If the woman is not breast-feeding, menstruation returns within 6 weeks of delivery. After 3 months, 70-90% of women menstruate; 6 months later, almost all have resumed menstruation (average time for resumption is 8 weeks). This timeline varies widely if the mother is breast-feeding. Some new mothers begin menstruating after 4 weeks, and this is hard to distinguish from bleeding (hemorrhaging).
# If there is irregular bleeding, chances are that it is abnormal uterine bleeding rather than menstruation.
# If the bleeding is modest and does not continue, there is no need for immediate treatment.
# If the bleeding is heavy, receive an examination and ultrasound to check the condition of the uterus.
# Two thirds of first menstruations after delivery are anovular menstruations (ovulation did not occur). Risk of pregnancy before menstruation is not high.
# When the woman is not breast-feeding, ovulation can occur 35-40 days after delivery, but on average it takes 2.5 months and 6 months for women who continue to breast-feed.
# The further away the first menstruation is from the delivery date, the better the chances for ovulation.
# When there is ovulatory menstruation, the ovaries have recovered and the mother can become pregnant again.
Effects of breast-feeding
# Many women who do not breast-feed during puerperium recover their ovary function, ovulate, and are capable of being pregnant roughly 6 weeks after delivery.
# Although the frequency of breast-feeding is a factor, 15% of mothers who do breast-feed menstruate 6 weeks later, one third menstruate within 3 months, and others can take more than a year and a half.
# Menstruation returns more slowly among mothers who breast-feed because the increase in hormones from breast-feeding causes the ovaries to recover late. The breast secretion hormones are concentrated and, like with infertile women, the ovaries do not respond well to ovary stimulus hormones from the pituitary gland.