For the new mother, the question of when fertility will return after childbirth is a common one. While every woman's body is different, the most common determinant of when her period will return is whether she is breastfeeding or not. Spotting may be indicative of the return of menstruation, or may be part of the healing process following childbirth.
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Amenorrhea is the lack of menstrual bleeding. Lactational amenorrhea is the lack of menstrual bleeding due to breastfeeding after childbirth. The hormone that stimulates milk production, called prolactin, also inhibits ovulation, according to Women's Health Queensland Wide. When ovulation is inhibited, so is the return of menstruation. The amount of time that lactational amenorrhea lasts is determined by how many times a day you breastfeed your child, and for how long you continue nursing.
Guidelines to LAM
The Lactational Amenorrhea Method (LAM) is a method of family planning for postpartum women and families. Family Health International (FHI) identifies three criteria to LAM that must be met to ensure protection from unplanned pregnancy. The first criteria is amenorrhea. Second, you must be fully or nearly fully breastfeeding, also called exclusive breastfeeding. Lastly, LAM is most reliable within the first six months postpartum.
Full breastfeeding, or exclusive breastfeeding, is recommended for the first six months for the health of your new baby as well as to have the highest rate of effectiveness of LAM. According to FHI, pregnancy rates during lactational amenorrhea within the first 6 months postpartum were very low, even if the mother breastfed and offered formula supplements to her baby. However, since it is the effect of frequent breastfeeding on a woman’s body that causes amenorrhea, adding formula to baby’s diet may decrease his desire to breastfeed often, resulting in the return of menstruation.
The End of Amenorrhea
The end of amenorrhea is outlined by FHI as two days in a row of bleeding or spotting. This does not include the bleeding or spotting that occurs immediately after childbirth. If bleeding or spotting occurs within the first 56 days after childbirth, it is not considered menstruation. From day 57 postpartum and after, if you have two consecutive days of vaginal bleeding or spotting, amenorrhea has ended and it is possible menstruation has returned.
Following childbirth, a woman’s menstrual cycle may return beginning with ovulation and followed by her first period. Therefore, you may be fertile, having ovulated, prior to having your first menstrual period with vaginal bleeding or spotting.