Making Sense of your Period Postpartum

Postpartum charting has been touted the wild wild west of charting for a reason. Getting the hang of fertility awareness in regular cycles is one thing, but once you add the uncertainty of postpartum into the mix it can be all the more challenging. Whether you’re currently pregnant or have recently given birth and are wondering what the heck is going on with your cycle, read on to learn more about making sense of your period postpartum.

Postpartum Hormonal Landscape

What’s happening hormonally following birth and how does this impact your cycle? From conception, progesterone remains the dominant hormone during pregnancy, nourishing the placenta, fetus and ensuring a healthy pregnancy.

A switch in hormones occurs as labour approaches, and progesterone along with estrogen drop drastically. The hormone oxytocin is responsible for contracting the uterus during labour, and also promotes the birth of the placenta and baby-to-mama bonding post birth.

Prolactin and oxytocin are released as the baby breastfeeds, and these happen to be two hormones that suppress ovulation.

Now that baby is here, estrogen is in a wrestling match with prolactin and oxytocin. Estrogen is fighting to trigger the events of ovulation, while prolactin and oxytocin are fighting to suppress ovulation.

The time it takes for the return of your fertility will be based on many factors and this can differ after each pregnancy. Just because your fertility returned at a certain time for your first baby, doesn’t mean you will follow the same pattern for subsequent postpartum time.

Breastfeeding, and general time spent with baby are factors that impact the production of prolactin and oxytocin. And if prolactin and oxytocin are consistently suppressing ovulation, you might be waiting a long time for your cycle to come back.

Waiting for your period postpartum from a FAM perspective means that you’re technically in a long, drawn out pre-ovulatory phase.

In regular cycles, fertility awareness based methods have rules for opening the fertile window which can be based on the presence of cervical mucus and a calculation rule.

The return of your fertility depends on your breastfeeding patterns, and whether you are exclusively breastfeeding, partially breastfeeding, or not breastfeeding at all. Fertility can return as early as a few weeks in some cases, and in many many months in others. Approximately 60% of menstruators will ovulate before they have their first period postpartum.

It’s important to note that because postpartum is such a tricky time for charting, FAM postpartum is best done with a trained fertility awareness educator. Which methods are the best for charting postpartum? Let’s get into it!

Basal body temperature and symptothermal charting

Basal body temperature is a progesterone biomarker, and will only shed light on ovulation after it’s actually happened. During your return of fertility you might be tracking BBT for a very long time until you notice a temperature shift. And once you do notice a shift, ovulation has already come and gone. It’s not a helpful sign for identifying ahead of time when ovulation will take place.

Because of this, symptothermal methods which rely on both cervical mucus and basal body temperature to track fertility, might not give you the most available days for unprotected sex.

If you’re tracking your periods and cycle postpartum, cervical mucus remains the number one biomarker that indicates ovulation might be happening. The reappearance or change in cervical mucus signals that estrogen is rapidly changing and could rise enough to trigger ovulation. You might experience several of these phases of high estrogen before ovulation actually occurs.

The Lactational Amenorrhea Method

Because ovulation is suppressed with the release of prolactin and oxytocin from breastfeeding, there are several breastfeeding dependent approaches to managing postpartum fertility.

However, it’s not just ‘breastfeed and you won’t get pregnant.’ With these approaches, a strict set of rules is to be followed to ensure highest efficacy.

With the lactational amenorrhea method (or LAM, as its typically referred to), ovulation can be suppressed for up to 6 months if the rules for breastfeeding are followed. The following are a general overview of the LAM breastfeeding rules. You can use LAM if:

There is no vaginal bleeding after first 56 days.
Baby is exclusively breastfeeding and not receiving supplementation of pumping or bottle feeding.
You are co-sleeping with baby.

There is no more than 4 hours during the day, and 6 hours during the night between feeds.

If these conditions are met and maintained, and amenorrhea continues to be extended, ovulation may be suppressed for up to 6 months, and is 98% effective at preventing pregnancy.

Ecological Breastfeeding

An even more precise set of breastfeeding rules ensures higher efficacy if your period continues to be suppressed. These rules, outlined in The Seven Standards of Ecological Breastfeeding (Kippley) are as follows:

1. Breastfeed exclusively for the first six months of life; don’t use other liquids and solids, not even water.

2. Pacify or comfort your baby at your breasts.

3. Don’t use bottles and don’t use pacifiers.

4. Sleep with your baby for night feedings.

5. Sleep with your baby for a daily-nap feeding.

6. Nurse frequently day and night, and avoid schedules.

7. Avoid any practice that restricts nursing or separates you from your baby.

After about 6-8 months, or your baby starts desiring solids, a second set of rules (Phase 2) is followed.

Of course, life doesn’t allow every mother to be able to follow these rules so closely and it may not be realistic. Work, other children or one’s own mental health, can all be a barrier to following the strict roles of Ecological Breastfeeding.

Even if you’re able to perfectly follow the LAM or Ecological Breastfeeding protocols, they’re not foolproof and your fertility could hypothetically return sooner than average. This is why if you’re postpartum and having unprotected sex, I’d recommend charting so that you can track your cervical mucus, avoid potentially fertile days, which would be the safest way to avoid pregnancy in the postpartum. Here are the methods of fertility awareness which I would recommend for postpartum.

The Marquette Method

Marquette is a popular choice for postpartum charters. This method uses hormone testing to identify the fertile window. The Clearblue fertility monitor is used to measure urinary hormones and can be a helpful objective measure when the postpartum pre ovulatory phase is long and cervical mucus is ambiguous.

Each day, the user measures estrogen levels with the Clearblue monitor (the user must purchase a monitor and there is a recurring cost for the tests). When estrogen levels meet a threshold amount, an LH test is done which also needs to meet its own threshold to confirm. The monitor does have a specific protocol for postpartum, learned through an instructor.

The Billings Ovulation Method

The Billings Ovulation Method is really best learned with an instructor (are you tired of hearing that yet? 😅), because the user needs to be closely coached until they reach autonomy with the method. It is a very simple method, and the concepts are quite easy to learn. Billings relies heavily on vulval sensation, and because it uses cervical mucus only, its quite a simple and freeing method. For new mamas with a lot on their plate, the freedom of only needing the chart and your own observations is appealing.

Billings has a much better protocol for long cycles, like in postpartum, because the instructor is trained in establishing what’s called a basic infertile pattern, or BIP. The BIP might be dry, it might be infertile discharge, or it might be a combination of the two. In cases like postpartum, you’ll be relying on the early day rules of the Billings method for available days for unprotected sex. Billings is a simple method, but requires diligent charting and record keeping as well as close support from an instructor.

Barrier methods

Now, postpartum is a challenging enough time on its own - physically, emotionally, mentally and spiritually. Contributing to these challenges are the lack of sleep, the upheaval of life as you know it, and the physical healing (just to start!). If you haven’t yet learned a method of fertility awareness, and you’re already in postpartum, the very thought of learning to chart might send you into a tailspin.

Time for some real talk: If you don’t want to learn a method of fertility awareness right now, or it simply feels too overwhelming, don’t!

Barrier methods like condoms, diaphragms or cervical caps (slightly less effective than diaphragms), alternative sex, perfect withdrawal are effective and responsible methods of contraception. These options are available to you, and if you use them properly and use them each time you have sex, once life settles down you’ll have the brain space to learn a method of fertility awareness.

Cycles after the return of fertility

Until your cycles return, it’s hard to predict what to expect or how long it will take for ovulation to return. Once you do start ovulating again, there might be a period of time where your cycles are still not quite how they used to be. I often see my postpartum clients taking several cycles for the length of the cycle and luteal phase to regulate. This is reflected in the studies as well.

This is reflected in at least one study (McNeilly et al) with 37 participants, examining the adequacy of the luteal phase after cycles resumed postpartum. The study found that for women and menstruators who breastfeed, the first 3 cycles were likely to demonstrate progesterone deficiency.

What this means for you is that you may experience some irregularity in your periods postpartum, specifically around ovulation and the luteal phase length. If this happens, don’t worry, things will even out as your body and hormones heal after birth. Give yourself time and grace.

Charting postpartum can be a confusing and challenging time, because your fertility signs might not follow a pattern you are used to. There is also no set amount of time it takes for your cycles to return. Even if your cycles returned at a certain time following one birth, this does not determine the future return of fertility. Reach out to a fertility awareness educator who is trained in a method that has a strong postpartum protocol, and who can guide you what can sometimes be a rocky phase of life. And when in doubt, barrier methods, alternative sex or withdrawal are perfectly acceptable methods of contraceptives.

References

McNeilly, A. S., et al., (1982). Fertility After Childbirth: Adequacy of Post-Partum Luteal Phases. Clinical Endocrinology: 609–15.

Kippley, S. 2008. The Seven Standards of Ecological Breastfeeding.

Kennedy K., Rivera R., McNeilly A. (1989). Consensus statement on the use of breastfeeding as a family planning method. Contraception, 39(5), 477-96.