Breastfeeding and Your Postpartum Periods

One of the best perks about breastfeeding is the delay of the return of your period after your baby is born. Not everyone gets the delay, and there is no guarantee how long it will last for any one person. The period of time postpartum where many people do not have a menstrual period is called lactational amenorrhea. Most commonly, you will hear this referred to as a form of natural pregnancy spacing called the Lactational Amenorrhea Method.

Why is there typically a span of time where you don't get your monthly cycle after having a baby if you are breastfeeding?

PROLACTIN!

Prolactin is one of the lactation hormones, and it is responsible for driving milk production. Prolactin levels are naturally elevated after giving birth and remain elevated during lactation as long as nipple stimulation from nursing or pumping is happening. Over time, prolactin levels naturally decrease even with stimulation, and as stimulation decreases or pump sessions are dropped, babies feed less often as they increase their intake of solid food.

Prolactin levels directly inhibit ovulation, so until prolactin levels drop, you won't get your cycle back. This is most likely nature’s way of spacing children during lactation to ensure the nursing child can be sustained until they can consume alternative food sources, and the body can devote more energy and resources towards the pregnancy.

How long will lactational amenorreha last?

If you are exclusively breastfeeding, and removing milk 8-12 times per day, you will typically experience a period of 3-6 months without a monthly cycle, although this varies by person.

So why does supply seem to drop when your cycle returns?

The most common reason is the reality that your prolactin levels have dropped overall which curbs milk making potential for many parents. This is particularly problematic for exclusively pumping parents who may have been able to drop some pump sessions and sustain their desired output with less frequent milk removals. Once the normal cycle of reduced prolactin levels over time begins, these pumping plans may no longer support the same level of output with less frequent milk removals.

Some people experience a temporary drop in supply around ovulation due to reduced blood calcium levels. This can typically be addressed with calcium and magnesium.

Some people find their supply dips while they are actually having a period. This may be from hormone fluctuations, and in some cases, depleted iron levels and dehydration from heavier bleeding. Typically, focusing on solid nutrition, food intake, and considering working to investigate and balance the hormones can aid in that.

For individuals dealing with hormonal imbalances, these issues may become apparent after the menstrual cycle resumes as the lactational amenorrhea was preventing the fluctuations that they were previously experiencing, and these imbalances were not actively influencing milk production.

So why does this issue of supply dips seem to be more frequently discussed and pronounced in pumping parents compared to nursing parents?

When you are nursing directly, there is a lot of information about your daily milk supply that you aren’t routinely aware of. If you are making enough to satisfy your baby in 24 hours, that is all you truly know. With pumping, we are much more aware of small fluctuations and breastmilk production can be viewed more scientifically in terms of actual output versus an unknown detail in a relationship like we see with nursing.

A nursing baby will respond to decreasing milk levels by doing the very thing needed to bring back the milk supply, they nurse nurse nurse nurse nurse. Nursing is a two-party relationship and the baby is sensitive to shifts in supply that encourage compensatory nursing behavior to maintain the supply. My experience nursing three different babies through this cycle shift was that my babies responded to decreases in supply and flow by nursing more frequently, vigorously, and for longer nursing sessions. My cycle tended to return about the time my babies started solid foods, so they also responded by consuming higher amounts of solids for a few days, but as milk production responded favorably, they decreased their solids a bit again. I often noticed this increased nursing behavior about 24-36 hours before I noticed the decrease in pump output. The more I pumped, the more aware I was of the supply drop, which makes sense as to why we hear about this issue more in pumping parents.

Pumps are great for breast milk removal, but they have no ability to anticipate and respond to supply dips like a baby. Exclusively pumping parents may want to add strategies such as cluster pumping or power pumping during this time to help mimic a baby’s response to this natural occurrence.

Another challenge pumping parents may be grappling with is while prolactin levels are high enough to maintain lactation amenorrhea, they may be able to support their desired milk supply by pumping fewer times a day. BUT, once prolactin levels drop enough for the menstrual cycle to return, these pumping schedules may not be adequate to sustain milk supply. In cases like this we would need to evaluate milk supply concerns and consider modifying goals or pumping schedules.

Do you ovulate when you first get your cycle back postpartum?

Not always! It’s not uncommon for the first few cycles to be annovulatory which means no egg was released during the cycle. It’s also not uncommon for ovulation to precede the first postpartum period.

Can you get pregnant before your period returns postpartum?

This is a tricky question....the answer depends on how you define period returning. The bleeding we refer to as a period is the final stage of the menstrual cycle and happens when an egg was not fertilized and implanted, so the body sheds the uterine lining that was growing to support a possible pregnancy. So, before you would see your period, there is a good chance you already ovulated and that the body was fully prepared to sustain a pregnancy. Relying on the return of your period to tell you when you need to start worrying about pregnancy prevention could result in an unanticipated pregnancy.

How do we know if you ovulated before your period arrived the first time?

Well, if you were to become pregnant without a period postpartum, we can clearly see you ovulated and were fertile. It is not a rare thing for people to become pregnant again on the first ovulation before they actually get their period back. Oftentimes, they discover they are in fact pregnant again when investigating breastfeeding issues like lowered supply or sore nipples. This is why every intake form asks my clients if there is any chance of pregnancy, and why this is a question I ask whenever these symptoms appear together without another clear cause.

Some people choose to use natural methods of fertility tracking and management and may have been able to see the shifts in temperatures and cervical mucus that would confirm ovulation was occurring prior to the first postpartum period.

So once my period returns, am I considered fertile again?

YES! Once your period returns, it is considered that you are fertile and capable of becoming pregnant again. It is also important to note here that some people who struggled with fertility challenges or achieved pregnancy with assistive reproduction support may not want to automatically consider that they will not be able to achieve another pregnancy easily. Depending on the cause of the initial fertility challenges, there may be more favorable conditions postpartum. If you are not open to another pregnancy, previous fertility struggles is not a great form of pregnancy prevention to rely on.

Is birth control compatible with breastfeeding and maintaining my milk supply?

There are lots of methods of birth control and pregnancy spacing that are considered compatible with breastfeeding. A lot of the decisions around birth control come down to personal family decisions between you and your partner, but you can simultaneously breastfeed and make family planning decisions.

Should I be worried about getting my period back, and how it will impact lactation?

No, very few people avoid getting their menstrual cycle back with term breastfeeding (2-2.5 years), so clearly the return of the menstrual cycle does not doom you to poor milk production. It just means we need to respond according to your body’s particular needs to adjust your nursing and/or pumping plan to help support your goals. This is not a topic we want to stress about as much as a topic we want you to be informed about so that you can make the decisions about breastfeeding and postpartum fertility that are right for you.

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