Getting Periods Again Postpartum

One thing many women who have experienced hypothalamic amenorrhea / no periods want to know is … will I get my periods again after I have a baby, and if so, WHEN??

We discuss this in depth in No Period. Now What? and here’s a cool graph that shows when my survey respondents started cycling again in relation to weaning (because breastfeeding increases levels of the hormone prolactin, which suppresses the reproductive system – to different levels in different women).

One of the key factors I found in my research around cycle resumption was an article that suggested a small weight gain was helpful in cycle resumption; this makes sense as it signals the body that energy is plentiful and reproduction is once again “safe” – just as with resuming cycles after hypothalamic amenorrhea in the first place. I was recently listening to the Period Podcast with Kate Clancy and was pleased to hear the expert she interviewed back this hypothesis up. Which turns out makes a lot of sense because it was Dr. Claudia Valeggia, who wrote the article I referenced. 🙂

Anyway, Laurel who is in my facebook support group agreed to share her story, including postpartum cycle resumption – she hoped to continue breastfeeding but wanted to try and get pregnant again.

“I was a heavy teen and young adult. I went on oral contraceptives early to lessen my acne. I lost weight quickly when I was 23 years old and got into running. I never really noticed my cycle until I got married at 28 and went off the pill. I didn’t regain a cycle after 6 months, and started looking for reasons. Everything about HA resonated with me, and I found the support of the Fertile Thoughts board [genesis of No Period. Now What?] around the same time I met with a reproductive endocrinologist. Two rounds of injectables and 20 pounds later, I still didn’t have a period and wasn’t responding well to meds. I was “all in” in name only, but not mentally all in, as I was already resigned to doing IVF. We did one very easy (probably because I had gained weight!) round of IVF in May 2014 and I conceived my son. He was born in February 2015.

I breastfed my son and he was very needy, never sleeping more than an hour at a time. He nursed constantly. I started running again at 6 weeks postpartum and slowly lost weight. I settled at about 10 lbs. above my HA weight and was running what I thought was a reasonable 4 times a week, definitely not as much as before pregnancy. I wasn’t worried when I didn’t get my period for the first year, then 18 months, then 2 years postpartum. When my son turned 2 I started wondering. He still nursed all the time and I was still running. We weren’t trying to conceive, but I was worried about my bone density and heart health long-term. After running a disappointing race in October 2017, I quit running and vowed to give “all in” a better try. If I didn’t get my period in a few months, I’d try to start the weaning process with my son.
I looked at my diet and although I wasn’t restricting, I went 12+ hours without eating overnight and was nursing multiple times during that time, so my caloric deficit was high for several hours. I had just read an article on Nico’s blog about hours in energy deficit, so I added in a big pre-dinner snack and amped up my breakfast. I ate and ate. Twenty+ pounds and 3 months later, I noticed funny symptoms. I randomly took an ovulation test and it was positive! Eleven days later, I got my first non-medication (BCP or fertility medication) period since I was 17! It was amazing. My husband and I thought that since I was cycling, we might as well try to have a baby naturally. My second cycle was long, and I didn’t ovulate until cycle day 38. I was excited to have a second cycle, and even more excited when I started getting positive pregnancy tests 10 days later!
I’m very happy I didn’t have to wean to conceive again, because extended breastfeeding was important to me. Figuring out that the energy expended overnight was an important part of the equation, for me, was great. I also had to be comfortable getting to a weight I hadn’t seen since my overweight teens. It’s worth it for another baby and for my long term health.

If you’re in this situation, or might be in the future, I hope that it helps you to know that 84% of women in my survey resumed natural cycles after pregnancy (in those who wanted to conceive again), and 94% had resumed cycles at the time I performed my survey, after they were done having children. I do need to update those numbers, I do believe that a few years out the final cycle resumption number is higher 🙂

Many of those who resumed cycles had not restored periods prior to pregnancy – but they maintained a weight at which their body was happy, fully fueled any exercise they were participating in, and did resume cycles after having a baby. For those who didn’t, many were anxious to conceive again and didn’t want to wait – hence the higher rate of recovery after families were complete.

Anyway if you’re interested in more data and information on this topic, please do check out our book!