Completely stopped during pregnancy, the rules naturally reappear after childbirth. This is commonly called the return of diapers. But the time between the birth of a baby and the resumption of the menstrual cycle depends on each woman and on many factors, including breastfeeding. Let us try to take stock of the subject.
A missed period, also called amenorrhea, is usually one of the first signs of a happy event. It represents important information for the rest of the follow-up because it allows to calculate the term and the APD, expected date of delivery. If this stoppage lasts throughout the pregnancy, how long does it take before the cycle returns to its normal course after birth?
Pregnancy causes a real hormonal and uterine upheaval. After the birth of a baby, it therefore takes several weeks before the uterus and the cervix have healed and the system has regained a balance allowing again the secretion of estrogen and therefore ovulation. The postpartum period (not to be confused with postpartum depression or baby blues), the period between childbirth and actual return to diapers, that is to say the reappearance of periods, can last from 5 weeks to several months depending on whether the mother has chosen to breastfeed her child and / or decided to resume contraception affecting menstrual loss.
While the return of childbirth is different for each woman, all women will experience a postpartum phase of bleeding, often profuse and impressive, which can be like a period but is actually part of the process of healing the uterus and that have nothing to do with menstruation: it is lochia.
Lochia and the return of childbirth
During the aftermath of childbirth, whether the delivery has taken place vaginally or by cesarean section, lochia are perfectly normal. In full recovery and reconstruction, the uterus evacuates the remains of the pregnancy and heals wounds caused by placental detachment. This causes a vaginal discharge that is often profuse and composed of clots which can be quite large. If this phenomenon can be frightening by the amount of blood that seems to be lost, there is actually no need to worry.
Lochia begins within days of giving birth and usually lasts 3 to 4 weeks, but can persist for up to 6 weeks in some women. The losses are first concentrated in blood and clots, containing uterine lining, placental membranes, vernix caseosa (whitish and oily substance that protects and waterproofs the skin of the fetus in utero) and sometimes meconium (first stool) . They will gradually become brownish then more watery, yellowish then whitish, before stopping. In women who have given birth by caesarean section, the lochia may be shorter and less abundant, especially if curettage has been performed to remove a large part of the residue.
During this period what is called a “little return of diapers” can occur. About 12 days after childbirth and for about 48 hours, the discharge is again heavily loaded with blood, resembling menstruation. And yet, it is not yet a period. The phenomenon is once again quite normal and common, and even goes unnoticed in women whose lochia are still very red and abundant at this time.
In order to absorb these losses and limit any risk of infection while the uterus is healing and therefore vulnerable, the mother will have to wear external hygienic protection, such as washable cloth napkins. Tampons and menstrual cups should be avoided.
If the lochia should not alarm the mother, the appearance of certain symptoms should be taken very seriously. If the discharge is accompanied by fever, headache, pain in the lower abdomen, a strong and unpleasant odor or an abundance of bleeding (need to change protection several times within an hour), seek immediate medical attention. doctor. It may be congestion in the cervix which, too contracted, prevents the flow of substances to be evacuated.
Breastfeeding: how does it affect the return of diapers?
A very important factor intervenes in the return of diapers: breastfeeding. Indeed, a mother who does not breastfeed her baby will see her periods reappear within 5 to 8 weeks after giving birth, while for a breastfeeding mother, it may take several months before returning. Why ? Because breastfeeding stimulates the secretion of a hormone, prolactin, which promotes lactation. This blocks ovulation and the secretion of estrogen and therefore the return of the menstrual cycle. Generally, the rules appear again around 3 or 6 months postpartum, when breastfeeding ends, or when the frequency of feedings decreases (mixed breastfeeding or introduction of solid foods).
But as always in the case of motherhood, the situation changes from one woman to another and nothing is set in stone! Some will experience a return to diapers despite exclusive breastfeeding (this may be due to a lower amount of prolactin secreted without preventing lactation or altering the quality of the milk), others will experience it for weeks or even months. after you stop breastfeeding. It may even be that a woman who has chosen or has to feed her baby with formula will go several months without returning to diapers, even though ovulation still occurs (and with this, the risk of becoming pregnant again without having it. foreseen).
When the infant formula is preferred, the doctor prescribes a drug to stop the flow of milk that could cause engorgement. The production of prolactin is thus blocked in favor of estrogen. The resumption of the menstrual cycle is no longer delayed and the return of diapers is done within 2 months of birth.
What does the return of diapers look like?
Regardless of when it occurs, returning to diapers can be different from the usual rules. The body has undergone a major upheaval and it takes patience to return to normal. The first period after childbirth may therefore be very heavy and last longer than usual. The pre-menstrual syndromes that accompanied them before pregnancy can return early on or after several cycles. It is the same with the regularity of the latter which can take time before returning, in particular without contraceptive pill.
Regarding hygienic protections, if intrauterine methods are to be banned, they can be reinstated in the habits of each one after the return of diapers. However, it is not uncommon for young mothers to experience some discomfort when using their usual tampons, due to vaginal dryness, a common consequence of pregnancy. They can keep this system by opting for organic cotton models. The same goes for towels which can cause irritation. Do not hesitate to discuss it with your gynecologist.
Return of diapers and contraception
A return to childbirth means that there has been ovulation in the previous 2 weeks. If a pregnancy immediately after childbirth is not on the program, it is therefore necessary to think about the contraceptive devices to adopt after the baby is born. The subject is normally discussed with health professionals before leaving the maternity ward.
For women choosing the pill, its reintroduction will depend on its formula and on privileged breastfeeding. The “classic” pill disrupting the production of prolactin, a progestogen pill (or micro-progestogen), without affecting lactation, may be prescribed. Whether in the case of exclusive breastfeeding + microdose pill or infant formula + estrogen-progestogen pill, treatment can be resumed from the 15th day after childbirth. During these two weeks after birth, it is best to use condoms or spermicides.
The pill is obviously not the only option available to young mothers. Contraceptive implants or patches, injections, vaginal ring, IUD … Their method of operation (diffusion of hormones, intrauterine installation) will depend on their return. For the IUD, for example, doctors generally prefer to wait 2 to 3 months for the uterus to regain its shape and capacity. In this case, alternatives like the condom are to be envisaged.
Be careful, the apparent absence of a return to diaper, whether due to breastfeeding or not, does not mean that ovulation has not taken place. In about 10% of women, ovulation resumed after childbirth, with no return to menstruation. It is therefore quite possible to get pregnant without having had a period if no contraceptive is used. Exclusive breastfeeding is not a contraceptive, and your period is not the only sign that an egg has been produced. Be careful, and do not forget to discuss it with your doctor or midwife.