The menstrual cycle is often misunderstood, especially in the postpartum phase. In order to understand what happens after having a baby, we have to know the basics of the cycle. The entire cycle is not just the period bleed, but includes the period, the fertile window, ovulation, and many days of natural infertility both before and after ovulation. The cycle is governed by multiple hormones that communicate systematically in order for cycle events to occur.

Let’s break it down. I’m going to use a textbook cycle example, but keep in mind that there’s lots of variety in what is considered normal. The cycle can be segmented into two main phases: follicular and luteal. Let’s look at each of the main events & hormones in those phases. 

Follicular Phase

1. Menstruation: The uterine lining sheds in a period due to a drop in progesterone as a result of no conception occurring the previous cycle.
2. Pre-Ovulatory Dryness: Natural phase of infertility and all hormones are low.
3. Point of Change: Fertile window opens. Follicle-stimulating hormone (FSH) communicates to the ovaries that it’s time for ovulation. Follicles (eggs) mature and produce increased levels of estrogen. 
4. Estrogen Rises: The uterine lining thickens and the characteristics of cervical mucus change. Fertility increases the closer we get to ovulation. 
5. Peak Fertility: High levels of estrogen stimulate a release of the luteinizing hormone (LH).
6. Ovulation: LH causes the release of an egg from the ovary. 

Luteal Phase

1. After Ovulation: The corpus luteum forms in the ovary and produces progesterone. 
2. Progesterone Rises: The uterine lining stays intact for a time, in case a viable pregnancy signals its presence to the mother. 
3. Pregnancy: If conception occurs, then progesterone continues to be produced by the mother until the placenta forms. 
4. No Pregnancy: If conception does not occur, then progesterone slowly drops and the uterine lining sheds in menstruation again. 

What happens after baby arrives?

• Postpartum hormone levels, especially heightened prolactin, keep other hormones suppressed so you don’t experience ovulation or a regular cycle. 
• Breastfeeding and spending time with baby keep prolactin and oxytocin levels high, which continues to suppress ovulation. Essentially, you’re in a long pre-ovulatory phase until you see a return of regular cycles. You’re awaiting the point of change to fertility and the transition of your body as hormones start to communicate and prepare for ovulation. Once that hormonal communication begins, you will see a return of fertility and eventually a return of regular cycles. 
• This whole process can take months. Even once you’ve regained cycles, it’s normal to experience some irregularities in your cycle patterns. Mucus patches, long follicular phases, multiple ovulation attempts, and short luteal phases are some of the common cycle variances that may occur in the first cycles postpartum. It typically takes 6-8 months for cycles to regulate back to the way they were pre-pregnancy, so be patient! 

How do I use a fertility awareness method postpartum?

• If you were using a fertility awareness method prior to conception and want to do the same postpartum, now would be a good time to reconnect with an instructor and get a refresher course on your method of choice and its rules. Sometimes postpartum protocols vary from typical family planning protocols. Also, it’s very common for women’s cervical mucus patterns to change after having a baby, so having the support of a trained instructor is invaluable. 
• Ideally, you should begin charting again at 6 weeks PP or when lochia stops. This might seem early to begin again, especially if you’ve seen your fertility subdued for months postpartum with previous pregnancies. Each pregnancy, baby, and postpartum journey is different and you should never assume that a prior experience (or a family member or friend’s experience) will be similar to this one. 
• A postpartum woman waiting on her return of fertility is essentially in an extended pre-ovulatory phase. At this time, she could experience mostly dry days, or she could see extended patches of cervical mucus. These mucus patches may or may not mimic her prior cycle patterns. Because of the possibility of mucus patterns changing from pre-pregnancy, cervical mucus during this time should always be considered fertile until a basic infertile pattern can be established. 
• Especially for women with continuous mucus, establishing a basic infertile pattern (BIP) is clarifying and necessary to determine which mucus may be fertile versus which is not. A BIP can be determined with an instructor’s guidance. Once cycles regulate, it will be much easier to differentiate your fertile mucus again. 
• Cervical mucus is still the key to observing for the onset of a return of fertility. Using ovulation predictor kits or luteinizing hormone strips will not give you enough time to avoid pregnancy. Sperm can live in fertile mucus for up to 5 days, prior to ovulation even. Basal body temperature and progesterone strips only confirm that ovulation has occurred and not that it is approaching, so those are also not useful until you are cycling regularly again.
• Using a fertility monitor (i.e. Daysy, Mira, Clear Blue Monitor) or an app (i.e. Natural Cycles) is not an effective method unless combined with a true fertility awareness protocol (i.e. Marquette Method). 

How does breastfeeding affect the return of fertility?

• Lactation amenorrhea method (LAM) and exclusive breastfeeding (EBF) have their own specific criteria that must be met in order to be used successfully as a method of natural ovulation suppression (even then, there is a small failure rate, like all methods of birth control). These methods are only considered good for up to 6 months postpartum. Usually by 6 months, prolactin levels even out and women are more likely to see a return of fertility, especially if they are not following LAM or EBF criteria. Introducing solids and a baby sleeping for longer intervals are other factors that influence an earlier return of fertility. 
• Pumping can not be considered breastfeeding either because you are not spending time with the baby on the breast and the action of the pump does not have the same effect as a baby suckling at the nipple. 

What if I want to encourage my return of fertility? 

• Some women want to encourage their period to return postpartum. Reasons vary from wanting to be regularly cycling again, to hoping to assess hormones, to wanting to conceive again. If you’re hoping to encourage your cycle to return, try to spend less time with your baby, and less time breastfeeding. 
• Frequent blocks of time away (they don’t have to be long), is the best way to avoid the stimulation of breastfeeding and bonding hormones that leads to suppressed ovulation. Try not to cosleep or nurse as much at night. You could try to introduce bottle feeding at night and have your partner try their hand at night feedings. This can help your fertility return sooner and your cycles regulate faster, as well as give you a break and a little extra sleep!

How about a little myth-busting?

• Your body is not the most fertile immediately after giving birth and it is not trying to replace the baby you just gave birth to. You may believe you are more fertile because you conceived or know someone who conceived without regaining a cycle. This usually happens because you are not charting and are unaware that ovulation occurs before a period. So you fell pregnant with your first ovulation and never saw a period. 
• If you struggled to conceive, sometimes pregnancy has the effect of rebooting your system so you unexpectedly fall pregnant. 
• There is also a huge misunderstanding of LAM and EBF and their specific criteria to suppress ovulation. You may think that because you breastfeed regularly you will see a suppression of their cycle. However, you may not be with your baby enough, not feeding often enough (perhaps on a schedule instead of feeding on demand), or are pumping as well as breastfeeding. Whatever the reason, if you are not following LAM or EBF criteria, you may see an earlier return of fertility. 

What’s the takeaway from all this?

The postpartum phase is a big waiting period that challenges many women as they try to navigate irregular cycle patterns. Every woman, every baby, and every postpartum phase is different and you can never predict how it will go. It is not impossible to use a fertility awareness method on your own, but it is well worth having a qualified instructor to turn to with questions and concerns. During this time of body changes, lack of sleep, learning a new person and their cues, remember to give yourself a bit of grace and support where you can. Your body accomplished an amazing feat by growing a new human being! Take this time to slow down, nourish yourself and your baby, and reconnect with yourself and your incredible body. 

Mairead Suthoff is a certified athletic trainer and a certified FEMM instructor. She thrives in inspiring women to chart their cycles. Her business, Lumina Health Services, teaches women how to chart for health, body literacy, cycle syncing, and family planning. Her background in sports medicine makes her particularly passionate about helping active women achieve cycle health and sync their workouts to the phases of their cycle.

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