Your Postpartum Body: What to Expect During the Fourth Trimester

Content medically reviewed by Caitlin Pandolfo, MD

The postpartum period—sometimes called the fourth trimester, or the first 12 weeks after delivering your baby—doesn't get the attention it deserves, according to Dr. Caitlin Pandolfo, OB/GYN at Essentia Health. Taking more time to learn about what happens to your body postpartum may help you better prepare for the changes that can occur and improve postpartum care.

“It seems like no one asks postpartum questions until they’re postpartum,” Pandolfo said. “We want new parents to be better informed about what’s to come in the postpartum timeline, so when they start to lose hair or feel exhausted, they can say, ‘My women’s health provider told me this might happen.’”

Like many women, you may feel mostly recovered six to eight weeks after childbirth, according to the American Academy of Family Physicians. Every new mother’s postpartum recovery timeline (and postpartum body) is different, though. Give yourself grace and know one of the most predictable things about the postpartum period is you’ll likely look or feel differently than you did before pregnancy, at least temporarily.

Your Postpartum Body & ‘Mini Menopause’

You’ll get your period again during the weeks after delivery—breastfeeding may delay its return—but it may not be the same as you remember.  

“Whatever your period was like pre-baby, you can’t assume it’s going to go back to the same light, heavy, crampy, or regular period,” Pandolfo said. “It’s almost like it’s a brand-new period. Initially, for a lot of women, it can be heavier, but then it will settle a bit.”

It’s unclear what drives these period changes, Pandolfo said, but many other postpartum symptoms trace back, at least in part, to a sudden, post-delivery change in estrogen levels.

“Estrogen is still rising in the third trimester, and then there’s an abrupt decline after you deliver,” Pandolfo said. “That’s what causes many symptoms to start kicking in, including mood changes and hair loss. The postpartum period is like a mini-menopause. The decline in hormone levels can cause mood swings, night sweats, vaginal dryness, and other symptoms we associate with menopause. You can expect your hormones to return to their baseline by six months postpartum, but it may take longer for some women.”

Mind Your Head

Postpartum headaches, including migraines, are common. According to the American Migraine Foundation, 25% of women have a migraine within two weeks after childbirth, potentially triggered by falling estrogen and progesterone levels. In addition, the stress and lack of sleep that come with being a new parent may also play a role.

If you experience postpartum headaches, tell your primary care or women’s health provider. They can determine what type of headache you’re having. Some women experience headaches related to postpartum preeclampsia or having had epidural anesthesia during labor and delivery, both of which are treatable. If necessary, your provider can also recommend a medication that’s safe to take while breastfeeding.

Handling Postpartum Hair Loss

When estrogen falls after giving birth, you may lose some hair.

“Hair loss typically peaks four to six months after delivery,” Pandolfo said. “The most important thing to know is you’re not going to go bald.”

Hair regrowth usually starts around a year after having your baby, according to Pandolfo. In the meantime, take care of your hair. The American Academy of Dermatology Association recommends using products that will nurture your hair, such as a volumizing shampoo and fine-hair conditioner. Avoid stressing your hair by, for example, wearing it in a high, tight ponytail, Pandolfo said.

Intimacy & Your Postpartum Body

Most experts, including Pandolfo, recommend waiting six weeks after giving birth before having sex.

“We don’t have data from a randomized, controlled trial that says six weeks is the exact timeline to wait,” she said. “The thought is most new mothers bleed for about six weeks. Once that stops, we assume the cervix has closed, the endometrium and any perineal or vaginal lacerations have had time to heal, and the uterus is back to its pre-pregnancy size.”

Between vaginal dryness and the stress placed on your pelvic floor muscles from having a baby, what previously felt good during intimacy might feel less pleasant during the postpartum period. Fortunately, you can take steps to make things more comfortable and enjoyable, such as using a vaginal lubricant and performing Kegel exercises to strengthen your pelvic floor.

More than the physical experience of sex may change. Your sex drive may shift, too. Maintain open communication with your partner about how you’re feeling and discuss what you can do to meet both of your needs. 

Don’t Forget About Postpartum Anxiety

You’ve probably heard of the baby blues—postpartum sadness due to hormone changes—and postpartum depression, but postpartum anxiety may be less familiar. Postpartum anxiety occurs when constant worrying keeps you from functioning normally and, in some cases, leads to panic attacks. 

“There’s usually some aspect of postpartum depression with postpartum anxiety,” Pandolfo said. “If you tell a medical provider what you’re feeling isn’t normal, we can work together to treat the conditions.”

Self-Care for Your Postpartum Body

Making time to care for your body can help smooth the transition to motherhood. You can start with the following steps –

• Drink plenty of water and eat high-fiber foods to encourage bowel movements and reduce post-anesthesia constipation in the days after delivery.
• Use a heating pad to calm abdominal pain as your uterus returns to its normal size.
• Use a squirt (peri) bottle to spray warm water on the perineum—the skin between your vagina and anus—which can help clean it and soothe soreness during the week after delivery.
• Use a stretch mark cream or lotion daily, which may help stretch marks fade.
• Wear sanitary pads, not tampons, to help manage lochia—postpartum bleeding and vaginal discharge—after childbirth.
• Treat hemorrhoids with a witch hazel pad, which can reduce pain.