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by Gretchen Lidicker for Parsley Health
Parsley Health is a female-founded digital health care company focused on identifying, treating, and reversing symptoms and conditions with holistic medicine. We are the largest holistic wellness company in the country and see members online everywhere and in-person in New York and Los Angeles.
If you’ve recently given birth, your body is going through natural hormonal fluctuations that might make you feel a little different (on top of, you know, having a baby.). You may feel overwhelmed, sad, teary, and exhausted.
Rest assured that almost everyone that gives birth experiences postpartum hormone fluctuations and while it’s new, it’s normal. That said, you should know what’s happening in your body and why, so we talked to two Parsley Health experts about what to expect from your hormones after you give birth, how long these changes will last, and how to promote postpartum hormone balance.
What happens to your hormones after you give birth?
According to Elizabeth Milbank, MD, MPH, physician at Parsley Health in New York City, several different hormones are responsible for the physical and emotional changes that women experience during delivery and postpartum.
“Estrogen and progesterone rise steadily in pregnancy, mostly from placental production. When the placenta is removed at delivery, these two hormones fall precipitously,” she explains. “This drop in estrogen and progesterone is critical so that the hormones needed for breastfeeding, like prolactin and oxytocin, can get to work, but the dramatic shift may contribute to the emotional lability that is common in the first few weeks postpartum.”
Endorphins also rise during labor, reach a peak immediately after delivery, and decline postpartum. High endorphin levels help women cope with the process of birth and may help women feel more alert, attentive and even euphoric after birth, but as they fall in the first few days postpartum, they too may contribute to mood changes, says Dr. Milbank. Corticosteroids also reach a peak during labor and decrease significantly within three hours postpartum, making this an emotionally vulnerable period.
With these hormone fluctuations come fluctuations in mood and emotions—the so-called “baby-blues”—where women can feel weepy, tearful and overwhelmed, says Christina Kang, health coach at Parsley Health San Francisco. The moving and shifting of these hormones can be distressing, but it’s normal to experience them in the first few weeks after delivery. Typically the “baby blues” last a few days or up to 1-2 weeks, however, if they last significantly longer, or are accompanied by intense feelings of sadness, anxiety, or despair, or are preventing a woman from being able to complete daily tasks, it is important to seek evaluation for postpartum depression, says Kang.
In some cases, postpartum depression can be attributed to hypothyroidism, which can develop postpartum due in part to certain immune system changes that occur, Kang explains. Even if postpartum depression is not present, if you’re experiencing any symptoms of thyroid disease (both hyper- and hypothyroidism) postpartum, ask for a full panel of thyroid tests, including antibodies. If you have a history of thyroid disease then it is especially prudent to get this full panel done.
Physical changes may also be a cause of concern for some women. Low estrogen levels— which stay low until a woman starts cycling again, and may last throughout the duration of breastfeeding—can contribute to postpartum hot flashes, pelvic floor dysfunction, vaginal dryness and low libido. Hair loss, or telogen effluvium, is another common symptom that can happen between one to five months after delivery. As Dr. Milbank explains, the increase in the ratio of “growing” hair relative to “resting” hair during pregnancy reverses postpartum, but normal hair patterns are typically restored by 6 to 15 months after delivery.
In addition, the ongoing production of relaxin during breastfeeding—the hormone produced during pregnancy to soften the joints and ligaments in order to make space for the growing baby—may contribute to joint laxity.
When will your hormones return to their pre-pregnancy state?
“This hormone calibration can go on for many months with the production of breast milk, the uterus slowly moving back to normal size, and the body flushing itself of excess hormones,” Kang says.
According to Dr. Milbank, practicing patience around postpartum hormone recalibration is key. “The time it takes to recover can be really variable for women depending on their delivery, the type of pregnancy they had, whether they are breastfeeding, and their baseline health status,” she says.
All of this is why Kang and Dr. Milbank often try to prepare patients that feeling “back to normal” is a process that may take as long as a year, and some of the symptoms may persist until women are done nursing.
How do you support your hormones after pregnancy?
At Parsley Health, doctors and health coaches work with women postpartum to ensure they’re optimizing their sleep and nutrition and taking care of their mental health. They also work on lifestyle practices to support hormone balance.
“When taking care of patients during their pregnancy, I always do a session in the third trimester to discuss postpartum care, nutrition, movement, mental health and lactation support (if they plan to breastfeed) and I am in close touch with my patients postpartum to make sure they have access to the support they need,” says Dr. Milbank.
There are steps you can take to prepare and lessen the effects of postpartum hormonal fluctuations. Here’s where to start:
1. Know what to expect.
According to Dr. Milbank, simply knowing what to expect can be enough to prepare for postpartum hormonal ups and downs. “When women are informed, they are more equipped to handle the normal physiologic and emotional shifts postpartum,” she says.
A mother of four herself, Dr. Milbank has had friends and patients say to her: “Nobody told me it was going to be like this!” As she explains it, “I have been surprised through my personal and professional experiences that so little time and attention is given to educating patients about what to expect postpartum. There’s so much focus on being pregnant—what to buy, what to eat, what to avoid—and very little conversation about what it’s going to feel like postpartum, how to care for a newborn, what your own recovery is going to look like, how to approach breastfeeding, and what it feels like to be a new parent. In addition, there are very few touchpoints with a patient’s doctor postpartum, other than the six-week checkup, after many of the changes have already taken place.”
2. Sleep (as much as you can).
Sleep can do wonders for feeling better postpartum, but for obvious reasons, it’s the most challenging to prioritize, says Kang. She recommends taking naps when you can and enlisting childcare support from friends, family members or childcare providers. These drug-free ways to get better sleep may also be helpful.
3. Eat plenty of clean proteins and healthy fats.
Sleep deprivation and stress during the postpartum period can lead to sugar cravings, and minimal time to prepare healthy meals can be challenging for women postpartum. To combat cravings and keep your body properly fueled, Kang recommends eating plenty of clean proteins, like grass-fed beef and wild-caught fish, as well as healthy fats, such as cold-pressed coconut oil, extra-virgin olive oil, grass-fed butter, nuts and seeds, and avocado. Meal-prep kits or meal delivery systems can help automate decision-making around food and ensure that a woman is well nourished postpartum.
4. Lean on your support system.
If there’s ever a time to call in the support system, it’s right after you’ve given birth. “Talking to friends or joining a postpartum or breastfeeding support group can normalize experiences postpartum. Peer-to-peer counseling has been proven very effective in the prevention of postpartum depression and anxiety,” said Dr. Milbank. “In addition, many women find working with a postpartum doula or baby nurse for professional support or leaning on friends and family allows them more time to focus on their recovery and the baby.”
5. Don’t cut calories.
“Breastfeeding moms need around 500 extra calories a day to produce adequate breast milk,” says Kang. The number of additional calories needed for an individual breastfeeding woman is also affected by her age, body mass index, activity level, and extent of breastfeeding (exclusively breastfeeding versus breastfeeding and formula feeding), notes Kang.
She encourages patients to avoid worrying about weight loss for the first 3 to 6 months after giving birth. “With patience, good nutrition, and moderate exercise, much of the weight will come off on its own over a period of time. When people are overly restrictive, the body may hold on to excess weight in order to have enough fuel to continue making breast milk,” she continues.
6. Practice patience
“We think about the 6-week mark as the moment we can exercise, have sex, go back to work.
But the truth is, many women are not ready to do any of these things, and reframing expectations around when someone feels ‘back to normal’ can decrease anxiety and minimize the pressure to be perfect postpartum,” says Dr. Milbank.
Usually, hormones will return to pre-pregnancy levels on their own, especially if you’re taking care of yourself with a healthy diet, plenty of sleep, and managing stress. There are rare cases where women may need extra support to rebalance hormones. Keep reading to learn the symptoms of a postpartum hormone imbalance.
What are the symptoms of a postpartum hormonal imbalance?
According to Kang, signs of a postpartum hormonal imbalance can include symptoms such as:
- Anxiety and depression
- Low libido
- Weight gain
- Cysts or fibroids
- Chronic fatigue
So what determines whether you’ll experience these symptoms or not? “So many different factors—such as baseline constitution of your health pre-pregnancy, gut microbiome, delivery method, breastfeeding, stress levels, diet and lifestyle, thyroid health, and genetics contribute to hormone health,” says Kang. If the symptoms you experience become severe and persist 3 to 6 months after breastfeeding ends, reach out to your doctor who will be able to evaluate you for postpartum depression, postpartum anxiety, and other more serious issues.
Copyright 2021, Parsley Health
