The delivery of your baby is followed by a period of temporary infertility induced by the cessation of your menstrual flow. This amenorrhea that results occurs as a result of the changes in the response of your ovary to your hormonal stimulation.
The moment you deliver, the ovary begins to alter it responses to hormonal stimulation from the anterior pituitary. The hormones estrogen and progesterone that rose 10 to 100 folds in pregnancy return to practically zero and another set of hormonal influences start to rise in the body to maintain the postpartum period of nurturing your child.
This response of the female body that leads to anovulation due to the hormonal changes that accompanies delivery results in postpartum amenorrhea (PPA).
The Physiology of PPA
In the postpartum period, as the hormones return to normal after delivery and breastfeeding is initiated, there is a cessation of the pulsatile release of gonadotrophin releasing hormones GnRH from the hypothalamus thereby affecting LH release from the pituitary. The plasma levels of FSH are noted to be within the normal range in the serum and they remain at levels that can stimulate follicle growth but the lack of pulsatile LH release leads to reduced estrogen production with the associated lack of pulsatility resulting in the inhibition of ovulation as the rhythmic ovarian cyclicity is altered due to commencement of lactation and breastfeeding. This inhibition of ovulation helps to maintain the amenorrhea postpartum.
As the suckling reflex of breastfeeding is established it helps to enhance the inhibition and the return of cyclicity aided by the loss of pulsatile gonadotrophic response from the hypothalamus. The hormone prolactin is the major hormone involved in the maintenance of lactation and as the prolactin level rises to very high levels it has an inhibitory effect on ovulation helping suppress ovulation. This effect is aided and reinforced by suckling as the more the baby suckles, in both frequency and duration of suckling, the higher the blood prolactin level rises and the more it suppresses the return of ovulation. This is one of the basis of the use of lactation as a means of fertility control in the post delivery period.
Duration of PPA
The duration of PPA varies from one person to the other and within the same person and it is not definite. The duration is the period from the delivery of your baby to the time of your first successful ovulation.
The duration of the amenorrhea is affected by several factors:
Breastfeeding –
When you choose to do exclusive breastfeeding the period of amenorrhea lasts longer because of the impact of the sustained level of high prolactin and loss of pulsatile release of LH that leads to inhibition of ovulation. The duration may lasts for as long as you choose to exclusively breastfeed or more. When you are not engaged in exclusive breastfeeding, the duration varies also depending on your hormonal response.
No Breastfeeding-
If you choose not to breast feed at all the PPA will usually resolve in a space of 6 weeks to 3 months as the fertility and hormonal and ovarian cyclicity returns to normal within this period.
Income and Nutritional Status-
The family income and nutritional status have an inverse relationship with PPA. Returning earlier in women with poor income and nutritional status as nutrient levels are needed to maintain proper and functional lactation and breastfeeding.
Other factors that determine duration of the postpartum amenorrhea are
Age of the mother, being longer as the women advances in age
Parity of the women, being also longer with increasing parity
These factors are not specific as there are women to women variation and variation in duration in the same women in different pregnancies. There are also population and racial differences in duration perhaps related to the economic status of the different populations and races.
PPA with Breastfeeding
Postpartum amenorrhea occurs in every women who has given birth. The full establishment of PPA depends on what your plans are following delivery. If you choose to breastfeed then there is some added benefits that can be derived from this decision to breast feed. Secondly you have to make a decision if you want to do exclusive breastfeed or supplemental feeding. The route you take and your decisions all have impact on the duration and effectiveness of your PPA either by shortening the duration of PPA with supplemental feeding or prolonging it with exclusive breastfeeding as long term breastfeeding is accompanied by a longer period of anovulation with the associated prolongation of duration of PPA lasting in some cases to up to a year and six months to 2 years.
PPA without Breastfeeding
Without your engaging in the practice of breastfeeding in any form postpartum amenorrhea also occurs but lasts for a shorter duration as the hormones return to normal levels following delivery and with no inhibitory factors coming from the initiation of breastfeeding or from the lactating hormones prolactin and with ovarian cyclicity and pulsatility restarting, the follicles grow to maturity and ovulate. This happens within 6 weeks to 3 months depending on several other factors within the patient and the environment.
Benefits of PPA
The most widely recognized benefit of postpartum amenorrhea is its fertility regulating potential. If you desire to use the temporary infertility it confers to a new mom to its maximum potential, PPA offers you this ability but you have to improve your breastfeeding potentials
Lactational Amenorrhea Method (LAM)
LAM is a method of family planning that woks on certain well laid down principle that:
1 If you are breastfeeding (exclusively or minimal supplementation)
2 If you are within six months of delivery
3 If you have not seen your menses within this six months of delivery
When you meet these 3 criteria you are protected from pregnancy within the first 6 months of delivery. Lactational amenorrhea is over 98% effective if you follow the 3 principles judiciously and its advantages are numerous to both the mother and the baby.
It serves as a precursor to other forms of family planning practices as it confers protection from birth and the other artificial means of contraception can then take over from where its effectiveness begins to fade.
The other benefits of postpartum amenorrhea relates to its use by the couple for child spacing. By prolonging the duration of breastfeeding some women continue to be amenorrhoeic even without any other measures and hence remain infertile beyond the 6 months of standard LAM.
The pattern of PPA within a community can be studied and the result will help in policy planning on issues like population and health policy to advocate measures and policies that will be beneficial to women like family planning practices that will work best within a specified community.
Conclusion
Postpartum amenorrhea is really a welcome development at a time every new mom is going through a hectic period of nursing and all the related stresses associated with early postnatal period that menstrual flow and its management will really be an unwelcome distraction.
Most moms relish the idea of freedom from menstruation for this though short-lived period and the added advantage of freedom from pregnancy that PPA confers makes the whole experience of this period of senescence of menses uplifting with its attendant romantic attractions.
Dr mawa
To your postnatal health and freedom
mypostnatalmanagement.com
