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.
In Summary
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.
References
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.
Thank you for this! I wish I had this resource when I opted to discontinue breastfeeding at 19 months postpartum in an effort to increase my luteal phase. (Although come to find out breastfeeding was causing major physiological PPanxiety for me – come to find out this is more common than most know). My first PP was about a year ago and I wish I could say that my luteal phase did in fact increase substantially by stopping breastfeeding but it did not. Only since this pandemic and the shutting down of the gyms have I had a luteal phase over ten days (12 days actually the past few months) so the steps you mentioned above I believe apply to TTC and lengthening luteal phase as well! When you’re dealing with struggling to get pregnant, it can feel powerless at times but there really are some objectives measures as the ones you’ve outlines that do help! Thank you for sharing this empowering information!
Thanks for sharing your experience and I so agree, Carley, that the similar lifestyle changes for getting a period can apply to TTC. I’m so glad to hear your LP is lengthening!
THANK YOU SO MUCH for sharing your research and experience related to postpartum periods and breastfeeding. My daughter is 14 months old and still breastfeeding 3-4 times per day and I haven’t had a period yet. I have a long history of HA prior to recovering and conceiving my daughter and have been super anxious that it won’t come back once my daughter is weaned. That makes a whole lot of sense about increasing energy availability in order to see a faster return of your cycle which is the same premise to recover from HA. Thank you for reiterating this concept and again for sharing your experience!
Awesome to hear she is still nursing at 14 months! I hope this post is helpful as you await your period Erin – I am so hopeful for you!
11 months postpartum I was aware I was ovulating. It seemed so clear to me. Checking my CM and even confirmed it with temp. and ovulation stick. Two weeks later I get a positive pregnancy test! We were wanting our two kids to be close so we were excited. But I was surprised it happened on first ovulation. Currently 14 weeks ☺️ have to say though your articles on FAM were helpful in understanding my body. Been practicing for almost three years and it’s been so neat to observe how the body works.
Congrats! I’m so glad the content has been helpful for you Micole 🙂
As a new mama with a 7-month-old baby girl, these breastfeeding posts have been SO helpful both for encouragement/insight and research-based information. Thank you!!
Two quick questions:
1) Do you have any insight or have you come across any information about how to maintain your supply once your baby starts eating solids? I’ve been wondering about how this may or may not impact my supply and also how to balance the two as she eats more solid foods over time.
2) Have you read anything about whether breastfeeding on one side per nursing session impacts your supply? I found a little bit of information from kellymom.com about this which was helpful and this has been a successful strategy for me so far, but I am wondering if I should try to encourage feeding on both sides to help with supply as she starts eating more solid foods and also sleeping almost or all the way through the night.
1) if you are nursing on demand your supply will meet baby’s needs – as baby takes more solids your supply will go down if he is eating more solids and nursing less – that’s normal! Kellymom.com has some great articles on making sure you’re not ramping up solids too fast that is leads to early weaning – I found Cal LOVED solids so much that around 7-8 months I cut back to 1 meal/day vs 2 because I wanted him to be getting primary breastmilk per kellymom’s articles (which you can fact check with the articles she sites at the end of each article too!)
2) kellymom and LLLs womanly art of BFing address this in length I think!
Robyn, do you mind sharing the link to the Kelly Mom articles you mentioned on starting solids?
Also, just wanted to share a bit of my experience- I also have a history of HA and got my first postpartum period at 5 months, despite exclusively breastfeeding. Sounds like that is pretty rare!
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Congrats on getting getting pregnant again! Thank you so much for this post! I’m 6 months postpartum and want to get pregnant again in late summer/early fall and have yet to get my period back so that being a possibility has def. been weighing on me! After reading what you did, It sounds like I’m doing all the things you’re not supposed to- structured workouts, probably not eating enough (not intentionally). Going to try out some of your suggestions!
On another note, do you have any info on how you felt before getting your period for the first time? I know it can be different than before having a baby, but I’ve Suddenly been having cramping and kind of just a sore/ tightness in my lower abdomen/ pelvic area which is never had before. My doctor said I could just be getting ready to be getting my period, but For some reason I don’t feel like it’s that. If you have any posts or suggestions that could relate to this I’d love to hear! 🙂
Congrats on getting getting pregnant again! Thank you so much for this post! I’m 6 months postpartum and want to get pregnant again in late summer/early fall and have yet to get my period back so that being a possibility has def. been weighing on me! After reading what you did, It sounds like I’m doing all the things you’re not supposed to- structured workouts, probably not eating enough (not intentionally). Going to try out some of your suggestions!
On another note, do you have any info on how you felt before getting your period for the first time? I know it can be different than before having a baby, but I’ve Suddenly been having cramping and kind of just a sore/ tightness in my lower abdomen/ pelvic area which is never had before. My doctor said I could just be getting ready to be getting my period, but For some reason I don’t feel like it’s that. If you have any posts or suggestions that could relate to this I’d love to hear! 🙂
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Thank you so much for sharing this! I had hypothalamic amenorrhea for 10 years as well; in fact, my 6 year old was conceived with the help of fertility treatments. I didn’t even get my period back until my daughter was 3. I was finally able to conceive our second daughter last year without medical assistance. Now I’m 3 months postpartum and would like to add one more child to our family, but I’m almost 38 and definitely feel like I’m running out of time.
This post is so helpful! Thank you again!
I think reading from you about pregnancy has been such a privilege. It’s put so much more of a wonder and joy and thankfulness in my heart when I do see a woman get pregnant. I’ve realized through following you and your love and sensitivity to all the women who come here, those who are trying to conceive, those who have babies, those who are pregnant, that it’s such a wonderful, delicate, amazing journey, and there’s nothing super easy about it. But I’m thankful for your LOVE for the ladies you help here and in your practice, Robyn. It really shows.
Just wondering if you are anything specific to help the returning your period? I’m in the EXACT same boat, my baby is 7 months now and we are wanting to try again but I’m exclusively nursing with some solids and water throughout the day but no sign of my cycle returning. I previously had HA as well. So any advice would help when it comes to specifics on your diet! Thanks!
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That’s something I’d work 1:1 on with a client to do that individual work. Happy to work with you if you’d like – email me!
Cannot tell you how much relief this post gave me. I am still nursing my 16 months old baby girl and not return of a period. I have a history of HA and it was near impossible to find information on that in the first place to recover and conceive. This makes so much sense and honestly brought tears to my eyes. It’s such an emotional thing and this gives me so much hope. Thank you
Hi Mekensie (and Robyn), I just wanted to say that I am having the same experience. I just stopped nursing my son a month ago, when he was 16 months old, and I haven’t had my period come back. My OB told me that this is “abnormal,” but something about this feels wrong. I breastfed my son through the night until he was over a year old, and I have a stressful high-responsibility job that I work at irregular hours because of the pandemic. My OB didn’t even ask me about these factors, other than when I stopped breastfeeding. I’ve been trying to conceive with no luck, but this post gives me a lot of hope. I am going to start trying to get more rest, eat more (I do eat healthy food, regularly), and probably quit worrying so much about exercise. We’ll see what happens. I’d love to get in touch though if you want, to support each other. I can be found on my blog at doublefourteen.com. I would love, love, love to talk to another mama during this process. <3 <3
Thank you! very well written.
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Reading more about the Relative Metabolic Load Hypothesis, there isn’t information out there about how long you would need to increase your caloric intake to help jumpstart ovulation. Do you have any info on this? Also, reading about it, it seems like insulin production is the main thing that may help with triggering ovulation, so it seems like eating a carb heavy diet would be more effective than just increasing caloric intake in general- do you agree?