Most women who breastfeed, don’t get periods. That’s because during breastfeeding the hormone prolactin is made. The name of this hormone, which is produced in the pituitary gland, comes from the Greek ‘pro lactis’, which means ‘for milk’. Prolactin stimulates the milk production, but also suppresses the thickening of the uterine lining and ovulation. Breastfeeding can keep prolactin levels high enough to prevent ovulation. And if there’s no ovulation, there’s also no menstruation.
When the amount of prolactin decreases, the chance of ovulating, and thus of getting your period, increases again. A few weeks after giving birth, the prolactin levels in the blood of the mother gradually drop. However, in breastfeeding women these levels stay higher than in women who don’t nurse. That’s why these women will be having a longer menstruation holiday.
How long does this menstrual leave last?
If you don’t breastfeed at all, you’ll get your first menstruation five to eight weeks after giving birth. Often this first postpartum period is preceded by a light bleeding or spotting. Because the menstrual cycle has to start all over again, it can be a bit irregular in the beginning; a few months between your first and second period isn’t uncommon. Also the length of your cycle can differ from what it was before the pregnancy. The blood loss you experience in the weeks directly after giving birth (postpartum bleeding), isn’t menstruation. It’s lochia: a combination of blood, mucus and uterine tissue. To prevent bacterial infections, you shouldn’t use tampons to manage the lochia.
If you do breastfeed, then various factors decide the duration of your menstrual leave. These include the duration of the feeds, the frequency (how often you nurse), if you also nurse at night (that’s when the prolactin levels are highest) and if you only give your baby breast milk or also other liquids or solid food. Things like your age, your own diet, stress levels, the closeness of your baby and if your body is already strong enough for another pregnancy, play a major role as well. It’s different for everybody: one woman might get her periods back after only three months despite frequent breastfeeding, while the other woman does the same, but can enjoy a menstrual holiday of 1.5 years.
Menstruating after giving birth: the numbers
- Between 9 and 30% of women get their period within three months after giving birth.
- 19-53% of women don’t menstruate in the first half year.
- A small percentage get their monthly bleeding already between 6 and 12 weeks and another part only get it when they’ve completely stopped breastfeeding.
- The majority of women don’t menstruate in the first six months after giving birth.
- On average, the menstruation returns again by itself between 7 and 13-14 months after giving birth.
Want a longer menstruation holiday? Nurse more!
Generally speaking: the more often you breastfeed, the longer it takes before your periods start again. Nursing often keeps your prolactin levels high, especially in the first few weeks after giving birth. So don’t fancy the return of the monthly bleeding? Start breastfeeding as early as possible and keep it up regularly and diligently. For some women, the menstruation holiday lasts up to six months after they’ve completely weaned. This isn’t the case for most though: at a certain point your menstruation will return, even if your toddler is still sucking on your breast every single day.
When you’ve started menstruating again, you can definitely continue breastfeeding. However, your breasts and nipples can become more sensitive during your period and it could be that you’ll notice a decrease in your milk supply in the days leading up to your menstruation. Also the taste and smell of your milk can be different (a bit saltier and more concentrated) during your menstruation.
Beware: you can get pregnant again!
Not yet menstruating doesn’t automatically mean you’re not ovulating either. Seeing as ovulation happens before menstruation, you can already be fertile before you’ve gotten your first period. And you can certainly get pregnant when breastfeeding, especially when your periods have already returned. Don’t want your baby to have a tiny brother or sister just yet? Use contraception. For example a condom, because some forms of hormonal contraception, like estrogen-containing birth control pills, aren’t recommended when breastfeeding. That’s because there’s a chance the estrogen has a negative influence on the breast milk supply or composition.
Breastfeeding as contraception: the Lactational Amenorrhea method
In some countries, breastfeeding is used as a form of contraception. This happens mostly in non-western countries where babies are carried by their mother for a long time (closeness of mother and child also stimulates prolactin production) and get breastfed often. But also in the UK and USA the so-called Lactational Amenorrhea method (LAM) is used as a form of birth control.
This method means exclusive breastfeeding: your baby gets nothing but breast milk and is fed on cue (so not on a schedule, but whenever he/she wants to drink). Time between feeds should be no more than four hours in the daytime and no longer than five hours at night. Pumping or expressing breast milk by hand doesn’t count; the baby’s sucking is essential for prolactin production. Also: the Lactational Amenorrhea method only works if your periods haven’t yet returned. When used correctly, this method is 99% effective in preventing pregnancies in the first six months after giving birth; after that, additional contraception is needed.
European Fertility Week is from 5-11 November.