Generality
In the article dedicated to the relationship between pregnancy and menstruation, we investigated the biological significance of these small hemorrhages, explaining why during gestation the menstrual flow disappears, and then reappear some weeks or months after the birth.
The occurrence of a new menstruation after a pregnancy is called capoparto, and should not be confused with the so-called lochiazioni, loss of blood combined with pregnancy residues that occur during the puerperium. In fact, after giving birth, blood loss will continue for a few days, decreasing in quantity and becoming increasingly clear, until it is normally exhausted within a couple of weeks.
During breastfeeding
Can the resumption of menstruation occur during lactation?
In women who breastfeed the resumption of menstruation can delay even a few months, due to the hormonal antagonism, against estrogen, exerted by prolactin, the lactation hormone.
Breastfeeding increases both the likelihood of postponing the return to menstruation and the possibility of an anovulatory division (in practice the first menstruation appears without ovulation, thus the possibility of becoming pregnant again).
As a rule, in women who breastfeed regularly, the return of menstruation will be the more anticipated and the more numerous will be the anovulatory cycles.
On average, in breast-feeding women menstruation reappears at the end of breastfeeding (5-6 months after birth). If, on the other hand, the woman is not breastfeeding, the loss of blood in the ward may occur about 6-8 weeks after the baby is born.
During breastfeeding ovulation continues to be suspended, provided that the lactation hormones are secreted on a regular basis, so that the newborn is exclusively breastfed, both day and night, at regular intervals and less than four hours .
Get pregnant
Can I get pregnant due to sexual intercourse consumed during breastfeeding, if my period has not yet reappeared?
After giving birth there is no way to predict with certainty when the woman will return to being fertile; for this reason during breastfeeding it is not appropriate to rely too much on this natural mechanism as a form of contraception; its effectiveness in this sense, even if not excellent, is however good, but only in the case in which breastfeeding is regular and constant. Among other things, the resumption of ovulation and the consequent menstruation during breastfeeding does not necessarily mean high probability that the woman remains pregnant; lactation hormones, in fact, can induce the development of deficient oocytes and an inadequate luteal phase, with a consequent low level of estrogen and progesterone, which results in a natural obstacle to the onset of a new pregnancy.
Given that - although difficult - it is possible to become pregnant even before the onset of the bump, during lactation as a contraceptive method it is advisable to use a condom or diaphragm. If the birth took place vaginally, the spiral can be inserted as soon as the uterus returns to its original size, while in the case of a caesarean it is necessary to wait six months to prevent the device from becoming trapped in the internal incision scar. Estroprogestinic oral contraceptives cannot be taken during breastfeeding, as estrogens may inhibit milk production; instead it is possible to take the progestagen-based pill, which is harmless for the baby and quite effective.
Questions and answers
What is the normal amount of the first menstrual flow during breastfeeding?
The head section can be a little more abundant than the usual menstrual flow.
The recovery of menstrual cycles after childbirth is quite irregular, is it normal?
Often, menstrual cycles can be irregular for a few months and, as anticipated, not all are ovulatory.
If menstruation after childbirth is slow to arrive should worry?
If your period does not appear within six months of the date of delivery, it is advisable to report it to your gynecologist or treating doctor. In some cases - fortunately very rare in industrialized countries - severe bleeding and shock related to childbirth can damage the pituitary (Sheehan's syndrome).
If menstruation reappears during breastfeeding, can I continue to breastfeed?
The reappearance of menstruation during breastfeeding must NOT suspend the breastfeeding itself, although in this period the milk may take on a slightly different taste, which may not be pleasing to the child; moreover, it is possible to observe a decrease in the quantity of milk, and very often an increase in gastro-intestinal disorders with variations in the consistency of the stools and evacuation. Sometimes skin irritations and other ailments also appear that push mother and child to abandon breastfeeding. However, during the first menstruation breastfeeding should not be suspended, even when the newborn feeds less willingly, is irritable and evacuates more often and in a less consistent manner.
