What’s Behind an Abnormal Period After Birth?

One of the many things nobody told me about the postpartum period was how I would need a ton of those super-thick, hospital-grade maxi pads after bringing home my baby daughter. (I should’ve grabbed as many as my arms could carry more before being discharged!)

Turns out I was clueless about something called “lochia” — which I simply referred to at the time as my six-week-long abnormal period. This was a three-stage bleeding cycle that required way more than my usual moderate-flow maxi pads. While I certainly wasn’t familiar with lochia, it turns out this kind of abnormal period is normal for those in the postpartum stage.

Is lochia part of my menstrual cycle?

Not exactly. Lochia is the bleeding that occurs “immediately after birth, and it’s the mixture of blood, mucus, and tissue that is shed from the uterus as it heals,” explains Dorothy Bestoyong, DO, an OB/GYN based in Orlando, Florida. It’s normal for lochia to last for up to six weeks, but it will taper off through stages:

• During those first few days postpartum, lochia resembles a dark-red blood color, and is usually pretty heavy (prepare to soak through a thick pad every few hours).
• After about a week, the lochia will look more pinkish-brown and the flow will be much lighter.
• Then, after 10-14 days, you can expect the discharge to appear yellowish-white — and you probably won’t need such heavy pads anymore. 

And yes, you will still experience lochia if you had a C-section, although you may bleed less than you would from a vaginal delivery. 

Since lochia is an integral part of the healing process, it’s wise to avoid using tampons or having sexual intercourse during the typical postpartum six weeks. These guidelines help to prevent infection while your body gets some much-needed rest. (A foul odor and/or greenish vaginal discharge are two tell-tale signs of potential infection during the lochia period.)

Although Dr. Bestoyong says regular periods “can start again as soon as eight to 12 weeks after giving birth,” these are women’s bodies we’re talking about here (read: They can be unpredictable!). Sometimes, our cycles don’t return to normal after the lochia period for several reasons. Dr. Bestoyong breaks down those reasons below, advises on the common causes for abnormal periods — and recommends when you should see your healthcare provider. 

Common causes of postpartum abnormal periods

After the lochia period has ended, breastfeeding is the most common reason postpartum women either have irregular menses or don’t experience menses at all, says Dr. Bestoyong. Regular lactating and nursing can extend the period before your menstrual cycle restarts, but your period can return sooner depending on how often you breastfeed (or pump). That being said, Dr. Bestoyong warns, that just because you’re not getting your period regularly doesn’t mean exclusive nursing “should be mistaken as a method for contraception.” Although nursing can cause “lactational amenorrhea,” she says “people can still get pregnant even if they are breastfeeding and not having a period, as they can still ovulate.” 

Dr. Bestoyong says another cause of postpartum abnormal periods is “a change in bleeding pattern.” If you notice your bleeding is “heavy, painful, or persistently irregular,” it’s worth a visit to your healthcare provider to figure out what’s going on. She also mentions postpartum abnormal periods could be caused by an exacerbation of previous medical issues” such as “fibroids or endometriosis.” Other pre-existing conditions that could cause postpartum abnormal periods include eating disorders, thyroid disease, PCOS, and obesity.

I’m well past the lochia period and my cycle is still abnormal. What should I do? 

You know your body better than anyone else, so call your doctor if you’re concerned about your abnormal menses after the traditional six-week lochia period. Abnormal menses can mean either heavy bleeding or the lack of a period.

If you haven’t had a period for three months postpartum, aren’t pregnant, and aren’t breastfeeding, a visit with your healthcare provider is definitely in order. 

On the other side of the spectrum, “typically any bleeding past six weeks postpartum is investigated,” says Dr. Bestoyong. Symptoms to look out for include bleeding through more than one pad an hour, fever, large blood clots, intense cramping and pain, and bleeding between menstrual cycles. “[Your symptoms] may necessitate an ultrasound to identify the source, and from there, blood work and further testing may be recommended,” says Dr. Bestoyong. Treatment will depend on the abnormal bleeding source. 

Shifting from lochia back into your regular menstrual cycle is rarely a straight line, and it’s not always easy to tell if your body is just readjusting or if there’s an underlying issue. Dr. Bestoyong reiterates the importance of consulting with your OB/GYN if you have “persistent bleeding six weeks postpartum,” or are experiencing irregular periods that are “outside of 21-35 day cycles.” 

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Sarene Leeds holds an M.S. in Professional Writing from NYU, and is a seasoned journalist, having written and reported on subjects ranging from TV and pop culture to health, wellness, and parenting over the course of her career. Her work has appeared in Rolling Stone, The Wall Street Journal, Vulture, SheKnows, and numerous other outlets. A staunch mental health advocate, Sarene also hosts the podcast “Emotional Abuse Is Real.” Subscribe to her Substack, the Critical Communicator, and follow her on Instagram, BlueSky, or Threads.