Duration of Postpartum Lochia
Lochia typically lasts approximately 3-5 weeks postpartum, with a median duration of 27-33 days, though it can persist up to 6 weeks or longer in some women. 1, 2, 3, 4
Normal Duration Ranges
- Median duration: 27-33 days across multiple studies, with significant variation between individual women 1, 2, 3, 4
- Interdecile range (10th-90th percentile): 10-42 days, demonstrating substantial normal variation 5
- Extended duration beyond 40 days occurs in 11-13% of women and should not automatically be considered pathological 2, 4
- Complete resolution by 6 weeks (42 days) occurs in approximately 87% of women 4
Lochia Color Patterns and Phases
The traditional teaching of sequential rubra→serosa→alba phases does not reflect the actual experience of most women. Three distinct patterns have been identified 1:
Type 1 Pattern (Most Common - 51%)
- Classic progression: rubra→serosa→alba 1
- Rubra phase duration: 12.1 ± 6.7 days 1
- Strongly associated with breastfeeding 1
- This is considered the "classic" pattern but occurs in only about half of women 1
Type 2 Pattern (28%)
- Prolonged rubra phase with shortened serosa/alba phases 1
- Rubra phase duration: 24.8 ± 5.0 days 1
- Associated with higher parity and shorter/absent breastfeeding 1
Type 3 Pattern (21%)
Factors Affecting Duration
- Parity: Lochia duration is shorter in parous women compared to primiparous women 4
- Infant birth weight: Smaller babies are associated with shorter lochia duration 4
- Breastfeeding: Women with Type 1 pattern (classic progression) are more likely to be breastfeeding 1
- Geographic/population variation: Median duration varies significantly across populations (range 22-34 days) 2
Important Clinical Considerations
End-of-Puerperium Bleeding
- 20.3% of women experience a distinct bleeding episode around day 40 postpartum, separate from continuous lochia 2
- This phenomenon is poorly understood but appears to be a normal variant 2
Intermittent Bleeding Patterns
- More than 25% of women experience bleeding that stops and restarts, or intermittent spotting/bleeding within the first 8 weeks 3
- 11.3% of women have bleeding within 56 days of delivery that is separated from lochia by at least 14 days 2
Warning Signs Requiring Medical Attention
Despite the wide variation in normal lochia, certain findings mandate evaluation 6, 7:
- Sudden heavy bleeding or large clots after lochia has lightened 6
- Foul-smelling discharge suggesting postpartum endometritis 6, 7
- Fever >100.4°F (38.0°C) on more than two occasions >6 hours apart 6, 7
- Severe abdominal pain or uterine tenderness 6, 7
Clinical Pitfalls to Avoid
- Do not assume the traditional 2-week duration is normal - this teaching is outdated and does not reflect actual clinical experience 1, 3
- Do not automatically diagnose pathology when lochia extends beyond 4 weeks - up to 13% of normal women have lochia lasting beyond 40 days 2, 4
- Do not dismiss patient concerns about intermittent bleeding - while common (>25% of women), this pattern can cause anxiety and warrants reassurance 3
- Primiparous women are 4 times more likely to feel surprised or shocked by their vaginal bleeding experience and require more detailed anticipatory guidance 5