Heavy period postpartum: warning signs and next steps

Lochia follows birth as the uterus sheds blood and tissue, so its colour and amount can change over time. A period is a later menstrual cycle, and its first appearances may be heavier, lighter, irregular or more painful than before pregnancy. Breastfeeding can delay or alter cycles, while contraception can affect flow. If heavy periods continue, possible contributors include fibroids, adenomyosis, endometrial polyps, endometrial hyperplasia or perimenopausal hormone changes. Repeated blood loss can reduce iron stores and cause iron deficiency anaemia.

Note the type of bleeding, its pattern, clots, pain, temperature and any dizziness. Use maternity or menstrual products that help you observe the amount, and change them regularly. Contact your maternity team or doctor if bleeding is becoming heavier instead of settling, returns heavily after easing, or makes you too tired to care for yourself or your baby. Tell them about delivery complications, contraception, medicines and whether pregnancy could happen again. Do not start iron or bleeding treatment without checking what is suitable for you.

Get urgent help for rapidly heavy bleeding, large or repeated clots, faintness, marked weakness, breathlessness, a fast heartbeat, fever, foul-smelling discharge, severe pelvic pain or a tender abdomen. Ask someone to stay with you if you feel unwell. Heavy bleeding with possible pregnancy also needs prompt assessment.

Is this lochia, a returning period or bleeding from another cause? Could retained tissue, infection, fibroids or a lining problem be involved? Do I need a blood count or iron check? Which options are safe during breastfeeding?