In today’s episode of Holistic Health Radio I’m joined again by Stefanie Valakas, an expert fertility dietiitan & nutritionist and founder of The Dietologist. Stefanie and her virtual practice are dedicated to excellence in nutrition for reproductive health concerns, fertility & pregnancy. Her passion for nutrition in this space has truly grown from her experience helping her clients online from around the world and also through her own personal experiences of navigating a diagnosis of endometriosis.
In this episode we cover all aspects of recovering your periods post partum and answer your most commonly asked questions about the return of your menstrual cycles after giving birth including:
1. Is it common for periods to be delayed or irregular post-partum?
2. How long does it typically take for menstrual cycles to normalise after childbirth?
3. Could breastfeeding be affecting the return of my periods?
4. Are there any specific factors that might delay period recovery in post-partum women?
5. How can I differentiate between lactational amenorrhea and hypothalamic amenorrhea in my post-partum period?
6. Are there any specific markers or signs that can help identify the cause of amenorrhea after childbirth?
7. What role does breastfeeding intensity and frequency play in lactational amenorrhea and its impact on menstrual recovery?
8. What steps can I take to support my body in regaining regular menstrual cycles?
9. Is it possible to regain periods naturally without compromising breastfeeding?
10. What dietary and lifestyle factors might influence post-partum amenorrhea?
11. Could exercise or physical activity affect the return of my periods?
12. Are there any red flags that I should be aware of when it comes to post-partum health and menstrual recovery?
13. Should I consider seeking medical advice if my periods haven’t returned after a certain amount of time?
14. What is your approach to tailoring nutritional recommendations for individuals who are simultaneously navigating lactational amenorrhea or hypothalamic amenorrhea after birth?
You can learn about how you can work with Stefanie and The Dietologist team below:
- Website: www.thedietologist.com.au
- Instagram @the_dietologist and @endo.dietitian
- Facebook Pages: The Dietologist and The Endometriosis Dietitian
- Facebook Group: Fertility Friendly Food
- Podcast: Fertility Friendly Food
- Trying to Conceive Whilst Breastfeeding with Lana Hirth APD – Fertility Friendly Food Episode 105: https://thedietologist.com.au/podcast-ep/trying-to-conceive-whilst-breastfeeding/
Hi everyone, welcome back to Holistic Health Radio. I’m your host, Sarah Liz King. Today on the podcast, I’m joined by Stephanie Vallakis. Stephanie is an expert fertility dietitian and nutritionist and founder of The Dietologist. Stephanie and her virtual practice are dedicated to excellence in nutrition for reproductive health, fertility and pregnancy. Her passion for nutrition in this space has truly grown from her own experience.
helping clients online from around the world and also through her own personal experiences of navigating a diagnosis of endometriosis. You can learn more about how to work with Stephanie and the dietologist team by clicking all of the links in the show notes. A big warm welcome to the podcast. Well, I should say back to the podcast. Stephanie, how are you?
Stefanie Valakas (01:41.669)
I am so good. How are you Sarah? Thanks for having me.
I am so good. Now, for those of you who may have missed our first podcast episode that Stephanie and I have done together, I’ll be sure to link that in the show notes as well. But today we are kind of discussing postpartum amenorrhea, how to get your periods back after having a baby. But before we dive into that, I always like asking my guests if you get to know you questions.
Stefanie Valakas (02:03.962)
These ones will be similar but also a little bit different to the ones I’ve asked you before. The first one is, what is your coffee order?
Stefanie Valakas (02:19.472)
Ooh, are you a one a day kind of gal or you have multiple in a day?
Stefanie Valakas (02:24.98)
Oh, oh, more than one. Uh, I’m a, I’m a two to three at the moment. The third has snuck in, snuck in because it’s like ice latte season here in Sydney. And it just hits different when it’s two o’clock, you know, and you need the little pep in your step for the afternoon. You get it. And I am that girly that just shakes the ice. I shake the ice. I walk and I shake the ice and it’s like.
I’m going to go to bed.
Stefanie Valakas (02:52.024)
The sound of summer to me is the ice in the cup shaking. I love it.
feel like whenever I’m drinking hot coffee like I’ll stop at about two. If it’s iced coffee I feel like I could have about ten. Like there is no limit which is kind of bad because the productivity goes from being really productive to just being like a little bit jittery and then it doesn’t really help you that much.
Stefanie Valakas (03:03.887)
They were snowing like that.
Stefanie Valakas (03:15.928)
And then down we go. Yeah, look, I always regret the third because when I’m lying in bed, wide awake, wired but tired at like 11.30 PM, I go, oh, what’s the ice latte worth it? And then I do the same thing the next day. So look, do as I say, not as I do. Yeah.
And down we go.
Yeah. Well, for some things, yeah. We are kind of good role models in some respects, but also human beings in others. So coffee, I would say, is definitely, sometimes my downfall, sometimes I’m balanced. What is something that we can always find in your fridge?
Stefanie Valakas (03:50.028)
Ooh, feta cheese, always. Um, it touches many of the foods that I eat in my life. I can’t have avocado toast without feta. I can’t have salad without feta. I can’t have an omelette without feta. I make spinach pie with feta. It’s just… Yeah, it’s just being Greek.
Oh, okay. What do you, what’s your favorite thing to make with feta cheese?
Tell me you’re Greek without telling me you’re Greek. Right.
Stefanie Valakas (04:19.384)
And I have a saying, everything is better with a little bit of feta and it’s true. Like it just is so much better.
Hands down, I’ll take your word for it. I mean, you can make me avocado toast any day and I will take the feta on top.
What is something that you’re really grateful for today?
Stefanie Valakas (04:37.916)
I am really grateful for my friends today. It’s been a week of checking in with my friends and being there for them and I’m grateful that when I need them to be there for me they always are. So yeah, grateful for my friends. Yeah.
We got your back. Outside of Stephanie and I being colleagues, we are also besties beyond the Instagram scene, which is really lovely.
Stefanie Valakas (05:05.336)
Yeah. Be sure.
Now for anyone that may not know who you are and a little bit about what you do, obviously I gave a small amount of information in the intro, but do you want to give the listeners a little bit more of a background about yourself?
Stefanie Valakas (05:22.184)
Yeah, absolutely. So I’m the reproductive health fertility and pregnancy dietitian and nutritionist and I run the dietologist. We are a fully telehealth nutrition practice. We see clients from all over Australia and we focus exclusively on this arena of reproductive health. So we see lots of people with PCOS, endometriosis, thyroid dysfunction, HA, as well as people who are trying to conceive.
navigating fertility treatments is a really common presentation that we see and then we get the delightful joy of following them into pregnancy and beyond which is always such a thrill for us. And I got into this arena kind of I always say ass backwards because I was actually a children’s dietician many years ago and I loved being a pediatric dietician but I did start to notice that a lot of my
patients who were coming in with nutrition related concerns, I could track back a lot of what was going on in kids into what mom was eating in pregnancy, what mom and dad were doing pre-pregnancy. And it really re-sparked my passion for genetics, physiology and microbiology, which I all majored in at university. And I went back and did some extra studying and professional development in the space of preconception and fertility nutrition and pregnancy nutrition. And
got home and felt like I can’t not do this, like I have to do this. No one was really doing it at the time. And I just felt like there was such a need and for a dedicated space and profession for, you know, the one in seven women that have endometriosis, the one in 20 women that have PCOS, the one in six couples that face infertility, the millions of pregnant people, like.
I just felt like there needed to be something dedicated, not just going to see any regular old dietician. And yeah, the diatologist was kind of born after that. So yeah, that’s a bit about how I got into this space and my passion for it is driven through a variety of different reasons, some of which being, including my own health, I think I’ve always been a little bit.
Stefanie Valakas (07:37.884)
know, if you talk to a lot of midwives a bit pregnancy or baby obsessed or obsessed at least with that life stage and I just find it so fascinating. I love the science of it and I love the, I love working with women as well. I just and such a motivated group of women especially who are really wanting to work towards those goals and yeah I also love the fact that I was going to have this intergenerational impact. I was going to impact the next generation.
from before they were even conceived and whilst they were being grown in their mom’s tummies and potentially even grandchildren too. So yeah, I was really inspired to get to the root of a preventative health and yeah, ended up in that preconception space.
And honestly, you are in my eyes the go-to expert. Anyone that is working with me who recovers from HA and wants to go beyond to get pregnant and have a healthy pregnancy, Stephanie is always who I send them to because although I have some knowledge, she is definitely the expert. And I think it’s so important to collaborate with colleagues and make sure that.
the people that we’re looking after are getting the best care, the best support, the best evidence-based advice possible. And when it comes to, you know, sometimes like your rainbow baby, like making sure that child has every opportunity to thrive in utero and then beyond in childhood into adulthood is, yet such an amazing impact to have. Now today, specifically, we’re talking about the
Stefanie Valakas (09:00.889)
postpartum period of life and about periods postpartum because I specifically see some women who come to me and they’re like, oh, is this just normal postpartum amenorrhea or have I slipped into hypothalamic amenorrhea? How do I tell the difference? So we’re gonna be having a little bit of a discussion around that today. But Stephanie, I kind of wanted for you to touch on is it common for periods to be delayed or irregular postpartum?
Stefanie Valakas (09:50.844)
extremely common, in fact expected. So something called lactational amenorrhea, which is the suppression of your period and usually then ovulation as well, due to the fact that you are breastfeeding usually is the main reason why this would occur. And those high levels of prolactin which
create breast milk and tell your body to breastfeed is what is at play when it comes to actually slowing down and stopping the cycle from returning. And it’s really an evolutionary response for the body to try and preserve energy. If we think about it, if we’re breastfeeding, you actually have higher energy and nutrient demands, you’re more sleep-derived in that postpartum period. And so the body shuts down that cycle to conserve energy and also
prevent you from getting pregnant again. It’s an unreliable form of contraception and we wouldn’t recommend it, but yes, certainly historically, that’s how pregnancies would be able to be spaced accordingly. And so we are now, like, I mean, in my work as well, I see a lot of people who want to have children in close succession for a variety of factors, but typically due to age and fertility concerns
having a long journey to trying to conceive. And so, you know, it might take two or three years again to have another baby. And so often preparations for a subsequent child start very early and there’s a lot of frustration when your period or ovulation isn’t reinstating as quickly as you thought it might. So it’s very common, but I also appreciate the frustration if you are in that position of wanting to start to try for another baby or
If you’ve had a history of HA and you have this absence of your menstrual cycle, postpartum, it can really like wind you back and think, oh my God, have I slipped back into some old habits or some old patterns and this is actually HA and it’s hard to know what is what.
Yeah, yeah. So I mean, differentiating between the two, like you said, can be really, really tricky. And obviously, there’s going to be, I guess, a range of factors that go into a person’s periods, menstrual cycle and ovulation returning postpartum. But can you give us an idea of how long it typically takes for menstrual cycles to return and normalize after childbirth?
Stefanie Valakas (12:39.528)
Yeah, so it is very dependent on whether you exclusively breastfeed, you pump, you mix feed, or you formula feed. Typically the first six or so weeks after you deliver you will expect some postpartum bleeding. It is typically not defined as your period. This is bleeding that is occurring due to birth.
And that’s typical whether you have a C-section or a vaginal delivery. So that part isn’t considered your quote-unquote period, that’s more your postpartum bleeding which is what you would expect. If that is much lighter or much heavier than you know your obstetrician has expected then it’s time to check in with your doctor about that. Usually at that six-week appointment
postpartum when you go and visit your GP or obstetrician, they’ll have a conversation with you about the likelihood of your period returning and what measures you’d wanna take, whether that be contraception or not. And they usually then have a discussion around, you know, family planning, if you would like future children, which is, you know, a bit of a confronting conversation six weeks after you’ve just had a baby and you’re probably feeling quite.
fatigued. But it is an important conversation to be having. And especially depending on the way that you birth, there can be some limitations to then, you know, proximity to a vaginal delivery after you have a C-section, all those kinds of things. So the spacing is quite relevant. So typically then that’s a conversation that you have then. On average, I would say the first year
if you are breastfeeding, is typically quite unpredictable with your period. And I can’t seem to find in having many conversations with clients any kind of average or normal. I have seen people, you know, reinstate their period straight away. And I’ve also seen people who may go up to two years whilst breastfeeding not having a regular cycle or a cycle at all.
Stefanie Valakas (15:01.212)
Now, whether there’s underlying other issues at play, that’s then what we have to question, but there is no normal, which is challenging because then you end up at mom’s group and asking other women when they got their period and then you start to feel like maybe I’m not normal or something’s wrong or am I pregnant again or what’s going on? So it’s totally understandable that there’s this need and desire to
be normal. Everyone wants that part of it, but I am yet to find something that’s quote unquote average or normal. It is just so wide ranging. And yeah, some people just have the type of period that will come hell or high water and other people don’t. So it is, it is quite individual in that, in that regard.
Yeah, and you mentioned that obviously, exclusively breastfeeding versus pump versus formula can have an impact on obviously, your energy, the energy requirements that your body has and potentially how long it takes to recover your periods postpartum. In your experience, are there, or to your knowledge, are there any other specific factors that might influence a person’s time to their first
periods, like anything during pregnancy or after pregnancy.
Stefanie Valakas (16:21.632)
Yeah, that’s a great question. So there are a few things. Number one is the total amount of time spent breastfeeding and the spacing in which you are breastfeeding. That is quite important and relevant because sometimes those dips in the breaks might be sufficient to help with hormonal signals to kick you over into ovulating. So that’s one thing to think about if you are breastfeeding.
And I have a great podcast episode, not to plug my own podcast, but there is a really great podcast episode that I recorded, um, with another dietitian who’s real like nerd about this area. Um, and it’s about trying to conceive whilst breastfeeding. She goes into quite a lot of detail about how to manipulate breastfeeding to try and reinstate ovulation, which is above what I know. So I would recommend checking that out if that’s of interest to you. Um,
But other things are that women in the postpartum period are really great at looking after their babies and not so great at looking after themselves. And so what can happen is you are on your ninth piece of Vegemite toast for the day and you haven’t really eaten a balanced meal in a week. And that’s an artifact of the demands of early parenthood. And I totally acknowledge that.
However, I try and build systems for clients so that we don’t rely on just whatever you can stuff into your face because this then creates an energy deficit that can sometimes be too large and can exacerbate any underlying propensity to have a bit of hypothalamic amenorrhea or energy deficit related amenorrhea.
So that’s something that I work on with my clients actually during pregnancy is postpartum preparation and setting the expectation of actually how much food they need to be eating, especially if they choose to breastfeed. And so, or can breastfeed, not even choose breastfeed. You know what I mean? But the energy requirements are above that of what we see in third trimester. And most people are pretty shocked to find that out. We need a lot more fluid. We need a lot more.
Stefanie Valakas (18:41.76)
actual energy, we need a lot more carbohydrates, we need a lot more starchy vegetables, you know, the protein requirement drops a lot so that makes room for more of those types of foods. And we need to be taking our, you know, postnatal vitamins, like all those things are important and relevant. So that’s one component of it and I think getting that right, especially for your listeners, is really important and
It is really easy and it is the default not to pay attention to this because you are tired and you are time poor and you are going to just reach for that comfort thing or that convenience thing or whatever your status quo is. Like for me, it’s avocado toast with feta on it. You know, like that would be my status quo thing if I don’t know what I’m doing because I always have avocado, I always have feta, I always have bread, you know? And like I get that and that’s okay. That’s better than not eating anything at all. But.
Stefanie Valakas (19:38.992)
Over time those things accumulate and can cause an issue. There’s also a whole range of other things that can occur, independent of being postpartum, but coincidentally kind of synchronized to this period of time. So for example, you may have a thyroid concern. About 10% of women up to will have something called postpartum thyroiditis. This is a reaction.
to the fact that baby’s now out, but the thyroid doesn’t behave like the baby’s out. So it doesn’t regulate its function back down. So you then are left with an overactive thyroid. And it’s a bit like being, I tell people, it’s a bit like being on speed. Everything’s sped up. So, and I have no personal experience with this. So, but from working with clients who have hyperactive thyroids or overactive thyroids, what we see is a…
Stefanie Valakas (20:36.144)
quickening of things, your thoughts will race, you’ll feel more anxious, you’ll feel hot, you will lose weight without even trying. And because in this postpartum window a lot of times weight loss naturally occurs because you know you probably just delivered a few kilos of a baby and your uterus is going to shrink down and the fluid is gone and your blood volume is going to regulate back to normal, it gets masked by that and so marked weight loss.
Stefanie Valakas (21:03.712)
often goes unflagged or sometimes in society applauded. And so that is a common coverup and that’s a problem. The other symptoms include things like diarrhea and so on. And so if you do have an overactive thyroid, you can sometimes have an interference in ovulation and menstruation as well. So that’s something to think about. There’s also a group of people that fall on the other side of the spectrum have underactive thyroid and you just put all those symptoms in reverse.
Stefanie Valakas (21:32.716)
lower mood, slower digestion, sluggishness, feeling cold. And again, you can have menstrual disturbances as well. And then other things can come up, you know, coincidentally sometimes people, you know, didn’t know or didn’t have before and now they have PCOS or they have another type of condition. They have HA, they have, you know, so there’s so many things that can come up and just because it didn’t.
come up for you before you got pregnant, doesn’t mean it’s not relevant now. And I think that’s a thing that I see a lot of people fall into the trap of is like, you think that your health status goes back to the way it was preconception after you have a baby. It’s a whole, like you were birthed too, to a new version of yourself when you delivered your baby. And so your health is different now. So to say that it’s what happened to you before is irrelevant.
but it’s probably not ever going to be identically the same. And so I think that’s a common trap that a lot of people do. I’ll just do what I did before and it’ll be fine. And sometimes that’s not the case at all.
And I think this really just speaks to the fact that there are so many factors that can influence our health postpartum and also our periods postpartum. And if you have that gut instinct that something feels not quite right, the best thing is to go and get it checked out. I think part of the problem is, you know, like some things get swept under the rug because obviously you’re quite
fatigued, you may not be eating as well, but I think most people know if they’re not feeling themselves to use that as motivation to go and speak with your doctor, your gynaecologist and really get those tests run so you can get deeper understanding of whether it’s something to be concerned of or over or not is better safe than sorry in these instances.
Stefanie Valakas (23:36.505)
You kind of mentioned in that part of your conversation that being well equipped postpartum with the knowledge of how much you need to be eating and the kinds of foods that can be helpful and to have on hand is really part of what you do in your work leading up to birth. Can you give us some examples of some like…
meals or some handy things that you have talked to your clients about that they have found work really well for themselves in that kind of postpartum, especially kind of like newborn era.
Stefanie Valakas (24:18.656)
Yeah, I always tell people to start at around 35 weeks pregnant to start making double of your dinners and freezing them. Do that for between two and six weeks and you’ll have lots of things in the freezer to reheat and eat. The meal that most new moms struggle with is lunch. With dinner there is typically for those who have partners somebody else there that also
you’ll likely put more effort into preparing that meal if you’re the person preparing that meal, or someone’s gonna prepare that meal for you. So you don’t really need to think that hard about that. And most new moms are pretty aware that that’s the case. It’s lunch that typically goes out the window and ends up being, okay, I put the baby down for a nap. Okay, I need to put a load of washing on, call my mom back, I don’t know, have a shower.
breathe for a second, have a cup of tea, and then the baby’s up and you didn’t eat lunch. Or, oh my God, I’ve only got five minutes till I need to wake the baby up. What am I gonna eat for lunch? Too hard basket, decision fatigue, what am I going to do? And then the like 16th piece of Vegemite toast emerges for the week, you know? Like, so it’s all those kinds of things. And I paint that picture for people early on because it is likely going to happen to you. And so I…
teach my clients not only like why things are important, like I said, carbohydrates and vegetables because it’s got the right amount of energy and you have higher energy demands and fiber and vitamin C and B vitamins and all this good stuff. Like, yes, okay, you need to have some nutrition knowledge to like understand why you’re doing it, but also the practicalities. Okay, let’s make sure that the pantry is always stocked with microwave brown rice and quinoa cups. Let’s make sure that we have
freezer meals for lunches because then you can just reheat and eat. Let’s try and pick a few things from the supermarket and give them a test run as to things that you can just quickly assemble. I had like this whole like assembly meal guide that I give to my clients. I’m like, you can’t be bothered. I know just like literally put these things together and you’ll have somewhat of a balanced meal. Um, and the other thing I, I kind of get my clients to focus on is, uh, meals that are a little bit more carb forward. So.
Stefanie Valakas (26:43.4)
Fried rice, risotto, lasagna, pasta salad, shepherd’s pie with lots of mashed potato on top and lentils in the base. All those kinds of things and all those things you can make bulk, you can make heaps of. Do lots of soups, but make sure they’re quite nourishing, not just vegetable and broth. Like put legumes and beans and blend it through and add some protein on top. Don’t be afraid of the supermarket roast chicken. Like all those kinds of things so that you’ve got things on hand.
Stefanie Valakas (27:12.856)
You don’t have all the pregnancy food rules anymore. You don’t need to worry about listeria and salmonella and, oh my God, I can’t eat the mayo and this and that. No, that’s fine. You can have all that. The only things you really got to be mindful of is alcohol and mercury and excess amounts of caffeine. So that’s the only three things you got to worry about, which is really a walk in the park after you’ve been pregnant. So you, you have much more range.
Stefanie Valakas (27:40.824)
And that’s really exciting, but you gotta flex the range as well. So leverage the things that you weren’t eating before. Oh, I couldn’t eat smoked salmon before. How convenient is it to have smoked salmon in the fridge? I can pop that on my cream cheese on toast for breakfast with some eggs, great. And I think as well, like actually having a conversation, if you do have a partner, about how you’re actually going to prioritize nourishing yourself during this time, you may need to have them remind you.
Stefanie Valakas (28:09.312)
You may need to have an external person ask you if you’ve eaten lunch today. Having also some one handed snack snacks available as well. Nut bars, bliss balls, pre-cut pieces of fruit, single serve tubs of yoga. Yes, it’s more packaging. Yes, it’s more expensive to buy things single serve, but honestly, when you’re in that phase, like
just getting it in your gob is the most important thing. So like don’t sweat, don’t sweat that kind of stuff. And I think they’re like my main thing. Oh, and hydration, like big water bottle, like six of them, put them everywhere. One at your bedside, one in the car, one in the place where you get nap-trapped all the time, one in your kid’s room, one in the kitchen, because you often find you’ll get stuck in places and you will…
Stefanie Valakas (29:04.012)
Like, especially if you are breastfeeding, your mouth feels like the Sahara desert. So thirsty. So, yeah, and honoring those hunger cues, because typically, again, if you are breastfeeding, you will be quite hungry. So that’s a pretty normal experience and speaks to the higher energy demand. So not underestimating it and making sure you’re shopping enough and all that good stuff. And then the main.
You get so thirsty. Yeah.
Stefanie Valakas (29:30.212)
The main other sticking point I see is actually not in the early phase, because in the early phase, people are going to bring you the meals. People are like, oh, how are you doing? They’re checking in on you. And then when you get to four months and your kids not sleeping because they’re going through the four month regression, they’re not sleeping at all. And you are a wreck. That’s when all hell breaks loose. And that’s when if you don’t have systems in place, everything falls on its face. And the other sticking point I also find is when solids start.
All hell breaks loose. Yeah.
Stefanie Valakas (29:57.944)
because then moms are spending all this time in the kitchen pureeing things, baby lead weaning things, they’re flaking the roasted salmon, they’re picking the best blueberries from the punnet, they’re like doing everything for the solids and then they sit down, their child’s eating, they’re watching their child eat, so they don’t gag and they don’t choke and this and that and then they gotta get them ready for the nap and then oh my God, it’s three o’clock and I haven’t eaten anything today.
they’re not eating.
Stefanie Valakas (30:25.836)
And that’s no good either. If whether you’re breastfeeding or not, that’s not gonna help you. So I also, when solids come to the party, I always say what’s good for your baby is probably good for you. You can probably create a mom version of what you are spending a lot of time on in the kitchen. You’re not sitting there boiling broccoli four times a day. You make a batch, you puree it, you freeze it. Or you make a batch, you put it in a Tupperware, you put it in the fridge.
Stefanie Valakas (30:54.076)
can do the same thing for yourself. It takes hardly any extra effort and time if you’re already doing it for your child. And then as well whatever’s on mummy’s plate is always so much more appetizing at this age so like it’s good to eat the same time the same similar thing. Even from when I was children’s dietitian we always advocated for that because it’s that positive role modeling behavior as well. So yeah probably the world’s most long-winded answer but hopefully that’s helpful.
but also such a good comprehensive answer. I feel like we spend so much time thinking about how we’re like nourishing our body while we’re growing our baby. And then we have to remember that, yes, baby still needs a lot of nourishment and a lot of care once they’re out in the big wide world, but in order for you to provide that care, you also have to make sure that you’re looking after yourself. And I guess it comes back to basics and…
making sure that you have good nutrition for yourself, getting sure, making sure that you’re eating enough. It might be like inconvenient, it might be hard, there might be like new routines that you have to navigate, but it is the most fundamental form of self-care that you need to kind of make sure that you’re making time for. And I think it’s just a little bit of trial and error, especially for first time parents to really figure out what’s gonna work.
Stefanie Valakas (32:11.646)
for them, which is why having support is so incredibly crucial, because you’re already going to be tired, you’re going to be having decision fatigue, you’re not going to know what to make, which is why having someone to go like, make X, Y, and Z, try X, Y, and Z, buy X, Y, and Z can be so helpful in this process.
Stefanie Valakas (32:33.207)
So that’s kind of really, really good to know. And I guess those defining points in baby’s life where you kind of see that sticking point of mom not getting enough energy might just like be a little bit of a warning flag for people to look out for if they are in that postpartum journey. And I think mostly, and this is I guess my last kind of question, specifically speaking to kind of my audience is if there are any ways to…
Stefanie Valakas (32:45.466)
I guess differentiate between whether this is just lactational amenorrhea or postpartum amenorrhea that’s quite normal and to be expected or when we might suspect that actually maybe we’re kind of dropping back into hypothalamic amenorrhea if we have had that previously prior to pregnancy.
Stefanie Valakas (33:25.116)
Yeah, I’m not familiar that with any blood work that would differentiate you, because it would probably look quite similar, irrespective of whether and it’s not typical that hormones will get measured at this time because they will be off kilter for a variety of reasons. So it’s then hard to then standardize that and say well this is normal, this is what we’re aiming for if we we’re not really screening for it.
So I think a really good history with your healthcare provider could give you some clues. And typically people like you and I would be people that can pick up these kinds of red flags. Like what I just said, like skipping meals, being very light with meals, trying to exercise a lot, not sleeping, doesn’t help, you know, those kinds of patterns. We start to then say that maybe
It’s exacerbating the lactational amenorrhea certainly, and maybe it’s HA as well at the same time, or it’s morphed into that. There is a very, it’s going to be very gray. There’s not gonna be this delineation of, you had lactational amenorrhea for the first eight months, and now you have hypothalamic amenorrhea the last eight months. It probably isn’t gonna be that black and white, but a good history is certainly like a great starting point. And then,
Stefanie Valakas (34:52.004)
those peripheral kind of blood tests that I just mentioned or conditions to screen for like thyroid disorders, PCOS. If there’s any kind of, and this is like definitely not as common, but I have seen this before, where if you have a C-section in particular, the scar can kind of cause an adhesion internally and that can create a structural issue.
And then you may be actually building up the lining to shed, but it’s not gonna come out as easily. So those kinds of things like you can medically check for as other courses of your amenorrhea. But HA to lactational amenorrhea is very, very hard to delineate. And I think it’s probably why you will get a lot of wait and see kind of advice typically from medical practitioners of like,
let’s wait till XYZ time or let’s wait till you drop a feed or let’s wait till you decide to wean or whatever it is. And I see a lot of people, a lot of people who feel forced, particularly if their desire to regain their period is to try to conceive again, who feel backed against a corner of making a decision as to whether to continue to breastfeed their child.
or to cease breastfeeding in the hopes of reinstating their period and to try to conceive again for another baby. And it’s a really, really hard time for women and a really challenging choice to make. And so I do get a big influx of people pretty desperate to try whatever means necessary to reinstate their period and maintain breastfeeding. It is sometimes possible, but I would say for like,
Stefanie Valakas (36:45.924)
that just that bio biology part is really hard to surmount. And so then it becomes a more of a personal decision. And it was something that I talked about with in that interview. And it feels ironic because as healthcare professionals, we’re all trained to advocate for breastfeeding and, and to push forward and to support people with it and encourage breastfeeding. And that’s incredible. And that’s
what we should be doing as a society. But I also think that this particular scenario does foster then a lot of advice, typically that is to stop breastfeeding then. And so that is so tricky because there is no guarantee that at the moment you stop breastfeeding one month later, you’re gonna get your period back either. And so I think you need to tick off all the boxes that you need to tick off before you contemplate those kinds of huge decisions.
Stefanie Valakas (37:43.884)
Um, as well. So, I mean, it is completely really quite individual in that regard, but eating enough, um, hydrating yourself enough, just trying to get whatever sleep you practically can. Looking after yourself, getting your blood tests done, getting, checking in with your doctor, if you’re concerned, and then reviewing your breastfeeding plan.
is I think the best place to start. And if you’re not breastfeeding and it’s been a number of months since you’ve ceased breastfeeding or you’ve not been able to breastfeed, then I would give it maximum six months and then I would be definitely kicking up a bit of a fuss about getting checked out again. Three to six months, I kind of put it in the same camp as like how long is abnormal after you come off the pill where you don’t get your period back?
Stefanie Valakas (38:38.564)
three to six months is about like, ooh, something’s not right, you know? So it’s the same kind of camp. And unless there’s another reason why you wanna absolutely be reinstating your period, then we would just let nature do its thing. Otherwise, yeah, you can intervene as well. Like you can medically induce your period and so on and so forth. So just depends how much intervention you want, why you want your period back.
Stefanie Valakas (39:05.648)
If you just want that reassurance that it’s not HA again, all those kinds of things. So there’s lots to factor in there.
so much to factor in. And I think it’s such a nuanced conversation and topic, which is why I wanted to have you on to discuss it. Because I feel like, you know, similar to like you just mentioned before, going off the pill, a lot of the advice we get given is the wait and see. And while that might be pertinent to someone who doesn’t feel in a rush for their periods to return, for others, it might be really important. So…
Stefanie Valakas (39:38.707)
Stefanie Valakas (39:41.773)
Getting that individualized support and knowing what your options are can be incredibly helpful on this journey. For anyone who would like to connect with you, find out a little bit more about what you do or work with you, what is the best place to find you?
Stefanie Valakas (39:58.876)
Yeah, you can come and hang out with us on Instagram, which is at the underscore dietologist, our website, which is thedietologist.com.au, which has a fair archive of about 100 plus reference blog articles. So if you love a read, then that’s a really great place to start. And then our podcast, Fertility Friendly Food, which you can tune into, we had Sarah on for an episode, so give it a listen.
And yeah, we have a hundred or so episodes there to go back and listen to. And yeah, I definitely think that trying to conceive whilst breastfeeding episode would be a great listen and complementary to the conversation we’ve had today. So if that’s something that’s on your mind, then I would recommend checking that particular episode out.
Yep, and we’ll be sure to grab that link off of you so we can put it in the show notes so that people can easily find it and wrap their ears around it. But if you really enjoyed today’s episode, feel free to take a screenshot of wherever you’re listening. Tag myself at saralizzking or Stephanie at the underscore dietologist. We’ll be sure to reshare those on our stories. And of course, if you are listening on Apple podcasts or Spotify and you really enjoyed today’s podcast,
Stefanie Valakas (40:52.204)
Yes, I shall.
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