Periods after delivery: when do they return and can you get pregnant before then?

English version

There is no single date by which menstrual periods must return after childbirth. The timing varies considerably and is influenced particularly by breastfeeding.

If you are not exclusively breastfeeding, a period may return as early as five to six weeks after delivery. With frequent exclusive breastfeeding, including night feeds, periods may remain absent for several months or longer. Both patterns can be normal.

Is bleeding soon after delivery a period?

Usually not. Vaginal bleeding after childbirth is called lochia. It contains blood, mucus and tissue from the uterus as it recovers after pregnancy.

Lochia commonly:

• Begins as red bleeding.
• Gradually becomes brown or pink.
• Later becomes lighter, yellowish or whitish.
• Reduces over several weeks.
• May briefly appear heavier after activity or breastfeeding.

Postnatal bleeding commonly continues for several weeks and often settles within six to eight weeks, although the duration varies. Bleeding that had stopped and then returns later may be a period, but it may also have another cause.

How does breastfeeding affect periods?

Frequent breastfeeding raises prolactin, a hormone that can suppress ovulation. Periods may therefore remain absent while breastfeeding, especially when:

• The baby receives only breast milk.
• Feeding occurs frequently during the day and night.
• There are no long gaps between feeds.
• Formula or solid foods have not been introduced.
• Night feeds continue.

Periods may return when feeds become less frequent, the baby sleeps longer, formula or solids are introduced, or breastfeeding stops. Some women continue breastfeeding after their cycles restart. Having no period during breastfeeding does not usually mean that blood is accumulating inside the uterus.

Can you become pregnant before the first period?

Yes. Ovulation occurs before menstrual bleeding, so the first egg may be released before you see your first postpartum period.

Pregnancy can occur from around three weeks after childbirth, even while breastfeeding and before periods return. Contraception therefore needs to be discussed early if another pregnancy is not currently planned.

Breastfeeding should not be assumed to provide reliable contraception unless all criteria for the lactational amenorrhoea method (LAM) are fulfilled:

• The baby is younger than six months.
• Menstrual bleeding has not returned.
• Breastfeeding is exclusive or nearly exclusive, day and night, without long intervals.

If any criterion changes, another contraceptive method is required. Even light menstrual spotting may mean that fertility is returning.

What may the first periods be like?

The first few cycles after childbirth may be irregular or difficult to predict, heavier or lighter, longer or shorter, more or less painful, or accompanied by small clots. They may become irregular again when breastfeeding patterns change.

Hormonal contraception can also change bleeding. A contraceptive implant, injection, hormonal intrauterine system or progestogen-only pill may cause irregular bleeding or stop periods.

When should you arrange a consultation?

• Bleeding remains troublesome or unpredictable.
• Periods are extremely heavy or painful.
• Bleeding repeatedly occurs between periods or after sex.
• You feel tired, dizzy, breathless or unusually weak.
• There is pelvic pain, fever or unpleasant-smelling discharge.
• Periods remain absent after breastfeeding has substantially reduced or stopped.
• Pregnancy is possible.
• You are unsure whether bleeding is lochia, a period or a complication.
• You would like advice about contraception or planning another pregnancy.

Assessment may include a pregnancy test, blood count, thyroid testing, pelvic examination or ultrasound depending on the symptoms. Not every patient requires every test.