Breastfeeding individuals often wonder about the return of their fertility. While breastfeeding can naturally delay your menstrual cycle and ovulation, it is not a reliable method of birth control. Fertility can resume unexpectedly, even before your first postpartum period, making it important to understand how to recognize the signs of ovulation.
Understanding Fertility During Breastfeeding
Breastfeeding influences fertility primarily through the hormone prolactin, which is responsible for milk production. When a baby suckles at the breast, it stimulates the release of prolactin. High levels of this hormone can suppress ovulation by signaling the hypothalamus to reduce gonadotropin-releasing hormone (GnRH). This reduction in GnRH subsequently lowers the secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which are necessary for egg development and release, thus inhibiting ovulation.
This natural suppression of ovulation is known as the Lactational Amenorrhea Method (LAM). For LAM to be considered an effective form of birth control, specific criteria must be met: the baby must be under six months old, the mother must be exclusively or nearly exclusively breastfeeding, and her menstrual periods must not have returned. If these conditions are strictly followed, LAM can be highly effective, though its effectiveness can vary.
Recognizing Ovulation Signs
Your body may still show signs that ovulation is approaching or has occurred. Tracking these signs can help you identify your fertile window.
Basal Body Temperature (BBT) charting involves measuring your body’s lowest resting temperature each morning before getting out of bed. A slight increase in BBT, typically less than 0.3 degrees Celsius (0.5 degrees Fahrenheit), that remains elevated for three consecutive days or more can indicate that ovulation has happened. However, breastfeeding can sometimes affect BBT, potentially making readings less consistent due to hormonal fluctuations and interrupted sleep patterns.
Changes in cervical mucus provide another indicator of fertility. As ovulation approaches, cervical mucus typically becomes clear, stretchy, and slippery, often compared to raw egg whites. This “egg-white” cervical mucus is a sign of peak fertility, as its consistency helps facilitate sperm movement. After ovulation, the mucus usually becomes thicker, stickier, or may dry up.
Ovulation Predictor Kits (OPKs) detect the surge in luteinizing hormone (LH) that occurs 24 to 36 hours before ovulation. While OPKs can be used during breastfeeding, their reliability may be affected because prolactin can suppress LH, potentially leading to inconsistent results, especially if your period has not yet returned. Combining OPK use with other tracking methods can increase accuracy.
Other subtle signs can include mild pelvic discomfort or a slight twinge, known as mittelschmerz. Breast tenderness or sensitivity can also occur due to hormonal shifts before or after ovulation, though this sign is less reliable as it can happen at other points in the menstrual cycle.
Factors Affecting Fertility’s Return
The timing of fertility’s return while breastfeeding is influenced by several factors and varies greatly among individuals.
The frequency and duration of breastfeeding play a significant role. Exclusive, on-demand nursing, particularly including nighttime feedings, tends to keep prolactin levels higher, which typically prolongs amenorrhea. When a baby starts sleeping longer stretches at night or nursing frequency decreases, prolactin levels may drop, signaling ovulation’s return.
The introduction of solid foods to a baby’s diet also contributes to changes in nursing patterns and can influence fertility. As babies consume more solids, their reliance on breast milk may decrease, leading to fewer nursing sessions and a potential return of ovulation.
Pumping breast milk, while stimulating prolactin production, may not suppress ovulation as effectively as direct nursing. This is often because pumping sessions are less frequent or shorter than direct breastfeeding. A mother’s overall health, stress levels, and conditions such as Polycystic Ovary Syndrome (PCOS) can also affect hormonal balance and the timing of fertility’s return.
When to Seek Medical Guidance
While variations in cycle return are common during breastfeeding, seeking medical guidance is advisable in certain instances. If your menstrual cycles have returned but are highly irregular, very long, or accompanied by unusual symptoms, a healthcare provider can offer clarity and check for underlying issues. Persistent heavy bleeding, severe pain not relieved by over-the-counter medication, or bleeding between periods also warrant medical attention.
If you have been actively trying to conceive after fertility has seemingly returned but are unsuccessful, consulting a doctor can help identify potential causes and discuss options. If menstruation has not returned by 12 to 18 months postpartum, particularly if you are concerned about your fertility or overall hormonal health, seeking an evaluation is reasonable.