What happens to your hormones after having a baby
My medical school degree or work in obstetrics and gynaecology certainly did not prepare me for the changes after giving birth. So I want to spend a few minutes sharing with you the 5 things I wish all women knew about their hormones.
Number 1 is that after birth you get a glimpse in the future and it is not very appealing.
The hormonal changes after pregnancy begin very quickly after the delivery of the baby, and more importantly the placenta. During pregnancy oestrogen levels are very high, this is one of the causes of nausea and sickness in early pregnancy.
The delivery of the placenta triggers a sudden and severe drop in oestrogen and progesterone levels. If women are breastfeeding this becomes the new status quo for many months. It is a mini taster of the future in that it is very similar to the hormone changes seen in menopause. Women can experience hot flushes, and thin hair and dry skin can make every day seem like a bad hair day.
Vaginal dryness is a symptom not often talked about but incredibly common. The loss of oestrogen causes the tissues to be thin, delicate and sensitive. This can make sex painful and if having a newborn and being sleep deprived has been often to put you off sex this will certainly do the trick.
Add to this that the hormone changes can affect women mentally, making them more inclined to feel low and I know many mummies who feel like even if George Clooney asked them out for dinner they would have zero interest in a Nespresso after dinner.
The vaginal dryness symptoms are actually relatively easy to treat. Water based lubricants can be very helpful and vitamin E oil is a very soothing natural oil than can ease dryness. If these are not helpful or a woman is in real discomfort than using a topical oestrogen cream can certainly help too.
The good news is that it is a temporary state of affairs. Once breastfeeding has finished then your oestrogen levels should return to normal and you can forget about your little glimpse of menopause, at least for a few years.
Number 2 on my hormone hit list is thyroxine, this is main hormone made by your thyroid gland in the neck and released into the blood stream. It works all around the body and is crucial for digestion, muscle function and energy levels among lots and lots of other functions.
In up to 1 in 10 women their thyroid gland will stop working correctly in the months after giving birth.
In most women this is what we call an ‘autoimmune’ process. This means that they have antibodies in their blood which attack their own thyroid gland. This usually causes a short phase of an overactive thyroid in the first few months after birth. An overactive thyroid sounds quite an attractive prospect to many mums, it tends to make you slightly hyperactive and you often lose weight, but you also feel hot, with a fast heart beat and slight tremor. It is little like having too many coffees to try and pick yourself up after a long night, it is not really a very pleasant form of feeling energetic. Thankfully it is usually quite a short phase and doesn’t need any medical treatment.
Following this phase woman usually then become hypothyroid, i.e. they have an underactive thyroid gland. This is definitely even less fun for women, it causes tiredness, weight gain, feeling cold, heavy periods and thin hair. For most women I see if their symptoms have been noticeable enough that they have found the time to come and see me about it themselves then they benefit from taking a supplement of levothyroxine, this is the medicinal form of thyroid hormone in tablets which is identical to your natural thyroid hormone. Regular blood test will then make sure your thyroid hormones stay in a good healthy range.
So any woman who is feeling particularly low and tired in the postnatal period should definitely thinking about having their thyroid function checked with a blood test. This applies especially to women who are high risk such as those who are already know to have thyroid antibodies, women with a family history of thyroid disorder or other autoimmune disorders.
Quite subtle disturbances in thyroid dysfunction have been associated to reduced fertility and miscarriage so it is definitely important if you have experienced these difficulties. There is now really good scientific evidence that for the best chance of falling pregnant and having a healthy pregnancy women don’t just need “normal” thyroid function using the standard ranges but very good thyroid function.
Number 3 in my list of hormone changes I think all women should know about it that your periods will start again but they might not be quite as you knew them. If you ever find yourself calling me to wonder, why you are having bleeding a few months after having a baby then you definitely won’t be the first woman to have forgotten about periods.
It is little bit of Russian roulette what happens after pregnancy. Women that have had very light periods before pregnancy often seem to find their periods are much heavier. They will have new found sympathy for their best friend who has also cursed their periods. If you do start to dread that time of the month then do think about getting some treatment. We are so lucky now that we have great options. The contraceptive pill is often really useful for making periods lighter. But if you want to avoid hormones then there are non-hormonal tablets that can make sure life doesn’t have to be put on hold for a few days every month.
The lucky ones who have very light periods are usually very happy. If your periods are so light to be pretty non-existent then that might be a cause for concern though. Especially if you are keen to try for another baby. There is a particular condition post childbirth which should be considered called Sheehan’s syndrome. This is when a large blood loss or shock following childbirth causes damage to the pituitary gland in the brain. The pituitary gland is a tiny pea sized gland that sits at the base of your skull, it has also been called the master gland because it regulates all your other hormones. It controls the adrenal glands, thyroid gland and ovaries.
Women who have suffered damage to the gland often have low milk supply as this is controlled by the gland too and their periods don’t return or are very infrequent. Many women unfortunately are not diagnosed for some years as they have just about enough gland function to carry on until some other major stress affects their bodies such as an infection or surgery when they get diagnosed and the treatment they need.
Number 4 on my list is the hormone Prolactin. I really wish I had really understood this part of endocrinology before being a breastfeeding mother. Prolactin is produced by our old friend the pituitary gland in the brain it works on the breast to increase milk production. Successful breast feeding needs plenty of prolactin and another hormone oxytocin, this is sometimes called the love hormone. It controls the release or let down of milk when baby is feeding.
If a woman is worried about her milk supply then there are a few herbal tricks you can try such as fenugreek, fennel and Brewer’s yeast. Actually a small bottle of beer which contains lots of yeast is my secret tip for more milk. If you’re particularly worried about alcohol Becks make an alcohol free version too. And I know lots of Americans swear by lactation cookies, I think Bayley and Sage could definitely start do well if they started stocking those.
Stress and fatigue are really common feelings for breastfeeding mums but they certainly don’t help promote all the happy hormones you need for a great milk supply. There have been lots of scientific studies on links between poor milk supply and postnatal depression, it is a little bit chicken and egg as to which comes first. Certainly I think as mothers we are far too hard on ourselves about breastfeeding or not. When you look around the world we are all so lucky in being able to provide our babies with warmth, food and love.
That prolactin hormone we’ve been talking about is also the one that will likely stop your period coming back if you are breastfeeding in the early months. After 6 months over half of breast feeding mums will see their periods return. When exactly this happens does not usually matter very much but if the mum is a little older and wishes to fall pregnant again it can be a tricky choice. Prolonged breastfeeding may stop periods completely and even when they return you may not be ovulating regularly, if time is of the essence it can seem hard to stop breastfeeding early because of fertility worries. Luckily for most mums if their baby starts to go longer periods through the night without feeding once they get a 12-hour gap between feeds this will usually let their prolactin levels fall enough to allow their periods to resume. If you are worried about ovulation, then it is usually best to do home urine sticks or a blood test to confirm.
And so last but definitely not least on my list is that pregnancy, childbirth and being a mother, not matter how big your children get is hard work on our bodies. If you want to have healthy hormones for yourself, your bone strength, your cardiovascular health and wellbeing we must all put some of our energy in to caring for ourselves. I see so many mums who are mentally and physically exhausted, with high stress levels, low iron and vitamin and poor sleep. They don’t feel well and struggle with premenstrual tension and gaining or losing too much weight.
The best piece of advice is to spend some of your precious time looking after yourself. Eat that fruit. Take that yoga class. Spend an hour reading a magazine. Treat yourself to a blow-dry. Your body will be very thankful for it.
Dr Lucy Hooper