Question: When can I expect my first menstrual period after c-section? Is it normal to have a light or heavy menstrual period after c-section? How long does first period after c-section last?
Before getting pregnant and having a baby, your body naturally produces hormones that function to make you have your monthly period.
These hormones act without you knowing they exist and their role is to ensure cyclical thickening and breakdown of the endometrium during your 3–7 days menstrual period.
After getting pregnant, your body regulates itself again, meaning that you no longer see any monthly period for the duration of your pregnancy.
And the reason this happens is that you are no longer ovulating, and some hormones that normally fluctuate during your menstrual cycle, i.e., before getting pregnant, are now elevated thereby stopping ovulation completely.
After your nine successful months of pregnancy, your hormones will also start changing again and for most women, your period will return at some point after delivery.
However, this depends on many factors, and in fact, it is difficult to say exactly when a woman’s period will start-off after vaginal birth or cesarean section. For women who do not breastfeed, periods often return about 6–12 weeks after birth, while the time frame can be much longer for breastfeeding mothers.
Here’s an email I received from LUCY:
Hi, Dr. Dunn,
How are you doing, hope you are great. I recently had my first period after c-section today after months of waiting and surprising it’s heavier than I expected.
During my first pregnancy, which was three years ago, I experience light vaginal spotting that lasted for about four days. I’m worried why my period is now heavy after a c-section and I need help to know if I should seek medical care or not. Kindly reply Quickly.
Just like Lucy, after waiting for months and then having your first period, another question sets in. That is, how heavy should your period be after a c-section or vaginal birth. In fact, “what the duration of period after surgery”, “how heavy should first period after c-section be?” are common postpartum questions.
But the truth is, no two women will have exactly the same flow after a c-section, and it’s even more difficult to predict when your period will start.
This article explains how long your first period after c-section should last, and when you ought to worry about possible problems.
When will first period after c-section start?
There are many factors that determine when your next period after c-section will begin, and in most parts, it depends on your hormones.
During pregnancy, as already explained, your body experiences elevated hormones like estrogen and progesterone that stops you from ovulating. Because you do not experience ovulation, there is no way you can have your menstrual period during pregnancy.
Besides estrogen and progesterone, there is another hormone, called prolactin, that stops you from ovulating. During pregnancy, a woman’s prolactin levels continue to rise and its main role is preparing your breast for the “feeding role” after delivery, that is, stimulating breast milk production.
The main reason you do not get to experience “breast milk leaking” during pregnancy (despite high prolactin levels) is because of antagonizing effects of estrogen and progesterone.
After your c-section, your body hormones (estrogen and progesterone) fall, resulting in no antagonistic effect on prolactin and then resulting in breast milk production.
But here’s the thing, because prolactin levels are elevated and you are exclusively breastfeeding your baby, you are not likely to have ovulation and your period will also be delayed for a while. For some women who breastfeed exclusively, periods may stay away for many months, and occasionally up to a year or more, before returning.
So in simple terms, if you are exclusively breastfeeding your baby, it’s very likely your period will take a while before coming back again. On the other hand, if you are not exclusively breastfeeding, you are likely to have your period come earlier than expected.
It is also important to know that ovulation can happen before your first visible period, so you can get pregnant again even if your menses has not yet returned. If you do not want to conceive soon, talk with your doctor or midwife about safe contraception after birth.
(Helpful resource on periods and breastfeeding: Healthdirect Australia – “Periods while breastfeeding” – https://www.healthdirect.gov.au/periods-while-breastfeeding)
First period after c-section: How long will it last?
Another question women ask is how long their first period will last after a c-section? But here’s the truth, it is difficult to also tell how long you will bleed after your c-section and it is important that you do not confuse your post-surgery lochia with your menstrual period.
After having a c-section, your body begins to clean your womb, and because of this, you will experience bloody discharge from your vagina for some weeks. This bleeding is called lochia, and it usually changes from bright red, to brown, then yellowish-white over about 2–6 weeks after birth.
This should not be confused with your menstrual period. However, if you are still having very heavy blood loss (for example, soaking a pad in less than an hour, passing very large clots, feeling dizzy or unwell) or if bleeding suddenly becomes heavier again or has a bad smell, it’s important that you see a doctor quickly or go to the hospital.
Your true menstrual period usually returns after lochia has settled. The normal duration of a menstrual period is 3–7 days, however, because of unstable hormones after your surgery, you may experience a shorter or slightly longer period, especially in the first one or two cycles.
(More on normal postpartum bleeding: Cleveland Clinic – “Lochia (Postpartum Bleeding)” – https://my.clevelandclinic.org/health/body/22485-lochia
Tommy’s – “Bleeding after a c-section: what to expect” – https://www.tommys.org/pregnancy-information/giving-birth/caesarean-section/bleeding-after-c-section-what-expect)
Light or heavy period after c-section, what does it mean?
One other reason to be concerned is the frequency and volume of your menstrual period. If your period is unusually light or heavy, it normal that you want quick answers to know if it’s okay or not.
After your surgery, your womb pushes out lochia (reddish discharge) that may last for a few weeks. After 2 weeks after your surgery, light spotting may not mean something serious, so, you don’t have to panic unnecessarily.
When your real periods start again, they can be lighter, heavier or just different from what you had before pregnancy. A heavy first period with bright red blood and some small clots is still not unusual. It’s best to monitor your periods for over 2 or 3 cycles to identify if there is a problem. If your heavy bleeding is persistent, gets worse, or you feel unwell, see a doctor for help.
Many women notice that their first periods after pregnancy are heavier because the uterine lining and blood supply were increased during pregnancy and your hormones are still adjusting. This can sometimes come with small blood clots.
However, if you are soaking through a pad in less than an hour for several hours, passing clots bigger than a small egg, feeling dizzy, breathless, or having chest pain or a racing heartbeat, this is not normal period bleeding and you should seek urgent medical care, as this can be a sign of excessive postpartum bleeding or another complication.
Having said that, it’s best to check with your doctor to determine if there is any underlying medical factor like a fibroid, thyroid abnormalities, blood clotting problems, or even retained placental tissue or infection causing your problems.
(Helpful overview on first period after pregnancy: Healthline – “What to Expect from Your First Period After Pregnancy” – https://www.healthline.com/health/pregnancy/first-period-postpartum
Warning signs after childbirth: Mayo Clinic – “Postpartum complications: What you need to know” – https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/postpartum-complications/art-20446702)
An irregular period after c-section: should I be concerned?
Besides a heavy menstrual flow after your surgery, it’s important you prepare for irregular periods after your surgery.
As previously explained, the timing of your period-return will depend on many factors like if you are exclusively breastfeeding or not, stress, weight loss or weight gain, or if you are already getting close to the natural age of around 51 that menstrual period ceases in women.
Exclusive breastfeeding means you only give your baby only breastmilk (no food or water), and in fact, it’s always recommended by doctors and midwives for the first 6 months. After this time, you can start other supplementary feeds that can assist your baby’s nutritional need, thereby increasing your chances of period return.
Your second period after c-section may also not be predictable and this is because your hormones are still adjusting to normal levels. For many women, cycles gradually become more regular within a few months, but if you have very irregular cycles, frequent spotting, or no period at all for many months after you stop breastfeeding, you should talk to your doctor.
A painful period after c-section, should I be concerned?
Because the flow of your menstrual period will likely increase (or become lighter), you may also experience a more or less painful period.
For women struggling with endometriosis, a condition that causes severe abdominal pain before and during menstruation, symptoms may sometimes feel better for a while during pregnancy and breastfeeding, but they can return when normal cycles restart. Some women feel less painful periods after c-section or after having a baby, while others notice no change or even more cramps.
If your period pain is so severe that you cannot carry out normal activities, or if it is suddenly much worse than before pregnancy, it is safer to see your doctor or gynecologist to rule out problems like endometriosis, adenomyosis, infection, or fibroids.
(For general recovery information: ACOG – “Cesarean Birth” FAQ – https://www.acog.org/womens-health/faqs/cesarean-birth)
Dr Akatakpo Dunn is a Nigerian medical doctor, sonologist and Medical Director of Verah Clinic & Maternity in Warri, Nigeria. He holds an MBBS from the University of Nigeria, Nsukka, a Postgraduate Diploma in Diagnostic Ultrasound (India) and a Professional Diploma in Obstetrics & Gynaecology (RCPI). Through Medplux, he explains women’s health, pregnancy, fertility and ultrasound in clear, practical language so readers can make informed decisions with their own doctors.
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