C-section or cesarean delivery is a surgical procedure to deliver a baby. The onset of the first period after a C-section may not differ from that after a vaginal delivery. However, it depends on an individual’s body, hormone status, and breastfeeding frequency after delivery. Pregnant women do not have their menstrual periods for the full duration of their gestation or even more, but the cycle gradually reestablishes after delivery. Read this post to understand the factors influencing the return of periods after cesarean delivery and when it can be a cause for concern.
When Do You Have Your First Period After C-Section?
The return of your period usually depends on your breastfeeding pattern, and how soon your hormones return to normalcy, because the levels of estrogen and progesterone hormones may drop after pregnancy.
- If you are exclusively breastfeeding, you may not get your period back until you wean your baby.
- If you are not breastfeeding, you may get your period back in five to six weeks after delivery (1).
Will C-Section Delay Your First Period?
Having a C-section may not delay your first period after delivery. The return of the menstrual cycle is likely to be influenced by certain factors such as breastfeeding, hormones, and health conditions before and after pregnancy.
What Factors Affect Menstruation After C-Section?
The hormonal changes that take place in the body after delivery may have a significant effect on the first few periods. This could depend on the:
- Health issues you had before pregnancy
- Changing hormonal levels
- Irregular menstruation before your pregnancy
A few other factors that may affect your first period are:
- Weight loss or gain
- Thyroid disorder
- Irregular physical activity
C-section may not affect the start of your first period, but it could change the way you bleed.
How Is Your Period Different After Pregnancy?
The period after C-section or vaginal delivery may not be the same as the ones before pregnancy. The body is once again adjusting to the menstrual cycle, and therefore it may differ from the pre-pregnancy period in various aspects (1).
- Heavy flow: The bleeding could be heavy during the first period after C-section. One of the reasons is the surgical incision on the uterine wall.
- Bright red: The first-period blood that is formed after the clearing of uterine tissue is fresh, and could be bright red.
- Lasts longer: The first period usually continues for seven days like a normal period. But most of them may have heavy bleeding for four to five days, followed by lighter bleeding for a longer time.
- Irregular periods: Factors such as pregnancy weight gain or loss, stress, and thyroid problems might make the menstrual cycle irregular.
- Blood clots: Dark color or bright red clots may be released, especially when the first period is heavy.
You are likely to have heavy bleeding in cases such as thyroid problems or adenomyosis (thickening of the uterine wall), and lighter bleeding if you had conditions such as endometriosis (the tissue grows outside the uterus), Asherman syndrome (existence of scar tissue in the uterus) and Sheehan syndrome (the damage of pituitary gland) (2) (3).
It may take some time for your menstrual cycle to get regular. Sometimes, you may not get back your regular periods for months. Also, you might have the first period, and then experience a break in the cycle before it resumes (4).
Can Postpartum Periods Be Less Painful Than Before?
A study has found that period-related pain was likely to be lesser after childbirth due to the bodily changes brought in by the pregnancy (5).
Why Is Your First Period Delayed When Breastfeeding?
Your first period could be delayed if you are breastfeeding because of the hormones produced by the body. Prolactin, which is needed for breast milk production, might suppress the reproductive hormones (6). Therefore, you may not ovulate or produce an egg for fertilization. As a result, your first period may be delayed until after you stop or limit breastfeeding.
Will The First Period Affect The Breast Milk?
You might see some changes in your breast milk supply or your baby’s reaction to milk when your period returns. Hormonal changes could result in:
- A decrease in milk supply
- Changes in the frequency of nursing
- Composition and taste of the milk
These changes are sparse and may not affect your breastfeeding ability (7).
When To Meet The Doctor?
If your periods do not become normal even after a few months, and you notice some unusual changes, you should check with your doctor. You may also consult the doctor in the below instances:
- Soaking more than one pad in one or two hours
- Heavy bleeding with pain
- Sudden fever and severe headache
- Blood clots that are bigger and unusual
- Foul-smelling period
- Pain during urination
- Difficulty in breathing
First Period After C-Section And Tubal Ligation
Tubal ligation (tying of the fallopian tubes to prevent future pregnancies) after the C-section does not affect your first period. The period might be heavy, but that is nothing to worry about (8). If you are sure of having a tubal ligation after the current pregnancy, then you may consider having that done at the time of C-section itself to avoid additional incisions and anesthesia.
If you had a C-section delivery, know that it has no influence on your first period after delivery, but an individual’s health, hormone levels, and breastfeeding frequency affect the period after birth. The first period after C-section might be heavy and painful or light and painless. It can also occur shortly after delivery for some mothers, while it may take months for others, especially those who are exclusively breastfeeding their babies. Moreover, the menstrual cycle may sometimes be irregular for a few months. However, if you have any unusual symptoms, you should consult your doctor.
2. Vaginal or uterine bleeding – overview; U.S. Department of Health and Human Services National Institutes of Health (2019)
3. Do Your Periods Change After Pregnancy; Cleveland Clinic (2019)
4. Breastfeeding and periods; Healthdirect (2017)
5. Mahboobe Firouzi, et al.; Comparing the pattern of primary dysmenorrhea before and after childbirth; Journal of Midwifery and Reproductive Health (2019)
6. Marc E. Freeman et al.; Prolactin: structure, function, and regulation of secretion; American Physiological Society Physiological Reviews
7. Menstruation And Breastfeeding; La Leche League International
8. Shahideh Jahanian Sadatmahalleh et al.; Menstrual Pattern following Tubal Ligation: A Historical Cohort Study; Int J Fertil Steril. (2016)
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Dr. Shivani Chaturvedi(MD)
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