What is the return of menstruation?

The return of menstruation is the resumption of the menstrual cycle after childbirth, signaling the return of ovarian function and the renewed production of estrogen and progesterone hormones. This phase represents a normalization of the female body after pregnancy. It is important to differentiate the return of menstruation from lochia, the latter being the vaginal bleeding and discharge after childbirth. Lochia is the result of the uterus healing and the elimination of placental residue, unrelated to ovulation or the menstrual cycle.

The return of menstruation also indicates the return of fertility, even before the reappearance of menstruation. Ovulation can occur before the first postpartum menstrual cycle, making pregnancy possible before the return of menstruation. This resumption marks a key step towards the return of the woman's body to its pre-pregnancy state, highlighting its importance in the postpartum period.

How long does the return of menstruation last?

Contrary to what one might think, the return of menstruation does not last over time: it refers to the first menstrual period occurring after childbirth, marking the resumption of ovarian activity. This first period can last from 3 to 8 days, like normal menstruation, but it can be more abundant or irregular. What can take time, however, is the regularization of the menstrual cycle, which can spread over several weeks or even several months, especially if the woman is breastfeeding. The return of menstruation varies depending on the woman, their level of breastfeeding and their postpartum hormonal balance.

How to cope with the return of your period after having a baby?

The return of menstruation after pregnancy is a crucial time for many women. This postpartum phase can vary considerably depending on various physiological and individual factors. Understanding these changes and knowing how to manage them is essential for a smooth transition to this new menstrual cycle.

What happens in our body when our period returns?

The return of menstruation after childbirth, known as “return of menstruation,” is influenced by various factors, including hormones, breastfeeding, and the method of contraception used . On average, the first postpartum period can appear between 6 weeks and 3 months after delivery, but this varies from woman to woman.

The return of menstruation varies from one woman to another and from one pregnancy to another. After giving birth, the woman has brownish discharge called lochia, this flow, abundant and rich in clots, can last several days. Lochia is uterine discharge made of blood, liquid and mucous fragments, which testifies to the healing of the uterine wound left by the expulsion of the placenta after childbirth. This physiological phenomenon lasts 2 or 3 weeks , a little less in the case of breastfeeding.

Around the twelfth day after giving birth, discharge is often heavier , without being followed by a resumption of the menstrual cycle: this is called "small return of menstruation" . It results from the healing of the uterus and the rejection of waste.

Then comes the return of menstruation. If the woman is not breastfeeding, menstruation returns six to eight weeks after the birth of the child. If breastfeeding, menstruation returns later: either after the end of breastfeeding, or, if breastfeeding continues, approximately 3 months after delivery. According to the French National Institute of Health and Medical Research (INSERM), the return of menstruation after childbirth can be delayed due to breastfeeding, as it can suppress ovulation and therefore delay the return of menstruation.

Difference between lochia and return of menstruation

It is essential to distinguish lochia from the return of menstruation, although these two terms are often confused, they do not describe the same phenomena.

• Lochia is a vaginal discharge present immediately after childbirth, consisting of cervical mucus, vaginal secretions, and sometimes blood clots. This discharge is a result of the uterus healing and the removal of remaining placental debris. Lochia can persist for several weeks and is not associated with ovulation or the menstrual cycle.
• The return of menstruation, on the other hand, signals the resumption of menstruation and therefore the menstrual cycle. This phenomenon is characterized by bleeding resulting from the drop in estrogen and progesterone levels, followed by ovulation and a regular menstrual cycle. Unlike lochia, the return of menstruation indicates that the woman's body is ready for another conception.

The postpartum period is also marked by significant hormonal changes. The rapid decline in placental hormones (progesterone and estrogen) after childbirth is followed by an increase in FSH (follicle-stimulating hormone) and LH (luteinizing hormone) levels, leading to the resumption of ovulation and the menstrual cycle.

When does the return of menstruation occur?

The return of menstruation, which marks the reappearance of menstruation after pregnancy, varies considerably from one woman to another. This variation is influenced by many factors, of which breastfeeding plays a major role.

Breastfeeding and return of menstruation: what you need to know

Breastfeeding has a significant impact on the timing of menstrual cycle return. Prolactin, a hormone that stimulates milk production, inhibits ovulation, thus delaying the return of the menstrual cycle. For women who exclusively breastfeed, this return can be delayed by several months or even more than a year, depending on the frequency and duration of feedings.

As the baby spaces out feedings or sleeps longer at night, prolactin levels drop, potentially promoting the resumption of ovulation and the menstrual cycle. However, even while breastfeeding, some women may experience an earlier return of their period, depending on their hormonal sensitivity and feeding frequency. Understanding the link between breastfeeding and the menstrual cycle is essential for anticipating a new pregnancy or better navigating this hormonal transition phase. It is recommended to speak with a midwife or healthcare professional if you have any doubts or experience unusual symptoms.

Can he have an absence of menstrual bleeding?

The return of menstruation can be delayed or not occur for a variety of reasons. Aside from breastfeeding, factors such as eating disorders, intense emotional stress, or excessive physical activity can be the cause. Poor nutrition, a deficiency or excess of body fat can also explain this absence.

If menstruation does not return after 6 to 8 weeks postpartum for women who are not breastfeeding, or after stopping breastfeeding, it is advisable to consult a healthcare professional. This consultation will help identify possible causes and rule out any complications.

Signs and characteristics of the first postpartum period

The reappearance of menstruation after pregnancy is accompanied by signs and characteristics that may differ from those experienced before pregnancy. These first postpartum periods often present notable peculiarities.

One of the most striking aspects is the intensity of the bleeding. These first periods can be longer and heavier than usual. It is therefore essential for women to have protection adapted to a heavy flow, such as sanitary towels or specific menstrual cups.

Menstrual cramps can also vary, becoming either more intense for some or less bothersome for others, compared to their pre-pregnancy experience. The appearance of small blood clots and irregular cycles are also possible, especially in the first few months after childbirth.

Resumption of ovulation and risks of pregnancy

It's important to note that ovulation can resume even before menstruation returns. The first postpartum ovulation can occur up to three weeks before menstruation returns, making the woman fertile and likely to conceive again. This explains why some women can become pregnant even before their first postpartum period.

The possibility of a closely spaced pregnancy must be considered, especially if the woman does not wish to conceive immediately. Therefore, it is essential to consider contraceptive methods as soon as ovulation returns, even before the return of menstruation. Options include the use of condoms, spermicides, birth control pills, or intrauterine devices, depending on personal preference and medical recommendations.

When should you consult a healthcare professional?

The return of menstrual cycles after childbirth is a natural process, but there are situations where consulting a healthcare professional becomes essential. These consultations are essential to monitor the mother's health and address any potential complications or concerns.

It is generally recommended to have a postnatal medical check-up between the 6th and 8th week after delivery. This visit allows for the mother's health to be assessed, wound healing to be monitored, and general physical and mental health to be checked.

Outside of these scheduled visits, it is important to recognize when urgent consultation with a healthcare professional is necessary.

Abnormal signs to watch for

Certain conditions require immediate medical attention. Here are some abnormal signs to watch for:

- Excessive or prolonged bleeding : If postpartum bleeding is heavy, lasts more than 3 weeks, or is accompanied by severe pain, it is imperative to consult a doctor. These symptoms could signal the presence of placental debris or other complications.

- Fever and foul odor : A fever with foul-smelling bleeding may indicate an infection, such as endometritis. In this case, prompt consultation is necessary.

- Severe pain : Abnormally severe menstrual cramps or persistent pelvic pain should be evaluated by a healthcare professional to rule out any complications.

- Absence of periods : If your period has not returned 3 months after giving birth (or complete weaning if breastfeeding) and the pregnancy test is negative, it is advisable to consult a doctor to determine the cause.

- Emotional changes : Signs of postpartum depression, such as persistent sadness, feelings of detachment, or difficulty caring for yourself and the baby, should be discussed with a healthcare professional.

What hormones play an important role after childbirth?

1. Oxytocin: This hormone is crucial during childbirth because it promotes uterine contractions during labor and the expulsion of the placenta . After delivery, oxytocin continues to be secreted, which helps the uterus return to its normal size (uterine involution) by promoting uterine muscle contractions and the reduction of the wound where the placenta was attached. This helps reduce blood flow to this area and minimize bleeding.
3. Progesterone: During pregnancy, progesterone is produced in large quantities to support the growth of the uterus and maintain the uterine lining. After delivery, when the placenta is delivered, progesterone levels drop rapidly, which helps trigger the shedding of lochia by allowing the uterine lining to shed and reestablish itself.
5. Estrogen: These hormones, which increase during pregnancy, decrease after delivery. Decreased estrogen levels are also associated with the onset of lochia. The drop in estrogen after delivery helps trigger the healing process of the uterus and uterine lining, leading to the expulsion of lochia.
7. Prolactin : This hormone is vital for lactation and the development of the mother-child bond. Its concentration increases significantly after childbirth, stimulating breast milk production and promoting sleep. As long as breastfeeding continues, prolactin is produced in large quantities, helping to maintain milk production and strengthen the emotional bond between mother and child.
9. Cortisol : Known as the stress hormone, cortisol plays a role in mobilizing energy for new maternal responsibilities, such as breastfeeding and caring for a newborn. However, prolonged high cortisol levels can be tiring and contribute to postpartum depression.
11. Melatonin : A sleep-regulating hormone, melatonin remains important after childbirth to help establish a regular sleep cycle. Quality sleep is essential for the mother's recovery and well-being.

These hormones, by interacting and gradually decreasing after childbirth, play a vital role in the natural physiological process that allows the uterus to recover and heal after pregnancy and childbirth.

How to manage hormonal and emotional changes?

The return of menstruation after pregnancy can be accompanied by significant hormonal changes . This can have an impact on mood. According to the National Association for Psychiatric Research, these hormonal changes may be linked to mood disorders such as postpartum depression, energy, and overall well-being. Some women may experience more intense premenstrual symptoms , while others may experience heavy bleeding or increased menstrual pain. A study by the French National Research Agency (ANR) highlighted the importance of postpartum hormonal changes in the return of menstruation.

Here are some strategies and tips to help you do this effectively:

Rest and Sleep : Prioritizing rest and sleep is essential, even if it can be challenging with a newborn. Try to sleep when the baby sleeps and don't hesitate to ask those around you for help to get some uninterrupted sleep.

Balanced Diet : Eating a nutrient-dense diet, including whole foods, lean proteins, and healthy fats, helps stabilize hormones and improve mood. Choose foods rich in omega-3 fatty acids, such as fish and flaxseeds.

Regular Exercise : Engaging in regular physical activity, such as walking, yoga, or swimming, helps regulate hormones and improve mood. These activities also help reduce stress and anxiety.

Stress Management : Stress management techniques, such as meditation, deep breathing, mindfulness, and sophrology exercises, are very beneficial for regulating emotions and reducing anxiety. They promote emotional balance and help prevent mood disorders.

Social and Family Support : Support from loved ones and postpartum support groups is essential. Sharing parenting responsibilities, seeking help with daily tasks, and having an emotional support network can greatly ease the transition to motherhood.

Expressing Emotions : It's important to recognize and express your emotions, whether positive or negative. Allowing yourself to ask for help and taking time for yourself, such as a solitary walk or a leisure activity, contributes to a healthy emotional balance.

Psychotherapy : For those experiencing persistent symptoms of postpartum depression or anxiety, psychotherapy can be a valuable resource. It helps you understand and manage your emotions and find strategies to ease the signs of depression and anxiety.

How to better cope with the return of your period?

• Self-care : Paying attention to self-care is crucial. A healthy lifestyle, including a balanced diet, regular exercise, and relaxation, can help alleviate menstrual symptoms.
• Medical consultation : If periods are excessively painful or if persistent depressive symptoms are present, consulting a health professional is essential to obtain appropriate advice and treatment.
• Stress management : Stress management can be beneficial in alleviating premenstrual symptoms. Relaxation techniques such as meditation or yoga are recommended.

What are the right actions to take?

When menstruation returns after childbirth, it is advisable to avoid certain practices to promote optimal recovery of the body and minimize the risk of complications:

1. Early intercourse: It is recommended to wait until your doctor gives the all-clear, usually after the postpartum visit, before resuming intercourse. This allows your body to fully recover, including time for lochia to stop and prevent infections.
2. Tampons : Avoid using tampons when your period returns after childbirth. Tampons can increase the risk of infection, especially while the uterus is still healing. Instead, use period panties.
3. Public baths or swimming pools: It is advisable to avoid public baths or swimming pools during the first few weeks after delivery to reduce the risk of infections.
4. Intense physical activity: During the first few weeks after delivery, it is recommended not to do any intense exercise or physical activity, especially if bleeding is heavy. It is important to allow your body to recover and strengthen gradually.
5. Neglecting postpartum care: It's crucial to follow medical advice and take care of yourself during this time. Make sure you get plenty of rest, maintain a healthy diet, and stay hydrated.

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CONCLUSION

The resumption of menstruation after childbirth marks an important phase in a woman's recovery and physical adjustment. It is essential to understand that this phenomenon signals the return of fertility and the menstrual cycle, which can be influenced by breastfeeding as well as various hormonal and psychological factors.

To approach this period in a beneficial way, it is essential to prioritize adequate rest, a varied and balanced diet, and manage stress with appropriate methods. Postpartum consultations and the support of a reliable medical network are essential for a complete recovery and to prevent or treat possible complications such as postpartum depression.

Furthermore, the importance of contraception to avoid another premature pregnancy and of consulting a healthcare professional in the event of any unusual symptoms should not be underestimated. By taking care of your physical and mental well-being, you will be able to get through this period with confidence and peace of mind, thus ensuring an optimal quality of life for you and your child.

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SOURCES:

1. National Institute of Health and Medical Research (INSERM)
2. National Research Agency (ANR)
3. National Association for Research in Psychiatry
4. https://www.doctissimo.fr/html/sexualite/hygiene-feminine/articles/gr_6502_retour_couche.htm
5. https://www.bepanthengamme.fr/futures-mamans/retablissement-et-sante/vos-regles-apres-laccouchement
6. https://www.dictionnaire-medical.fr/definitions/1002-lochiae/
7. Learn more about lochia: https://www.perdieme.com/blogs/infos/lochies-saignements-post-partum