After giving birth, the cycle of menstruation gets lost. Menstruation after childbirth - irregular cycle, delay, features

Restoring the cycle after childbirth is a physiological process that speaks of a return to normal women's health. Not everyone's reproductive system works well, so menstruation proceeds with complications and disruptions.

Recovery rates and terms

During gestation, the body completely changes, affecting the internal systems. The birth of a child and the normalization of the cycle represent the process of returning female organs to a pre-pregnant state.

The resumption of the menstrual cycle is divided into two stages:

1. the ovaries begin to produce estrogen, the inner layer of the uterus swells, and the ovulation process starts;
2. the egg moves through the fallopian tubes, entering the uterus for further fertilization.

Menstruation, or bleeding, occurs because the egg is not fertilized and the endometrium is rejected by the body. Normally, bleeding lasts up to 7 days, the volume of lost fluid does not exceed 150 ml.

The timing of the onset of the first menstruation in the postpartum period depends on the physiological characteristics of the body, lactation, the number of previous births, and age. In non-breastfeeding women, menstruation begins 6-8 weeks after the baby is born.

Symptoms of recovery of the monthly cycle after childbirth:

• pulling light sensations in the uterus;
• menstruation from 3 to 5 days;
• discharge has a scarlet tint;
• the volume of blood loss is not more than 80 ml for the entire period of menstruation.

The average cycle time is 21 to 35 days. The body recovers in different ways, but the main thing is that the terms do not exceed the norm.

Possible deviations and complications

The rate at which menses recover depends on age, lifestyle and breastfeeding. In women in labor, there are complications during menstruation, as well as their complete absence.

Why the cycle of menstruation does not recover in any way:

1. age over 30;
2. a large number of previous pregnancies and childbirth;
3. genital pathology;
4. incorrect postpartum regimen;
5. inflammatory processes.

In women, the cycle is normalized during lactation after the introduction of the first complementary foods. This is due to the fact that the number of breastfeeding decreases and the body begins to return to its previous mode of operation.

Complications when a cycle is established:

• irregularity;
• duration over 6 days;
• large blood loss;
• severe pain;
• hyperprolactinemia;
• menorrhagia;
• postpartum hypopituitarism;
• dysfunction of the ovaries.

Disruptions in the menstrual cycle often lead to bleeding for more than 6 days. Long periods speak of uterine fibroids, inflammatory processes, endometriosis. Large blood loss, over 150 ml, is not the norm. The deviation can be determined if the gasket is not enough for 5 hours.

Pain in the uterus and abdomen is called algodismenorrhea. When the cycle is restored in women, pain is associated with birth stress, inflammation of the genitals, and contraction of the uterus.
Menorrhagia is a condition in which your period lasts 10 days. In this case, the woman loses a large amount of blood.

Postpartum hypopituitarism appears due to vasospasm. The disease manifests itself in severe blood loss in the amount of more than one liter. Hyperprolactinemia results in an irregular menstrual cycle caused by elevated prolactin levels.

Signs of deviations and recovery rules

Deviations from the norm during the recovery period of the female body are associated with inflammatory processes, exacerbation of chronic diseases. Unstable or absent menstruation is a serious malfunction in the reproductive system.

How long does it take for menstruation to recover after childbirth? Normally, in breastfeeding women, menstruation begins when lactation ends or complementary foods are introduced into the baby's diet. With artificial feeding, the body of a woman in labor returns to normal in the first six months.

Signs when the menstrual cycle is not restored:

• absence of menstruation when lactation stops;
• short or long periods;
• severe pain in the uterus;
• swelling of the mammary glands;
• increased blood pressure;
• mood swings.

These signs indicate malfunctioning of the female reproductive system. The reason for the complete absence of menstruation is an unplanned early pregnancy. Contraceptive methods must be used even when breastfeeding.

Can the menstruation cycle go astray after childbirth? In the postpartum period, the regularity of menstruation changes. The number of days often exceeds the pre-pregnancy time. On average, the cycle takes 21 to 30 days.

How to restore the cycle after childbirth:

1. observe a rest and sleep regimen;
2. avoid stress;
3. observe vaginal discharge during lactation;
4. spend more time in the fresh air;
5. follow your doctor's recommendations.

Menstruation during breastfeeding occurs after six months. During this period, it is worth taking care of health, and if any failures and deviations are detected, start treatment in a timely manner.

Feeding cycle

When the menstrual cycle is restored after childbirth, we can talk about the return of the female body to normal. The timing of the establishment of menstruation depends on whether the mother is breastfeeding or not.

There are three types of infant feeding:

1. breast;
2. artificial;
3. mixed.

When breastfeeding, the hormone prolactin is produced in the body of a nursing mother. It affects the ovaries and prevents the eggs from fertilizing. In exceptional cases, menstruation during lactation occurs in 1-2 months.

With artificial feeding, when the baby eats milk formulas, the cycle is restored immediately after the disappearance of the discharge - lochia. On average, this happens by the end of the second month. Prolactin is not produced by the body and the uterus, having returned to its previous size, begins reproductive function.

With mixed feeding, menstruation should be restored after delivery in a period of 2 to 4 months. The natural process is associated with hormonal changes, the presence of pathologies and chronic diseases.

Some women recover for a long time after giving birth due to Sheehan's syndrome. Such a deviation appears if there was a lot of blood loss during childbirth. The decrease in blood pressure, which occurs for this reason, leads to the death of pituitary cells. The reproductive system does not function and menstruation occurs much later. Regardless of the way of feeding, a woman must monitor the body. It is recommended to avoid stress, take vitamins for nursing mothers.

Cycle after cesarean section

Caesarean section is performed in case of complicated pregnancy. With a quick recovery and healing of sutures, menstruation comes on time. But with complications after childbirth, there may be a failure of menstruation.

Healing of the uterus, accompanied by the separation of lochia, lasts about 1.5 months. The restoration of the menstrual cycle in the absence of pathologies depends on the feeding of the baby. During lactation after 6 months or more, with artificial feeding - after 2 months.

Disruption of the menstrual cycle after childbirth is a frequent occurrence in gynecology and requires timely treatment. The most common complications that lead to deviations in menstruation are inflammation and bleeding. The infection affects the functioning of the genitals and interferes with the fertilization of eggs.

The absence of menstruation after cesarean is caused by diseases such as endometritis, hematoma, placental polyp. Pathologies are accompanied by pain in the uterus, smearing vaginal discharge.

To avoid adverse effects and quickly restore the menstrual cycle after childbirth, you need to carefully look after the seams, observe personal hygiene. The operation requires a lot of energy from the woman in labor, so you need to get enough sleep and eat right.

Failure of menstruation after childbirth is often associated with how the baby was born. With a cesarean section, it is impossible to say how long the cycle is restored, since the operation affects the entire body.

If, after the operation, menstruation is lost, a woman should pay attention to the quality and quantity of discharge, the presence of pulling pains, and overall well-being. Surgical intervention requires more strength from the body to recover and return to normal.

Folk methods and physical education

Traditional methods of restoring menstruation are used with caution. This is especially true for those women who are breastfeeding. Medicinal herbs can cause allergic reactions and poisoning in a baby.

Popular folk methods:

1. wormwood decoction. For cooking, take 30 grams of dried herbs, pour 250 ml of boiling water and let it brew for 4 hours. Strain the cold broth and drink 50 ml three times a day;
2. effective tea from lemon balm leaves. A handful of dried herbs are poured with boiling water in a glass, given time to brew and drunk. No more than 500 ml of tea is allowed per day;
3. with prolonged bleeding, if a woman is not breastfeeding, use a tincture of water pepper. For a glass of alcohol or good vodka, take 200 grams of pepper. The tincture is kept in a dark room for one month and then taken half a teaspoon three times a day before meals.

An active lifestyle helps to restore the function of the reproductive organs after the birth of a child. Physical activity can be started one month after a natural birth, and two after a cesarean section.

Suitable for nursing mothers:

• breathing exercises;
• yoga;
• swimming pool;
• light dancing;
• walking.

It is impossible to overload the body, physical activity should be light, without jumps and dumbbells. It is optimal to practice three times a week for 40 minutes.

In combination with an active lifestyle, thermal procedures will help restore the cycle. These are foot baths with chamomile or essential oils. Postpartum massage is effective when menstruation fails, as pressure is exerted on the uterus.

Medical and surgical treatment

Violation of menstruation is associated with hormonal disruption in the postpartum period. In the absence of menstruation, gynecologists prescribe medications. Contraceptives, for example, Yarina or Janine, are aimed at correcting and normalizing the cycle.

Duphaston tablets are used to produce progesterone. The dosage is determined by the attending physician according to an individual dosage regimen. According to the instructions, the drug is taken from the 11th day of the cycle, 20 mg twice a day.

Utrozhestan suppositories help in the treatment of hormonal imbalances. It is used to eliminate endometriosis and uterine fibroids. The active substances reduce the production of estrogen. Vaginal suppositories are applied once a day before bedtime.

Vitamin and mineral complexes support the work of the nursing mother's body. Accepted in courses up to six months. Vitamins are necessary for a woman, since with breast milk, trace elements are transferred to the baby.

Homeopathic remedies are often used, such as Pulsatilla. The drug affects the functioning of the genitals. A complex remedy is considered quite effective in violation of the cycle. It features a short course of treatment - no more than 7 days.

In special cases, surgical intervention is used. With a change in the layers of the endometrium, scraping is performed. If tumors are found, laparotomy surgery is necessary. Recovery from surgery will take longer.

The postpartum period is considered quite difficult for the female body. The restoration of the menstrual cycle is accompanied by disruptions, complications and side symptoms. With profuse bleeding, absence of menstruation and severe pain, urgent examination and treatment is required. A healthy lifestyle, proper nutrition and adherence to the rules of postpartum hygiene will allow the female body to quickly return to its previous rhythm of work.

After childbirth, all organs and systems of the female body should gradually return to normal. The main sign of a successful recovery is the resumption of the menstrual cycle. Therefore, many women are interested in the question of when menstruation returns after childbirth.

Physiological processes

After the birth of a baby, the resumption of menstruation means a return to normal activity of the endocrine glands. It all starts with the gradual cleansing of the uterus. This period lasts for six to eight weeks and is accompanied by the release of lochia. The functions of the mammary glands are gradually restored. The cardiovascular and nervous systems return to normal.

To resume the menstrual cycle, the following processes must occur in the uterus:

• Returning the organ to its original size. This process is usually called involution. It passes quickly enough due to the active contraction of muscles, compression of blood vessels and the breakdown of intracellular proteins.
• Involution is associated with the prolapse of the fundus of the uterus. This process occurs in the first ten to twelve days after birth. Every day, the bottom drops by about one centimeter, and on the 10-12th day it is already below the pubis.
• Decrease in organ mass. Seven days after delivery, the weight of the uterus is reduced to four hundred grams. After six to eight weeks, she already weighs no more than sixty grams.
• Contraction of the cervix. Closure of the internal os occurs in the middle of the 2nd week after delivery. The external pharynx is formed only after 2 months. If before childbirth the opening of the external pharynx was round, now it takes the form of a transverse slit.

Reasons for Slow Recovery

Recovery of menstruation may be delayed. This happens for a number of reasons. These include:

• pronounced weakening of the body after pregnancy and childbirth;
• having more than three pregnancies;
• first childbirth in a woman over thirty;
• labor with complications;
• violations of the postpartum regime;
• poor mother's nutrition;
• the presence of postpartum depression.

If the patient thinks that the resumption of the menstrual cycle is slowed down or, on the contrary, the menstruation came early, then it is worth visiting the doctor and understanding the reason for what is happening. An experienced doctor will answer the question of how long it will take to restore the body and how long there may be no menstruation after childbirth.

Discharge after childbirth

Do not be afraid that within five to six weeks after the birth of a baby, a woman has discharge. They are called lochies. Every day the nature of uterine secretions changes:

• In the first two days, the discharge is abundant, scarlet, with clots. During this period, there is an active contraction of the uterus. On the second or third day, the intensity of the discharge decreases somewhat, but the lochia still remains bloody. Perhaps the appearance of painful sensations when feeding the baby (due to the increase in the contractile activity of the uterus).
• On the third or fourth day, the lochia change shade. They become pinkish-red, less abundant.
• Ten days after childbirth, the discharge becomes light in color and becomes liquid, pinkish. Their number decreases every day.
• In the third week, lochia becomes scanty, smearing.
• After five to six weeks, the discharge should stop altogether.

Lochia that persists for more than 6 weeks after childbirth is a sign of complications. In this situation, you should immediately consult a doctor. The appearance of an unpleasant odor, impurities of pus in vaginal discharge is also a reason to see a gynecologist.

Menstruation while breastfeeding

It is a well-known fact that menstruation after childbirth with breastfeeding (HB) comes later. This condition does not apply to pathological processes. But there are two options for the development of events:

1. Menstruation only begins after breastfeeding is complete. This phenomenon can be explained by the fact that there is a lot of prolactin in the female body during HB. It is this hormone that stimulates the production of breast milk and suppresses the activity of the ovaries, as a result of which the egg does not mature. Often, menstruation with HS comes at the moment when the first complementary foods are introduced to the child (six months later).
2. The second option is to restore menstruation after childbirth within eight weeks. This process is also not a deviation. In this case, the first period is usually anovulatory. That is, the follicle at the same time matures and ruptures, but the egg does not come out, since it does not exist. After this, the vesicle undergoes reverse development, resulting in disintegration and rejection of the uterine mucosa. In the future, the recovery of the cycle after childbirth begins, and the menstrual function is fully restored.

In practice, it also happens that menstruation came after childbirth, and then disappeared and went again after two months. This condition is also the norm, since ovulation does not always occur during the first menstruation.

It is worth noting that the first menstruation after childbirth can be scanty and short (no more than three days). The thing is that the lining of the uterus has not yet fully recovered. But with subsequent cycles, everything will be as before.

If a woman has her period after giving birth, this does not mean that it is time to stop breastfeeding. There is an opinion that when menstruation begins, the baby refuses to breast itself. There is some truth in this. But it is caused not by a change in the taste of milk, but by a change in mother's smell.

If we talk about artificial feeding, then in such a situation, the cycle will be able to normalize within six to eight weeks after childbirth.

Features of the menstrual cycle after childbirth:

• Irregular (if a woman is breastfeeding her baby).
• The nature and volume of discharge changes (in the first months, menstrual bleeding can be profuse).
• Ovulation against the background of hepatitis B does not always occur, and many cycles are anovulatory.
• The average cycle time can increase to 35 days or more. The interval between menstrual bleeding increases.
• The intensity of painful sensations can be different. Many women note that menstruation after childbirth is easier and is not accompanied by PMS.

An unstable cycle in a nursing mother is a variant of the norm. After weaning the baby, the cycle will return to normal without additional therapy.

Often, the menstrual cycle after childbirth with a caesarean section is different from the menstrual period that was before pregnancy. Such changes may relate to the regularity, soreness, and volume of bleeding during menstruation.

Abundant or very scanty, irregular periods after childbirth indicate that something is wrong in the body; consultation of a gynecologist is required.

Re-pregnancy should be avoided within two years after surgery. It is necessary to choose the correct method of contraception in consultation with your gynecologist.

Artificial termination of pregnancy during the first year after a cesarean section will also not benefit a woman.

Problems with periods after childbirth

After menstrual function has recovered, the woman may have several problems. These include:

• Irregularity of the cycle. You don't need to worry if your period has not been established in the first six months after giving birth. Menstruation delays may occur from two to seven days. This is considered normal as the body tries to recover.

Irregular periods may occur with breastfeeding. The whole process depends on how much prolactin is secreted in the body to produce milk. If the mother has a lot of milk, then the function of the ovaries fades a little. As soon as its quantity decreases, appendages come into play.

Women may be worried about the long absence of menstruation after childbirth. If the patient is breastfeeding the baby, then you should not worry. Your period may not come until the end of the lactation period. However, after childbirth, when breastfeeding and no menstruation, contraceptive methods must be used. Often a woman thinks that if she is breastfeeding and does not have a period, she cannot get pregnant a second time. This opinion is erroneous, since the ovaries reproduce eggs anyway.

• Changing the cycle time. Many women wonder how long the cycle will recover after childbirth. In ninety percent of cases, the cycle varies and can range from twenty to thirty-five days. Too frequent menstruation after childbirth is also considered a deviation, because this may indicate the presence of endometrial hyperplasia and other gynecological pathology. This problem arises due to hormonal disruption.

• Change in the duration of menstruation. Under normal functioning of the body, they should last from three to six days. If your period is shorter than two days or more than a week, you need to see a doctor. In some situations, this can be a signal of the presence of uterine fibroids or endometriosis.
• Change in the amount of discharge. On average, the amount of discharge per day should not exceed one hundred and fifty milliliters. To determine this parameter, you need to track how often the gaskets are changed. One pad should last four to six hours.
• The presence of pathological discharge. If the patient has a menstrual cycle failure against the background of the appearance of unusual vaginal discharge (cloudy, with an unpleasant odor), you should see a doctor. This can be a symptom of uterine inflammation (especially when combined with an increase in body temperature).
• Pain. Severe pain during menstruation with a violation of the general condition is called algodismenorrhea. Severe pain can occur due to reasons such as:
  • immaturity of the body;
  • postpartum depression;
  • inflammatory processes;
  • tumors.
• Unplanned pregnancy. To avoid this problem, the patient needs to choose methods of contraception.
• Premenstrual syndrome. In most cases, PMS after childbirth is easier or disappears altogether, but this is not always the case. PMS can be expressed not only in the form of increased irritability or bad mood, but also in the form of other symptoms:
  • headache;
  • swelling and soreness of the mammary glands;
  • swelling;
  • mood swings;
  • insomnia.

After the period comes, all unpleasant symptoms stop. Therefore, a woman needs to learn to control herself so as not to harm herself and the baby.

Many women ask the doctor how to restore the cycle if the period does not go for a long time.
Specialist recommendations in this situation:

• Avoiding stress. Having a baby is stressful for the body. Possible development of postpartum depression. To avoid this, close people should be nearby.
• Taking infusions of sedative herbs (only after consulting a psychologist or neurologist).
• Use of reliable methods of contraception.
• Balanced diet.
• Breastfeeding your baby for at least six months.
• Performing simple physical exercises daily.

If these measures are followed, the menstrual cycle will completely normalize six months after giving birth. The absence of menstruation in a lactating woman 6 months after childbirth is also a variant of the norm.

Many young mothers are interested in how long the first period goes and when organs and systems are fully restored. Only an experienced specialist can answer these questions, based on the characteristics of the patient's body. If the cycle does not recover, although all the terms have passed, you should undergo a course of therapy with a gynecologist.

It is known that after childbirth, a woman's body needs some time for those organs and systems that have undergone changes during pregnancy and childbirth to return to normal. This usually takes 6-8 weeks. The exceptions are the mammary glands and the hormonal system: they take longer to recover. It is with hormonal changes that recovery is associated. This complex process deserves a detailed discussion.

A small excursion into physiology

Immediately after childbirth, the level of proteins that were produced by the placenta and regulated many metabolic processes in the body of the expectant mother sharply decreases. Special parts of the brain - the hypothalamus and pituitary gland - are a kind of "conductors" of the endocrine glands. They regulate the activity of various endocrine glands - the thyroid gland, adrenal glands, ovaries in women and testes in men. In the postpartum period, the endocrine system, in particular the pituitary gland, produces the hormone prolactin, which is sometimes also called the "milk hormone", since it stimulates the formation of milk in women after childbirth and at the same time suppresses the cyclical production of hormones in the ovary, thereby interfering with the maturation process oocyte and ovulation - the release of an egg from the ovary. That is why most women do not have periods during the entire period of breastfeeding. If the baby feeds only on breast milk, then menstruation is likely at the end of the lactation period, and in the case of mixed feeding, menstruation is restored by 3-4 months after childbirth. But it should be noted that there are exceptions to each rule, and in women who breastfeed their babies for up to a year or more, menstrual cycles can recover in the same time frame.

I would like to warn against a mistake: often a young mother is sure that in the absence of regular menstrual cycles during the breastfeeding period, pregnancy cannot occur. This is not true. , which means that conception can happen during this period.

In the absence of lactation, ovulation occurs on average at the 10th week after childbirth, and the first menstruation at the 12th. Menstruation may appear 7-9 weeks after childbirth; in such cases, the first menstrual cycle is usually anovulatory, i.e. is not accompanied by the release of the egg from the ovary.

After a cesarean section, the restoration of the menstrual cycle occurs in the same way as after a natural birth, and depends on the method of feeding.

What can you feel

Discharge from the genital tract continues from the moment of delivery until the 6-8th week of the postpartum period. Despite its similarity with menstrual blood, especially in the first 3-4 days, these secretions differ in origin from menstrual ones; they are called lochia. In place of the separated placenta, an extensive wound surface is formed; in the first three days, the discharge from it has a bloody character, then, as the wound heals (from 3-4th to 7-10th day), it becomes serous-bloody, and from the 10th day it becomes yellowish-white, while their number decreases. At the 5-6th week, discharge from the uterus stops and has the same character as before pregnancy.

More often, resumed menstruation after childbirth is of the correct cyclical nature, but the establishment of the menstrual cycle during the first 2-3 cycles is permissible, which can be expressed by a delay in menstruation, or, conversely, by a decrease in the interval between menstruation. Despite the likelihood of these phenomena in the norm, with such symptoms, you should consult a doctor in order to exclude diseases such as inflammatory processes of the internal genital organs, tumors of the uterus and ovaries, etc.

A normal menstrual cycle lasts an average of 28 days (21-35 days). The first day of menstrual bleeding is called the first day of the menstrual cycle. Menses usually last 4-6 days (+ 2 days). The greatest amount of blood loss is observed during the first and second days. The average blood loss per cycle is 30-35 ml (within 20-80 ml). Blood loss of more than 80 ml in one menstrual cycle is considered pathological.

The interval between periods and the duration of bloody periods may vary; it is important that they "fit" within the physiological norm described above.

It should be noted that sometimes the nature of menstruation after childbirth changes. So, if a woman had irregular menstruation before childbirth, then after childbirth they can become regular. Menstrual periods that are painful before childbirth may become painless after childbirth. This is due to the fact that the soreness is caused by the so-called bending of the uterus anteriorly, which makes it difficult for menstrual blood to drain from the uterus. During pregnancy and childbirth, the interposition of organs in the abdominal cavity changes, and the uterus acquires a more physiological position.

Possible menstrual irregularities

One of the reasons for the violation of the restoration of the menstrual cycle after childbirth can be hyperprolactinemia... The hormone prolactin is formed in the pituitary gland (this hormone is produced in smaller quantities in men). Normally, a woman's blood prolactin level rises during pregnancy and lactation, which leads to the secretion of milk by the mammary glands. As soon as the woman stops feeding the baby, the prolactin level drops to normal. If the prolactin level rises regardless of pregnancy or does not return to normal after the termination of breastfeeding, then this condition is called pathological hyperprolactinemia (PG). As noted, prolactin suppresses ovulation. This is why maintaining an increased amount of prolactin after breastfeeding can lead to a lack of menstruation.

This situation is more often associated with the increased function of prolactin-secreting cells of the pituitary gland, the number of which remains normal or increases very slightly. Another cause of hyperprolactinemia can be prolactinoma - a tumor (adenoma) of the pituitary gland that produces prolactin. This is the most common cause of PH during the non-lactation period. Pituitary prolactinoma is a benign formation. Experts call this formation a tumor only because it leads to an increase in the size of the pituitary gland. The cause of hyperprolactinemia at the end of breastfeeding may be insufficient thyroid function (hypothyroidism), which is easily detected by measuring the level of thyroid-stimulating hormone (TSH) in the blood and is easily corrected in the foyer of thyroid hormone replacement therapy (L-Thyroxine).

One of the symptoms of PH may be a disturbance in the rhythm of menstruation (oligo- or opsomenorrhea - a decrease in the amount of menstrual blood or shortening of menstrual bleeding), up to their complete cessation (amenorrhea), since an increased level of prolactin disrupts the formation of follicle-stimulating hormone (FSH) and luteinizing hormone (LH ) that regulate the menstrual cycle. Such patients often suffer from headaches. At the end of breastfeeding, the formation of milk in small quantities remains - a few drops with pressure on the nipple. Against the background of the existing hormonal imbalance, it often develops. Obesity may develop in women with PH.

The diagnostic tests that are carried out to confirm the diagnosis are quite simple. Usually they include a blood test for the content of various hormones and a study of the pituitary gland to determine the form of the disease. By the way, primary tests (blood test for the content of prolactin and hormones that characterize the function of the thyroid gland) can be prescribed by a doctor in the antenatal clinic, but for further research, you may need to consult a number of specialists.

If, according to the results of a blood test, it turns out that the level of prolactin is increased, and there are no other manifestations of PG, then it is advisable to repeat the analysis to make sure that this is not an error. It is imperative to check the function of the thyroid gland, as well as determine the level of other hormones. To study the pituitary gland, tomography is used.

Usually, drugs are prescribed for the treatment of PG. The most proven drug for treating hyperprolactinemia is Bromcriptine (Parlodel). Other drugs are also used: Lisenil, Abergin, Metergoline, Cabergoline (Dostinex). All these drugs help to reduce the release of prolactin, the level of which in the blood often drops to normal within a few weeks after starting treatment. In women, as prolactin normalizes, the menstrual cycle is restored.

Another complication leading to menstrual dysfunction after childbirth is postpartum hypopituitarism (Sheehan syndrome)... This disease develops as a result of necrotic changes - "cell death" in the pituitary gland. Such changes can occur as a result of massive bleeding in the postpartum period, after severe septic (bacterial) complications of childbirth, such as postpartum peritonitis 1 or sepsis 2. Severe gestosis in the second half of pregnancy, manifested by edema, the appearance of protein in the urine, an increase in blood pressure, rarely a convulsive syndrome, can also cause Sheehan's syndrome, due to the development of intravascular coagulation (DIC). The incidence of Sheehan's syndrome is 0.1%, but with massive postpartum or post-abortion bleeding it reaches 40%.

Since we are talking about a violation of the restoration of the menstrual cycle, it should be said that one of the manifestations of Sheehan's syndrome is amenorrhea - the absence of menstruation or oligomenorrhea - a decrease in the amount of menstrual blood down to small smearing discharge. The degree of menstrual dysfunction, as well as the function of other endocrine glands, depends on the extent of the lesion of the pituitary gland. Even before the manifestation of menstrual irregularities, such signs of Sheehan's syndrome appear, such as headache, fatigue, weakness, chilliness, (decrease in blood pressure), significant weight loss, slight swelling (pastiness) of the lower and upper limbs, dry skin, baldness.

Diagnosis is based on anamnesis data (connections between the onset of the disease and complicated roles), characteristic manifestations and hormonal research data, which show a decrease in ovarian pituitary hormones.

The treatment of this disease is based on hormone replacement therapy, when with the help of special drugs they try to replace hormones that should be produced in the pituitary gland and other endocrine glands, including the ovaries. Prescribe glucocorticoid drugs, thyroid-stimulating drugs. With oligo- and amenorrhea, sex hormones are prescribed to compensate for the lack of hormones produced by the pituitary gland and ovaries. Treatment is carried out by a gynecologist in conjunction with an endocrinologist.

Once again, I would like to remind you that if you have any doubts about the restoration of the menstrual cycle, you must consult a doctor. By the way, the long absence of menstruation after childbirth may indicate the beginning of a new pregnancy ...

1 Peritonitis is an inflammation of the peritoneum, a thin layer of connective tissue that covers the walls and organs of the abdominal cavity.

2 Sepsis is a condition in which an infectious agent enters the bloodstream.

Marina Pilnenskaya
Obstetrician-gynecologist,
Central customs hospital

Young mothers are always interested when menstruation begins after childbirth. During the restoration of the cycle, it can change the length, menstruation often takes on a different character, intensity, duration, becomes more or less painful than before pregnancy. This is often the norm, but in some cases the consultation of a gynecologist is required.

Postpartum bleeding

Postpartum spotting, or lochia, is the cleansing of the wound surface, which forms at the site of the detached membranes and placenta. They last during the entire period of restoration of the inner surface of the uterus.

At this time, the uterus is especially vulnerable to infection, so you should regularly change sanitary napkins and monitor the nature of the discharge. They are maximally expressed within 3 days after childbirth, and then gradually weaken.

Sometimes such discharge completely stops literally every other day. This is due to the retention of blood in the uterine cavity (), which leads to an increased risk of infection. In this case, the help of a doctor is needed.

Normally, the cleansing of the uterus after the natural birth process lasts from 30 to 45 days. After surgical delivery, this time may increase due to scar formation and longer healing time.

How to distinguish between periods and bleeding after childbirth?

Lochia gradually change their character. By the end of the 1st week, they become lighter, after 2 weeks they acquire a slimy character. Within a month, an admixture of blood may appear in them, but its amount is insignificant. Usually, a woman can easily distinguish this process from menstruation. At least 2 weeks should elapse between the cessation of lochia and the beginning of the first menstruation. In case of doubt, it is better to consult a gynecologist or at least start using barrier contraception that protects the uterus from infections.

Onset of menstruation

During pregnancy, menstruation is absent. It is a natural protective mechanism for the preservation of the fetus, which is regulated by hormones. After childbirth, the restoration of the normal hormonal status of a woman begins. It lasts for a month if breastfeeding is not started.

When should your period start after giving birth?

This period is determined primarily by the type of feeding the child: natural or artificial. Breast milk is produced by the pituitary hormone prolactin. It is he who inhibits the growth of the egg in the ovary during lactation. The level of estrogen does not increase, therefore, when breastfeeding, menstruation begins, on average 2 months after childbirth, more often when feeding "by the hour".

For many young mothers, this interval is extended to six months or more, especially when feeding "on demand". In very rare cases, while maintaining breastfeeding, even intermittently, women note that they have not had their periods for a year, and sometimes longer. In such cases, you need to regularly use contraception, and if necessary, do a pregnancy test. You also need to consult a doctor to rule out hyperprolactinemia.

With artificial feeding from birth, the cycle duration is restored after a month and a half. At this time, and arises, so that a new pregnancy is possible.

When a baby only feeds on breast milk, the woman may not have her period all this time. In this case, the first menstrual period after childbirth will begin within the first half of the year after the end of lactation "on demand" or the introduction of complementary foods. However, this is not necessary, and even during breastfeeding, menstruation may return.

With mixed feeding (bottle and natural), menstruation recovery develops faster, within 4 months after childbirth.

How long does your period last in the postpartum period?

The first period is often very heavy. There may be strong discharge, periods with blood clots. If you have to change the gasket every hour, you should seek medical help: this may be a symptom of bleeding that has begun. Subsequent periods usually return to normal.

In other cases, irregular spotting appears in women in the first months. This is typical for breastfeeding, when prolactin synthesis gradually decreases.

Additional factors affecting the rate of recovery of the normal cycle:

• difficulties in caring for a child, lack of sleep, lack of assistance from relatives;
• unhealthy diet;
• too young age of the mother or late childbirth;
• concomitant diseases (diabetes, asthma and others), especially requiring hormone therapy;
• complications after childbirth, such as Sheehan's syndrome.

Menstrual changes

Irregular periods often persist for several cycles after birth. These changes don't have to be permanent. Within 1 to 2 months, the cycle will normally return to prenatal characteristics or slightly change in duration.

• Lean menstruation may be normal during the initial 2-3 cycles, especially if mixed feeding is used.
• In contrast, during the first cycles after childbirth, some women experience heavy periods. This may be normal, but if your period does not become common in the next cycle, you should consult your gynecologist.
• The regularity of menstrual flow is disrupted, that is, the cycle gets lost.
• Painful periods may occur, even if the woman has never complained of pain before pregnancy. The reason for this is infections, too much contraction of the uterine wall. In most cases, on the contrary, painful periods before pregnancy become normal. This is due to the normalization of the location of the uterus in the body cavity.
• Some women develop or its precursors: nausea, swelling, dizziness, emotional changes before menstruation.

Causes of postpartum changes in menstruation

The delay in menstruation after childbirth appears under the influence of changing hormone levels:

• secretion in the pituitary gland of prolactin, which helps to excrete breast milk and suppress ovulation;
• suppression of estrogen production under the influence of prolactin, which leads to irregular menstruation or their complete absence during breastfeeding (lactational amenorrhea).

When a child feeds only on mother's milk, and “on demand”, and not “by the hour,” and a woman has no monthly period after giving birth, this is the norm.

After menstruation occurs, it is advisable to start using contraception. Although breastfeeding reduces the chances of conception, it is still possible. For example, if your period started after giving birth and then disappeared, the most likely reason for this is a second pregnancy. It should also be remembered that ovulation occurs before the onset of menstrual bleeding. Therefore, pregnancy is quite possible even before the first menstruation. If a woman is worried about why there is no menstrual bleeding for a long time, you must first do a home pregnancy test, and then consult a gynecologist. You may need an endocrinologist consultation.

You should not refuse to breastfeed after the onset of the menstrual cycle. Menses do not change its quality. It happens that a child these days eats poorly, is capricious, refuses to breast. This is usually associated with emotional disturbances in a woman, her worries about the quality of feeding.

During menstrual bleeding, nipple sensitivity may increase and breastfeeding may become painful. To reduce such sensations, it is recommended that before giving the baby a breast, massage it, warm it, apply a warm compress to the nipples. It is necessary to monitor the cleanliness of the chest and axillary region. During menstruation, the composition of sweat changes, and the baby smells it differently. This can be another reason for feeding difficulties.

Irregular periods

What to do if your menstrual cycle becomes irregular:

1. In the first months of the postpartum recovery period, do not panic. In most cases, this is a variant of the norm. For each woman, the normalization of the cycle occurs individually, usually during the first months of the resumption of menstrual bleeding. Irregularity is more common in women who are breastfeeding.
2. It takes about 2 months to restore the normal function of all organs and systems. The balance in the endocrine system comes later, especially if breastfeeding is used. Therefore, a woman can feel quite healthy, but at the same time she will have an absence of menstruation.
3. Pay attention to an irregular cycle only after 3 cycles. This may be due to an inflammatory process, or a tumor of the genital organs. A delay in the second menstruation is not dangerous, unless it is associated with repeated pregnancy.

If you have any doubts, it is better to consult a gynecologist, undergo diagnostics in a timely manner and start treatment.

Cycle after the pathological course of pregnancy or childbirth

Menstruation after a frozen pregnancy is not restored immediately. Only a part of women have regular bleeding after a month. In most cases, hormonal imbalance, which led to the termination of pregnancy, causes an irregular cycle.

After terminating a frozen pregnancy or abortion, the first menstruation occurs within 45 days. If this does not happen, the woman should seek help from a gynecologist.

To exclude such causes of amenorrhea as the remaining part of the ovum in the uterus or inflammation, an ultrasound scan is necessary 10 days after the termination of a frozen or normal pregnancy.

The first menstrual flow after begins 25 to 40 days after its completion. If they started earlier, it is likely bleeding from the uterus, which requires medical attention. A delay of more than 40 days also requires consultation with a gynecologist. If the disease has caused severe stress in a woman, it is considered normal to extend the recovery time to 2 months.

Menstruation after surgery is restored in the same way as after a normal birth. During lactation, menstruation does not come for six months. With artificial feeding, there are no periods for 3 months or even less. Both during physiological and during childbirth by cesarean section, in a small part of women, the cycle is not restored within a year. If no other pathology is found, this is considered normal.

In the first few months after a frozen, intrauterine pregnancy or cesarean section, the cycle may be irregular. Subsequently, its duration may change from the previous one. But normally it is at least 21 days and no more than 35 days. Menstruation lasts 3 to 7 days.

Pathology of menstruation

Sometimes bleeding that began in a woman after childbirth is pathological. In this case, you should not wait for several cycles for them to normalize, but immediately consult a doctor.

• A sudden cessation of postpartum discharge is a sign of a bend in the uterus or, an accumulation of lochia in the uterine cavity - lochiometers.
• Scanty periods for 3 cycles or more. Perhaps they are a symptom of hormonal disorders, Sheehan's syndrome or endometritis.
• Irregularity of menstruation six months after its recovery, a break between bloody discharge for more than 3 months. Most often it is accompanied by ovarian pathology.
• Excessive bleeding for 2 or more cycles, especially after surgical delivery or termination of pregnancy. They are often caused by the tissues of the membranes remaining on the walls of the uterus.
• The duration of menstruation is more than a week, which is accompanied by weakness, dizziness.
• Abdominal pain, fever, foul odor, or discoloration of vaginal discharge are signs of a tumor or infection.
• Smudging spots before and after menstruation are a likely symptom of endometriosis or inflammatory disease.
• Itching in the vagina, an admixture of cheesy discharge is a sign.
• Bleeding twice a month for more than 3 cycles.

In all these cases, the help of a gynecologist is needed.

Sometimes, despite the apparent health of a woman, her menstruation does not occur at the right time. This may be a symptom of a complication of childbirth - Sheehan's syndrome. It occurs with heavy bleeding during childbirth, during which blood pressure drops sharply. As a result, the cells of the pituitary gland die - the main organ that regulates the function of the reproductive system.

The first sign of this disease is the absence of postpartum lactation. Normally, in the absence of milk, menstruation appears after 1.5-2 months. However, with Sheehan's syndrome, there is a deficiency of gonadotropic hormones. The maturation of the egg cell in the ovary is disrupted, there is no ovulation, there are no menstrual bleeding. Therefore, if a woman who has given birth does not have milk, and then the cycle is not restored, she urgently needs to consult a doctor. The consequences of Sheehan's syndrome are adrenal insufficiency, which is accompanied by frequent infectious diseases and a general decrease in the body's resistance to various stresses.

There is also the opposite problem -. This condition is caused by an increase in prolactin production in the pituitary gland after lactation ends. This hormone inhibits the development of the egg, causes anovulation, disrupts the normal thickening of the endometrium in the first phase of the cycle. Its excess leads to the absence of menstruation against the background of ongoing milk synthesis.

The main causes of hyperprolactinemia are pituitary adenoma, gynecological diseases, polycystic ovaries.

When a woman is healthy, her cycle is restored normally. To avoid possible failures, you need to follow some simple guidelines:

1. To enable the body to quickly restore hormone synthesis, you need to eat well. Lots of fruits, vegetables, whole grains, and water, combined with regular exercise, are an effective way to restore hormonal balance. The menu should include dairy products, cottage cheese, meat. After consulting a doctor, you can take a multivitamin for nursing mothers.
2. Not to accept . They can change hormones and cause unpredictable changes in the cycle. If a woman is sexually active, it is better for her to use condoms or other non-hormonal methods of contraception.
3. Organize your regime as efficiently as possible. If your baby does not sleep well at night, you should try to get enough sleep during the day. You should not refuse any help from loved ones. A woman's good physical condition will help her recover faster.
4. In the presence of chronic diseases (diabetes, thyroid pathology, anemia, etc.), it is necessary to visit the appropriate specialist and adjust the treatment.

For every woman who has given birth to a child, the question of the timing of the restoration of the menstrual cycle is relevant. This is not surprising, because it is the regularity of menstruation that can tell about the state of women's health. Menstruation is an indicator of correct recovery in the postpartum period and the absence of postpartum complications. When menstruation returns and what can be said about the irregularity of the cycle after childbirth.

Causes of irregular menstruation after childbirth

The postpartum period for each woman is individual. Many factors can affect the recovery of the menstrual cycle after childbirth. The main reason for a long period of irregular menstruation is a change in hormonal levels. It is hormones that are responsible in the female body for the frequency of menstruation.

In addition to hormonal changes, the failure of menstruation after childbirth may be due to heredity, physiological features, or breastfeeding.

In most cases, a failure in the cycle should not cause concern for young moms. Experts say that adjusting the cyclicality can take quite a long time. For some women, menstruation takes on a regular cycle only after breastfeeding has stopped.

In any case, when you are concerned about disruptions in the menstrual cycle, visit your gynecologist in order to rule out possible pathologies.

What happens after childbirth

Immediately after the birth of the baby, the process of involution of the uterus starts in the body of a young mother. During this period, the uterus is restored to its pre-pregnant state. Usually, this period does not take much time and the organ takes its original state after 2 months.

These changes affect not only the uterus itself, but also the entire birth canal. The cervix is \u200b\u200brestored and the internal pharynx is closed. Upon completion of the process of restoring internal organs after childbirth, the menstrual cycle should resume.

However, your period doesn't always come by the end of the 8th week. For many women, the recovery period is delayed. This does not always indicate the presence of deviations or pathologies. According to gynecologists, about 70% of women in labor experience a delay in the recovery of menstruation after childbirth.