Dear Doctor,

It’s been one year and four months since I gave birth to my first baby. However, my period has never returned. I’m still breastfeeding and my friends say that that is what is delaying it but I feel like it has been too long. Is this normal? What’s the normal time for menstruation to return after child birth?

Elaine

Dear Elaine,

Accept my heartfelt greetings on having your first baby. Usually, pregnancy is suspected with cessation of menstrual cycles.  After delivery, due to high levels of prolactin (hormone responsible for producing milk), periods take some time to resume.  Usually, periods can restart four to six weeks after delivery. But this is highly variable. Some women restart their menstrual cycles about four to six weeks after child birth, whereas in some it may take six months to even one year. Those who breastfeed exclusively usually begin their menses later than those who bottle feed their babies. This includes women who breast feed every four hours, who empty their breasts regularly. Women who latch their babies to their breasts usually have delayed menses as compared to women who pump milk and feed their babies later. Usually, the menstrual cycle beginning after delivery is not the same as before. There may be alteration in the duration of blood flow, time interval between periods and even the pattern of flow may change.  This happens because the body is still adjusting to the hormonal changes and new balance of hormones following child birth.

Menstruation may not start or may be delayed, if a woman has some hormonal disorder like hypothyroidism, Cushing’s syndrome or pituitary disorder.  Polycystic ovarian syndrome is also one pathological condition causing irregular or absent menses. Any of these disorders, if existing, can be diagnosed clinically and with suitable relevant investigations. They are treated easily with appropriate treatment.

A word of caution regarding absence of menstruation, following child birth, usually high levels of prolactin prevent conception as well.  Hence, many women resort to exclusive breastfeeding to prevent subsequent pregnancy as well.  But it is not a hard and fast rule. About four to six weeks after delivery, even while breastfeeding, a woman can conceive. The problem comes up here. Absence of menstruation after child birth is considered to be due to breastfeeding. But another pregnancy could have started, of which she may not be aware. The typical symptoms of pregnancy may not even occur. It may be diagnosed after a routine clinical examination or ultrasound. Hence one has to be very cautious. If a second baby is not desired soon, some other birth control method may be used to prevent pregnancy.  Intrauterine device or abstinence or coitus interruptus, use of male or female condoms is better than hormonal contraceptives at this stage.

Dr. Rachna Pande is a specialist in internal medicine.

E-mail- rachna212002@yahoo.