

Emily Jackson et al. Obstet Gynecol. 2011 Mar.

. 2011 Mar;117(3):657-662.

doi: 10. 1097/AOG.0b013e31820ce18c.

Authors

Emily Jackson¹, Anna Glasier

Affiliation

¹ From the World Health Organization, Geneva, Switzerland.

PMID: 21343770
DOI: 10.1097/AOG.0b013e31820ce18c

Abstract

Objectives: To estimate, from the literature, when nonlactating postpartum women regain fertility.

Data sources: We searched PubMed and Cochrane Library databases for all articles (in all languages) published in peer-reviewed journals from database inception through May 2010 for evidence related to the return of ovulation and menses in nonlactating postpartum women. Search terms included "Fertility" (Mesh) OR "Ovulation" (Mesh) OR "Ovulation Detection" (Mesh) OR "Ovulation Prediction" (Mesh) OR fertility OR ovulat* AND "Postpartum Period" (Mesh) OR postpartum OR puerperium AND Human AND Female.

Methods of study selection: We included articles assessing nonlactating women's first ovulation postpartum. Studies in which women breastfed for any period of time or in whom lactation was suppressed with medications were excluded.

Tabulation, integration and results: We identified 1,623 articles; six articles reported four studies met our inclusion criteria. In three studies utilizing urinary pregnanediol levels to measure ovulation, mean day of first ovulation ranged from 45 to 94 days postpartum; 20%-71% of first menses were preceded by ovulation and 0%-60% of these ovulations were potentially fertile. In one study that used basal body temperature to measure ovulation, mean first ovulation occurred on day 74 postpartum; 33% of first menses were preceded by ovulation and 70% of these were potentially fertile.

Conclusion: Most nonlactating women will not ovulate until 6 weeks postpartum. A small number of women will ovulate earlier, potentially putting them at risk for pregnancy sooner, although the fertility of these early ovulations is not well-established. The potential risk of pregnancy soon after delivery underscores the importance of initiating postpartum contraception in a timely fashion.

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Byamukama O, Migisha R, Kalyebara PK, Tibaijuka L, Lugobe HM, Ngonzi J, Ahabwe OM, Garcia KRM, Mugyenyi GR, Boatin AA, Muhumuza J, Ssalongo WGM, Kayondo M, Kanyesigye H. Byamukama O, et al. BMC Pregnancy Childbirth. 2022 Mar 30;22(1):268. doi: 10.1186/s12884-022-04611-4. BMC Pregnancy Childbirth. 2022. PMID: 35354443 Free PMC article.
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Pradhan N, Dongol A, Bastakoti R, Karmacharya SB, Shrestha OH. Pradhan N, et al. JNMA J Nepal Med Assoc. 2021 Nov 15;59(243):1086-1089. doi: 10.31729/jnma.7043. JNMA J Nepal Med Assoc. 2021. PMID: 35199751 Free PMC article.

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References

1. World Health Organization. Medical eligibility for contraceptive use. 3rd ed. Geneva: World Health Organization; 2004.
1. Lidegaard O, Lokkegaard E, Svendsen AL, Agger C. Hormonal contraception and risk of venous thromboembolism: National follow-up study. BMJ 2009;339:b2890.
1. Vandenbroucke JP, Rosing J, Bloemenkamp KW, Middeldorp S, Helmerhorst FM, Bouma BN, et al. Oral contraceptives and the risk of venous thrombosis. N Engl J Med 2001;344:1527–35.
1. van Hylckama Vlieg A, Helmerhorst FM, Vandenbrouke JP, Doggen CJ, Rosendaal FR. The venous thrombotic risk of oral contraceptives, effects of oestrogen dose and progestogen type: Results of the MEGA case-control study. BMJ 2009;339:b2921.
1. Dahlman T, Hellgren M, Blombäck M. Changes in blood coagulation and fibrinolysis in the normal puerperium. Gynecol Obstet Invest 1985;20:37–44.

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How soon can you get pregnant after having a baby?

Myths about postpartum fertility are widespread. From rumors that it is impossible to get pregnant while breastfeeding to beliefs that the body will not get pregnant until it is “ready,” it can be hard to get the facts.

While unlikely, it is possible to get pregnant less than 6 weeks after having a baby. However, it is impossible until a woman ovulates again. The point at which ovulation happens varies from person to person, which means some women could get pregnant earlier than others.

Sometimes, ovulation happens before a period, so it is also possible for a woman to get pregnant before having the first postpartum period.

In this article, learn more about how soon a woman can get pregnant after having a baby, as well as how long to wait, and the possible risks of pregnancies that are too close together.

Share on PinterestMost women resume ovulation between 45 to 94 days after giving birth.

Ovulation occurs when an ovary releases an egg for fertilization. If the egg is unfertilized, the body expels the egg, the uterine lining, and blood in a menstrual period. Ovulation must occur for a woman to get pregnant, and regular periods are a sign that a woman has ovulated.

A 2011 review of previous studies found that women ovulate for the first time between 45 to 94 days after giving birth. Most women did not begin ovulating until at least 6 weeks after childbirth, but a few ovulated sooner.

Usually, women who are not breastfeeding ovulate sooner after giving birth than women who do breastfeed.

However, a woman’s first ovulation cycle might occur before she gets her first postpartum period. This means that it is possible for a woman to get pregnant before menstruation begins again.

Pregnancy causes many hormonal shifts, and it takes the body time to get back to normal. For many women, their first few postpartum periods are irregular.

Breastfeeding often prevents ovulation, but this is not always the case. However, women who breastfeed their infants exclusively for 6 months are less likely to ovulate during this time than women who do not breastfeed.

Some women use breastfeeding as a birth control method. Doctors call this the lactational amenorrhea method (LAM). Amenorrhea means a lack of menstruation.

According to the Centers for Disease Control and Prevention (CDC), the following three factors must be present for LAM to have the best chance at preventing pregnancy:

The baby must be younger than 6 months old. After 6 months, breastfeeding often becomes less frequent, increasing the risk that ovulation will return.
The mother must be exclusively or almost exclusively breastfeeding. Giving formula or other foods to the baby increases the time between breastfeeding sessions. Breastfeeding on demand with intervals of no more than 4–6 hours between feedings is the most effective strategy.
The woman’s period must not have returned. While not all menstruating women are fertile, the return of a woman’s period suggests the body is preparing to ovulate.

Research on the effectiveness of the LAM is mixed. One major challenge of this method is that it is difficult to use correctly. Traveling away from the baby overnight or spending long days at work can create gaps in breastfeeding that make this method less effective.

According to Planned Parenthood, LAM is about 98 percent effective when people use this method in the first 6 months after the baby is born.

After 6 months postpartum, LAM is less effective. Women who are not considering another pregnancy might think about starting to use another contraceptive method.

Share on PinterestThe World Health Organization advise waiting 24 months before trying for another baby.

Getting pregnant again too soon after giving birth increases the risk of adverse outcomes for both the woman and baby. Recovering from birth takes time, especially if there were complications.

According to the World Health Organization (WHO), the safest option is to wait 24 months before trying for another baby. The charity March of Dimes suggests waiting at least 18 months.

Women who have had a pregnancy loss, stillbirth, hemorrhage, or surgical birth may need to wait longer. Talk to a midwife or doctor for help timing the next pregnancy.

Some women cannot imagine having another baby after giving birth, while others cannot wait to start planning for another.

There is no right or wrong way to feel about getting pregnant after childbirth. But practical considerations — including whether pregnancy might disrupt breastfeeding, and the safety of a pregnancy soon after birth — should play a role in the decision.

Also, recommendations for when it is safe to have sex after giving birth vary. In general, it is best to wait until postpartum bleeding has stopped, pain has disappeared, and a woman wants to have sex.

Consider using the final postpartum doctor’s visit as a chance to discuss birth control options and ask questions about fertility, as well as any concerns about having sex.

Women have many options for preventing pregnancy, including condoms and hormonal contraceptives that are safe to use while breastfeeding. In many cases, the LAM method will be effective for the first 6 months postpartum.

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 already 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.

How to know if you are ovulating while breastfeeding

Breastfeeding is not like TV commercials, it is quite a difficult process for many new mothers. In addition to the exhaustion of childbirth, possible difficulties are added when the child naturally adapts to the breast. As if that weren't enough, there's the issue of risking another pregnancy while hormones are at their peak. ¿С How do you know if you are ovulating while breastfeeding ?

This is the key to preventing unwanted pregnancy and too close to a recent birth. Due to myth or misinformation, many couples believe that they cannot get pregnant while breastfeeding. Nine months later, a new baby arrives to bust that myth. That is why today we analyze ovulation during lactation.

Index

1 Secrets of ovulation.
2 Types of lactation and ovulation

Secrets of ovulation.

During pregnancy, a woman stops menstruating and ovulating. During those nine months, she is unable to conceive, but after giving birth, everything changes. Although this does not happen immediately, depending on the body of each woman, the fertile cycle adjusts and organizes itself again. The postpartum period is a period when hormone levels remain high, but gradually begin to decline. When they return to their starting point, the first postpartum menstruation occurs.

It doesn't happen overnight. That's why it's hard to know when you are ovulating while breastfeeding . There are women who do not re-ovulate during the entire lactation, while others do not re-ovulate for several months. Differences are associated not only with each organism, but also with the type of breastfeeding that each woman engages in.

Types of lactation and ovulation

Absence ovulation during lactation This is a consequence of the work of two hormones: estrogens and progesterone. These hormones increase significantly during pregnancy, and after childbirth, this level begins to fall. But this top-down process doesn't happen on a regular basis, and that's where breastfeeding comes in.

During pregnancy, the ovaries suppress ovulation as a result of hormonal changes. After childbirth, the ovaries no longer suppress ovulation. This is why in women who are not breastfeeding, menstruation resumes 6 weeks after giving birth, the period can be extended up to 4 months. However, breastfeeding has the same effect on the ovaries during pregnancy.

During breastfeeding, the suckling of the baby blocks the hormonal activity of the hypothalamus, so the ovaries are inhibited, and then the normal hormonal activity leading to the menstrual cycle does not occur. While this does not mean that it is impossible to get pregnant while breastfeeding, it is true that the chances are much less. Of course, this will be closely related to the type of breastfeeding. The more exceptional and constant it is, the greater will be the inhibition and, therefore, the less the risk of ovulation.

Article subject:

When does menstruation occur after childbirth

In other words, the more frequently vaccinated, the better natural contraception.