Postpartum Hormones: Normal Vs. Not
After pregnancy, postpartum hormones go down to menopausal levels. How can you help get them back up? And what symptoms are expected during this time vs. what is a red flag that your body needs some TLC?
11/17/2021
So you just had a baby. Whether it was 3 weeks ago, 3 months ago, or 3 years ago - the hormone rollercoaster can still be impacting how you feel!
But how do you know if what you’re feeling hormonally is normal and expected, or what is actually an imbalance that needs some work? I wrote this post to help you get an idea of what is normal and what isn’t, and help you through it. As a registered dietitian specializing in functional women’s health, and as a mom of two - I know just how this feels and what to do about it.
The months after baby are filled with hormonal ups and downs. And here’s why - progesterone and estrogen peak during pregnancy and then abruptly come down closer to menopausal levels after delivery. This is the most dramatic hormone change a human can ever experience. So really, it’s no wonder we feel out of sorts for a while after baby! On top of that, your thyroid and adrenals can get whacked out from the stress of pregnancy, delivery and lack of sleep after baby arrives. Some of these hormone changes are normal and just take time, others need some gentle help to push in the right direction.
Let’s take a look at the 6 most common hormone & nutrition related issues that commonly plague the new and not-so-new mom.
1. Night Sweats
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 there are a few things you want to keep in mind:
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).
Drink tons of fluids, although it sounds counterintuitive you can become very easily dehydrated during this stage.
Eat flax seed everyday to help perk up your estrogen
Eat regular meals to support your hormonal balance. If you need help with what that looks like, read this article next.
2. 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) like the description above, please reach out and seek an evaluation from your health care provider.
Things you can do from home:
Ask for help. Or pay for help. Or both. In these early days and weeks, trying to do it all and be superwoman will only worsen the overwhelming feelings.
Replenish your nutrients. Your baby is a little nutrient thief! Pregnancy (and breastfeeding, if applicable) robs your body of loads of nutrients, some of them related to higher risk for mood disorders. It’s no coincidence that Vitamins B12, omega 3 fats and several minerals are all commonly depleted in pregnancy and also related to PPD and PPA!
Check your gut - supplementing with certain strains of “good” bacteria have been shown to reduce severity of postpartum depression.
Gently help bring up those lady hormones. Remember how they crashed after delivery? Low progesterone is related to more cases of anxiety, and low estrogen is related to depression. Work on a comprehensive plan to bring those back up to equilibrium.
3. Hair Loss
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. In the meantime make sure you’re getting the building blocks of hair production like:
Protein - hair is made of protein! And it’s in higher demand while healing from birth, going toward your own hormonal balance (hormones are made of protein too!) and feeding a nursing baby. Make sure to get enough to cover all of these bases and leave enough leftovers for hair growth.
Low intakes of Iron and Zinc are both associated with hair loss - as are B vitamins.
Healthy fats (especially omega 3s) - these are needed to keep hair moisturized and less prone to breakage.
4. Low Libido
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 6-12 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. When you’re ready for more sexy time -
Bring focus back on your relationship and plan some date nights!
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).
Consider the interplay between hormones- specifically estrogen and testosterone which both need to be present for a juicy libido.
Work on sleep, stress and relaxation - the stress hormone cortisol can seriously tank your libido.
5. Fatigue
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. Working on routines and sleep schedules can gently nudge your little one into a nice sleep routine (hiring a sleep consultant can also help!).
For the fatigue that is not related to bad sleep, we have a few things to look at-
Nutrient depletions again! Feeling tired all the time is definitely a symptom of nutrient deficiency. This tends to show up more commonly after a second or later baby but can also happen after a first as well. Iron, B12 and magnesium are the first that come to mind with their relationship with energy.
Eat enough! This sounds obvious, but so many of my postpartum clients are simply not eating enough leading to that low, dragging-through-the-day energy feeling. Having a small rushed breakfast, picking on bites of food throughout the afternoon for lunch and then hitting a monster sugar craving at 4pm are signs we need to look at total calorie, protein and healthy starch intake.
Hormones - again! The stress hormone cortisol is a major player in fatigue. Cortisol is released when we’re stressed, not sleeping 8 uninterrupted (LOLOLOL) hours of sleep and nutrient depleted. So basically all the motherhood things. While we’re figuring out the sleep and stress management pieces, check out my free video on how to boost energy and bust through new mom exhaustion.
6. Weight gain/ loss
You gained weight in pregnancy, and are now expecting to lose it during the postpartum period. I mean, celebrities “bounce 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. Work on -
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 along with sugar cravings.
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 checked or take my hormone quiz. Elevated estrogen may cause easy weight gain, postpartum thyroiditis could be the culprit, as well as undiagnosed PCOS.
That’s a wrap! I hope you now understand if what you are feeling is normal for the stage of postpartum you are in, or if your body needs a bit of help.
