Lochia or first period after birth: how to tell the difference, and when periods return

Lochia starts at birth and gradually lessens over four to six weeks. Your first period after birth comes later: usually after a break with no bleeding, six to eight weeks after the birth if you are not breastfeeding, and often much later if you are breastfeeding exclusively.

A few weeks after the birth, bleeding starts again, red, and you wonder: is it still lochia, is it already my period, or should I be worried? Here is how to tell the difference, when periods really come back, and why contraception needs thinking about first.

What is the difference between lochia and your first period?

Lochia is bleeding from the womb as it heals after the birth: it starts straight away, heavy and red, then turns pinkish, brown and finally pale, over four to six weeks. Your first period is the start of a new cycle: it comes later, often after a few days or weeks with no bleeding, and lasts like a period.

Landmark	Lochia	First period
Start	From the birth	Most often after six weeks, later if breastfeeding
Duration	Four to six weeks in total	Three to seven days, like a period, sometimes a little longer
Colour	Red, then pinkish, brown, yellowish and whitish	Red, like a period
Pattern	Gradually lessens	Often follows a time with no bleeding
Smell	Mild, similar to a period	That of a period
Cause	Healing of the womb where the placenta was	Return of the cycle and ovulation
Protection	Pads only	Any protection, once lochia has ended and your midwife agrees

How can you tell whether it is your period or still lochia?

Look first at the timing and the trend. Bleeding that has been lessening since the birth, with no real break, is still lochia. Red bleeding that comes after several days, or even weeks, of nothing, and lasts three to seven days, looks like your first period, especially after six weeks. If in doubt, ask your midwife.

Other clues help: your usual period signs, such as tender breasts, mood changes or cramps, or stretchy discharge around mid-cycle, a sign of ovulation, a few days or weeks before.

What about the bleeding that comes back around day ten?

It is not your period. Between about the tenth and fifteenth day, many women see lochia turn red and heavier again for one to three days. This happens when the scab covering the wound in the womb comes away. It is expected, as long as the bleeding slows within a few hours or days.

To learn all about how long lochia lasts and what it looks like, read our article on how long lochia lasts.

When does your period come back if you are not breastfeeding?

Most often six to eight weeks after the birth, sometimes a little earlier or later. Ovulation can return from the end of the third week, even before the first period. The first cycles are often irregular: shorter, longer, heavier. It can take several months for them to get back to their pre-pregnancy rhythm.

When does your period come back if you are breastfeeding?

With exclusive breastfeeding, day and night, your first period is often delayed by several months, sometimes until weaning. Frequent feeds hold back ovulation. It usually returns when feeds become less frequent: longer nights, top-up bottles, starting solids. With mixed feeding, it often returns earlier.

Every woman is different: some get their period at three months while breastfeeding exclusively, others not before a year. Both are normal. To get breastfeeding started, read the first weeks of breastfeeding.

And after a caesarean?

The timing is the same as after a vaginal birth: about six to eight weeks without breastfeeding, later if breastfeeding. A caesarean changes neither how long lochia lasts, often a little lighter, nor the return of your cycle. For recovery as a whole, read our guide to recovering after a caesarean.

And on contraception?

Hormonal contraception changes bleeding, and it becomes harder to recognise your first period. With a progestogen-only pill, bleeding can be irregular, light or absent. With a combined pill, only possible without breastfeeding and after a certain delay, the bleeds between packs are not true periods. With a copper coil, periods are sometimes heavier.

Is the first period heavier than a normal period?

Often, yes. The first periods after birth are frequently heavier, longer or more painful than usual, then cycles settle. If you are changing protection every hour, if bleeding lasts more than seven days or if you feel very tired or breathless, mention it: anaemia can be treated.

Can you get pregnant before your first period?

Yes. Ovulation happens about two weeks before a period: you can therefore be pregnant without having seen your period come back. Without breastfeeding, contraception is advised as soon as you have sex again, from day twenty-one after the birth. Breastfeeding only protects under strict conditions, to check with your midwife.

• Breastfeeding as contraception (the lactational amenorrhoea method) requires exclusive breastfeeding day and night, a baby under six months and no return of periods. If any of these conditions is missing, it no longer protects.
• Other methods are chosen with your midwife or doctor, ideally before you leave the maternity unit, then at the postnatal check.

Which protection during lochia, then for your first period?

During lochia, pads only: the cervix is still slightly open, and tampons or menstrual cups increase the risk of infection. Change them every three to four hours, more often at first. For your first period, all types of protection are possible again, once the lochia has ended and your midwife agrees.

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• when periods come back

When should you seek advice?

Frequently asked questions

How do you recognise your first period after birth?

It is red bleeding, like a period, lasting three to seven days, which usually comes after a time with no bleeding, most often after six weeks. Lochia, by contrast, has been lessening since the birth.

How long does the first period after birth last?

Like a period, usually three to seven days, sometimes a little longer. It is often heavier than usual. Beyond seven days of heavy bleeding, talk to your midwife.

When does your period come back after a caesarean?

At the same time as after a vaginal birth: about six to eight weeks without breastfeeding, often later with exclusive breastfeeding.

Can you have periods while breastfeeding?

Yes. Breastfeeding often delays your first period, but does not prevent it. It often returns when feeds become less frequent or your baby starts eating solids.

Can your first period make you tired?

Heavy periods can be tiring, especially if you are already anaemic after the birth. If you are very tired, breathless or pale, ask for a blood test.

Does milk supply drop when your period returns?

Some women notice a temporary dip in supply or a fussier baby at the breast for a few days. It usually settles on its own: keep feeding on demand.

Do you need contraception before your first period?

Yes, if you do not want another pregnancy soon. Ovulation comes before the period. Talk to your midwife about it while still in the maternity unit.

Two kinds of bleeding, two stories

Lochia closes the pregnancy, the first period reopens the cycle. In between, the body takes the time it needs. To follow these weeks in order, read the postpartum period week by week.