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

Des légers saignements se produisent durant les 56 premiers jours, dès la maternité, c'est le reste des lochies. Quand l’utérus reprend son volume, cela génère des contractions dans votre corps qui entraînent des saignements, les lochies. Ces écoulements sont dus à la plaie laissée par le retrait du placenta.

Le retour de couche correspond aux premières règles après l'accouchement. Ces pertes sont généralement plus abondantes et longues que des règles “habituelles”. 

Le retour de couches survient généralement chez la maman 6 à 8 semaines après la naissance si vous n’allaitez pas. Dans 92 % des cas, à 3 mois (Dr R. Ecochard, CLER). En cas de césarienne, c’est en moyenne entre la 6ème et la 8ème semaine également. 

Pour une femme allaitante, la reprise de ces menstruations peut être plus tardive. Lors d’un allaitement complet, environ un quart l’ont avant 6 mois (pour des raisons génétiques), et la majorité vers 9 mois (Dr R. Ecochard, CLER). Cela est dû au fait que les hormones vont avoir un impact sur le retour de couche. 

Il n'y a pas de schéma typique pour les premières règles en post-partum. Certaines femmes peuvent avoir des règles abondantes et douloureuses. D'autres peuvent avoir des règles légères et faciles. Le flux de ces menstruations peut dépendre du choix de contraception (il sera probablement plus léger si vous prenez la pilule). Il est difficile d’estimer la durée du retour de couche, car cela va varier grandement d’une femme à l’autre. Si votre flux vous inquiète, n’hésitez pas à consulter un professionnel de santé (médecin, gynécologue, etc).  

Notre complément alimentaire post partum en ampoules à base de plantes Happy postpaturm soulagent les douleurs et saignements.

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. 

Il est trop tôt pour utiliser des contraceptifs locaux comme diaphragme. Il faut 6 à 8 semaines, après l’accouchement, pour que le vagin retrouve ses dimensions d’avant la grossesse, et pour que le périnée récupère sa tonicité, permettant alors l’usage correct des diaphragmes.

Attention aux spermicides, intéressants durant le postpartum en “relais”, mais déconseillé durant l’allaitement, car ses effets restent mal évalués sur le nourrisson. 

Le stérilet est généralement posé après 6-8 semaines après l’accouchement. 

Le préservatif reste le contraceptif de choix en post-partum.

• Si vous n’allaitez pas

Les estroprogestatifs ne sont pas recommandés avant 42 jours, pour éviter tout risque thromboembolique veineux.

Les progestatifs sont utilisables à partir de 21 jours.

La consultation du post-partum (6 à 8 S après l’accouchement) doit permettre de confirmer le choix contraceptif, son renouvellement éventuel, sa surveillance ou la pose d’un dispositif de longue durée (DIU, implant).

• Si vous allaitez

Les œstroprogestatifs sont déconseillés chez la femme allaitante.

La microprogestative est possible, en débutant 6 semaines après la naissance.

La HAS recommande aux mamans allaitantes : “La contraception hormonale ne doit pas être débutée avant l'installation de la lactogenèse de stade II (montée laiteuse). Les progestatifs ne seront pas utilisés avant la sixième semaine du post-partum." 

Avant cette période de 6 semaines, il vaut donc mieux utiliser un préservatif, ou suivre la méthode MAMA comme nous le verrons par la suite. 

Après cela, vous pouvez vous faire prescrire une pilule faiblement dosée à base de progestérone, ou ne pas utiliser de contraceptif si votre allaitement est complet (exclusif, fréquent et à la demande). 

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!