Breastfeeding and Your Period: How to Maintain Milk Supply When Menstruation Returns

One of the welcomed side effects of breastfeeding is often the temporary pause of your menstrual cycle. However, for many lactating parents, the return of menstruation can bring unexpected challenges, particularly concerns about maintaining milk supply. Understanding what's happening in your body and knowing how to support your breastfeeding journey during this transition can make all the difference.

Understanding Lactational Amenorrhea

Lactational amenorrhea is the natural delay of menstruation that occurs during breastfeeding, primarily driven by elevated prolactin levels. Prolactin, one of the key lactation hormones, not only drives milk production but also inhibits ovulation. This biological mechanism is nature's way of spacing pregnancies, allowing the nursing child to receive adequate nutrition before a new pregnancy begins.

For parents who are fully breastfeeding, menstrual periods typically remain absent for 6 months or longer, with some experiencing lactational amenorrhea for 9-18 months or until weaning occurs. However, the timeline varies significantly between individuals based on factors such as:

- Frequency of nursing or pumping sessions

- Whether night feeding continues

- Introduction of supplemental foods

- Individual hormonal variations

- Baby's age and nursing patterns

- Underlying health conditions, including autoimmune disorders and thyroid conditions

- Hormonal imbalances that may affect the typical lactational amenorrhea pattern

**Important note about health conditions**

Certain autoimmune conditions, thyroid disorders, polycystic ovary syndrome (PCOS), and other hormonal imbalances can cause irregular menstrual patterns during lactation. Some parents may experience an earlier than expected return of their cycle, while others may have irregular or unpredictable cycles. If you have a known health condition or notice unusual patterns in your cycle return, it's important to work with your healthcare provider and a lactation consultant to understand how your specific condition may be affecting your menstrual cycle and lactation.

Why Milk Supply May Fluctuate With Your Cycle

When your menstrual cycle returns, you might notice changes in your milk supply at certain points in your cycle. This is completely normal and temporary. The primary reasons for these fluctuations include:

• Decreased Prolactin Levels: As prolactin levels drop overall to allow menstruation to return, your milk-making potential may decrease. This is particularly noticeable for exclusively pumping parents who may have successfully reduced pumping sessions but now find their previous schedule insufficient.

• Calcium Level Changes: During ovulation through the first few days of menstruation, blood calcium levels gradually decrease, and for some women, this drop in blood calcium causes a corresponding drop in milk supply. This mid-cycle dip is one of the most commonly reported supply changes.

• Hormonal Fluctuations: The natural rise and fall of estrogen and progesterone throughout your cycle can temporarily affect milk production and may make nursing less comfortable.

• Health Condition Considerations: For individuals with autoimmune conditions, thyroid disorders, or other hormonal imbalances, supply fluctuations may be more pronounced or follow different patterns than what's typically expected. These conditions can affect the timing of cycle return and the severity of supply changes, making it particularly important to work closely with both your healthcare provider and lactation consultant to develop an individualized support plan.

Lactational Amenorrhea Does Not Guarantee Pregnancy Prevention: 

While the absence of menstruation during breastfeeding provides some natural family spacing, it's crucial to understand that ovulation can occur before your first postpartum period returns. This means you could become pregnant without having had a period since giving birth.

The bleeding we refer to as a menstrual period is actually the final stage of the menstrual cycle, occurring when an egg isn't fertilized. Since ovulation happens before menstruation, relying solely on the absence of your period to determine fertility status could result in an unplanned pregnancy. Many parents discover they are pregnant again when investigating breastfeeding changes like decreased supply or nipple sensitivity. If you're not ready for another pregnancy, it's important to discuss prevention options compatible with breastfeeding with your healthcare provider and a lactation consultant, regardless of whether your period has returned.

Supporting Your Milk Supply During Menstruation

The Womanly Art of Breastfeeding recommends "a daily dose of 500 to 1,000 mg of a calcium and magnesium supplement from the middle of your cycle through the first three days of your period may help minimize any drop in supply".

Key points about supplementation:

- The recommended dosage ranges from 500mg calcium/250mg magnesium to 1500mg calcium/750mg magnesium, with higher dosages generally being more effective

- Always take calcium and magnesium together, not separately, as the magnesium enhances calcium absorption

- Begin supplementation when you ovulate and continue through the first few days of your menstrual period. For irregular cycles, start 14 days after your last period began, or consider daily supplementation

- The amount needed may depend on your diet - higher animal protein intake typically requires more supplementation

Practical Nursing and Pumping Strategies

• For Nursing Parents: Babies naturally respond to supply decreases by nursing more frequently, vigorously, and for longer sessions. Trust your baby's instincts and allow for increased nursing during this time.

• For Pumping Parents: Since pumps cannot anticipate and respond to supply changes like babies can, consider: Temporarily increasing your pumping frequency by evaluating whether your current pumping schedule is adequate now that prolactin levels have decreased. 

• Nutrition and Hydration: Focus on maintaining excellent nutrition and hydration, particularly if you experience heavier bleeding that could lead to iron depletion.

• Rest and Stress Management: Supply dips during menstruation may be related to hormone fluctuations, and focusing on solid nutrition and investigating hormone balance can be helpful.

• Monitor and Adjust: Keep track of your supply patterns throughout your cycle so you can anticipate and prepare for temporary dips.

What to Expect: 

It's important to remember that experiencing a temporary supply dip during your menstrual cycle does not doom your breastfeeding journey. Very few people avoid getting their menstrual cycle back with long-term breastfeeding (2-2.5 years), so clearly the return of menstruation does not prevent successful lactation. Most parents find that with appropriate support strategies, their milk supply stabilizes and they can continue breastfeeding successfully throughout their menstrual cycles. The key is understanding what's happening in your body and having a toolkit of strategies ready to support your goals.

Consider reaching out to a lactation consultant if you experience:

- Significant, sustained drops in milk supply

- Difficulty maintaining your breastfeeding goals after implementing support strategies

- Questions about balancing hormonal changes with your feeding plan

- Concerns about whether your baby is getting adequate nutrition

- Irregular menstrual patterns that don't follow typical expectations, especially if you have underlying health conditions

- Earlier than expected return of menstruation, particularly if accompanied by supply concerns

The Bottom Line

The return of your menstrual cycle while breastfeeding is a normal part of the postpartum journey. While you may experience temporary fluctuations in milk supply, these changes are manageable with the right knowledge and support strategies. Understanding the role of calcium and magnesium supplementation, adjusting your nursing or pumping routine as needed, and maintaining overall good health can help you continue your breastfeeding journey successfully.

Remember that every parent's experience is unique. What works for one person may need adjustment for another, and that's perfectly normal. The most important thing is having accurate information and appropriate support to make decisions that align with your family's needs and goals.