8 Things to Know About Postpartum Periods

Most parents are all about getting life to run smoothly, or at least trying. You're organizing kids' schedules, maintaining relationships, and juggling multiple responsibilities. But there's one thing that likely won't slip into cruise control: your period, which often changes post-birth.

Menstrual cycles can switch gears as adulthood progresses, and changes may result from:

• Pregnancy and birth
• Postpartum hormonal shifts
• Age
• Weight fluctuations
• Stress

In fact, you're all but guaranteed to see your period evolve through perimenopause, the transition into menopause. As OB-GYN Dineasha Potter-McQuilkin, M.D., of Hoboken, New Jersey, puts it, "Your uterus can feel like the Wild West."

We asked experts to demystify the menstruation journey. Read on for their insight into eight helpful facts about periods from post-birth to perimenopause.

Post-Birth Period Pause

The discharge that starts immediately after a childbirth that lasts from two to six weeks, going from reddish to white in color, isn't your period. That's lochia, a collection of blood, tissue, and other waste left from childbirth. It's your body's way of cleaning you out, says Erica Montes, M.D., an OB-GYN in Phoenix.

Dr. Montes adds that people should wear a pad during this time instead of insertable period products like menstrual cups or tampons. That's because these products can injure or infect the healing uterus or worsen vaginal tearing. Plus, an exhausted new parent may forget to take them out.

Your period's return depends on whether or not you're solely breastfeeding, Dr. Montes says. If you're using formula, your period can return in as little as six weeks, around the time of your first postpartum checkup.

On the other hand, if you nurse or pump exclusively, you'll likely go period-free until you start supplementing with solid food, thanks to hormones that suppress ovulation while you produce milk. People who still nurse or pump often, though, may stay period-free even longer.

You Can Get Pregnant Before Your Period Resumes

People who aren't nursing can ovulate as early as 25 days after giving birth, and though breastfeeding tends to keep periods at bay, it can't reliably prevent pregnancy. Known as lactational amenorrhrea method (LAM), this temporary form of birth control relies on the body's natural suppression of ovulation while breastfeeding.

According to the American College of Obstetrics and Gynecology (ACOG), LAM requires exclusive, frequent breastfeeding with feedings spaced no more than four hours apart during the day. For this reason, it is impractical for most people. Additionally, since you begin ovulating before your period resumes, there's a risk of pregnancy with this method, especially the closer you get to six months postpartum.

Only birth control can help avoid a back-to-back pregnancy, which runs a higher risk of premature birth and rupture of a C-section scar, Dr. Montes says. "Pregnancies are safer if you space them out by at least 18 months," she says. "Your body needs to replenish nutrients and shrink your uterus."

ACOG suggest avoiding combined birth control options for the first three weeks after giving birth, as these methods come with a higher risk of blood clots. Further the estrogen in these products have a slight chance of decreasing your milk supply before it is fully established between four to six weeks postpartum.

Birth Control Can Change Your Cycle

Post-pregnancy is a natural time for people to reconsider their birth control options, whether it's because they're ready for a long-lasting option, don't want to take a pill, or aren't keen on a contraceptive's side effects. Transitioning to a new hormonal birth control can affect periods in different ways.

Some contraceptive options can make periods lighter, including:

• Patches
• Pills
• Vaginal rings
• Injections
• Intrauterine devices (IUDs)

These birth control methods work by leveling out hormones, keeping the uterus's lining thin, so there's less blood to shed, Dr. Montes explains. Some pills, IUDs, and shots, especially progestin-only methods, can stop periods altogether for the duration they're used. For the record: "Stopping your period is safe and won't hurt your chances of having a baby later," Dr. Montes says.

On the flip side, Paragard, the nonhormonal copper IUD, can actually spur heavier and longer periods. The metal it contains causes an inflammatory reaction that's toxic to sperm but safe for you, and that leads to more flow, Dr. Montes explains. According to ACOG, more bleeding is usually more common in the first few months and typically decreases within a year.

The Depo-Provera injection can also cause irregular bleeding and can make your period go away during its use. However, you should avoid the injection if you want to have closer-interval pregnancies, since for some people it can delay the return of fertility for up to a year.

Aging Can Affect Periods, Too

A 2020 study in Obstetrics and Gynecology found an age-dependent change in cycle length, including the following:

• Short in the teens
• Stable in the 20s
• Shortened in the 30s and 40s
• Patchy in the 50s

As you get older, your hormones shift, altering your period. As you near and enter perimenopause (usually in your 40s), your ovaries make less estrogen. Some months your ovaries may release an egg, while other months they may not. According to ACOG, this can result in irregular periods—they may be shorter, longer, and days in between may increase or decrease. In addition, Dr. Potter-McQuilkin notes, "as estrogen decreases, you may gain weight around your midsection."

Though many people's periods stay the same, your period may become lighter, heavier, and unpredictable, says Lori Atkins, M.D., an OB-GYN in Fort Worth, Texas. In most cases, there's no reason to be alarmed. "You don't need to read too much into bleeding for five days one month and seven the next or having a heavier period, as long as it's tolerable," says Holly W. Cummings, M.D., M.P.H., assistant professor of clinical obstetrics and gynecology at the Perelman School of Medicine of the University of Pennsylvania.

That said, ACOG calls perimenopause a "diagnosis of exclusion," meaning that since other conditions mimic the symptoms, a health care provider will want to first determine another condition isn't the culprit. Other conditions to rule out include thyroid and hormonal problems, uterine polyps or fibroids, and infection.

In the meantime, you might consider switching the size of your tampon or menstrual cup, if need be, and using nonsteroidal anti-inflammatory drugs (NSAIDs), like naproxen or ibuprofen, to help manage discomfort. You can also ask your health care provider about using hormonal birth control to help lighten periods.

Stress Can Also Alter Your Period

"You're dealing with a lot at this age—kids, career, aging parents," Dr. Potter-McQuilkin says. "Stress does crazy things to our body, including making you skip your period or bleed more heavily." While you can't eliminate all stress from your existence, any tweaks you can make to your lifestyle might reduce stress and help normal periods return. Some ideas:

• Regular exercise
• Balanced diet
• More sleep

Perimenopause Can Begin Earlier for Some People

Menopause might not be on your radar yet. After all, it occurs on average for most Americans who menstruate at around age 51. But it's worth familiarizing yourself with perimenopause, the extended process leading up to it, which can last six to ten years and may start as early as your mid-30s, says Stephanie Faubion, M.D., medical director of The North American Menopause Society and the Mayo Clinic Center for Women's Health.

Estrogen levels may fluctuate wildly in the years before menopause, and symptoms vary from person to person. However, according to Dr. Faubion, common issues include:

• Irregular bleeding
• Intermittent hot flashes
• Trouble sleeping
• Anxiety
• Vaginal dryness or painful sex

If you have a big change in bleeding patterns, whether more frequent and heavier or spaced out and lighter, speak to your health care provider. People entering this phase should try to manage stress and stick to a nutritious diet as the risks of heart disease, diabetes, high cholesterol, and hypertension go up during this period.

If Something Seems Off, Get It Checked Out

While period changes are often totally normal, certain changes to your period can also be signs that something serious may be going on. For example, if you experience the following symptoms, reach out to your health care provider:

• Soaking through more than one pad or tampon per hour
• Passing blood clots bigger than a quarter
• Spotting between periods
• Missing three or more periods

"Any change that feels wrong or is bothersome requires a visit to your gynecologist," Dr. Atkins says. "Menstrual changes and irregularities can be common and normal, but it takes a qualified specialist to work through the issues with you and determine a plan."

Your Period Might Make Some Illnesses Worse

If you have migraines, IBS, or another common condition, you may notice that your symptoms get more intense just before or during your period.

Anemia

It's no surprise that heavy blood loss during your period can worsen anemia, a condition in which the body lacks enough red blood cells to carry oxygen through the body. "Iron supplements and hormonal birth control like pills, vaginal rings, arm implants, and IUDs can make periods lighter," explains Dr. Cummings. Your health care provider may also prescribe the oral medication Lysteda, which is used to treat heavy menstrual bleeding.

Fibromyalgia

The widespread musculoskeletal pain caused by fibromyalgia may worsen days before your period, as can sleep troubles and brain fog. "For a parent, this can be debilitating," says Maggie Cadet, M.D., a rheumatologist in New York City.

Some things that can help alleviate fibromyalgia pain include:

• Medications like naproxen and ibuprofen
• Swimming
• Massage
• Pelvic floor exercises
• Warm baths

Managing stress through methods such as meditation and cognitive behavioral therapy are also key, Dr. Cadet says.

Migraines

These severe headaches can worsen right before and during your period because of hormone fluctuations, says New York City–based neurologist Risa Ravitz, M.D. Keep up with medications you're already taking, she says, and help prevent migraines with the following:

• Drinking lots of water
• Eating regular, nutritious meals
• Getting cardio exercise
• Getting plenty of sleep

Fibroids

These are benign growths or tumors in the uterus. Fibroids tend to grow during pregnancy and shrink postpartum. If they stay large or get even bigger, they can make periods very erratic by prolonging them, and cause heavy bleeding and pain.

Doctors' go-to fix, Dr. Atkins says, is a hormonal contraceptive to manage symptoms. In extreme cases, they can be removed surgically.

Endometriosis

Pain is the hallmark of this condition, in which uterine cells grow beyond the uterine lining. "Pregnancy suppresses it, and that benefit can last three years," Dr. Atkins says. Once it returns, pain starts a few days before your period. Doctors may suppress or adjust your hormones through birth control or opt for surgery if initial treatment fails.

Irritable Bowel Syndrome (IBS)

Symptoms of this disorder of the large intestine include:

• Abdominal pain
• Gas
• Diarrhea
• Constipation

Symptoms get worse during your period thanks to fluctuating hormones. Hormonal birth control can help alleviate symptoms, Dr. Atkins says.

This article originally appeared in Parents magazine's August 2021 issue as "Going With the Flow."