Most moms are all about getting life to run smoothly, or at least trying to. You're corralling kids' schedules, maintaining your relationship with your partner, making strides at work. But there's one thing that likely won't slip into cruise control: your period.
It can switch gears often as adulthood progresses, from vanishing post-baby to changing as a result of hormonal shifts, weight gain, and stress (all common in our 30s and 40s). In fact, we're all but guaranteed to see our period evolve through perimenopause, the long transition into menopause. As OB-GYN Dineasha Potter-McQuilkin, M.D., of Hoboken, New Jersey, puts it, "Your uterus can feel like the Wild West."
We asked experts to demystify the menstruation journey ahead, and we compiled their insight into eight helpful facts.
1. Post-baby, your period will return whenever it pleases.
The discharge that starts immediately after a vaginal or cesarean delivery and lasts from two to six weeks, going from reddish to white in color, isn't your period. That's lochia, a collection of blood, tissue, and other waste left from childbirth. "It's your body's way of saying, 'Let's clean you out, lady!'" says Erica Montes, M.D., an OB-GYN in Phoenix, who adds that women should wear a pad during this time instead of insertable period products like menstrual cups or tampons. (These can injure or infect the healing uterus or worsen vaginal tearing. Plus, an exhausted new mom may forget to take them out.)
Your period's return depends on whether or not you're solely breastfeeding, Dr. Montes says. If you're using formula, your period can return in as little as six weeks, around the time of your first checkup. If you nurse or pump exclusively, you'll likely go period-free until you start supplementing with solid food, thanks to hormones that suppress ovulation while you produce milk. Women who still nurse or pump often, though, may stay period-free for all of their breastfeeding journey.
2. Even if your period hasn’t yet returned in the postpartum phase, it’s possible to get pregnant.
Women who aren't nursing can ovulate as early as 25 days after delivery, and though breastfeeding tends to keep periods at bay, it can't reliably prevent pregnancy. Only birth control can help avoid a back-to-back pregnancy, which runs a higher risk of premature birth and rupture of a C-section scar, Dr. Montes says. "Pregnancies are safer if you space them out by at least 18 months," she says. "Your body needs to replenish nutrients and shrink your uterus."
Health experts suggest avoiding birth control options with estrogen for the first three weeks after giving birth, as these methods come with a higher risk of blood clots and may decrease milk supply.
3. Birth control can change your cycle.
Post pregnancy is a natural time for women to reconsider their birth control methods, whether it's because they're ready for a long-lasting option, don't want to take a pill, or aren't keen on a contraceptive's side effects. Transitioning to a new hormonal birth control can affect periods in different ways.
Contraceptive patches, pills, rings, shots, or IUDs containing estrogen and/or progestin, for example, can make periods lighter. They level out hormones, keeping the uterus's lining thin, so there's less blood to shed, Dr. Montes explains. Some pills, IUDs, and shots, especially progestin-only methods, can stop periods altogether for the duration they're used. For the record: "Stopping your period is safe and won't hurt your chances of having a baby later," Dr. Montes says.
On the flip side, Paragard, the nonhormonal copper IUD, can actually spur heavier and longer periods. The metal it contains causes an inflammatory reaction that's toxic to sperm but safe for you, and that leads to more flow, Dr. Montes explains. The Depo-Provera injection can also cause irregular bleeding and can make your period go away during its use. It should be avoided if you want to have closer-interval pregnancies, since for some women it can delay the return of fertility for up to a year.
4. Aging can affect periods too.
Hormones and getting older in general can cause your uterus to expand or contract, which alters your period. You make less estrogen as you age. Less estrogen means less bleeding, but a uterus that stays larger can mean more bleeding. In addition, Dr. Potter-McQuilkinnotes, "as estrogen decreases, you may gain weight around your midsection." This can result in heavy and irregular periods.
That's not all aging brings: "Though many women's periods stay the same, your period may become lighter or heavier. It's unpredictable," says Lori Atkins, M.D., an OB-GYN in Fort Worth. In most cases, there's no reason to be alarmed. "You don't need to read too much into bleeding for five days one month and seven the next or having a heavier period, as long as it's tolerable," says Holly W. Cummings, M.D., M.P.H., assistant professor of clinical obstetrics and gynecology at the Perelman School of Medicine of the University of Pennsylvania.
You might consider switching the size of your tampon or menstrual cup, if need be, and using NSAIDs, like naproxen or ibuprofen, to help manage discomfort. You can also ask your doctor about using hormonal birth control to help lighten periods.
5. Stress can also alter it.
"You're dealing with a lot at this age—kids, career, aging parents," Dr. Potter-McQuilkin says. "Stress does crazy things to our body, including making you skip your period or bleed more heavily." While you can't eliminate all stress from your existence, any tweaks you can make to your lifestyle to include regular exercise, a balanced diet, and more sleep can reduce stress and help normal periods return.
6. Perimenopause can begin earlier than you think.
Menopause might not be on your radar yet. After all, it occurs for most American women at around age 51. But it's worth familiarizing yourself with perimenopause, the extended process leading up to it, which can last six to ten years and may start as early as your mid-30s, says Stephanie Faubion, M.D., medical director of The North American Menopause Society and the Mayo Clinic Center for Women's Health.
Estrogen levels may fluctuate wildly in the years before menopause, and symptoms vary from woman to woman. However, "common issues include irregular bleeding, intermittent hot flashes, trouble sleeping, anxiety, and vaginal dryness or painful sex," Dr. Faubion says. If you have a big change in bleeding patterns, whether more frequent and heavier or spaced out and lighter, speak to your doctor.
Women entering this phase should try to keep an eye on weight gain, manage stress, and stick to a healthy diet as the risks of heart disease, diabetes, high cholesterol, and hypertension go up.
7. Even though many changes are normal, if something seems off to you, it’s worth checking out.
Certain changes to your period are signs that something serious may be going on. If you notice that you're soaking through more than one pad or tampon per hour, passing blood clots bigger than a quarter, spotting between periods, or missing three or more periods, reach out to your doctor. "Any change that feels wrong or is bothersome requires a visit to your gynecologist," Dr. Atkins says. "Menstrual changes and irregularities can be common and normal, but it takes a qualified specialist to work through the issues with you and determine a plan."
8. Your period might make some illnesses worse.
If you have migraines, IBS, or another common condition, you may notice that your symptoms get more intense just before or during your period. Here's why, plus ways to lessen the pain.
Anemia: It's no surprise that heavy blood loss during your period can worsen this condition, in which the body lacks enough red blood cells to carry oxygen through the body. "Iron supplements and hormonal birth control like pills, vaginal rings, arm implants, and IUDs can make periods lighter," explains Dr. Holly W. Cummings. Your doctor may also prescribe the oral medication Lysteda, which can prevent prolonged bleeding.
Fibromyalgia: The widespread musculoskeletal pain caused by this chronic disorder may worsen days before your period, as can sleep troubles and brain fog. "For a parent, this can be debilitating," says Maggie Cadet, M.D., a rheumatologist in New York City. Medications like naproxen and ibuprofen can help alleviate pain, as can swimming, massage, pelvic floor exercises, and warm baths. Managing stress through methods such as meditation and cognitive behavioral therapy are also key, she says.
Migraines: The severe headaches can worsen right before and during your period because of hormone fluctuations, says New York City–based neurologist Risa Ravitz, M.D. Keep up with medications you're already taking, she says, and help prevent migraines by drinking lots of water, eating regular, nutritious meals, and getting cardio exercise and plenty of sleep.
Fibroids: These benign growths or tumors in the uterus tend to grow during pregnancy and shrink postpartum. If they stay large or get even bigger, they can make periods very erratic by prolonging them, and cause heavy bleeding and pain. Doctors' go-to fix, Dr. Lori Atkins says, is a hormonal contraceptive to manage symptoms. In extreme cases, they can be removed surgically.
Endometriosis: Pain is the hallmark of this condition, in which uterine cells grow beyond the uterine lining. "Pregnancy suppresses it, and that benefit can last three years," Dr. Atkins says. Once it returns, pain starts a few days before your period. Doctors may suppress or adjust your hormones through birth control or opt for surgery if initial treatment fails.
Irritable bowel syndrome (IBS): Symptoms of this disorder of the large intestine, which include abdominal pain, gas, diarrhea, and constipation, get worse during your period thanks to fluctuating hormones. Hormonal birth control can help alleviate symptoms, Dr. Atkins says.
This article originally appeared in Parents magazine's August 2021 issue as "Going With the Flow." Want more from the magazine? Sign up for a monthly print subscription here