This is part two of a two part series on breastfeeding – you can read part one here. My goal with this series is to provide information that’s a little harder to find when you start digging around on the internet. I don’t know everything about breastfeeding and I am certainly not an IBCLC. What I’m sharing in this series is a combination of my nursing knowledge, a lot of time spent researching, and my experience as a mama. I hope you find it empowering & encouraging!
One of the most common questions I’ve received over the last year center around 1) how to know when your period will come back postpartum 2) how to support your body so you can get your period back while still breastfeeding and 2) how to conceive while breastfeeding.
My aim is for this post is to shed light on all three of these concerns. Since every woman is unique, this post certainly doesn’t take the place of working with a knowledgable healthcare provider to address your own body’s needs. But I do hope it equips you will some helpful information and practical tips. I’ve worked with hundreds of women over the past 8 years to help them regain healthy, normal periods. And over the past 18 months as I’ve gratefully experienced the conceiving-while-breastfeeding journey myself, it’s been really rewarding to expand my clinical work and knowledge to postpartum periods & fertility, which can present its own challenges.
How Breastfeeding Affects Fertility
If you’ve experienced breastfeeding, you’ve probably heard someone tell you the perk of not getting a period while nursing. Sounds great! But that’s not always the case for women – the time it takes for a woman’s period to return postpartum varies A LOT. Before we dive into factors that influence the absence or return of your period, let’s talk about lactational amenorrhea.
What is lactational amenorrhea?
Lactational refers to breastfeeding and amenorrhea refers to not getting your period. When you are exclusively breastfeeding under certain conditions, lactational amenorrhea is actually considered a form of birth control that is 98% effective. These conditions are:
- your baby is under 6 months old
- your period has not returned yet
- you are exclusively breastfeeding on demand both day and night – which means baby gets no solid food or other liquids and you are nursing at least every 4 hours during the day and every 6 hours during the night
Because lactational amenorrhea relies on the intensity and frequency of baby suckling, pumping (and therefore bottle feeding) unfortunately does not provide the same hormonal effect as nursing – so some moms who pump + bottle feed instead of breastfeed (even if it’s just 1x a day) might see the return of their period sooner. Suckling by the baby stimulates prolactin production – prolactin is the hormone responsible for producing milk. This prolactin production disrupts the release of a hormone (gonadotropin-releasing hormone aka GnRH) that gets released from your hypothalamus and therefore everything downstream in the HPG axis gets disrupted, preventing ovulation.
In short….high amounts of prolactin produced in breastfeeding prevent your body from ovulating.
What Affects the Return of Your Period Postpartum?
When I was exclusively breastfeeding Cal, I knew about lactational amenorrhea so didn’t expect my period to return in the early months – even though I would occasionally replace a nursing session with a bottle of pumped milk if I was away…or wanted to have a drink. He also wasn’t a baby who slept through the night so I was nursing 1-3x a night throughout the whole first year and beyond. When he was about 8 months old we were thinking about another baby, but for me, it didn’t feel right to cut back on nursing or wean to get my period back. I do remember being stressed when he would wake during the night and only want the boob though, because in my brain that meant more frequent nursing, which meant less of a chance of my period coming back. After a few weeks of stressing over this I realized the stress of that was very much not helpful and turned to the research and started digging for as much as I could find about return of fertility while breastfeeding.
The catalyst to all this digging was my history of hypothalamic amenorrhea or HA. Essentially, HA is a state of low energy availability. So your body is expending more energy than it is taking in. Stress plays a role too, but central to HA is this mismatch between energy going out and energy going in. In conjunction with my HA history, I thought about the vast variation of the return of postpartum periods in women. I knew women who got their periods back 6 weeks postpartum while exclusively breastfeeding, some at 6 months, 10 months, 16 months and beyond. There was so much variation! Of course genetics do play a role, but I thought there had to be something more going on. I knew from Nicola Rinaldi’s research that only about 20% of women with a history of HA (which is me) get their periods back while breastfeeding. That was discouraging, but I was determined.
After a lot of reading and digging I realized there was another theory out there besides the frequency and duration of baby suckling that could explain the return of ovulation (and thus, your period). The idea with lactational amenorrhea is that once any of the variables (age of baby, frequency of nursing, absence of period) are no longer met, there’s an increased likelihood of ovulation resuming. But that wasn’t happening for me – Cal was over 6 months, I was going more than 6 hours without nursing most nights and he was eating solids.
After coming across this study and reading this post, things started to click. There was this other theory out there called the metabolic load hypothesis where essentially researchers found when a nursing woman reached a positive energy balance her period would return soon after – despite a high nursing intensity. That positive energy balance usually resulted in a small amount of weight gain (as little as 1/2 a pound a month which shows how sensitive the body can be) as her body prepared to ovulate and potentially grow another baby. I was fascinated by this, but it made a lot of sense to me. Our bodies have to be in a place of adequate energy availability and low stress for them to think, “hey, it’s safe to house and grow a baby in here!” So I thought about my recovery process from HA years prior and focused on energy availability.
From what I’ve gathered, there are a couple theories out there regarding breastfeeding and the return of fertility – the intensity and frequency of baby’s suckling and the energy availability of the mom. The former is far more well known. Baby’s duration and frequency of suckling could play a role since that affects prolactin like stated above. But according to the metabolic load hypothesis, in the presence of adequate energy availability, it seems baby’s suckling has less influence over fertility – perhaps little at all. Breastfeeding is calorically expensive. And in a culture hyper-focused on wellness and diet, women consciously or subconsciously are likely not meeting their energy needs. Couple our diet culture with the mom’s needs often falling second to the baby’s and it’s easy to ignore hunger cues, go hours without eating, etc.
Anecdotally, I saw the metabolic load hypothesis play out in my own life. I stopped worrying about Cal’s night nursing and instead focused on my energy availability. I’m thankful for the years of knowledge I had stored up surrounding HA recovery and the work I’d already done around body image & intuitive eating so these changes were just matter-of-fact. I wanted my period back, so I was willing to make any changes. I know for many women, these changes could be very emotionally loaded. That is okay. You are right where you need to be in your own journey. Also keep in mind, that genetics do play role. Getting your period back postpartum isn’t an input/output equation and every woman’s situation is different. I’m sharing some of my own story to give you some practical application – not to say this is how it goes if you do xyz.
I have a 10 year history of HA, so knowing only 20% of women with HA regain their periods while still breastfeeding, my hopes weren’t high. After compiling all the information I’d learned, I made the following changes:
- stopped pumping at night before bed – this was just an “extra” session I’d been doing for a while for various reasons and I stopped that – looking back I’m not sure if this was that influential or not
- dialed back structured exercise – at the time, I was maybe doing a couple 30 minute barre3 at-home videos a week and a light jog or longer bike road with Nick on the weekends ….we lived in Boston so life involved a good bit of walking which I wasn’t worried about, but I dialed back where I could and didn’t do any exercise that was intentional
- focused on responding to hunger cues immediately – with a baby to care for, it’s easy to push aside your own needs and before you know it you’ve skipped a snack you should have eaten because you were caring for baby or you were rushed getting out the door and forgot to take food (prior to having a baby, it was hard for me to understand how one could forget to eat)
- stayed very mindful of not going too long without eating and making sure I was eating enough in the beginning of the day
Overall, I really tried to just eat what sounded good and add in extra food where I could without feeling overly full since I don’t prefer that sensation. I was shocked when my period returned a month later at the end of September 2019. I can remember the moment I realized it had returned and I was freaking elated. I know for some women, there would not be much emotion wrapped up in their period returning or it might be a burden, that’s okay too. For me, the return of my period while still breastfeeding was another layer of restored trust with my body.
Conceiving while Breastfeeding
Every woman’s journey to having a baby is different. The topic of conceiving is so fragile. I hesitated to even write this section because I can physically feel the weightiness of this topic as I type. If you’ve had a more challenging road conceiving than expected know that I see you and that you are very much not alone. I hope the information I share in this space is helpful, but if you find it triggering or unhelpful, please do what you need to do to care for yourself.
Monitoring your cervical fluid as you are supporting your body in getting your period back and while you are trying to conceive is a great way to get a gauge on when you might be ovulating. I saw some WILD cervical fluid patterns prior to my first period at 9 1/2 months postpartum. It was copious for 7-10 days a couple weeks before I bled. And I mean copious. Thick. And almost a neon yellow color. TMI? Maybe. But I’ll risk being too descriptive if it helps other women. I remember being completely fascinated with what was happening – I knew hormones had to be shifting. Not all women will experience what I did, but regardless of the characteristics, increases in CF are indicative of estrogen rising and you getting closer to ovulation. Read this post on monitoring your cervical fluid if you’re interested in knowing when you ovulated. Keep in mind that while your body is trying to ovulate again postpartum, you can experience many different waves of increased CF for weeks or months before you actually ovulate.
Some women do conceive before they actually get their period back. So they never get a period at all postpartum. They conceive the first time they ovulate postpartum and therefore don’t get a period and instead get a positive pregnancy test. This isn’t the norm, but it can happen. Once I had my first postpartum period, I really started monitoring my CF. I can never remember to take my temperature and Cal’s sleep was so whacky during that time that I didn’t worry about it. To read more about fertility awareness methods, check out this post. After my period came back at the end of September. I monitored my CF in October and around day 17 I started seeing the classic egg white CF and that lasted for about 6 days. I didn’t take my temperature to confirm ovulation, but I likely ovulated on day 23. That’s later than your textbook, “day 14” which is why I encourage women to use the fertility awareness methods since every body is different. It was only my second postpartum cycle so it makes sense I had a long follicular phase as my body was figuring things out after 19+ months of no period. But even prior to getting pregnant with Cal my cycles were on the longer side at 31-34 days with ovulation around day 18-21. All that to say, there is a wide range of normal.
A couple weeks later I had a positive pregnancy test. I was shocked it had already happened. I have a 10 year history of HA. My mom was taking Clomid when she had me and my brothers and I have many friends, family and clients where that is not their story. I have a lot of feelings surrounding the ease of our baby making journey knowing that isn’t the case for so many people I love. Gratitude, guilt, sadness, foreboding joy (as explained by Brené Brown) and a mix of others. I’m not sure what our future fertility journey holds, but I am thankful. Thankful thankful thankful.
How your period affects milk supply
I’ll touch on how your period affects milk supply briefly before wrapping up this post. I noticed a drop in my supply during that first postpartum period in September, which isn’t uncommon if you find that’s the case for you too. From mid-cycle (aka around ovulation) to the few days leading up to or at the time of your period, you might notice a dip in milk supply. You might also notice your nipples are more sensitive so nursing might be more uncomfortable. This is all due to the hormonal shifts of estrogen and progesterone. If you’re nursing on demand, your baby will typically compensate during this time with an increased frequency of nursing. I remember pumping during a wedding we went to and only pumping about half of what I normally would.
In LLL’s book, The Womanly Art of Breastfeeding, they state “a daily dose of 500 to 1,000 mg of a calcium and magnesium supplement from the middle of your cycle through the first three days of your period may help minimize any drop in supply.” I highly recommend LLL as a great breastfeeding resource, but please talk to your healthcare provider before starting any supplementation.
As women, I find our bodies to be pretty incredible. Our pastor in Boston once said, “a man’s contribution to reproduction is embarrassing” and I laughed with a strong head nod. Men’s bodies make their very necessary contribution, but I hope you remember how amazing your body truly is – no matter what your story surrounding fertility has held or will hold.
Bever, Jennie. “When Will I Get My Period Back If I’m Breastfeeding:?” Arizona Breastfeeding Center, Arizona Breastfeeding Center, 10 Mar. 2015, azbreastfeedingcenter.com/new-blog-1/2015/2/9/the-science-of-lactation-and-fertility-when-will-i-get-my-period-back-if-im-breastfeeding.
Valeggia, C., & Ellison, P. T. (2009). Interactions between metabolic and reproductive functions in the resumption of postpartum fecundity. American journal of human biology : the official journal of the Human Biology Council, 21(4), 559–566. https://doi.org/10.1002/ajhb.20907
Valeggia, C., & Ellison, P. T. (2004). Lactational amenorrhoea in well-nourished Toba women of Formosa, Argentina. Journal of biosocial science, 36(5), 573–595. https://doi.org/10.1017/s0021932003006382
Van der Wijden C, Manion C. Lactational amenorrhoea method for family planning. Cochrane Database of Systematic Reviews 2015, Issue 10. Art. No.: CD001329. DOI: 10.1002/14651858.CD001329.pub2
Wiessinger, Diane, et al. The Womanly Art of Breastfeeding. Pinter & Martin, 2011.