All About Your First Postpartum Period

After giving birth, it's common to have lots of questions about your first postpartum period: When will I get my first period after being pregnant? How will my menstrual cycle change? When is it time to worry about not having a period after pregnancy?

Luckily, there is usually nothing to worry about if your period doesn't restart within a few months after giving birth. In fact, if you're exclusively breastfeeding, you may not start menstruating for half a year or more after your baby is born. Still, there's plenty of mystery surrounding that first postpartum menstrual cycle. We've turned to the experts to answer some common questions and de-mystify the process.

When Will My Period Return After Giving Birth?

When you get your first period after giving birth often depends on whether you are breastfeeding and how often. People who exclusively breastfeed (only giving their baby breast milk either through nursing or pumping around the clock) tend to start their periods later than those who use formula or a combination of breast milk and formula.

A hormone called prolactin drives milk production, and it essentially stifles ovulation. When you don't ovulate, you don't have your period. It's normal not to menstruate for six months or longer when you're exclusively breastfeeding or chestfeeding your baby. However, everyone is different and some people get their cycles back sooner or later than others, especially if they experience disruptions in their nursing or pumping routines.

By contrast, people who don't breastfeed may get their periods as early as four to eight weeks after giving birth, says Amina White, MD, an associate professor of obstetrics and gynecology at the University of North Carolina at Chapel Hill. Those who combination feed (that is, they breast- and formula-feed) may not get one for weeks or months.

Can I Get Pregnant Before My Period Returns?

Yes, you can get pregnant before your period returns, because before you get your first postpartum period, you will ovulate. And if you happen to have unprotected penis-in-vagina sex while ovulating, pregnancy is definitely possible.

"I've seen people who are already pregnant at their six-week postpartum visit," says Angela Jones, MD., an OB-GYN in Freehold, New Jersey. You may not realize that you are fertile if you haven't gotten your period, but you can't get your period without ovulating first, and you can get pregnant during that window of time before you know your cycle is back.

While exclusive breastfeeding tends to delay ovulation, nursing parents aren't 100% safe from pregnancy, either. "A lot of them rely on breastfeeding as a form of contraception, but I wouldn't recommend it," says Dr. Jones. Menstrual cycle changes can happen when people supplement milk with formula or start introducing their babies to solid foods (usually around six months). When breastfeeding diminishes, their hormone levels drop, and ovulation may return.

If you want to avoid pregnancy, always use another method of birth control when you're breastfeeding. If you take the pill, talk to a health care provider about which type is best, as some aren't indicated for people who are nursing.

How Will My Postpartum Period Be Different?

Your period may change a little, a lot, or not at all after giving birth. You may have longer or shorter periods, a heavier or lighter flow, and the length of your overall cycle can be different, says Dr. White. Some people will even see a change in the amount of cramping they experience.

This is because the uterus grows during pregnancy and shrinks after delivery (although it may not be as small as it once was). When that happens, the body's endometrial lining—the tissue normally shed during a period—has to rebuild itself. This process takes place every time you get pregnant, so your period may look a little different with each baby.

If you used hormonal birth control before you got pregnant, you may have grown accustomed to lighter periods. Your postpartum period may be heavier after you give birth because your endometrial lining will be thicker than when you used hormonal contraception.

Using certain period products may feel a little strange at first, too: "If you had a vaginal delivery, a tampon might sit differently," says Siobhan Dolan, MD, a professor of obstetrics, gynecology, and reproductive science at the Icahn School of Medicine at Mount Sinai in New York City.

Though your tampon, menstrual cup, or menstrual disc may feel a little different, most people don't need to increase their tampon size or switch products. In time, using them should feel like it did before. However, feel free to experiment with different products or sizes if you find that what worked before pregnancy just isn't working now. As always, if you experience any concerning symptoms, like pain, extreme cramping, or extremely heavy bleeding, be sure to contact a health care provider for further examination.

Will My First Periods After Birth Be Irregular?

It's common for the first several periods after birth to be irregular. It can take time for your hormones to get back to normal, especially if you're breastfeeding, says Dr. White. One menstrual cycle might last 24 days, the next one might be 28 days, and a third could be 35.

If you had regular periods before pregnancy, your cycle should stabilize within a few months or after you've stopped breastfeeding. If you had irregular periods before getting pregnant, they'll likely be irregular after pregnancy unless the underlying cause is treated.

How Can I Tell If Something Is Wrong?

Heavier bleeding and increased cramping can be normal with your first few postpartum periods. But if you need to change your tampon or pad every hour (or even more frequently than that), alert a health care provider, says Dr. Jones. It could signal an issue such as an infection, fibroids, or polyps.

Also contact a health care provider provider to rule out anemia or thyroid dysfunction if you experience the following: periods that last longer than seven days, or those that contain clots larger than a quarter; missing a period after menstruation has restarted; spotting between periods; or the absence of a period three months after you give birth or stop breastfeeding.