How long does it take for menstruation (menses) to return after having a baby?

From the Guidelines

The return of menstruation after childbirth typically occurs within 4-8 weeks for non-breastfeeding mothers and can take 3-6 months or longer for those who are breastfeeding. This timeline varies significantly between individuals based on several factors. Breastfeeding delays the return of periods because it suppresses ovulation through elevated prolactin levels, a hormone that inhibits reproductive hormones, as noted in a study published in 2015 1. The more frequently a mother breastfeeds, especially if exclusively breastfeeding, the longer menstruation may be delayed. Once breastfeeding frequency decreases or solid foods are introduced to the baby, periods often return. Other factors affecting this timeline include individual hormone levels, body composition, stress levels, and sleep patterns. Some women may experience irregular cycles initially before establishing a regular pattern. It's essential to consider that ovulation can occur before the first visible period, so pregnancy is possible even before menstruation returns, highlighting the importance of contraceptive counseling postpartum, as discussed in guidelines from 2013 1. If periods haven't returned by 6 months postpartum for non-breastfeeding mothers or by 12 months for those who have stopped breastfeeding, consulting a healthcare provider is recommended to assess for any potential issues affecting menstrual return and overall reproductive health.

Key factors influencing the return of menstruation postpartum include:

• Breastfeeding status and frequency
• Individual hormone levels
• Body composition
• Stress levels
• Sleep patterns
• Use of contraceptive methods and their potential effects on menstrual cycling

Given the variability in individual responses to childbirth and breastfeeding, healthcare providers should offer personalized guidance on what to expect and when to seek medical evaluation if menstruation does not return within the expected timeframe. The most recent and highest quality studies support the notion that breastfeeding significantly impacts the timing of menstrual return, with non-breastfeeding women typically experiencing a quicker return to menstruation, as indicated by studies published in reputable journals such as MMWR Recommendations and Reports 1.

From the Research

Factors Affecting the Return of Menses

• The return of menses after having a baby can vary depending on several factors, including breastfeeding practices, maternal age, and parity 2, 3, 4.
• Breastfeeding has been shown to suppress fertility and prolong the period of postpartum amenorrhea, with more frequent and longer episodes of breastfeeding leading to a longer period of anovulation and infertility 3.
• The duration of postpartum amenorrhea can also be influenced by social and biological covariates, such as social status, level of income, religion, and residential status 4.

Timing of Menses Return

• According to one study, 64.5% of women had a return of menstruation within six months postpartum 2.
• Another study found that the return of menses is rare among fully breast-feeding women in the first 8 weeks postpartum, with only 10 women experiencing their first menstrual bleed before day 56 5.
• The median duration of lochia, which is the postpartum bleeding that occurs after childbirth, was found to be 27 days, and did not vary by age, parity, or breast-feeding frequency 5.

Association with Family Planning Use

• The return of menses has been found to be significantly associated with the use of modern family planning methods in several countries 6.
• Education about pregnancy risk prior to menses return is important, as unintended pregnancies can lead to poor maternal and child health outcomes 6.