The Emotional Return of the Menstrual Cycle After a Pregnancy Loss, Stillbirth, or Newborn Death

Content Warning

Let me just preface this post with a warning. If you are uncomfortable with “period talk,” then this is NOT the post for you. I understand that the female menstrual cycle is a taboo topic, and certainly not something discussed in great detail in public forms. However, menstruation is an integral part of conception, pregnancy, delivery, and the postpartum body. And when someone experiences a pregnancy loss, stillbirth, or newborn death, menstruation can become an integral part of the grief process as well. As such, I will be discussing menstruation openly in this post.

YOU. HAVE. BEEN. WARNED.

Menstruation Following Loss

As anyone who menstruates knows, these few days of the month can be physically and emotionally uncomfortable. But the return of menstruation after a miscarriage, stillborn, or newborn death is often especially challenging. For some, their cycles start back quickly. For others, it may take a few months. Regardless of when it comes back, it can be triggering, physically and emotionally exacerbating, a source of resentment, or cause emotional conflict. It can feel like the beginning of a new chapter. And, for better or worse, the end of an old one.

A Reminder of the Loss Experience

Chances are, no matter when you lost your baby, the experience was highly physical, intimate, and involved at least some amount of blood. For many, seeing period blood again can be jolting and traumatizing as it triggers images of the loss experience. It is a direct, and very visceral reminder which can cause flashbacks, nightmares, or dissociation.

But it can also be more than just the visual appearance of blood. The experience of menstruation also comes with many physical symptoms that can resemble sensations of pregnancy or delivery.  Cramps can feel similar to contractions. Even if the intensity differs, the engagement of the muscles can trigger memories of delivery. Nausea, headaches, food cravings, and a variety of other symptoms can similarly be reminders of pregnancy. The need to use feminine products can also produce memories of the postpartum experience.

For me, the ability to use ibuprofen to manage my menstrual discomfort became a trigger. During pregnancy, ibuprofen is not advised. Despite having daily migraines during my second trimester, I had trained myself to view ibuprofen as off-limits. Upon return of my period migraines, I cried as I remembered that there was no longer a reason to avoid taking ibuprofen.

No Baby to Distract from Post-pregnancy Changes

A lot of women say that their periods change after pregnancy. This is often mentioned as a sidenote peppered with a bit of annoyance. But for women who have experienced a pregnancy loss, stillbirth, or newborn death, the changes can become an area of hyperfocus and resentment. Because there is no baby to care for, love, and distract, a heavier and/or more painful period isn’t just a nuisance. It’s shit icing on the manure cake. I remember thinking, “Not only do I not have my baby, but I have to deal with a worse period than before?! How is any of this fair?!”

Menstruation is also notorious for its negative impact on emotional stability. While new moms certainly experience increased emotional distress upon the return of their period, they often use their new baby as motivation to keep it together or find support. Loss moms on the other hand can become…well unbridled messes. The hormone surges can exacerbate the pre-existing distress and challenge their emotional fragility. And because there is no baby to focus on or provide purpose, there is often little to no intrinsic motivation to engage in positive self-care. I personally enjoyed more than my share of chocolate, red wine, bed, and crappy TV.         

A Mix of Hope and Betrayal

The start of menstruation also marks the body’s ability to conceive again. For many women, this can be emotionally conflicting. Many women, including myself, want to try again as soon as humanly possible following a loss. So, when the period returns, they feel like it’s “go time.” But just because the uterus may be technically ready for a new baby, doesn’t mean the brain and/or the heart are. This can be confusing, especially for someone who thought they wanted to try again immediately but feels hesitant upon the reappearance of menstruation.

It can also be very difficult for those who do feel ready to start trying immediately. Many parents feel guilty when they start trying again as they see it as “replacing” their child. So while the return of menstruation can bring hope in terms of having a new baby, it can also cause great distress by making parents falsely believe they are betraying their lost baby.

Tips For Managing the Return of Menstruation

This is not an exhaustive exploration; but I think it establishes that the return of menstruation can be distressful for women after a pregnancy loss, stillbirth, or newborn death. If this is something you are struggling with then I commend you for reading this post. You’ve already taken a great step in supporting yourself by learning about the issue. Simply knowing that it is a common source of emotional turmoil can be helpful. It can help you be prepared, and normalize negative experiences associated with your periods following a loss. Many women don’t even realize this problem exists, let alone understand how complex it is.

But there are also a few other things you can do to support yourself if the return of your period is difficult. Practicing self-care, and self-compassion is at the top of the list. This means being kind, gentle, and nonjudgmental of yourself. It means taking time to care for yourself and your needs. This could include taking a day off work, going out with a friend, or talking to your spouse about the emotional return of your period. It’s also important to talk openly with your spouse about your readiness to try again and the emotional conflicts it can create. Remember that the return of your periods isn’t a mandate to start trying again. And if you choose to, you are NOT betraying your lost baby.

It’s also important to eat well (allowing for some chocolate, of course), move your body in ways that feel good (yoga was a big one for me), and get plenty of sleep. I know – that stuff sounds cliché BUT it does help.  Some women also find it helpful to talk with others who have had similar experiences; there are plenty of Facebook groups and other community options for connecting with other loss moms. And if needed, find a competent therapist who is well-versed in perinatal loss – and NOT afraid to engage in “period talk.”