Health after childbirth
Is everything the same? Monthly after childbirth
The birth of the child and the first months of motherhood are over, and many young mothers have a question: when will the first menstruation begin after the birth?
Victoria Gudebskaya Obstetrician-gynecologist, Moscow
In some women, the cycle after childbirth is restored quickly, others wait for critical days for many months. On what does this process depend and will the monthly after birth be the same as before?
One of the signs of a woman's reproductive health is a regular menstrual cycle. Pregnancy is the state of physiological amenorrhea. In other words, the absence of menstruation for a future mother is the norm. After giving birth, everything gradually returns to normal.
The menstrual cycle is the result of well-coordinated work of the ovaries, uterus and endocrine glands. Therefore, the normal restoration of the function of these organs after childbirth is the key to the formation of regular menstruation in a woman.
During pregnancy, the uterus undergoes changes. It increases due to the growth of its components - muscle fibers. So, for the entire period of bearing the baby the mass of the uterus increases from 40-50 g to 5 kg. Immediately after childbirth, the reverse process begins - involution, i.e. return of the uterus to the prenatal state, a decrease in its size and changes in structure. The uterus contracts, and its weight is close to 1 kg, and by the end of the 8th week after childbirth it weighs 50-70 g.
Monthly after natural delivery
Immediately after the separation of the afterbirth in the final stage of childbirth, a small amount of blood clots remains in the uterine cavity, which continue to be released up to 7-10 days. Within 2-3 days after delivery, the surface layer - endometrium (mucous membrane of the uterus) under the influence of the pregnancy hormone progesterone undergoes structural changes. In the postpartum period, this membrane is rejected and excreted outward in the form of lop (postpartum discharge).
During the first 3-4 days, the lochia is bright, dark red, can be with clots, then within about 10 days they acquire a saccharine character, then up to 3 weeks can have a yellowish color and be mucous in consistency.
Regenerative processes begin in the uterus cavity. The inner layer of the uterus, with the exception of the placental area (the place of attachment of the placenta to the wall of the uterus) is restored within the first 7-10 days. The normal thickness of the mucous membrane of the uterus reaches 3-4 weeks after delivery. The placental area heals by the end of the 6th week of the postpartum period.
The cervix is formed within 3 days, but the inner throat (the inner opening of the cervix, through which the cervical canal communicates with the uterine cavity) still remains open by 2-3 cm. And only at the end of the 1st week after birth the cervix will be formed finally.
The function of the ovaries in the absence of breastfeeding is restored on average 6-8 weeks, that is, after 2-2.5 months after the birth, the first menstruation can begin.
The duration of the menstrual cycle after childbirth and the duration of blood discharge may be different and differ from the menstrual cycles that the woman had before the birth. But it is important that they fit into physiological parameters. It is possible that the duration of the cycle will change - menstruation after childbirth will become longer or, conversely, shorten. During the restoration of menstrual function, it is possible to increase the volume of lost blood, but not exceeding the permissible limits - 150 ml (no more than 10 "maxi" pads). Within 4-6 months the menstrual cycle will be established, fluctuations of its duration from 21 to 40 days are possible. This is not a pathology if these changes fit within the limits of the physiological norm.
In nursing moms, menstruation may not be throughout the lactation or before the introduction of complementary foods. The absence of menstruation during breastfeeding is called lactational amenorrhea. When a woman is breastfeeding, her pituitary gland (the secretion gland in the brain) produces in large quantities a prolactin hormone that stimulates the production of milk. It blocks ovulation. Thus, against the background of lactation in the ovary, there are no major cyclic processes - the maturation of the follicle, ovulation, the functioning of the "yellow body." Accordingly, hormones that cause changes in the endometrium that are characteristic of the normal menstrual cycle are not synthesized. That's why a woman has no menses on the background of breastfeeding.
If the baby is only breastfed on demand, that is, receives breast milk at any time of the day or night, menstruation is usually absent for several months or throughout the entire breastfeeding period. With the introduction of complementary foods, the baby stops actively sucking breast milk, reduces the synthesis of the hormone prolactin. In this case, menstruation, as a rule, comes before the end of lactation. If the baby's nutrition is initially mixed (for example, due to insufficient milk secretion), menstruation is restored on average by the 4th month after birth.
Menses after caesarean section
Restoration of the menstrual cycle is a hormone-dependent process. And everything is resolved by the restoration of the function of the endocrine glands (ovaries, pituitary gland). The method of delivery - natural childbirth or childbirth by cesarean section - does not play a role. Most often after the operation, the menstrual cycle is restored in the same way as after normal delivery.
If the mother feeds the baby, the development of the menstrual cycle in women after the operative delivery takes place in the same way as after the natural delivery.
With artificial feeding of the pituitary gland, the hormone oxytocin, which reduces the uterus, is not released, so its recovery is slower, besides, the scar on the uterus after cesarean section complicates this process. As a result, menstruation during the feeding of the baby is renewed by mixtures, on average, 2-3 weeks later than with artificial feeding after natural childbirth.
Within normal limits The normal menstrual cycle is 21-35 days, the duration of blood discharge is 3-7 days, the most abundant secretions are noted in the first days of the cycle.
Absence of menstruation after childbirth
Absence of menstruation (amenorrhea) for half a year in the absence of lactation or during the year with breastfeeding is regarded as a possible pathology. This can be associated with hyperprolactinemia.
Normally, the synthesis of prolactin by the pituitary gland increases during pregnancy and lactation. At the end of lactation, prolactin should decrease to a normal level. If this does not happen, then prolactin suppresses the synthesis of pituitary hormones (follicle stimulating hormone - FSH, luteinizing hormone - LH) causing cyclic changes in the ovaries, namely, the growth of the follicle (the vesicle with the egg in which estrogens are synthesized), ovulation (rupture of this follicle and the yield of the egg) and the synthesis of progesterone by the yellow body (the temporary gland of internal secretion in the female body, formed after ovulation at the site of the burst follicle). Thus, a woman with hyperprolactinemia does not ovulate, and the ovaries do not synthesize hormones (estrogens, progesterone) that regulate the menstrual cycle. That's why my mother has amenorrhea.
Absence of monthly after birth should alert the woman in the direction of another, not always desirable pregnancy, as ovulation occurs before the onset of the first postpartum menstruation. To exclude it the analysis of a blood on ß-hCG (a chorionic gonadotropin of the person), or less reliable method - definition of this hormone in urine by means of the house test for pregnancy will help or assist.
Problem cycle after childbirth
In addition to the absence of menstruation, there may be problems with the regularity of the menstrual cycle, its duration, duration, volume of blood discharge, spotting before and after menstruation.
If within 6 months the menstrual cycle is not established, it is irregular - this is the reason for going to the doctor. If the duration of the cycle has changed after the delivery and it is less than 21 days or more than 35 days, the gynecologist's consultation is also necessary. Too short (1-2 days) or too long menstruation (more than 7 days) may be a sign of the presence of any pathology, for example, such as endometriosis (a disease in which the endometrial mucosa - appears in atypical places, in this case it germinates in the muscular membrane of the uterus) and uterine myoma (benign uterine tumor, consisting of muscle uterine tissue).
The amount of blood loss during menstruation should be at least 50 ml and not exceed 150 ml. In the first few months after the first postpartum menstruation, menstrual periods can occur with some abnormalities that still need to correspond to the physiological norm: for example, in the most "plentiful days" of one medium padding should suffice for 4-5 hours. Scarce menstruation can be a sign of hormonal disorders - hyperprolactinaemia, intrauterine pathology (chronic endometritis, synechia). Too much menstrual blood can be a sign of uterine myoma, inflammatory processes of the pelvic organs. In such cases, consultation with a gynecologist is necessary.
Perhaps after birth, the appearance of smearing blood secretions several days before menstruation and within 3-7 days after its termination. This symptom is a sign of endometriosis of the uterus or the presence of an inflammatory process in its cavity - endometritis. Any spotting in the middle of the cycle, blood allocation beyond the expected period of another menstruation is a pathology and require specialist advice.
Very often, mothers complaining about profuse painful menstruation before delivery, after the birth of the baby, do not experience such problems. This is due to the fact that after the birth of the baby the uterus changes its position somewhat. And excessive bending anterior or posterior, which causes pain during menstruation, disappears. There are also reverse situations, when women who do not experience any pain during menstruation before birth, after the birth of a child, are forced to take analgesics in order to reduce the pain syndrome.
Painful menstruation (algodismenorrhea) after childbirth is an indisputable reason to call a doctor. They can appear due to unfavorable psychological conditions, immaturity of the organism, severe infectious or somatic diseases (any internal diseases, with the exception of genitalia, some infectious diseases and mental illnesses). Painful menstruation is also a formidable symptom of pelvic inflammatory disease.
Urgent to the doctor!
Delayed pieces of the placenta can give and at the 2nd week after the birth of the baby late postpartum hemorrhages. More often these bleedings arise in connection with the wrong and belated healing of the placental area (the place of attachment of the placenta to the wall of the uterus).
Possible the appearance of abundant blood discharge by the type of bleeding at the 4-5th week after childbirth. In this case, urgent hospitalization in the hospital is necessary. This is not menstruation, bloody discharges are most likely to be caused by the placental polyp that has formed in the uterine cavity in the postpartum period (a piece of placental tissue that has lingered in the uterine cavity and is tightened by the formation of connective tissue). In this case, the woman will need emergency surgical help.
Most women know that the development of the menstrual cycle after childbirth is not always smooth. However, not all deviations can be considered a variant of the norm. It must be remembered that a regular menstrual cycle is an indicator of reproductive health and well-coordinated work of the systems of the organs of the female body. Therefore, any problems well the way to the formation of regular menstruation is better to decide together with the attending physician obstetrician-gynecologist.
Is it always reliable?
The possibility of conception is directly related to ovulation, which occurs on average 2 weeks before the first postpartum menstruation. Thus, a woman is ready for fertilization, even without knowing it. In such a situation, the likelihood of an unwanted pregnancy is high. Many obstetrician-gynecologists recommend sexual rest until 6 weeks after childbirth. In the future, in the absence of lactation or mixed feeding, a method of contraception is necessary.
When breastfeeding, you need to remember that lactation is an unreliable way to protect against pregnancy. He "works" for 6 months only with breastfeeding. The effectiveness of contraceptive effect with lactational amenorrhea is close to 95%. In order for this method to work, it is necessary to observe the following conditions: feeding the baby on demand, at least 6 times a day, mandatory presence of night attachments, absence of mixed feeding and lure.