It is always interesting for new mothers when menstruation begins after childbirth. During the restoration of the cycle, it can change the length, menstruation often acquire a different character, intensity, duration, become more or less painful than before pregnancy. Often this is the norm, but in some cases, a consultation with a gynecologist is required.

Bleeding in the postpartum period

Postpartum bleeding, or lochia, is the cleansing of the wound surface, which is formed at the site of the separated fetal membranes and placenta. They last during the entire period of restoration of the inner surface of the uterus.

At this time, the uterus is especially vulnerable to infection, so you should regularly change sanitary pads and monitor the nature of the discharge. They are maximally expressed within 3 days after childbirth, and then gradually weaken.

Sometimes such discharge completely stops in just a day. This is due to the retention of blood in the uterine cavity (), which leads to an increased risk of infection. In this case, the help of a doctor is necessary.

Normally, the cleansing of the uterus after the process of natural childbirth lasts from 30 to 45 days. After a surgical delivery, this time may increase, which is explained by the formation of a scar and longer healing.

How to distinguish between menstruation and bleeding after childbirth?

Lochia gradually change their character. By the end of the 1st week, they become lighter, after 2 weeks they acquire a mucous character. Within a month, an admixture of blood may appear in them, but its amount is insignificant. Usually a woman easily distinguishes this process from menstruation. There must be at least 2 weeks between the cessation of lochia and the onset of the first menstruation. In case of doubt, it is better to consult a gynecologist or at least start using barrier contraception that protects the uterus from infections.

Start of menstruation

There are no periods during pregnancy. This is a natural protective mechanism for preserving the fetus, which is regulated by hormones. After childbirth, the restoration of the normal hormonal status of a woman begins. It lasts for a month if breastfeeding is not started.

When should menstruation start after childbirth?

This period is determined primarily by the type of feeding of the child: natural or artificial. Breast milk is produced under the influence of the pituitary hormone prolactin. It is he who inhibits the growth of the egg in the ovary during lactation. The level of estrogen does not increase, therefore, when breastfeeding, menstruation begins, on average, 2 months after childbirth, more often when feeding “by the hour”.

For many young mothers, this interval is extended to six months or more, especially when feeding “on demand”. In very rare cases, when saving breastfeeding, even periodic, women note that they have no menstruation for a year, and sometimes even longer. In such cases, you need to regularly use contraception, and if necessary, do a pregnancy test. You also need to consult a doctor to rule out hyperprolactinemia.

With artificial feeding from birth, the duration of the cycle is restored in a month and a half. At this time, and occurs, so that a new pregnancy is possible.

When a baby is fed only breast milk, a woman may not have her period all this time. In this case, the first menstruation after childbirth will begin within the first six months after the end of lactation “on demand” or the introduction of complementary foods. However, this is not necessary, and even during the period of breastfeeding, menstruation can be restored.

With mixed feeding (from a bottle and naturally), the recovery of menstruation develops faster, within 4 months after childbirth.

How long do periods last in the postpartum period?

Often the first menstruation is very heavy. There may be strong discharge, menstruation with blood clots. If you have to change the pad every hour, you should seek help from a doctor: this may be a symptom of bleeding that has begun. Subsequent periods usually become normal.

In other cases, in the first months, women have irregular spotting. This is typical for breastfeeding, when prolactin synthesis gradually decreases.

Additional factors affecting the rate of recovery of a normal cycle:

• difficulties in caring for a child, lack of sleep, lack of help from relatives;
• unhealthy diet;
• too young age of the mother or late birth;
• concomitant diseases (diabetes, asthma and others), especially requiring hormone therapy;
• complications after childbirth, for example, Sheehan's syndrome.

Changes in the menstrual cycle

Irregular periods often persist for several cycles after childbirth. These changes do not have to be permanent. Within 1-2 months, the cycle normally returns to prenatal characteristics or changes slightly in duration.

• Scanty periods can normally occur during the initial 2-3 cycles, especially if mixed feeding is used.
• During the first cycles after childbirth, on the contrary, some women experience heavy periods. This may be normal, but if menstruation does not become normal in the next cycle, you need to consult a gynecologist.
• The regularity of menstrual flow is disturbed, that is, the cycle goes astray.
• Painful periods may occur, even if a woman never complained of pain before pregnancy. The reason for this is infection, too much contraction of the uterine wall. In most cases, on the contrary, painful periods before pregnancy become normal. This is due to the normalization of the location of the uterus in the body cavity.
• Some women develop or its precursors: nausea, swelling, dizziness, emotional changes before menstruation.

Causes of postpartum menstrual changes

The delay in menstruation after childbirth appears under the influence of changing hormone levels:

• secretion of prolactin in the pituitary gland, which helps to secrete breast milk and suppresses ovulation;
• suppression of estrogen production by prolactin, which leads to irregular periods or their total absence during breastfeeding (lactational amenorrhea).

When a child eats only mother's milk, and “on demand”, and not “by the clock”, and a woman has no menstruation for six months after giving birth, this is the norm.

After the onset of menstruation, it is advisable to start using contraception. Although breastfeeding reduces the chance of conception, it is still possible. For example, if menstruation began after childbirth and then disappeared, the most probable cause this is a second pregnancy. It should also be remembered that ovulation occurs before the onset of menstrual bleeding. Therefore, pregnancy is quite possible even before the first menstruation. If a woman is concerned about why there is no menstrual bleeding for a long time, she must first do a home pregnancy test, and then contact a gynecologist. You may need to consult an endocrinologist.

Not worth it after spawn menstrual cycle stop breastfeeding. Menstruation does not change its quality. It happens that a child these days does not eat well, is naughty, refuses to breastfeed. This is usually associated with emotional disturbances in a woman, her feelings about the quality of feeding.

During menstrual bleeding, the sensitivity of the nipples may increase, feeding becomes painful. To reduce such sensations, it is recommended that before giving the baby a breast, massage it, warm it, apply a warm compress to the nipples. It is necessary to monitor the cleanliness of the chest and axillary area. During menstruation, the composition of sweat changes, and the baby smells it differently. This may be another reason for feeding difficulties.

irregular periods

What to do if the menstrual cycle has become irregular:

1. In the first months of the postpartum recovery period, do not panic. In most cases, this is the norm. For each woman, the normalization of the cycle occurs individually, usually during the first months of the resumption of menstrual bleeding. Irregularity is more common in women who are breastfeeding.
2. It takes about 2 months to restore the normal function of all organs and systems. Balance in the endocrine system comes later, especially if breastfeeding is used. Therefore, a woman can feel quite healthy, but at the same time she will experience the absence of menstruation.
3. Pay attention to the irregular cycle should be only after 3 cycles. This may be due to an inflammatory process, or a tumor of the genital organs. A delay in the second period is not dangerous, unless it is associated with a second pregnancy.

If you have any doubts, it is better to consult a gynecologist, get diagnosed in a timely manner and start treatment.

The cycle after the pathological course of pregnancy or childbirth

Menstruation after a frozen pregnancy is not restored immediately. Only in some women regular bleeding appears after a month. In most cases, the hormonal imbalance that led to the termination of pregnancy causes the irregularity of the cycle.

After the termination of a missed pregnancy or abortion, the first menstruation occurs within 45 days. If this does not happen, the woman should seek help from a gynecologist.

To exclude such causes of amenorrhea as the remaining part of the fetal egg in the uterus or inflammation, 10 days after the termination of a frozen or normal pregnancy, an ultrasound scan is necessary.

The first menstrual flow after begins in the period from 25 to 40 days after its completion. If they started earlier, it's probably uterine bleeding which requires medical attention. A delay of more than 40 days also requires a consultation with a gynecologist. If the disease caused severe stress in a woman, it is considered normal to lengthen the recovery time to 2 months.

Menstruation after surgery is restored in the same way as after normal childbirth. During lactation, periods do not come for six months. With artificial feeding, there is no period for 3 months or even less. Both in physiological and in childbirth by caesarean section, in a small part of women, the cycle is not restored within a year. If no other pathology is found, this is considered normal.

In the first few months after a frozen, intrauterine pregnancy or caesarean section, the cycle may be irregular. Subsequently, its duration may change compared to the previous one. But normally it is not less than 21 days and not more than 35 days. Menstruation lasts from 3 to 7 days.

Pathology of menstruation

Sometimes bleeding that begins in a woman after childbirth is pathological. In this case, you should not wait for several cycles so that they normalize, but immediately consult a doctor.

• The sudden cessation of postpartum discharge is a sign of a bend in the uterus or, accumulation of lochia in the uterine cavity - lochiometers.
• Scanty periods for 3 or more cycles. Perhaps they are a symptom of hormonal disorders, Sheehan's syndrome or endometritis.
• Irregularity of menstruation six months after its restoration, a break between spotting for more than 3 months. Most often associated with ovarian pathology.
• Excessive bleeding for 2 or more cycles, especially after a surgical delivery or abortion. They are often caused by the tissues of the membranes remaining on the walls of the uterus.
• The duration of menstruation is more than a week, which is accompanied by weakness, dizziness.
• Abdominal pain, fever, bad smell, discoloration of vaginal discharge - a sign of a tumor or infection.
• Spotting before and after menstruation is a likely symptom of endometriosis or an inflammatory disease.
• Itching in the vagina, an admixture of curdled discharge is a sign.
• Bleeding twice a month that persists for more than 3 cycles.

In all of these cases, you need the help of a gynecologist.

Sometimes, despite the apparent health of a woman, menstruation does not occur at the right time. This may be a symptom of a complication of childbirth - Sheehan's syndrome. It occurs with severe bleeding during childbirth, during which blood pressure drops sharply. As a result, the cells of the pituitary gland, the main organ that regulates the function, die. reproductive system.

The first sign of this disease is the absence of postpartum lactation. Normally, in the absence of milk, menstruation appears after 1.5-2 months. However, with Sheehan's syndrome, there is a deficiency of gonadotropic hormones. Violated egg maturation in the ovary, no ovulation, no menstrual bleeding. Therefore, if a woman who has given birth does not have milk, and then the cycle is not restored, she needs to urgently consult a doctor. The consequences of Sheehan's syndrome are adrenal insufficiency, which is accompanied by frequent infectious diseases and a general decrease in the body's resistance to various stresses.

There is also the opposite problem -. This condition is caused by an increase in the production of prolactin in the pituitary gland after the end of lactation. This hormone inhibits the development of the egg, causes anovulation, disrupts the normal thickening of the endometrium in the first phase of the cycle. Its excess leads to the absence of menstruation against the background of the ongoing synthesis of milk.

The main causes of hyperprolactinemia are pituitary adenoma, gynecological diseases, polycystic ovaries.

When a woman is healthy, her cycle is restored normally. To avoid possible failures, you need to follow some simple recommendations:

1. To give the body the opportunity to quickly restore the synthesis of hormones, you need to fully eat. Lots of fruits, vegetables, whole grains and water, combined with regular exercise – effective method restoring hormonal balance. The menu should include dairy products, cottage cheese, meat. After consulting with your doctor, you can take a multivitamin for nursing mothers.
2. Not to accept . They can change the hormonal background, and cause unpredictable cycle changes. If a woman is sexually active, it is better for her to use condoms or other non-hormonal methods of contraception.
3. Organize your schedule as efficiently as possible. If the baby does not sleep well at night, you should try to get enough sleep during the day. Do not refuse any help from loved ones. A good physical condition of a woman will help her recover faster.
4. In the presence of chronic diseases (diabetes, thyroid pathology, anemia, and others), it is necessary to visit the appropriate specialist and adjust the treatment.

It is known that after childbirth, a woman's body needs some time for those organs and systems that have undergone changes during pregnancy and childbirth to return to normal. This usually takes 6-8 weeks. The exceptions are the mammary glands and the hormonal system: they need more time to recover. It is with hormonal changes that recovery is associated. This complex process deserves a detailed discussion.

A short digression into physiology

Immediately after childbirth, the level of proteins that were produced by the placenta and regulated many metabolic processes in the body of the expectant mother sharply decreases. Special parts of the brain - the hypothalamus and the pituitary gland - are a kind of "conductor" of the endocrine glands. They regulate the activity of various endocrine glands - the thyroid gland, adrenal glands, ovaries in women and testicles in men. In the postpartum period, the endocrine system, in particular the pituitary gland, produces the hormone prolactin, which is sometimes also called the "milk hormone", because it stimulates the formation of milk in women after childbirth and at the same time suppresses the cyclic production of hormones in the ovary, thereby preventing maturation processes ovulation and ovulation - the release of an egg from the ovary. That is why most women do not have periods during the entire period of breastfeeding. If the baby eats only breast milk, then the onset of menstruation is likely at the end of the lactation period, and in the case of mixed feeding, menstruation is restored by the 3-4th month after childbirth. But it should be noted that there are exceptions to every rule, and in women who are breastfeeding babies for up to a year or more, menstrual cycles can be restored at the same time.

I would like to warn against a mistake: often a young mother is sure that in the absence of regular menstrual cycles during the feeding period, pregnancy cannot occur. This is not true. , which means that conception can happen during this period.

In the absence of lactation, ovulation occurs on average at the 10th week after birth, and the first menstruation occurs at the 12th. Menstruation may appear on the 7-9th week after childbirth; in such cases, the first menstrual cycle is usually anovulatory, ie. is not accompanied by the release of the egg from the ovary.

After a cesarean section, the restoration of the menstrual cycle occurs in the same way as after natural childbirth, and depends on the method of feeding.

What can you feel

Discharge from the genital tract continues from the moment of delivery until the 6-8th week of the postpartum period. Despite their similarity with menstrual blood, especially in the first 3-4 days, these discharges differ in origin from menstrual ones; they are called lochia. In place of the separated placenta, an extensive wound surface is formed; in the first three days, the discharge from it is bloody in nature, then, as the wound heals (from the 3rd-4th to the 7-10th day), they become serous-sanitary, and from the 10th day they acquire a yellowish-white color, while their number decreases. At the 5-6th week, the discharge from the uterus stops and has the same character as before pregnancy.

More often, resumed menstruation after childbirth is of a regular cyclic nature, but it is permissible to establish a menstrual cycle during the first 2-3 cycles, which can be expressed by a delay in menstruation, or, conversely, a decrease in the interval between menstruation. Despite the likelihood of these phenomena being normal, with such symptoms, you should consult a doctor to exclude diseases such as inflammation of the internal genital organs, tumors of the uterus and ovaries, etc.

A normal menstrual cycle lasts an average of 28 days (21-35 days). The first day of menstrual bleeding is called the first day of the menstrual cycle. Menstruation usually lasts 4-6 days (+ 2 days). The greatest amount of blood loss is observed during the first and second days. The average amount of blood loss per cycle is 30-35 ml (within 20-80 ml). Blood loss of more than 80 ml per menstrual cycle is considered pathological.

The interval between menstruation and the duration of bloody may be different; it is important that they "fit" within the limits of the physiological norm described above.

It should be noted that sometimes the nature of menstruation after childbirth changes. So, if a woman had irregular periods before giving birth, then after giving birth they can become regular. Painful periods before childbirth may become painless after childbirth. This is due to the fact that soreness is caused by the so-called bending of the uterus anteriorly, which makes it difficult for the outflow of menstrual blood from the uterus. During pregnancy and childbirth, the relative position of organs in abdominal cavity, and the uterus acquires a more physiological position.

Possible menstrual irregularities

One of the reasons for the violation of the restoration of the menstrual cycle after childbirth can be hyperprolactinemia. The pituitary gland produces the hormone prolactin (in smaller quantities, this hormone is also produced in men). Normally, in a woman, the level of prolactin in the blood rises during pregnancy and lactation, which leads to the release of milk by the mammary glands. As soon as a woman stops breastfeeding, prolactin levels drop to normal. If the level of prolactin increases regardless of pregnancy or does not return to normal after the cessation of breastfeeding, then this condition is called pathological hyperprolactinemia (PH). As already noted, prolactin suppresses ovulation. That is why the persistence of an increased amount of prolactin at the end of breastfeeding can cause the absence of menstruation.

This situation is often associated with an increased function of prolactin-secreting pituitary cells, the number of which remains normal or increases very slightly. Another cause of hyperprolactinemia can be prolactinoma - a tumor (adenoma) of the pituitary gland that produces prolactin. This is the most common cause PG in a period not associated with lactation. A pituitary prolactinoma is a benign tumor. Experts call this formation a tumor only because it leads to an increase in the size of the pituitary gland. The cause of hyperprolactinemia at the end of breastfeeding may be an insufficiency of thyroid function (hypothyroidism), which is quite easily detected by measuring the level of thyroid-stimulating hormone (TSH) in the blood and is easily corrected on the basis of thyroid hormone replacement therapy (L-thyroxine).

One of the symptoms of PH may be a violation of the rhythm of menstruation (oligo- or opsomenorrhea - a decrease in the amount of menstrual blood or a shortening of menstrual bleeding), up to their complete cessation (amenorrhea), since an elevated level of prolactin disrupts the formation of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). ) that regulate the menstrual cycle. Such patients often suffer from headaches. At the end of breastfeeding, the formation of milk in small quantities remains - a few drops when pressing on the nipple. Against the background of the existing hormonal imbalance, it often develops. Women with PH may develop obesity.

Diagnostic studies that are carried out to confirm the diagnosis are quite simple. Usually they include a blood test for the content of various hormones and a pituitary gland test to determine the form of the disease. By the way, primary tests (a blood test for the content of prolactin and hormones that characterize the function of the thyroid gland) can be prescribed by a doctor at the antenatal clinic, but for further research, consultations of a number of specialists may be needed.

If, according to the results of a blood test, it turns out that the level of prolactin is elevated, and there are no other manifestations of PG, then it is advisable to repeat the analysis to make sure that this is not a mistake. It is necessary to check the function of the thyroid gland, as well as to determine the level of other hormones. Imaging is used to study the pituitary gland.

Usually for the treatment of PG prescribed medications in tablets. most tested medicine for the treatment of hyperprolactinemia is bromocriptine (Parlodel). Other drugs are also used: Lisenil, Abergin, Metergoline, Cabergoline (Dostinex). All of these drugs help to reduce the release of prolactin, the level of which in the blood often drops to normal within a few weeks after the start of treatment. In women, as prolactin normalizes, the menstrual cycle is restored.

Another complication leading to menstrual dysfunction after childbirth is postpartum hypopituitarism (Sheehan syndrome). This disease develops as a result of necrotic changes - "cell death" in the pituitary gland. Such changes may occur as a result of massive bleeding in the postpartum period, after severe septic (bacterial) complications of childbirth, such as postpartum peritonitis 1 or sepsis 2 . Severe gestosis of the second half of pregnancy, manifested by edema, the appearance of protein in the urine, increased blood pressure, rarely - convulsive syndrome, can also be the cause of Sheehan's syndrome, due to the development of intravascular coagulation (DIC). The frequency of Sheehan's syndrome is 0.1%, but with massive postpartum or post-abortion bleeding it reaches 40%.

Since we are talking about a violation of the restoration of the menstrual cycle, it should be said that one of the manifestations of Sheehan's syndrome is amenorrhea - the absence of menstruation or oligomenorrhea - a decrease in the amount of menstrual blood up to small spotting. The degree of violation of menstrual function, as well as the function of other endocrine glands, depends on the extent of the lesion of the pituitary gland. Even before the onset of menstrual irregularities, such signs of Sheehan's syndrome as headache, fatigue, weakness, chilliness (lowering blood pressure), a significant decrease in body weight, slight edema (pasty) of the lower and upper limbs, dry skin, baldness.

Diagnosis is based on anamnesis data (connection of the onset of the disease with complicated roles), characteristic manifestations and hormonal study data that show a decrease in ovarian pituitary hormones.

The treatment of this disease is based on hormone replacement therapy, when with the help of special preparations they try to replace the hormones that should be produced in the pituitary gland and other endocrine glands, including the ovaries. Assign glucocorticoid drugs, thyrotropic drugs. With oligo- and amenorrhea, sex hormones are prescribed to compensate for the lack of hormones produced by the pituitary gland and ovaries. Treatment is carried out by a gynecologist together with an endocrinologist.

Once again, I would like to remind you that if you have any doubts about the restoration of the menstrual cycle, you must consult a doctor. By the way, a prolonged absence of menstruation after childbirth may also indicate the beginning of a new pregnancy ...

1 Peritonitis - inflammation of the peritoneum - a thin membrane of connective tissue that covers the walls and organs of the abdominal cavity.

2 Sepsis is a condition in which an infectious agent enters the bloodstream.

Marina Pilnenskaya
Obstetrician-gynecologist,
Central Customs Hospital

The menstrual cycle is a cyclic fluctuation in a woman's body, designed to carry out the reproductive function. During pregnancy, menstruation does not bother a woman at all, and after childbirth, the cycle is gradually restored.

Features of the menstrual cycle after childbirth

Why menstruation does not occur for so long, almost a year, when they start, how long will menstruation be and whether it will be painful - all this interests women in the last months of pregnancy.

Changes in the body of a pregnant woman are caused by a restructuring of the hormonal status. The hormone progesterone is responsible for the lack of regular periods during pregnancy. It begins to be produced in the corpus luteum (temporary gland in the ovary) immediately after ovulation and is produced up to 10-12 weeks of pregnancy. Then the synthesis of progesterone is carried out by the placenta. After childbirth, the corpus luteum finally ceases to exist, the placenta leaves the uterine cavity, and the mechanisms for restoring the regular cycle are launched.

In contrast to these processes, as soon as a child is born and put to the breast, prolactin actively begins to be synthesized - a hormone produced in the hypothalamus of the puerperal during breastfeeding and stimulating milk production (lactation). Why doesn't a new cycle start while breastfeeding? Due to the suppression of prolactin maturation of the egg (ovulation) and, as a result, the blocking of menstruation. The restoration of the cycle after childbirth depends on how well these processes go.

Postpartum spotting

Not to be confused with menstruation, postpartum discharge - lochia. They are similar to normal cyclic bleeding, but they are not and are not accompanied by ovulation. In fact, this is bleeding from the site of attachment of the placenta in the uterine cavity. Lochia is a mixture of blood clots, pieces of endometrium and mucus. Abundant and bright red in the first days after childbirth, subsequently the discharge becomes pinkish-yellow. Their number can reach 1400 g per week. As the walls of the uterus heal, the lochia becomes light, scanty, without blood. Postpartum discharge can take a long time - up to eight weeks.

When does menstruation start after childbirth?

There is no exact and uniform term for the return of the normal menstrual cycle after childbirth. The time when menstruation begins after childbirth is individual for each woman. There are certain signs by which you can approximately predict when the first menstruation will begin after childbirth, and it is advisable for expectant mothers to know them. This is necessary in order to avoid a double load (after all, a repeated pregnancy in a breastfeeding woman can significantly deplete her body), and also not to miss a condition that requires urgent medical intervention.

The rate of recovery of regular menstrual bleeding does not depend on how the birth took place - whether the woman gave birth on her own or she had a caesarean section.

The physiological trigger for the appearance of menstruation after childbirth is a decrease in the production of the lactation hormone (prolactin) by the pituitary gland due to a decrease in the volume of breast milk produced or the complete cessation of breastfeeding. This usually happens in the fourth month after the baby is born.

What conditions accelerate the return of menstruation:

• too rare attachment of the baby to the breast;
• supplementing the child with water or feeding him with a mixture;
• with breaks between feedings for more than 6 hours, especially at night (at the peak of prolactin production).

Active breastfeeding and late introduction of complementary foods can delay the return of the cycle by one year.

If a young mother does not breastfeed a child from birth (no milk, acute infectious diseases), menstrual bleeding can recover as early as 4 to 8 weeks after the end of pregnancy. Monthly one month after birth should be differentiated from lochia.

The nature of the first menstruation after childbirth

• Anovulatory. Despite the fact that the first menstruation may begin 14 days after the end of the lochia, it is usually not accompanied by the maturation of the egg and its release into the fallopian tubes from the ovary.
• It is not significant how much menstruation goes after childbirth and how abundant the discharge is; subsequent periods will be different. The main thing is that they should not be more abundant than 50 ml per day, and their duration should not be longer than 10 days.

The onset of the first menstruation after childbirth does not mean their full recovery. Cycle yet long time may be irregular. It will become stable after the complete restoration of the hormonal regulation of the reproductive system after childbirth. This usually occurs after 4 to 5 months. The first few periods come early or late. Too short a break between the first and second cyclic bleeding (about 10 days) or too long (more than 3 months) should alert.

Factors affecting the recovery of menstruation after childbirth

Not only breastfeeding affects the start of the cycle. External and internal factors, their interaction also play an important role.

Lengthen the recovery period of a normal cycle or increase the risk that menstruation will not come:

• wrong daily routine;
• lack of proper sleep and nutrition;
• chronic diseases ( diabetes, arterial hypertension, pathology of the thyroid gland);
• complicated course of pregnancy (preeclampsia of the II-III trimester, pronounced edema, eclampsia);
• difficult childbirth (with bleeding, hypertension);
• postpartum depression.

All this is due to a violation of the control of ovarian function - a failure in the production of pituitary hormones.

Features of the recovery period of regular menstruation

The restoration of menstruation is not a hindrance or contraindication for breastfeeding. It is believed that the baby at this time may refuse to breastfeed. This is not due to a change in the quality of milk - it can simply change the mother's smell, to which the child is very sensitive.

If before pregnancy a woman was disturbed by painful menstrual bleeding, then after pregnancy there is a decrease in soreness. This is due to a change in the shape of the uterus and its position in the abdominal cavity.

It is important to observe the rules of personal hygiene during postpartum bleeding (lochia) and during the restoration of the menstrual cycle. Within six months, the use of tampons is contraindicated. It is recommended to use pads with a smooth surface, which should be changed every three hours. If personal hygiene products have to be changed more often, a doctor's consultation is necessary - this may be a sign of uterine bleeding.

Refrain from sexual intercourse for two months. Sex without barrier contraceptives (condoms) is contraindicated due to the risk of infection of the uterine cavity.

It should be remembered that a breastfeeding woman can become pregnant again, even if there was no first postpartum menstrual bleeding. Ovulation occurs, and the egg is released from the ovary 13-16 days before the onset of menstruation. Since ovulation has no external signs, a woman may not realize that her body is already capable of conception.

Situations requiring medical supervision

Restoring regular menstrual bleeding requires the coordinated work of many body systems. Failure of one of the systems can cause various cycle disturbances.

Types and causes of failures:

• Menstruation does not appear for eight weeks, despite the fact that the woman has already finished breastfeeding or the baby is initially on artificial. It is necessary to exclude the pathology of the reproductive system (endometriosis, inflammation of the ovaries, inflammation in the uterus) or hormonal failure (excessive production of prolactin). The cause of excess prolactin may be a tumor of the pituitary gland (prolactinoma). It is benign in nature and develops due to insufficient functioning of the thyroid gland.
• Irregular periods after childbirth. Pathological is a break between menstruation for more than three months. The reason may be a hormonal imbalance. Also, do not forget about the possibility of pregnancy after the first postpartum period, even if breastfeeding continues.
• Profuse bleeding that needs to be replaced hygiene products more often than once every two hours, are regarded as bleeding from the uterine cavity. In this case, urgent medical consultation is necessary. Especially if the discharge has an unpleasant odor, a brown or scarlet shade of blood, a large number of clots.
• If the duration of spotting is more than 10 days, uterine bleeding should be excluded.
• Profuse and prolonged bleeding can be the cause of the development iron deficiency anemia. Even if the bleeding corresponds to the conditional norm, but the woman has frequent dizziness, a feeling of weakness and fatigue, it is necessary to control the level of hemoglobin in the blood.
• Pathology is considered if less than 14 days have passed between the end of lochia and the onset of new spotting.
• If there were childbirth complicated by heavy bleeding, sepsis or severe preeclampsia, the development of Sheehan's syndrome (necrosis of pituitary cells) is possible. In this case, even after the cessation of lactation, monthly cyclic bleeding either does not come at all, or is restored, but the discharge is scanty, spotting.

Most women who have already given birth confirm that the menstrual cycle after childbirth is not restored immediately. There are certain periods at which a delay in menstruation is the norm. However, hormonal disruptions and the development of certain pathologies against the background of a weakening of the body lead to serious deviations during the cycle.

What you need to know about the menstrual cycle

The menstrual cycle is a natural process in the female body. It manifests itself in the form of a cyclic change in the state of the reproductive organs, the nervous system and the hormonal background.

It is customary to include the days between the start of subsequent menstruation in the cycle. Depending on age, weight and other individual characteristics women, its duration varies. The normal cycle length is 3 to 5 weeks. A process is said to be regular if it lasts approximately the same number of days each time.

The correct course of menstruation and the period between them is the preparation of the woman's reproductive system for the upcoming conception. The cycle consists of several phases, coming one after another:

1. First. It is characterized by increased production of estrogen by the appendages. The endometrium increases significantly in size. In the ovaries, a formation occurs that contains the egg. After maturation, the follicle ruptures. The process is called ovulation and is accompanied by the release of an egg and its subsequent advancement into the abdominal cavity.
2. Second. Until the fertilized cell moves through the channels of the uterus. She is completely ready for a possible conception. If within 3 days of contact with the sperm does not occur, the egg dies. According to the state of hormonal changes, this phase is characterized by the active production of progesterones, which affect the ability of the intrauterine layer to accept the zygote.
3. Menstruation. If the cell has not been fertilized, endometrial detachment occurs as progesterone levels decrease. The woman marks the beginning of the regulation. Menstruation is usually called discharge of a bloody nature from the channels of the reproductive system.

After the first bleeding, a new cycle begins.

Normal are critical days lasting from 3 days to a week and an average loss of 100 ml of blood.

If conception has occurred, the state of the body can change dramatically. The hormonal background is rebuilt to avoid interruption of gestation. Such changes lead to the absence of menstruation during pregnancy and the failure of menstruation after childbirth.

Allocations in the postpartum period

After childbirth, there is a gradual restoration of uterine structures. Within about two months, the organ actively contracts and returns to normal condition. Therefore, the woman notes the presence of bloody discharge. They are called lochia and in no case do they mean an early restoration of menstruation after childbirth.

In the normal course of the resumption of the work of the body, the discharge gradually changes, loses its saturated color and changes from red to yellow. Soon the lochia should stop altogether.

In the case of prolonged discharge (more than 50-60 days) and if their color does not change, a consultation with a doctor is necessary.

The reason for deviations in recovery may lie in hormonal imbalance or pathologies of the genital organs. After diagnosing, the specialist will prescribe the necessary therapy. With proper treatment, lochia will stop, and shortly after childbirth, menstruation will return to normal.

Causes of failure of the menstrual cycle after childbirth

The normal recovery of the cycle after childbirth is characterized by a natural delay in the onset of menstruation. The reason for this is an increase in the concentration of some and a decrease in the level of other hormones. In most cases, the regularity of discharge resumes after a couple of months.

The delay in the onset of critical days allows the mother's body to recover, increase protective functions and return the normal vitamin and mineral balance. And also the pause prepares the woman for the next conception and bearing the fetus.

In mothers who follow breastfeeding constantly, the hormone prolactin continues to be actively produced. The substance suppresses ovulation and thus prevents the natural cycle from starting. Therefore, women who transfer the baby to artificial feeding will soon ascertain the onset of menstruation.

Irregular monthly discharge after childbirth is observed in many mothers. The features of the cycle are influenced by factors of both pathological and physiological nature. Reasons why regula may be unstable and recover more slowly include:

1. Problems with general indicators of the reproductive and endocrine systems, infection or inflammation of the internal genital organs.
2. Emotional and mental instability.
3. Lack of rest and lack of sleep.
4. Complications arising from childbearing and childbirth.
5. Chronic diseases are responsible for the regular cycle of systems.
6. Mom is over 30 years old.
7. Third or more births.
8. Mistakes in proper hygiene.
9. Unbalanced diet, lack of useful components in the body.

How soon after childbirth will menstruation return?

When does it start menstrual cycle after childbirth depends on a huge number of factors affecting the state of the body of a woman. The following terms for the resumption of healthy menstruation are considered normal:

1. If you are breastfeeding and there are no complementary foods, menstruation does not occur until lactation stops.
2. In the case of prolonged breastfeeding (more than a year), the onset of menstruation is also possible during lactation. Completely artificial feeding of the baby and the absence of breastfeeding leads to ovulation after 2–3 months. That is, on average, it begins at 12 weeks after birth. Perhaps the onset of anovulatory critical days.
3. In the event of a shortage of mother's breast milk and partial introduction of mixtures into the baby's diet, blood will come out 4 or 5 months later, or even six months after birth.
4. A cesarean or natural birth of a baby does not significantly affect the duration of recovery. Both in the first and in the second case, the regulation will begin at about the same time, with the other conditions being equal.
5. Childbirth with complications, instability of the lochia, the development of endometritis and sepsis will lead to a dulling of the natural recovery processes. In this case, the woman will observe a delay in the first menstruation.

Although these terms are considered the norm, when the menstrual cycle is restored after childbirth, it depends on the individual characteristics of the female body. However, with a strong deviation in the delay from the generally accepted indicators, they go to the gynecologist and establish the causes of the failure.

The nature of the discharge after delivery

In most cases, the restoration of menstruation in the period after childbirth occurs after 2 or 3 cycles. Critical days pass regularly, otherwise you need to seek help from a doctor.

The following can lead to irregular periods:

• inflammation of the uterus and ovaries;
• development of endometriosis and adenomyosis;
• neoplasms on the structures of the genital organs;
• hormonal disbalance.

Another factor in which menstruation does not occur is a new pregnancy. Although prolactin is produced during lactation in large quantities, it is not a guarantee that conception will not be possible.

In most women, renewed regulation is characterized by a large volume of rejected fluid. Abundant discharge is not critical if the duration of menstruation is less than 7 days. The reason for consulting a doctor may be the ailment accompanying bleeding: loss of orientation in space, general, increased pulse.

It is not scary if a woman has an increase or decrease in the period of the cycle and menstruation separately. However, when more than 35 or less than 21 days pass between the first days of discharge, and discharge occurs 1-2 days or for a very long time (longer than a week), this is a reason to be wary.

Can menstruation go after childbirth not every month? Yes, this happens in the first times of menstruation during the recovery period. But in the case of frequent absence of discharge or their occurrence on inappropriate days, it is better to check for the presence of pathologies of the reproductive system.

Symptoms of PMS and cramps during menstruation in some young mothers may disappear, while others, on the contrary, appear. In the case of pain before childbirth, when the uterine bend is broken, the symptom may disappear. This is due to the fact that the state of the organ is normalized due to the birth of the child.

Menstruation becomes painful due to:

1. Inflammatory processes of the reproductive organs.
2. Contractions of the uterus of great force.
3. Unpreparedness of the body for childbirth.

Often there is an increase in the symptoms of premenstrual syndrome and even its appearance in those who have not experienced such problems before. After the birth of a child, women suffer before menstruation from excessive emotionality, constant mood swings for no reason, a tendency to resentment and tears, pain in the mammary glands, migraines, swelling, sleep problems, and pressure drops.

What to do to restore the cycle faster

There are rules that allow you to quickly normalize the number of days after which the menstrual cycle is restored after childbirth, and make bleeding stable:

1. Provide the body with useful substances. After 9 months of gestation, the amount of vitamins and minerals of the mother is significantly reduced. During lactation, the need for these components increases. In addition, the lack of useful elements slows down the recovery of the reproductive system and hormonal levels. As a result, menstruation is characterized by a small amount of discharge, comes at the wrong time and provokes pain in the lower abdomen.
2. Eat right. A newly born mother should eat healthy foods and monitor the balance of food. It is important to eat enough dairy products, meat, fruits and vegetables according to the season without chemical additives. Dieting to lose weight interferes with the natural resumption of body functions and menstruation may not go.
3. Enough rest. Constant fatigue and poor sleep, depression prevent menstruation from resuming. It is important to monitor the daily routine and, if necessary, ask the husband and parents to stay with the child, arranging a proper rest or sleep.
4. Get treated promptly. Complications due to childbirth and chronic diseases require correction or quality therapy.

Lactation, nutrition, the emotional component of health, and the presence or absence of pathological conditions can affect the normalization of the cycle.

Generally accepted dates for the onset of the first menstruation are not mandatory. In many women, they change in the absence of any violations of the state of the genital organs or the production of hormones.

There may be frequent monthly bleeding after childbirth, menstruation with delay and interruptions, not previously characteristic of a decrease or increase in duration. But if the cycle is normal, and the discharge has an acceptable color and volume, you don’t have to worry.

During pregnancy, hormonal changes occur in the body. During this period, menstruation stops, which indicates the onset of pregnancy, but when it is restored monthly cycle after childbirth? Pregnancy makes its own adjustments to a woman's life, but this is a physiological process that you should not be afraid of, because this is the most anticipated and wonderful period in the life of every woman.

After childbirth, the monthly cycle does not occur immediately. The timing of his arrival is individual for each mother. It may be slightly different from the cycle before pregnancy. This is related to physiological changes that happened to a woman during the birth of a child, since childbirth is the strongest stress for the body. Menstruation is one of the main indicators of women's health. Therefore, it is so important to monitor their recovery, the nature of the flow.

There is no exact period for the restoration of the menstrual cycle (menstruation) after childbirth; it is individual for each woman. There are factors that affect the resumption of menstruation. These include:

If the menstrual cycle is not immediately restored after childbirth, there is no need to worry, because the body needs to rest and additional blood loss leads to a weakening of the body. Therefore, the physiological absence of menstruation allows a woman to get stronger and gain strength. Normally, the cycle is restored in 2-3 months after childbirth. This is if you are not breastfeeding. Due to pathological childbirth, the presence of complications, the recovery period can be delayed up to three months. The body of a woman, as it were, regulates this process. But if the cycle does not recover for a long time (up to six months) and the woman does not breastfeed at this time, then you need to contact a gynecologist and consult about this delay.

Causes of delayed menstruation after childbirth

The reasons for delaying the onset of menstruation include:

• breast-feeding;
• pathological childbirth;
• the presence of an inflammatory process in the uterus;
• chronic sleep deprivation;
• poor nutrition;
• weakening of the body after multiple births;
• in primogeniture older than 30 years.

Normally, after childbirth, the uterus contracts and acquires a physiological size by the end of the second month. By the same time, the internal surface of the organ heals, suckers are released, which stop by 5-6 weeks. The nature of lochia during this period varies from bloody to light and mucous in consistency. If, after this period, the discharge does not stop and does not change its color, then you need to contact a gynecologist to exclude the presence of an inflammatory process in the internal genital organs (endometriosis).

The presence of neoplasms of the uterus and ovaries can cause a delay in the normalization of the menstrual cycle. At normal course postpartum period, the physiological functions of the ovaries resume after 2-3 months after childbirth. Again, if not breastfeeding.

If after stopping breastfeeding persists high rate prolactin, this condition is called pathological hyperprolactinemia (PH). Prolactin, which is produced by the pituitary gland, inhibits ovulation. After stopping breastfeeding in a woman, the amount of prolactin should return to normal. If this does not happen (the reason is thyroid dysfunction), then there is a delay in menstruation.

The main symptom of PG is a violation of the menstrual cycle, shortening its duration to complete cessation. Also, the number of secretions is reduced to their complete absence. Such hormonal disorders lead to mastopathy, pathological changes and inflammation of the mammary glands. A sign of this pathology is the release of drops of milk from the nipple after the cessation of lactation, as well as soreness and nodular seals in the mammary glands.

A woman can detect such seals herself, so it is important to monitor the condition of the mammary glands during the formation of the menstrual cycle after childbirth. Once a month, you should independently examine your breasts and nearby lymph nodes. Carefully feel the mammary glands and armpits and, if there are any deviations from the norm (seals, changes in the nipple, cracks, hyperemia), contact a mammologist without delay.

When these symptoms appear, it is imperative to consult a doctor to prevent the development of the disease and exclude the appearance of an abscess.

There is another reason why the normal recovery of the menstrual cycle is delayed - Sheehan's syndrome. it pathological process, indicating the death of pituitary cells and is characterized by the absence of menstruation, a decrease in the amount of discharge to spotting. The cause of the syndrome is complicated childbirth, massive blood loss, sepsis. The severe course of the second half of pregnancy also causes such a pathology:

• swelling;
• hypertension;
• impaired renal function.

Sheehan's syndrome can be diagnosed not only by the violation of menstruation, but also by the presence of hypotension, weakness, and headaches.

Menstruation and breastfeeding

In the postpartum period, the restoration of menstruation depends on the presence of breastfeeding. During lactation, a woman releases the hormone prolactin, which prevents ovulation. Therefore, the menstrual cycle is absent for the entire period while the woman is breastfeeding.

This physiological amenorrhea can last up to a year. A relationship has been established: the more often the mother puts the baby to the breast, the more milk and prolactin are secreted, the longer there is no menstruation. When a child switches to a mixed diet, a woman's monthly cycle may occur earlier (5-6 months after birth).

Breastfeeding is not a reason to be 100% sure that pregnancy will not occur during this period. After all, it happens that lactation fades, less prolactin is produced, and ovarian functions are restored. Ovulation occurs, which the woman does not assume. It is this period that is dangerous for the possibility of becoming pregnant. Therefore, it is necessary to use contraceptives, since a repeated pregnancy is undesirable for a still fragile organism. .

The gynecologist who needs to be contacted in the postpartum period should tell about the methods of contraception.

How is menstruation after childbirth

The monthly cycle is normal in the absence of breastfeeding, it is restored after 2-3 months after childbirth. At first, it may not be regular, but it normalizes over 3-4 months. If, after this period, menstruation does not improve, then this is a pathological deviation, indicating a hormonal disorder.

Immediately after childbirth, a woman has spotting, but they have nothing to do with menstruation. These are the so-called suckers, which begin immediately after childbirth and last up to two months, gradually subsiding. After their termination, normal menstruation occurs in 2-3 weeks. The nature of the course and the amount of discharge may differ from the menstruation that took place before pregnancy. Many women noted that menstruation began to be harder. This is due to the fact that the body has not yet fully recovered and the discharge brings it an additional load.

For the same reason, women who have recently given birth experience the so-called premenstrual syndrome (PMS), which is characterized by:

The amount of blood released may change. The discharge may increase, which is associated with the incomplete recovery of the endometrium of the uterus after childbirth. But if the discharge is very strong, scarlet blood or with an admixture of clots, then this should alert and be a reason to visit a gynecologist. There may have been bleeding. The duration of the menstrual cycle also changes after childbirth. If the monthly cycle before childbirth was 28-30 days, then after it it can be reduced to 25 and this is the norm. The duration of menstruation will be the usual 4-7 days.

Cases have been registered when, before the birth of a child, menstruation was accompanied by pain, and after childbirth, the pain disappeared. This is due to a change in the position of the uterus and the outflow of blood from it has improved. If the cycle is restored, but the woman experiences strong fights during menstruation and constantly relieves the syndrome with painkillers, then you need to contact a gynecologist to exclude the presence of pathologies in the genital area.

It is important to pay attention to the duration of menstruation, if it drags on and takes more than 7-10 days, then this indicates a serious problem. Perhaps the woman developed inflammation in the uterus and appendages. The doctor will tell her about this, to whom you need to contact immediately.

If the period of the duration of monthly discharge is reduced to 1-2 days, then this is a serious reason to consult a gynecologist, since such a course of menstruation is pathological.

An increase in the duration of the course of menstruation in women who have undergone a caesarean section is the norm, since there was an operative injury to the body of the uterus and a longer period is needed for its complete recovery.

The cycle and nature of discharge after childbirth depend on the methods of contraception used by a woman to prevent unwanted pregnancy. If a spiral is used as contraception, then there will be more discharge, and the duration of menstruation will increase. When using birth control pills, everything happens the other way around: the discharge becomes scarce, and the period of menstruation is reduced to 3 days. This is due to the content in the tablets of components that reduce the growth of the endometrium during the cycle.

How to quickly restore menstruation after childbirth

After childbirth, a woman's body requires a certain recovery period, and when menstruation occurs, it is impossible to answer unambiguously. It depends on the individual characteristics of the organism. But in the postpartum period, doctors recommend observing proper nutrition aimed at replenishing vitamins and trace elements lost by the body during pregnancy and childbirth. Therefore, a woman during this period needs to fully eat, including dairy products, meat products, vegetables, fruits in her diet. On the advice of a gynecologist, you need to take multivitamins and a complex of trace elements. Good sleep and rest are also very important, because during pregnancy and childbirth nervous system subjected to increased stress. Therefore, a woman needs to plan her day in such a way as to have enough time to rest and walk with her baby in the fresh air.

If the mother had endocrine disorders before childbirth, then in the postpartum period it is necessary to visit an endocrinologist and monitor the state of the hormonal system, since its dysfunction leads to a delay in the restoration of the monthly cycle.

If a woman had a pathological birth, which was accompanied by heavy bleeding, then to restore the normal functioning of the body, she needs to take iron-containing preparations. After all, bleeding caused iron deficiency anemia, and in order to resume the menstrual cycle, you first need to restore the normal state of the body.

Given the above, we can summarize that for the successful restoration of the menstrual cycle (menstruation) after childbirth, mommy needs:

• have a good sleep;
• do not overwork;
• walk in the air;
• keep calm and not be nervous;
• eat well;
• regularly undergo an examination by your gynecologist.

Very important. There is no need to resort to self-medication, even if the problem that has arisen seems insignificant. Any discomfort should be reported to your gynecologist.

Compliance with these simple rules will help a woman quickly restore the monthly cycle after childbirth and continue to maintain her female health for a long time.