Postpartum Menstruation + Period Wellness with Amanda Laird | Sage Woman Series

Postpartum menstruation is a bit of a guessing game. When will your cycle return? Will it be the same as it was? What if you’re breastfeeding? And how do you know when something’s not right? Whether you’ve given birth or not, your menstrual health matters – period.

In this installment of Sage Woman, we connect with Amanda Laird, a registered holistic nutritionist, host of the Heavy Flow Podcast and author of Heavy Flow: Breaking the Curse of Menstruation (forthcoming in Feb 2019). Needless to say, she knows a thing or two about periods, including postpartum menstruation.

In each podcast Amanda has casual convos with her guests about the health and wellness topics we’re not supposed to talk about: menstruation, fertility, pregnancy, childbirth, menopause, birth control, sexuality, mental health, hormonal health and reproductive health, through the lenses of feminism and body politics. We’re pumped to have her here!

In our Sage Woman Q+A series, wise women share their knowledge with Tenth Moon Mother Care in the spirit of empowerment and sisterhood.

POSTPARTUM

What should we expect flow-wise after giving birth?

Unfortunately there’s not an easy answer for this. Lochia – a mixture of blood and shedding of the uterine lining – can last from two to six weeks after giving birth. Some people will ovulate and start cycling shortly after lochia stops while others may find that it takes a year, sometimes even two for their cycles to return.

I know a lot of women who found that their cycles were a lot heavier or more painful after childbirth and I know a lot of women who found the opposite to be true. So really, there is a wide range of what is possible or even normal after pregnancy. The only thing that you can count on is that you will ovulate before your period shows up; so if you’re trying to avoid pregnancy make sure you’re taking precautions!

How long after giving birth do our cycles resume? How does breastfeeding affect the timing?

This is the million-dollar question! Many people incorrectly assume that they won’t have a cycle as long as they are breastfeeding. While it’s true that prolactin, the hormone that stimulates lactation, suppresses ovulation, studies are showing that lactation alone isn’t the only factor at play in cycles resuming after pregnancy.

The availability of maternal energy also plays a role – this signals the brain and endocrine system that there’s enough energy to sustain breastfeeding and potentially another pregnancy! Another consideration is that hormonal health is incredibly sensitive to sleep, stress, nutrition, and illness – all the things that might not be at their best when it comes to life with an infant!

And I know I’m repeating myself, but I can’t say it enough that you will ovulate before you see your period!!!

How does childbirth affect menstruation in the future?

The good news is that cramps seem to lessen after childbirth! However, it’s also not uncommon to have heavier periods post-pregnancy and there could be a number of reasons for this. First of all, what part of your body went back exactly the same as it was before you were pregnant?

Your uterus may be larger after pregnancy and so there is simply more surface area for the endometrium, the lining of the uterus, to grow. More lining = more flow. Beyond that, there a few other things to consider:

Birth control: If you were taking a form of hormonal contraception before you were pregnant, the withdrawal bleeds you were used to while on the pill were likely to be lighter and shorter than your “natural” periods. Heavier periods are also common when using a non-hormonal, copper IUD.

Your age: A heavier flow can be a symptom of perimenopause. So depending on your age it could be that you’re starting to experience perimenopause, which can start anywhere from 35 to 50 and last for about 10 years.

Your nutrient levels and hormone balance: Pregnancy and early motherhood can leave us depleted and our hormone levels out of balance, which can contribute to heavier periods and other symptoms associated with menstruation. It can be difficult to nourish our bodies, get enough sleep, exercise, meditate and just take good care of ourselves in those early years and that can show up in our menstrual cycles.

FERTILITY

How do you follow your cycle to know the best days to try to get pregnant?  

A normal, healthy menstrual cycle can range anywhere from 21 to 35 days so it’s important to get to know your cycle to figure out your fertile window. If you don’t have a 28 day cycle you’re not ovulating on day 14! Ovulation occurs about two weeks before your period. So if your cycle is 25 days, ovulation occurs around day 11. If you have a longer cycle that’s 35 days, day 21 is likely when ovulation occurs.

Get to know your cervical mucus! It will change throughout your cycle from the dry days after menstruation, to creamy/lotion to the very fertile egg white cervical mucus. Take a look at an online gallery like Beautiful Cervix Project to get to know what each phase looks like.

I always recommend the book Taking Charge of Your Fertility and working with a fertility awareness educator to really get to know your cycle. There are lots of great apps out there too – I like Kindara for charting.

CHANGES, CRAMPS + CUPS

What are some examples of irregularities/changes in our cycle when it's best to check in with our healthcare professional?

Pain or discomfort that interrupts your day-to-day or can’t be relieved with diet and lifestyle changes or an over-the-counter pain reliever like Advil is definitely not normal and should be taken seriously by a medical professional.

Beyond that, the range of what’s normal is so wide in terms of the length of your cycle, how many days you bleed, how heavy your flow is – so I always advocate for getting to know your normal and watching for any changes to that baseline. If your cycle suddenly gets longer or shorter; you’re noticing large clots, mid-cycle bleeding or you’re experiencing pain when you didn’t before, you definitely want to get it checked out.

Tracking your cycle is helpful to draw links between symptoms and your hormones – hormonal symptoms can show up at any point in your cycle, not just when you have PMS. And if you’re going to see a doctor or paramedical practitioner like a naturopath or nutritionist, they are going to want to see you record your symptoms for at least three cycles so start now!

Do you have any tips for helping to ease menstrual discomfort? 

Prostaglandins, hormone-like chemicals that are part of our inflammatory response, are to blame for menstrual cramps and other pains that you might experience around that time of the month. Reducing or cutting out inflammatory foods from our diet like sugar, fried foods, alcohol, caffeine, processed or packaged foods can reduce the prostaglandins and in turn the pain you might experience. Working with a qualified nutritionist to identify any food sensitivities might also help to further reduce discomfort.

And while there are no double-blind controlled studies that prove this, switching to natural, organic or reusable products like a menstrual cup or cloth pads seems to have a positive effect on menstrual pain.

What is a menstrual cup? How do we use it? What are the benefits? 

A menstrual cup is exactly what it sounds like – a small cup made of a medical-grade material, like silicone, that is inserted in to the vagina to collect menstrual blood. Depending on your flow and the size of the cup, they can be worn for up to 12 hours before being emptied out, washed and reused. If you’re interested in trying a cup, take the quiz at PutACupInIt to find the best cup for you; and they have great resources for how to use it and troubleshooting if you’re having a hard time making it work.

While it can take a few tries to get it in right, once you get the hang of it the benefits are numerous – it’s arguably way less messy (I have literally never used a tampon that didn’t leak), lasts an entire day or overnight and is environmentally friendly – diverting disposable pads and tampons and the plastic that comes with those products from landfills and oceans.

Although cups collect rather than absorb menstrual blood like tampons, there is still a risk of Toxic Shock Syndrome (TSS) when using cups. Make sure to boil your cup at the end of your cycle, change it frequently and consider having two in rotation at once.

Amanda Laird is a Registered Holistic Nutritionist and host of the Heavy Flow Podcast – a weekly podcast dedicated to casual conversations about periods, reproductive health and other taboo health and wellness topics. Amanda is the author of the forthcoming book, Heavy Flow: Breaking the Curse of Menstruation, published by Dundurn Press in February2019. She lives in Toronto.

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