The return of your menstrual cycle after birth isn't just back to business as usual.
As if new mamas don't have a steep learning curve already, one event can take most of us off-guard: that first postpartum period. After what was probably a hiatus of a year or longer, the return of your menstrual cycle isn't just back to business as usual. In most cases, your first period after having a baby can be initially less predictable and stronger than what your menstrual cycle may have been pre-pregnancy.
The good news? By preparing yourself for what's to come, the first postpartum period doesn't have to be so intimidating. Here's what to know about your first postpartum menstrual cycle.
1. When your period will return can vary
The biggest factor that affects your first period after having a baby is whether or not you are breastfeeding. "If a woman is not breastfeeding, then the first menses usually returns at six weeks postpartum to three months postpartum," says Elizabeth Sauter, MD, fellow of the American College of Obstetricians and Gynecologists (ACOG).
Among exclusively breastfeeding mamas, Sauter says it can be harder to predict when menstruation will return in full force: It's rare for your period to return until at least six months postpartum (at which point you've probably introduced some solid food to the baby's diet), but it may not return at all until you are finished exclusively breastfeeding—often a year or more postpartum. The timing can differ from person to person.
2. Your first postpartum period will probably be heavier than before pregnancy
Whenever your period does return after having a baby, it will likely be in full force—it's not only shedding your uterine lining, but also shedding any clots or old blood from the delivery process. (And you thought you got past that during the initial round of postpartum bleeding!)
This time around, you might also experience ovulation pain, wonderfully known as mittelschmerz (German for 'middle pain'). In some cases, women who have been pregnant may be more attuned or more sensitive to the one-sided abdominal twinging that comes with the action of an egg being released from an ovary.
While this can be a less-than-pleasant experience, Sauter says that many women eventually experience less painful and intense periods as they get farther away from their baby's birth.
If you experience very heavy bleeding—filling a pad or period underwear in an hour or two, having multiple clots or one clot that is the size of a golf ball or larger—seek emergency medical care immediately. Also look out for fevers, chills, lightheadedness, foul-smelling blood or discharge, belly pain, rapid heart rate or breathing rate or any other worrying signs, and seek medical care right away if you have them.
3. Your menstrual cycle may not be as easy to track as it was pre-pregnancy
Whether or not you are exclusively breastfeeding has an impact on how reliable your period will likely be for the first year or so. As Sauter explains, mothers who had regular periods before pregnancy and aren't breastfeeding often fall back into that rhythm within a few months of the baby's arrival.
For breastfeeding mamas, even once your period returns after you give birth, it may not come back in exactly 28 days (or whatever frequency you were used to). However, for some women, this is a silver lining.
"Many mothers who had irregular menses prepregnancy in fact start more regular menses postpartum," says Sauter, adding the disclaimer this isn't always the case, especially for women with polycystic ovary syndrome (PCOS).
Like everything with motherhood, soon enough you'll find your rhythm. But if you experience any worrying signs or symptoms, be sure to speak to your doctor or midwife.
A version of this story was originally published on August 12, 2020. It has been updated.