The first menstruation after giving birth is a special event for every woman. Especially as she doesn't know when it will happen again and what her period will be like. It may be lighter than before the pregnancy - or, on the contrary, heavier. It may be more or less painful than before. The duration of each period and the time between them can also change. Periods can also be irregular at first. This is because the entire female cycle first has to settle down again.
And not to forget: In almost all cases, the first menstruation after giving birth is also preceded by ovulation. It is therefore possible for another pregnancy to occur even before the first period after the birth has started.
When can I expect my first menstruation after the birth?
Once again, hormones are involved. During pregnancy, the pregnancy hormone HCG blocks renewed ovulation. This means that menstruation no longer takes place. In order to trigger the first ovulation after the birth, hormone production in the ovaries must stabilise again. This also requires a certain level of oestrogen and progesterone - which, however, has fallen sharply after the birth.
It takes different lengths of time from woman to woman until the hormone balance has been restored. Only then can ovulation take place again and bleeding begin if the egg is not fertilised. For one woman, this may be the case six to eight weeks after giving birth, for another after six months, in rare cases even after a year. The breastfeeding hormone prolactin also has an influence on this. It stimulates milk production, but at the same time inhibits the production of the hormones that ensure the formation of eggs and the development of the uterine lining. More on this below.
It is also important to differentiate: Postpartum haemorrhage - the bleeding that starts immediately after the birth - has nothing to do with the first recurring menstrual period. When the placenta has detached from the uterus as an afterbirth, it leaves a bleeding wound there. The resulting bleeding is still quite heavy in the first few days after the birth, but becomes less and less brownish in colour within about two weeks. The more the wound in the uterus heals, the weaker the lochia becomes. It finally stops when healing is complete. This can take up to six weeks.
However, if, for example, wound healing in the uterus is disturbed, a diminishing menstrual flow can also become more bloody again. It can also be difficult to distinguish this from the return of your period. In such a case, it is best to consult your midwife or gynaecologist.
What influence does breastfeeding have on menstruation after the birth?
Women used to be convinced: "Breastfeeding protects against pregnancy." Be careful - that's not true! I know quite a few mothers who breastfed and became pregnant again shortly after giving birth. The fact is that if the first menstruation after the birth starts again after six to eight weeks, then about two weeks of breastfeeding has already passed. before ovulation has already taken place and made the new pregnancy possible. This means that a new fertilisation is conceivable right at the end of the menstrual flow.
Let's take another look at the interaction of several hormones. They cause an egg follicle to mature and ovulation to occur. These include the hormone FSH (follicle stimulating hormone). It stimulates the growth of follicles in the ovaries, which in turn produce oestrogen. In addition, the hormone LH (luteinising hormone) is produced in the pituitary gland, which ultimately stimulates progesterone production. Progesterone in turn ensures the build-up of the uterine lining.
Your body also releases various hormones every time you breastfeed. These include prolactin. This stimulates milk production and inhibits the production of the hormones FSH and LH. Ultimately, this prevents an increase in oestrogen and progesterone levels - and therefore also ovulation and the build-up of the uterine lining.
So we can see that the mother's prolactin level rises with every breastfeed. However, this is not an automatic protection against a new pregnancy. Whether or not the period will start again and ovulation can occur depends on how frequently and intensively you breastfeed.
What does science know about breastfeeding as a "contraceptive measure"?
The World Health Organisation (WHO) points out that for every 200 women who breastfeed under optimal conditions, one woman will become pregnant. These "optimal conditions" are:
- The baby only receives breast milk.
- Breastfeeding breaks should not be longer than four hours or six hours at night (i.e. six breastfeeds within 24 hours).
- A breastfeeding session lasts at least 10 minutes with a total breastfeeding time of 80 minutes per day.
- The baby is not given a dummy (it only sucks on the breast).
- No menstruation has occurred yet.
- The birth was no more than six months ago.
Another survey comes to the conclusion that 5 per cent of breastfeeding mothers ovulate again six weeks after giving birth. In 25 per cent, ovulation starts again after 12 weeks and in 65 per cent it occurs again after 24 weeks.
To summarise, it can be said that Breastfeeding can make a new pregnancy less likely - but is not a reliable method of contraception. The fact is: it is already enough a single a longer break from breastfeeding at night, which lowers the prolactin level and thus enables ovulation.
If you want to be on the safe side, you should therefore take care of (additional) contraception in good time. Your midwife or gynaecologist can advise you on which method is right for you and your partner.
Which products are now suitable for menstrual hygiene?
Ultimately, every woman has her own personal preference for pads, tampons or menstrual cups. If, for example, the intensity and duration of menstrual bleeding changes after giving birth, the preferred hygiene product may also change.
If you have always been a fan of tampons, you may now prefer to use a pad. The vagina can be dry due to the lack of oestrogen, which makes inserting a tampon more difficult. Even a still weakened Pelvic floor can make wearing a tampon problematic because it may not be held in place well. A slipped tampon simply feels uncomfortable.
Many women who want to continue using tampons also prefer to use tampons that are one size larger or have wings for better leakage protection after giving birth.
If your period starts again after six to eight weeks after giving birth, it is better to refrain from using tampons at this point to rule out the risk of infection. This is especially true if birth injuries may not yet have fully healed. For the same reason, it is also better to use a condom if you want to have sex again.
