Is it normal to miss a period?
July 2, 2024
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Hooray! You just had a baby!
Now that your body has grown an entire human being from cells, and birthed said human one way or another, you get to start the next chapter …
Of wondering what the eff is going on with your postpartum hormones?
Mamas are generally somewhat prepared for the hormonal changes in the pregnancy part of the journey, but the postpartum hormonal shifts can often be totally unexpected, and honestly not really talked about in our day to day culture.
So, let’s talk about it!
First, let’s take a quick look at the key players in your postpartum hormone journey:
This hormone is essential for the viability and the health of the pregnancy, and progesterone levels are extraordinarily high during pregnancy.
The changes in progesterone cause a laxity or loosening of ligaments and joints throughout the body. It is also important for transforming the uterus from the size of a small pear — in its non-pregnant state — to a uterus that can accommodate a full-term baby. However, progesterone drops off almost immediately after delivering the placenta, leading to one of our first big hormone drops post birth. Your ovaries will not start creating progesterone again until your first menstrual cycle, which definitely creates a temporary imbalance.
A woman will produce more estrogen during one pregnancy than throughout her entire life when not pregnant. The increase in estrogen during pregnancy enables the uterus and placenta to create and form new blood vessels, transfer nutrients, and support the developing baby.
In addition, estrogen is thought to play an important role in helping the fetus develop and mature. Estrogen levels increase steadily during pregnancy and reach their peak in the third trimester. The rapid increase in estrogen levels during the first trimester may cause some of the nausea associated with pregnancy. During the second trimester, it plays a major role in the milk duct development that enlarges the breasts.
Oxytocin is released to stimulate contraction of the uterus during childbirth and postpartum, and plays a vital role in bonding and attachment between mother and child.
Research has shown that oxytocin impacts social behavior – it helps you stay tuned in and respond to important signs in your environment. For example, oxytocin may promote feelings of trust and bonding (such as mother–infant bonding or intimate connection) or contrary reactions such as defensiveness.
Prolactin is the hormone mostly responsible for milk production, though its effects aren’t usually felt until after giving birth – when your increased progesterone, which counters the effects of elevated prolactin, sharply declines. High levels of prolactin have been known to negatively affect dopamine, which gives us feelings of euphoria and happiness. As a result, prolactin can sometimes be the reason behind moodiness, low energy levels, and slowed metabolism after your baby’s birth.
Between high prolactin production, no progesterone, potentially lower dopamine, and your other pregnancy hormones decreasing, it’s no wonder that your energy, moods, and emotions can feel a mess after having your baby!
So, what happens immediately following birth?
You see your baby for the first time, your heart explodes, and you’re on a high that you think will never ever end.
Until it does, just a few days later.
Thanks, hormones!
Immediately following delivery of both your baby and placenta – whether via vaginal or cesarean birth – progesterone and estrogen levels begin to drop.
And then, to compensate for the progesterone and estrogen decline, oxytocin surges. This hormone is responsible for that strong mothering instinct you begin to feel, but it’s not uncommon to experience some “baby blues” in the first few days postpartum as oxytocin begins to level out.
In addition, prolactin now sharply increases to encourage your milk to come in and levels stay elevated to sustain breast milk production.
So, week one, the ebb and flow of hormonal changes begins, and it might feel like things are starting to go a little sideways …
AND IT’S TOTALLY COMMON.
Phew. You’ve finally got somewhat of a routine down with babe, and maybe things are starting to feel normal … ish. But your hormones three months postpartum are still working hard to find their new equilibrium. Once you hit the 2-3 month postpartum window, your estrogen and progesterone levels begin to reset to pre-pregnancy levels (though they won’t be fully reset until your first postpartum period returns).
BUT
This is also when the negative effects of consistently high cortisol levels can come into play. Cortisol is your body’s main stress hormone. It works with certain parts of your brain to control your mood, motivation, and fear.
High cortisol levels + postpartum insomnia = decreased melatonin (sleep hormone) and serotonin (wake hormone) levels. These postpartum hormone changes can have a negative impact on mood.
The shift in hormones mentioned above can also explain why many new mamas experience postpartum hair loss around two to three months postpartum.
During pregnancy, elevated estrogen levels slow down the natural cycle of hair follicle shedding. As a result, many women experience long, beautiful hair during pregnancy.
Unfortunately, once in the postpartum window, women experience a decrease in estrogen levels leading to an increase in your hair’s natural cycle of hair follicle shedding. This decrease in estrogen leads to what is known as postpartum hair loss.
Postpartum hair loss is temporary (but definitely intense), and may last between three and six months for most women. It will stop, I promise. But if it’s been more than 6 months and you’re still reallyyyyyy shedding, see your doctor and ask to get your thyroid and iron levels tested. Both of which can get out of whack during the postpartum time and can be an underlying cause for continued hair loss.
If you’re breastfeeding, prolactin and oxytocin continue to be elevated at the three month postpartum window.
At six months postpartum, many women will experience a decrease in prolactin production, leading to a reduction in breast milk.
Even if you breastfeed past the six-month mark, your child’s demand for milk has significantly decreased as you begin to introduce solid foods and have passed significant early growth spurts. This decrease in prolactin also causes your breast milk composition to change and is more suited for your growing baby. The human body is incredible in its wisdom!
Once your babe has completely stopped breastfeeding (which may be way beyond the 6 month mark!), prolactin levels will go back to pre-baby levels. The decrease in prolactin will cause you to stop lactating and help stimulate your natural menstrual cycle to return. Most women report getting their period back within one to three months of discontinuing breastfeeding, although this is not the case for everyone, AND THAT’S OK. Some women start menstruating while still breastfeeding, while other women don’t get their periods back until they’re 100% done making milk. It’s all normal.
If your menstrual cycle hasn’t returned after 3-4 months of stopping breastfeeding, it’s time to ask your doctor (or me!) to do hormone testing to see what might be the root cause contributing to the delayed return of your cycle.
There isn’t really a clear cut answer for this; however, in general, it’s safe to say that your hormones will go back to normal once you have your first postpartum period–which can be different for every woman.
You may also experience that your period may be irregular for the first few months upon its return. Although hormonal changes are “normal” postpartum, contact your medical practitioner if you are experiencing any new or persistent symptoms that seem troublesome.
To better understand your postpartum hormones and recovery, I recommend regular visits with your medical practitioner, whether it be your OBGYN, PCP, or myself, at least every three months for the first two years postpartum.
Doing so will help monitor and evaluate continued hormonal changes in the postpartum time. It will also allow assessment for various conditions, including thyroid diseases, like Hashimoto’s Thyroiditis, which often develops postpartum; as well as diabetes, anemia, and nutrient deficiencies.
If you want to work with me during your postpartum window, I’d love to help! As a functional nutrition therapist, I do lots of hormone testing – and all from the comfort of your own home, because who has time to be going to a doctor’s office for testing?!
Your hormones are going to do what they need to do to get back to (a new) normal – it’s a process all women who give birth go through – but there are a few nutrition and lifestyle tips ‘n tricks that will help to make your postpartum window more comfortable and more ideal for both you and your growing baby.
Even though you’re probably constantly hungry (especially if breastfeeding), feeding yourself may be the last thing on your priority list. But, the reality is, it’s one of, if not the most, important thing for new mamas to focus on. Food is what’s going to keep you (AND baby) going, providing you with sustained energy to not only survive, but thrive, in your new mama role.
Here are some tips and tricks to help you get the nourishment you need:
This is most important for ALL your animal foods. If your budget requires that you choose between organic meat and dairy products and organic produce, go for organic meat and dairy. Animals accumulate the highest amount of toxicity.
Check out the Dirty Dozen list which highlights the twelve most heavily sprayed fruits and vegetables – try to at least purchase these ones organic or don’t buy them at all! Eating toxin-free foods means that the foods you choose to eat are grown and raised without chemicals (pesticides, herbicides, insecticides), hormones, antibiotics or steroids, and are not genetically modified.
At every meal and snack to stable blood sugar levels, alleviating unnecessary stress on mama’s body.
Eat meals and snacks at regular intervals throughout the day. Don’t skip meals. No exceptions!
Eat at least one large, satisfying, nourishing meal every day to produce necessary oxytocin.
Cooked, warm foods should form the basis of your postpartum diet.
The majority of your meals should include anti-inflammatory, nutrient-dense ingredients. Pick a rainbow of colors of organic vegetables and eat them by the handful, and don’t forget your fermented veggies!
Think pastured egg yolks, low-mercury wild caught fish and seafood, coconut oil, raw nuts and seeds, grass-fed butter and ghee, avocados, and extra virgin olive oil.
Organic, pasture-raised, grass-fed, wild caught animal protein (red meat, poultry, fish, eggs) and plant-based protein sources like lentils, beans, quinoa, nuts, seeds, non-GMO organic fermented soy (like tempeh), and a variety of fresh herbs and spices.
Like sweet potatoes, yams, squash, lentils and whole non-gluten grains (rice, quinoa, millet, buckwheat, and gluten-free oats).
Like raw honey, pure maple syrup, coconut sugar, and 85% (or higher) chocolate.
Baby siphons off your reserves big time in the fourth trimester.
Fish oil is a game changer for mood fluctuations in that first year after birth. It’s no joke when women talk about feelings of sadness and despair and depression and anxiety or just underlying lethargy and apathy. Your brain undergoes massive changes with pregnancy and birth and having a baby to take care of. Team that up with baby basically taking all your essential fatty acids out of your bloodstream and it’s a perfect storm. So double up your fish oil in those first 6-8 months post birth. OR LONGER!
Here are my all-time favorite prenatal, magnesium, vitamin D, fish oil, and choline supplements.
Like, seriously – as everyone says – sleep when the baby sleeps. Take a nap. Forget about cleaning the house. Doing the laundry. Doing every other item on your to-do list. It’ll all get done at some point. And it doesn’t all need to be today.
Especially animal products (if you eat them). Breast milk contains a ton of fats that nourish your baby’s growing brain. Remember that fats attract and store fat-soluble chemicals, so the more you avoid hormones, chemicals and toxins, the less ends up in your breast milk.
Fish is the best place to get fully-formed EPA and DHA, both of which are critical for brain development. If you don’t eat fish, make sure to supplement with a high quality fish oil.
Coconut is the richest food source of lauric acid, which helps build your baby’s immune system. Eat lots of full fat coconut milk, coconut oil, and coconut butter.
Choline is critical for brain development and is the precursor to acetylcholine, important for memory and learning. Incorporate foods like egg yolks and grass-fed liver into your diet. I highly suggest supplementing with Phosphatidylcholine as most women don’t get anywhere near the necessary daily amount through food alone.
If you’re looking for more postpartum resources, look no further!
Self Care with a Newborn at Home
Mama and Baby Blog Series: Recovery From Birth
Mama and Baby Blog Series: Postpartum Depression
Postpartum hormone ebbs and flows will be your new normal for at least the first 12 months after your babe is born. Your hormones affect everything from mood to digestion and sleep and everything in between, so be prepared for a rollercoaster of hormonal shifts!
The return of your menstrual cycle is a good indicator that your hormones have returned to their pre-pregnancy levels, or somewhere in the vicinity. But even then, things can be a bit wonky in those first few months as your cycle and hormones find their new equilibrium and rhythm.
And, while all new mamas go through these changes, please be sure to reach out for help if you feel like something just isn’t *right*. I’m always happy to help support! I offer postpartum hormone testing, 1:1 virtual consultations, and am part of an ever-expanding group of experts offering support and advice for new mamas called Moms on the Upside. All mamas deserve support, so never hesitate to reach out for help!
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Sarah Jane Sandy is a certified nutrition therapist, and a fertility and women’s health expert. She has helped hundreds of women increase their fertility naturally and go on to have healthy full-term pregnancies. She has been working with women and couples trying to get pregnant for over 16 years and over 90% of the women who work with her get pregnant and have healthy babies.
She also works with women trying to fix their hormone imbalances, as well as supporting women through pregnancy and the postpartum period. Learn more about her own fertility and hormone journey here. To send Sarah a message, complete her Contact Form.
