Postpartum Hormones: What’s Normal and What’s Not
So you just had a baby. 3 weeks ago, 3 months ago, or 3 years ago - your body is permanently altered and your hormones have gone through a crazy rollercoaster of changes - progesterone and estrogen peak during pregnancy and then crash to menopausal levels after delivery. Your thyroid and adrenals can get whacked out from the stress of pregnancy, delivery and lack of sleep after baby arrives. Sometimes these issues and imbalances are temporary and transient, but when they last too long we want to take a look at what’s going on.
Let’s take a look at the most common hormone & nutrition related issues that commonly plague the new and not-so-new mom.
Nobody warns you about this one! Typically caused by a dramatic dip in estrogen, hot flashes and night sweats are similar to what you may later experience in menopause.
Normal: Feeling the heat in the first weeks postpartum. Your hormones are desperately trying to figure out what just happened and find equilibrium. Estrogen is in the tank and you likely have some extra fluid hanging around from the end of pregnancy (and if you had IV fluids during delivery) that make the sweating super dramatic.
Not normal: If the sweating and flashes hang around past about the first month.
What to do: in these first weeks as your body is adjusting and ridding itself of the extra fluids, try to keep your bedroom cool, and sleep on a towel with as little clothing as possible so you don’t have to get up in the night and change (yes it can get that bad). Make sure to drink tons of fluids, although it sounds counterintuitive you can become very easily dehydrated during this stage. If the sweating and flashes are lasting beyond the first weeks, eating oats, flax and soy can give your estrogen a boost.
Baby Blues & Postpartum Depression
From the more mild form of “baby blues” to full blown PPD, some mood issues are very common in the days, weeks and months following a new baby. Blame hormones again, lack of sleep, nutrient depletions as well as the massive shift of life and responsibility that just happened. Add in infant feeding issues, difficulty bonding and stress regarding horrible maternity leave coverage in the US and you can see why this is so common.
Normal: I wouldn’t say there’s a “normal” here, but some form of baby blues is fairly common (some estimates are between 60-80% of new moms). Feeling a little sad and weepy and overwhelmed is a fairly usual response to new motherhood and as you get into a routine and get some more sleep things should level out.
Not normal: Anything more severe or long lasting than the above. If negative thoughts, sadness or anxiety are interfering with your life, relationships and ability to care for your baby.
What to do: if the symptoms are severe, persistent and more along the lines of PPD (or PPA - postpartum anxiety) please reach out and seek an evaluation from your health care provider. And ask for help. Or pay for help. In these early days and weeks, trying to do it all and be superwoman will only worsen the overwhelming feelings.
From a nutrition standpoint, there are several things you can do to prevent these mood fluctuations (disclaimer: this will work better for prevention rather than treatment if you are in the throes of depression). There is quite a bit of evidence suggesting that the nutrient depletions common in pregnancy can have a significant impact on what happens with PP mood and your risk for depression. Think of baby as a nutrient thief. If you didn’t have a very nutrient dense diet (filled with vitamins, minerals, healthy fats and proteins), baby will rob you during pregnancy and nursing so he or she can have needs met, but causing you to be deficient. So prevention of PPD really starts in the pre-conception period with a whole foods diet. Continuing that trend toward nutrient dense foods during pregnancy, as well as taking a good quality prenatal + fish oil that you should take throughout the postpartum and breastfeeding time as well. Note that vegan and vegetarian diets tend to be lower in some key nutrients that help prevent mood disorders (specifically iron, b12, vitamin D and omega-3 fats) so you’ll need to spend extra care and attention to get enough if you fall into this category.
Ah the dreaded postpartum shed! Hopefully you were warned about this one. This usually takes place around 4 months postpartum although can happen before or after. Of note - you probably didn’t notice at the time but during pregnancy, your hormones cause you to lose LESS hair than normal. So part of this shed is catching up from what you didn’t lose for those 9ish months.
Normal: Hair loss that seems like way more than usual, coming out of nowhere. Hair in the shower, hair on your hands, hair on your baby’s face. Sometimes it can feel like it’s coming out in clumps. May be more concentrated in the front of your scalp. It’s normal for this to last up to 6-12 months postpartum, but should taper off after noticing a peak around 4-6 months. Personally I thought the regrowth with the shorty hairs was worth than the shed.
Not normal: Although it can still be on the normal spectrum and feel super excessive, distressing and extreme - you want to pay more attention to it if you’re getting large clumps of hair for an extended period of time, visible patches of scalp, or losing hair elsewhere on your body (like your eyebrows falling out). Prolonged hair loss past 12 months, or if it doesn’t seem to peak and then reduce.
What to do: check in with your doc if you feel like your loss is prolonged or excessive - and have your thyroid and iron levels checked out. Aside from that, it’s just a waiting game and try not to do anything that causes further hair damage (go easy on the heat styling and aggressive brushing, don’t sleep with your hair in a tight ponytail. Let’s also make sure that nutrient deficiencies aren’t exacerbating the loss - get plenty of protein, healthy fats (especially omega-3), iron and b vitamins.
Partly mother nature’s way of keeping you from getting knocked up while in the throes of tending to a newborn, your super low post delivery hormones along with fatigue, stress and the recent memory of delivery will keep you from feeling in the mood. Low estrogen will also cause vaginal dryness, and nursing will keep both estrogen and progesterone down.
Normal: Low libido for the first several months or even a year after delivery, and generally a different sex life than what you experienced before kids (I mean, obviously). Libido tends to go up after getting first postpartum period, and after ceasing nursing.
Not normal: Pain during sex after the first few months, or closer to 6 if you had any vaginal tearing or trauma during delivery. Low sex drive that is negatively impacting your relationship at any time postpartum. Little to no desire still after 12, 18 or even 24 months. Low libido along with feelings of sadness, anxiety and overwhelm - which could be another symptom of PPD.
What to do: First, manage expectations of sex life after baby and reign your partner in if you’re feeling pressure to do the deed too soon or too often than your body and mind are ready for. A refocus on your relationship, and spending time together without kids can definitely help create a spark, though possibly only temporarily. Make sure you’re getting the building blocks of hormones - namely protein and fat (especially saturated fat like coconut, eggs and omega 3 fats like fish). Have your hormones checked - specifically estrogen and testosterone either via labs test or symptom evaluation- to see if anything is amiss and then seek help to bring these back to balance naturally. Work on stress management and relaxation - the stress hormone cortisol can also tank your libido.
We’re all a little or a lot tired right?! Some is expected, but excessive is an indicator of an issue.
Normal: Feeling seriously tired is expected in the newborn stage, and as a parent of a small child or children you may always feel a bit beat and fall asleep on the couch at 8:30 (not that I'm speaking from personal experience or anything).
Not normal: Feeling super fatigue that doesn’t match with the amount of sleep you’re getting. Getting sick very often. Feeling run down all day, or needing to sleep 10+ hours a day to feel normal.
What to do: Obviously the amount of sleep you’re getting is going to impact this, so first thing’s first and pay attention to this. If baby is a terrible sleeper (or if you’re in the newborn stage), try to take naps, go to sleep early and take shifts at night and in the morning if you can. Personally one of the best moves we made during the early weeks was to start a bottle of pumped milk at night that dad gave, letting me get to sleep early and get a couple more hours of rest.
Diet can playa huge role in fatigue - you want to make sure you’re balancing your slow digesting carbohydrates with protein and fat and getting adequate calories. No restrictive diets or cutting out categories of nutrients like low carb or low fat. Avoid sugar and refined grains though- your blood sugar will spike and then plummet causing more fatigue. Starchy foods like sweet potato, beans and winter squash are best. Drink a lot of water, and mind your iron, especially if you ran low during pregnancy and/or lost a lot of blood during delivery. And again, stress management and relaxation can balance out cortisol, which when running high all the time makes you tired.
You gained weight in pregnancy, and are now expecting to lose it during the postpartum period. I mean, Giselle “bounces back” in a heartbeat so that’s what we’re all supposed to do right? Wrong. Give yourself some time mama. But there are some indications to look out for that my infer a bigger problem to address when it comes to your weight. Read on.
Normal: Holding onto weight after delivery. You’ll likely lose a chunk in the beginning, and the rest will take longer. Breastfeeding isn’t always the magic bullet for losing all the weight - in my experience about half of women hold on to at least 10 pounds until they wean. There is no real “normal” in terms of weight after baby, and instead a tremendous range of differences. Your sleep, stress, hormones, exercise and diet will have a tremendous impact on what is going on with your weight post baby. Waking up several times a night (or generally getting less than 7 hours of sleep)? You’re very unlikely to get back to pre-baby weight until rest becomes more manageable.
Not normal: Disclaimer - don’t even consider your weight until AT LEAST 6 months postpartum, perhaps closer to a year. If you’re reading this and just had a baby 1-6 months ago, just give yourself some time and grace to rebalance out. If after this time you are still holding on to significant baby weight (like 20+ pounds), despite eating healthfully and the parameters above are in check then we’d want to look into this. Also weight GAIN without an obvious dietary reason is cause for more investigation.
What to do: Gentle pushes towards healthy eating, without any kind of strict dieting is key here. Cooking more, eating regular meals (no skipping lunch!) and keeping sugar intake to a minimum are good places to start. Again, cortisol is a wrecking ball here which will be elevated with stress and sleep and can cause weight gain all by itself. So working on these two elements as mentioned above is so so important. Exercise at least a few days per week, some low impact and rejuvenating like yoga or hiking, some higher intensity. If all of these points are in check and you’re still struggling, consider a dietary change to be higher in protein and healthy fats to keep you and keep blood sugar controlled. If you’ve been doing this for several months and are still gaining or way above your baseline, have your hormones assessed (blood test or symptoms). Elevated estrogen may cause easy weight gain, postpartum thyroiditis could be the culprit, as well as undiagnosed PCOS.
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