First period after birth: duration and symptoms of your postpartum return to menstruation

Light bleeding occurs during the first 56 days, from the maternity ward onwards — this is the remainder of the lochia. As the uterus returns to its normal size, contractions occur in your body which cause bleeding: the lochia. This discharge is due to the wound left by the removal of the placenta.

The return of periods refers to the first menstruation after giving birth. This bleeding is generally heavier and longer than a "normal" period. 

The return of periods generally occurs 6 to 8 weeks after birth if you are not breastfeeding. In 92% of cases, by 3 months (Dr R. Ecochard, CLER). In the case of a caesarean section, it is also on average between the 6th and 8th week. 

For a breastfeeding mother, the return of menstruation may be later. During exclusive breastfeeding, around a quarter experience it before 6 months (for genetic reasons), and the majority around 9 months (Dr R. Ecochard, CLER). This is due to the fact that hormones have an impact on the return of periods. 

There is no typical pattern for the first period after giving birth. Some women may have heavy and painful periods. Others may have light and easy periods. The flow of these periods can depend on the contraception chosen (it will likely be lighter if you are taking the pill). It is difficult to estimate the duration of the return of periods, as it varies greatly from one woman to another. If your flow concerns you, do not hesitate to consult a healthcare professional (GP, gynaecologist, etc.).  

Our post-partum food supplement in plant-based ampoules Happy Postpartum help relieve pain and bleeding.

Symptoms vary from woman to woman depending on hormonal balance and feeding method. Some may experience pain similar to menstrual cramps, often caused by the uterus contracting back to its normal size. Bleeding may be heavier or more irregular than usual periods. Changes in the texture and colour of menstrual flow are also common. 

On an emotional level, hormonal fluctuations can cause mood swings, irritability, or increased fatigue. In breastfeeding women, the return of periods can sometimes be accompanied by a temporary dip in milk production due to hormonal changes. It is important to note that periods can return several weeks to several months after giving birth, with timing influenced by breastfeeding and other individual factors. You may also experience nausea, backache, and headaches. 

There are many myths surrounding the postnatal period; we address the 3 most common ones here. 

"I haven't had a period, so I can't get pregnant again"

The return of menstruation after birth clearly marks the resumption of a regular menstrual cycle, but it is possible to ovulate in the absence of periods.

In most cases, the first cycles following the return of menstruation after birth are anovulatory or are not accompanied by a sufficient rise in temperature to allow implantation; nevertheless, caution is still needed if you do not wish to become pregnant again. 

"When your periods return after birth, it will affect your milk supply or cause it to stop"

Some women notice during the first 2 or 3 days of their period that their baby becomes fussy at the breast, or that they express less milk. This is normal, not yet explained, and lactation returns to its usual rhythm within two or three days afterwards. 

"I'm breastfeeding, so I can't have my periods return"

Approximately a quarter of breastfeeding women will experience it within 6 months, even if they are feeding on demand and exclusively breastfeeding their baby.

The date your period returns does not determine the return of fertility. 

You may get your period back without ovulating, but you can also fall pregnant before your period returns… 

Irregularities can persist up to the sixth menstrual cycle after birth: anovulatory cycles, longer and irregular cycles, shortened high-temperature phases, etc. 

The later the return of periods, the greater the likelihood that ovulation will occur before menstruation resumes and that it will be "fertile".

• Not before 21 days

It is not possible to ovulate before day 21 after giving birth: contraception is therefore not necessary before this point (Haute Autorité de Santé).

• Without breastfeeding

1 month after giving birth, fertility is possible. 

• While breastfeeding

The first ovulations generally occur around the 5th month following birth.

Before 6 months, menstrual cycles are anovulatory in 45% of cases, and ovulatory cycles with luteal insufficiency in 41% of cases, meaning implantation cannot take place. 

With exclusive breastfeeding, lactational amenorrhoea lasts at least 5 to 6 months. After 6 months, fertility becomes a possibility. 

It is too early to use local contraceptives such as a diaphragm. It takes 6 to 8 weeks after birth for the vagina to return to its pre-pregnancy dimensions, and for the perineum to regain its tone, allowing correct use of diaphragms.

Be cautious with spermicides — useful during the postpartum period as a "bridge" method, but not recommended during breastfeeding, as their effects on the infant remain poorly assessed. 

An IUD is generally fitted 6–8 weeks after birth. 

Condoms remain the contraceptive of choice in the postpartum period.

• If you are not breastfeeding

Combined oestrogen-progestogen contraceptives are not recommended before 42 days, to avoid any risk of venous thromboembolism.

Progestogens can be used from 21 days.

The postnatal check-up (6 to 8 weeks after birth) should confirm your contraceptive choice, any renewal, ongoing monitoring, or the fitting of a long-term device (IUD, implant).

• If you are breastfeeding

Combined oestrogen-progestogen contraceptives are not recommended for breastfeeding women.

A progestogen-only mini-pill is an option, starting 6 weeks after birth.

The HAS recommends to breastfeeding mothers: "Hormonal contraception should not be started before the establishment of stage II lactogenesis (milk coming in). Progestogens should not be used before the sixth week postpartum." 

Before this 6-week period, it is therefore better to use a condom, or to follow the LAM method as we will see below. 

After that, you may be prescribed a low-dose progestogen-only pill, or choose not to use contraception if you are fully breastfeeding (exclusively, frequently, and on demand). 

It may occur later and vary from woman to woman, but it generally happens 5 to 6 months after giving birth.

The impact of hormones 

Prolactin, one of the breastfeeding hormones produced by the body, suppresses ovulation for a period of time that varies from woman to woman. The baby's suckling stimulates its production.

There is a close correlation between the frequency and duration of feeds, on the one hand, and the plasma level of this hormone in the body, on the other. Breastfeeding with at least 6 feeds per 24 hours, lasting a total of 65 minutes, suppresses ovarian activity (HAS).

Prolactin levels are highest between midnight and 5 a.m. This is why night-time breastfeeding is important — not only to maintain milk supply, but also to support the return of the menstrual cycle.

A 2004 American study, however, showed that prolactin levels had no measurable impact on the period of amenorrhoea. The authors concluded that only a high progesterone level after birth and the use of a dummy or infant formula were associated with an earlier return of periods. If you wish to delay this and use the LAM method, breastfeeding must be done at the breast only, with no dummy or bottle introduction.

The LAM method for amenorrhoea 

The Lactational Amenorrhoea Method provides a form of natural contraception.

It is the most widely used method in the world, and safe when followed correctly. If full breastfeeding is maintained up to 6 months, a fertile ovulation before the return of periods is uncommon: the pregnancy rate is 1% or less. A mother following LAM can calmly wait for her first bleed — the return of her period — before considering herself potentially fertile, until her baby reaches 6 months.

To use it, you need to breastfeed frequently, day and night, and give the baby virtually no other food.

You must meet the following criteria to use it:

- Baby is under 6 months old

- You have not yet had your period return

- Exclusive, on-demand breastfeeding (with no fixed schedule).

- Intervals between feeds must not exceed 4 hours during the day or 6 hours at night.

The mother must always be with her baby, which is not possible if she returns to work, even when expressing milk.

Your first period after childbirth can occur up to a year after giving birth. If your periods have not returned after this time, it is recommended to see a doctor to check for any underlying causes.
 

It may be delayed due to certain factors: breastfeeding, hormonal imbalances or stress can all delay the return of periods. If they remain absent with no clear explanation, medical advice is recommended.
 

When should you seek medical advice? Very heavy flow, significant pain or persistent irregularity in your cycle warrant a medical consultation for assessment and tailored advice.

You can take Happy Postpartum, a herbal and vitamin C ampoule, from the first signs of postpartum bleeding and continuously throughout its duration. Ginger helps reduce blood loss, vitamin C supports healing, and saffron helps support emotional wellbeing during this period.

Bonus: Happy Postpartum is compatible with breastfeeding. 

Do not hesitate to reach out to your healthcare professional (midwife, gynaecologist, GP, etc.) if needed. 

Many thanks to Marjorie Lamotte, obstetrician-gynaecologist in Dijon and specialist in reproduction, for her kind review!