Yes, Pregnancy Changes Your Period. No, Nobody Tells You That

I remember it like it was yesterday: Nine months postpartum, I was pumping (because I was always pumping), when I felt a familiar twinge in my stomach, near my hip. The next day, my back (and oddly, my butt?) started to ache. Then the cystic acne appeared. For days, my face broke out with a ferocity I hadn’t experienced since middle school.

I raced to the store to buy tampons. It was back. After 19 glorious period-free months, my menstrual cycle was back.

But even then, I didn’t anticipate what would happen next. For ten long days, I had marble-sized blood clots, severe cramps and mood swings that would make Mommie Dearest raise her overdrawn brows. I lived with heating pads on my back and stomach and fired up the TENS machine I’d originally bought to use in labor in the hopes of some relief. This all might have been more manageable if my baby wasn’t attached like a barnacle to my boob, cluster feeding for hours after what I guessed was a hormone-related drop in my milk supply. I called out sick from work. That night, despite doubling up on pads, I leaked all over my bed.

“I think something is wrong,” I remember telling my husband when we woke up. “Should I be bleeding this much?” He encouraged me to call my OB/GYN, who explained that it was completely normal for a birthing person’s menstrual period to get heavier after childbirth, then hung up. “Oh, OK,” I said, while soaking my sheets with vinegar in the bathtub.

So I did what I always do when I’m unsure about something postpartum-related: I texted my group of mom friends. Their responses were about a million times more comforting and reassuring than my doctor.

Like me, none of my friends saw this coming, and also like me, when they talked to their OB/GYNs about it, they were told it was normal, and that’s about it. (I was in such a sleep-deprived blur during my six-week postpartum check-up that my doctor may very well have explained to me in great detail about what to expect when my menstrual period returns. Who knows?!) But like a host of so many other pregnancy after-effects like hair loss and pelvic floor issues, “normal” doesn’t make it any less surprising when it’s happening to you.

So, what’s really going on in a person’s body when the menstrual cycle returns after pregnancy? I reached out to Dr. Jill Purdie, board-certified OB/GYN and medical director at Pediatrix Medical Group in Atlanta, Georgia, for more details. “During breastfeeding, the brain makes prolactin,” she explains. “This hormone interferes with ovulations, which in turn causes people to not have a period. This effect is not consistent, which is why people who are breastfeeding see varying returns to normal periods.”

OK, that all makes sense. And according to Dr. Purdie, the drop in prolactin can lead to many of the symptoms my friends and I experienced. “The first menstrual period after giving birth is often heavier than a person’s typical period. The vast majority of my patients experience this. After the first menstrual cycle, most people’s periods will be the same or very similar to before childbirth.” But, Dr. Purdie explains that after the first cycle, your mileage may vary. “I have had patients who report their periods are better (lighter, less cramps) and worse (heavier, more cramps) after giving birth, but this is not consistent.” Luckily, my periods did seem to settle down as the months went on, but that isn’t the case for everyone.

“The first postpartum menstrual cycle is like a hormonal reset,” adds Nikki Greenaway, a family nurse practitioner and lactation consultant who is also the Director of Clinical Services at Major Care. “Think of it as puberty 2.0. Your breasts are different. Your body is different. Your hormones are out of balance and recalibrating as you recover. There is a very good chance your period will be different.” And oh boy, was it.

And what’s the deal with the drop in my milk supply that felt so surprising and scary at the time? Greenaway helped me understand that as estrogen increases with menstruation, it affects the way prolactin works in the body. So this inverse hormonal relationship may cause a (usually temporary, phew) drop in milk supply. “The best thing parents can do is keep removing milk whether by nursing their baby or pumping,” she explains. “Once the estrogen levels decline towards the end or after your cycle, the prolactin is allowed to resurface and produce milk more efficiently. Be patient. This is the natural process of these hormones.”

Greenaway also assured me that her patients also tend to be surprised by these sudden changes just like I was. “They are equally surprised when their period returns and the fact that it is different than before,” she says, adding that this is why she believes it’s so important to educate parents about their postpartum hormones and how they can affect a pregnant person’s recovery.

So…what helps? “Hydrate and nourish your body to keep your energy up,” Greenaway advises. “Check in on your mental health. You may feel that your PMS was more intense. Continue your prenatal vitamins or switch to [postnatal supplements].” Taking ibuprofen, lying on the couch to my heart’s content and eating lots of good fats, like avocado, almonds and olive oil, seemed to make a difference for me. And, of course, talking to my mom friends. Like so many of the things that happen to our bodies postpartum, the more we talk about this stuff with each other, the more prepared new parents will be, and the less alone we’ll all feel.