Everyone’s post-pregnancy body is on a different schedule when it comes to periods (and recovery in general, TBH—just ask our beauty editor about her postpartum skin changes). But learning about the factors that can affect your period after birth can help normalize your experience, or alert you if something seems off.

Here, Holly Loudon, MD, MPH, associate professor and chair of obstetrics, gynecology, and reproductive science at Mount Sinai West and Mount Sinai Morningside, answers all your postpartum period questions—including when to expect a red streak in your underwear, what might delay Aunt Flo’s return, and how your period symptoms may be different than before.

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When do you get your period back after birth?

“The average time for a period to return after giving birth is between 45 to 64 days,” says Dr. Loudon. The vast majority of postpartum people (about 70 percent) will have a period by 12 weeks, she says.

Still, the timeline of the first postpartum period varies largely from person to person (and can even differ from one pregnancy to the next). For example, some people will get a visit from Aunt Flo as soon as two weeks after giving birth while others won’t need a tampon, pad, or menstrual cup until a year (or more) postpartum.

“The main factor that influences when your period returns is breastfeeding,” says Dr. Loudon. When you nurse, your body produces prolactin—a hormone that helps you make milk. But as prolactin spikes, other hormones that regulate your period (like estrogen and progesterone) dip, according to UT Southwestern Medical Center. And this can delay your period.

“The main factor that influences when your period returns is breastfeeding.” —Holly Loudon, MD, MPH, OB/GYN

Do you get your period while breastfeeding?

“Yes, you can get your period while breastfeeding,” says Dr. Loudon. But it might take a while—months or more—before it comes back. The breastfeeding hormone prolactin is the reason for this delay. It hinders the part of your brain called the hypothalamus from releasing the hormone that triggers menstruation, she says.

You might be waiting even longer for your first postpartum period if you’re exclusively breastfeeding (meaning, you don’t feed your baby anything other than your breastmilk). “In fact, 40 percent of people who exclusively breastfeed will not have a period by six months postpartum,” says Dr. Loudon. And some people won’t get their period until they’ve fully weaned (i.e., completely stopped breast- or chestfeeding).

On the other hand, if you combo feed your baby (i.e., you give them breastmilk and formula), you might get your monthly menses as soon as five to six weeks after birth, according to the National Health Service (NHS). Why is that? Well, when you combo feed, you’re usually producing less milk. This sends your body the message that it no longer needs to make milk, and it’s time to restart your menstrual cycle. Likewise, you might also speed the return of your regular cycle if you nurse less often or introduce other solid foods to your little one, says Dr. Loudon.

So, can you get pregnant while breastfeeding?

Yep. Though the odds are lower, you can still conceive when you’re breastfeeding, even if your period hasn’t returned. And it can happen as soon as three weeks after you give birth, according to the NHS. That’s because you can ovulate without knowing. Case in point: Most birthing people start ovulating sometime between delivery and the first postpartum period (typically up to six weeks after birth), per UT Southwestern Medical Center. So, if your ovaries release an egg, and it gets fertilized, boom, a pregnancy can happen.

But if you exclusively breast- or chestfeed your baby, your pregnancy risk is much, much lower in the first six months after birth. This is because your body stops ovulating when you exclusively nurse, according to Planned Parenthood. No ovulation equals no pregnancy.

Does that mean you can use exclusive breastfeeding as a reliable form of birth control? That depends. It can be up to 98 percent effective at preventing pregnancy if and only if all three of the following criteria are met, per Le Leche League:

• Your baby is younger than six months old
• Your periods have not returned (no spotting)
• Your baby is breastfeeding exclusively and on demand, day and night (this means your baby is not regularly receiving any other food or drink, including water, and your baby is not using a pacifier)

Even so, every postpartum person is different. Some will still get their first postpartum period (and thus, can still get pregnant) even when all of these conditions are true, per La Leche League. So, hear us out: if you don’t plan on getting pregnant while breast- or body-feeding, always, always use another kind of birth control.

Which forms of birth control can you use while breastfeeding?

Most experts suggest holding off on getting pregnant again soon after giving birth. Here’s why: When you conceive in the postpartum period, your body hasn’t fully healed or recovered. This raises your baby’s risk of premature birth and infant mortality, according to UT Southwestern Medical Center. To be safe, it’s recommended to wait at least 12 to 18 months before another pregnancy.

Talk to your doctor about birth control options during the postpartum period. There are many safe options while you breast- or chestfeed, including the following, per Penn Medicine:

• Non-hormonal methods of birth control: Condoms, diaphragms, and cervical caps (with or without spermicide) don’t have any effect on your breastmilk supply.
• The mini-pill, or a progestin-only pill: While a small amount of the progestin hormone passes through breastmilk, it has no known effects on your baby, and it won’t mess with your supply.
• Other hormonal birth control methods: IUDs, the Depo Provera shot, and implants (such as Nexplanon) don’t affect the quantity or quality of your breastmilk.

What to expect from your first period after baby

Your first few postpartum periods may be a little wonky, especially if you’re nursing. Though every person is unique, you might get the following changes in your menstrual cycle after birth, per the NHS, the Cleveland Clinic, and UT Southwestern Medical Center:

• Irregular periods (especially if it returns while you’re breast- or chestfeeding): These irregular period patterns may continue for a while (up to a year after birth) even if your monthly menses used to come like clockwork prior to pregnancy. Think about it: It took nine months (and many hormonal changes) to grow your baby, so returning to a regular cycle will also take time.
• Cramping: If you had period cramps pre-pregnancy, they’ll likely resume. But there’s a chance they’ll be better than before. Your period symptoms may improve now that pregnancy and childbirth have stretched the uterus and dilated the cervix. Plus, pregnancy also releases hormones that relax uterine muscles.
• Heavier, longer, or more painful periods: There’s also a possibility that your periods will be worse. This can happen now that your uterine cavity is larger and shedding more endometrium—the lining of the uterus. C-section scarring may also increase period pain and flow.
• Small blood clots in your periods: This happens as the uterus shrinks back to its normal size and sheds mucus, blood, and tissue.

In the weeks after birth, you’ll also have postpartum bleeding called lochia, which also involves shedding of the uterine lining, says Dr. Loudon. This isn’t a true menstrual period, but it can happen at the same time as the first postpartum period. It usually starts as bright red blood, then turns brownish or pink in color, and eventually fades to a yellowish/white discharge. “About 15 percent of postpartum people will continue to have lochia…for up to six to eight weeks after delivery,” she says.

Your first period while breastfeeding

Even if your period returns while you’re nursing, you can expect it to be, well, a little unexpected. People who breast- or chestfeed are more likely to have irregular periods when they’re postpartum. This has to do with lower levels of estrogen in your body, according to UT Southwestern Medical Center. Thanks to these hormonal changes, breastfeeding can also cause intermittent ovulation, says Dr. Loudon. This means your period may start and then disappear again for a bit, she says.

How, then, does the return of your (regular or irregular) menstrual cycle affect your milk supply? It really shouldn’t, says Dr. Loudon. As long as you’re feeding or pumping frequently, your milk production should stay strong.

When to see a doctor

Bottom line: Your periods might be a little off during the postpartum period, particularly if you’re nursing. As we learned, the first few periods after birth may be irregular, longer or shorter, heavier or lighter, or more (or less) painful. In most cases, these changes are totally normal, temporary, and nothing to worry about. But certain period symptoms may be a sign that something more serious is up, such as a postpartum hemorrhage.

See your doctor or midwife right away if you have any of the following symptoms, per Dr. Loudon and the Cleveland Clinic:

• Heavy bleeding that soaks a pad every hour
• Bleeding that lasts more than seven to 10 days
• Large blood clots (like the size of a plum or golf ball)

Likewise, if your period blood or discharge has a foul odor, or you have a fever or chills, let your doctor know. These can be indicators of an infection.

FAQ

How long should your first period after birth last?

As your body resets after pregnancy and birth, your first postpartum period may last a little longer or shorter than your pre-pregnancy periods. While everyone’s “normal” is different, bleeding generally lasts anywhere from two to seven days, per the Cleveland Clinic. If you bleed longer than seven days, tell your OB/GYN or midwife, says Dr. Loudon. They can check you out to see if there’s an underlying issue causing prolonged periods.

Do you ovulate while breastfeeding?

It depends on whether you’re exclusively nursing or not. When you nurse your baby frequently (and only give them breastmilk), your body naturally stops ovulating, according to Planned Parenthood. Again, this is thanks to the breastfeeding hormone prolactin. Prolactin prevents your body from producing higher levels of other hormones like estrogen that control your periods.

But if you combo feed with formula, or don’t nurse often enough, your period (and ovulatory cycles) will likely return sooner. Most people start ovulating within six weeks after giving birth, per UT Southwestern Medical Center.

Can your period start then stop again while breastfeeding?

Unfortunately, yes. Just when you think your periods are getting back to “normal,” they may suddenly go away again. That’s because breast/chestfeeding can cause intermittent ovulation, says Dr. Loudon. Meaning, sometimes your ovaries release an egg, and sometimes they don’t. When they do, you’ll get a period; when they don’t, your period will be on pause.

How long can you go without a period while breastfeeding?

If you combo feed, you can expect to get your period back anywhere between two and 12 weeks after delivery. But Aunt Flo might be on hiatus for much longer if you exclusively breast/chestfeed (i.e., your baby doesn’t get formula or table food, and you nurse at least six times a day). “Some people who are exclusively breastfeeding can go for a year or more without getting a period,” says Dr. Loudon. But, again, everyone is different. Some people see their periods return as early as six months postpartum (even when they’re exclusively breast/chestfeeding). On average, people who only breast/chestfeed will get their monthly cycle back on track between nine and 18 months after they give birth, according to La Leche League.