postpartum hormones

Balancing Postpartum Hormones

Dr. Jolene BrightenPublished: Last Reviewed: Balancing Your Hormones, Postpartum, Sex Hormones Leave a Comment

Postpartum hormone changes can lead to mood swings, fatigue, sleepless nights, and changes to your skin and hair. While some of these might be expected postpartum, continually feeling unwell weeks after delivery shouldn't be considered a normal part of motherhood. 

Motherhood comes with a unique set of challenges, including one struggle that nearly all new moms face: exhaustion!

One of the most common reasons moms come to see me is to get help with dealing with fatigue and moodiness. Now, some fatigue is to be expected as a new mom. After all, the demands of managing a household, caring for children, and balancing other responsibilities can take a toll on your overall hormonal health, including adrenal function.

But, all too often, I see moms struggling with symptoms that are beyond what should be expected. Not being able to function due to exhaustion and burnout isn't normal. Understanding how to support your hormones post pregnancy is crucial for restoring your energy, mood, and sleep.

In this article, learn helpful tips for balancing postpartum hormones, such as specific foods and supplements to try, as well as changes to your daily routine that can help you feel more rested and clear-headed.

Understanding Postpartum Hormonal Changes

Childbirth is arguably one of the most demanding physical activities of a woman’s life. After childbirth, a woman's body undergoes a ton of changes all at once, including rapid hormonal shifts as it returns to its pre-pregnancy state, in addition to new demands and responsibilities that can be stressful.

Changes to postpartum hormone levels can affect almost every aspect of a new mother's health, from her ability to recover physically to her emotional and mental well-being.

It's not uncommon for moms to deliver a baby, take only a few weeks (or sometimes less) to “recover”, and then push full steam ahead just after bringing a new life into this world.

The problem is a mom's body and mind aren't ready to push themselves after such a stressful event (pregnancy and delivery). Many moms are not prepared for what the infant phase entails, and their doctor might not have shared much advice with them about how to cope during the postpartum period.

What's Happening To Hormones Post Pregnancy?

The hormones most affected during the postpartum period include estrogen, progesterone, oxytocin, and prolactin, alongside stress-regulating hormones including cortisol and adrenaline.

Let's look closer at what happens to each of these key hormones following pregnancy, during what's often called the “fourth trimester”:

  • Estrogen: Your estrogen levels drop significantly immediately after childbirth, contributing to postpartum mood swings (and sometimes depression) and potentially affecting milk production. As estrogen drops, serotonin levels can decrease, too, causing mood issues like sadness and irritability. This is also the reason some moms report experiencing vaginal dryness.
  • Progesterone: Similar to estrogen, progesterone levels also decrease sharply after delivery. This decline is necessary for milk production to begin but can mess with a new mom's mood. The dip in progesterone and estrogen can lead to mood swings or what is sometimes called “baby blues.”
  • Oxytocin: Production of oxytocin, deemed the “cuddle hormone,” increases during the postpartum period, promoting bonding between the mother and the newborn. It also stimulates milk ejection during breastfeeding.
  • Prolactin: Prolactin levels rise significantly after childbirth to initiate and maintain breast milk production. Its levels can fluctuate based on the baby's feeding patterns.
  • Cortisol: As mentioned above, cortisol, a primary “stress hormone,” can remain elevated immediately after birth, reflecting the stress of childbirth and adjustment to motherhood. Typically, cortisol levels begin to normalize as the postpartum period progresses, but not always. If a mom is not getting sleep or nutritional support, she can experience high cortisol. And, creating a vicious cycle, elevated cortisol can contribute to insomnia during the postpartum period, further causing feelings of overwhelming fatigue and stress.
  • Adrenaline: Adrenaline (epinephrine) levels may spike during labor and delivery but usually decrease after childbirth. However, just like with cortisol, high levels of stress and lack of sleep can cause variations in adrenaline levels during the postpartum period.
  • Thyroid: The thyroid gland is responsible for producing thyroid hormones, which may remain stable immediately following birth with only slight fluctuation. As we will discuss, there are moms who develop postpartum thyroiditis in the months following birth. 

As one article published in the journal Acta Endocrinologica put it, “Between high prolactin production, low estradiol, no progesterone, potentially lower dopamine, and variations in thyroid hormones, it is not uncommon that these imbalances produce an important psychological impact.”

Signs of Hormonal Imbalance After Pregnancy

Hormonal imbalance after pregnancy can show up in a variety of ways, depending on the person.

Common signs of imbalances in hormones after pregnancy, or what's called “adrenal fatigue” in moms, can include:

  • Persistent fatigue and exhaustion, which don't seem to go away even with rest
  • Difficulty waking in the morning and afternoon fatigue
  • Mood swings, irritability, and feelings of overwhelm, sadness, and depression
  • Difficulty sleeping despite feeling tired (feeling “wired but tired”)
  • Changes in appetite, including cravings for sugar and salt
  • Physical symptoms such as acne, hair loss, and weight changes
  • Lots of postpartum hair loss
  • Increased illness due to immune system depression
  • Low libido
  • Poor memory
  • Increased PMS symptoms
  • Dizziness, feeling light-headed or “head rush” when rising from a lying or seated position.
  • Inability to cope with stress

Are you experiencing any of these symptoms to to the extent that it's interfering with your daily life and ability to parent? If so, it's a good idea to get help from your healthcare provider while also taking the steps below to help balance postpartum hormones.

Why Moms Experience Extreme Fatigue

While sleep disruption can certainly play a significant role in postpartum fatigue, conditions like postpartum depression, postpartum thyroiditis, iron deficiency, and hypothalamic pituitary adrenal axis dysfunction (HPA-D) can also be a cause of fatigue.

Labor is physically and mentally exhausting, and most women aren’t afforded the opportunity to rest, recover, and rejuvenate for long enough before being flung into full-time mom life, sometimes coupled with career responsibilities, too.

Little sleep, a lengthy to-do list, and a baby to take care of can quickly become exhausting and overwhelming.

Postpartum Depression

As many as 20% of new moms experience postpartum depression or anxiety in the first six weeks after childbirth.

Symptoms of Postpartum Depression (PPD) include feeling tired all the time, excessive worry or sadness, and having difficulty sleeping. Unlike baby blues, which usually resolves in the first month, PPD persists.

If you suspect postpartum depression symptoms are contributing to your fatigue, it is important to discuss this with your provider.

Postpartum Thyroiditis

As I explain in my book, Healing Your Body Naturally After Childbirth, postpartum thyroiditis is most likely to affect those with a history of hypothyroidism prior to or during pregnancy, elevated TPO antibodies, other autoimmune conditions, and depression.

Symptoms of underactive thyroid include dry skin, constipation, hair loss, fatigue, depression, anxiety, and joint pain. Screening for thyroid disease is an important for any mom that feels fatigued or is having mood changes.

Iron Deficiency Anemia

Many women develop iron deficiency anemia during pregnancy, which can become worse postpartum. 

Symptoms of iron deficiency anemia include fatigue, anxiety, restless leg, easy bruising, and strange cravings.

HPA Dysfunction (HPA-D)

HPA dysfunction, or what is commonly called “adrenal fatigue,” can develop in response to the many demands of postpartum motherhood. 

Your adrenals love routine. They love consistent sleep, regular meals, and low amounts of stress—you know, all the things you had before the birth of your child!

The adrenal glands, which sit above the kidneys, are responsible for managing stress. However, if they are never given a break, disruption in how your brain and adrenals communicate (the HPA system) can become dysfunctional, resulting in fatigue, mood symptoms, 

While adrenal fatigue is not a diagnosable condition, HPA dysfunction (or dysregulation) is a very real condition.

HPA dysregulation better describes what happens to many new moms because it explains how high amounts of stress—including from sleep deprivation and adapting to life as a parent—can cause hormonal changes that result in fatigue.

When stress takes a toll on the HPA axis, more cortisol than usual is produced. Cortisol, along with adrenaline, is a hormone involved in your stress response that prepares the body for a “fight or flight” reaction.

After childbirth, the demand on the adrenal glands increases significantly due to the physical and emotional stress of caring for a newborn. If you're feeling extra hormonal after pregnancy and unlike yourself, it's not all in your head.

HPA-D  can exacerbate the hormonal fluctuations experienced after pregnancy, contributing to symptoms such as difficulty waking, afternoon fatigue, brain fog, mood changes, and increased susceptibility to illness due to immune suppression.

Strategies for Balancing Postpartum Hormones

Balancing hormones post-pregnancy usually involves a combination of lifestyle adjustments, nutritional support, and, in some cases, supplementation or medication, if needed.

Overall, you'll recover quicker if you focus on eating a balanced diet that ensures proper blood sugar regulation while consuming nutrients that support your adrenals. I suggest taking care of yourself and your HPA axis during the postpartum phase by focusing on these steps first and foremost:

1. Nutrient Dense Diet

A balanced diet rich in whole foods can support hormonal balance by providing your body with the fuel it needs to keep you going.

  • Include protein in every meal: Protein, along with healthy fats, helps regulate your blood sugar levels. This is crucial for adrenal health and overall hormonal regulation. Emphasize protein sources like eggs, poultry, grass-fed meat, fish, yogurt, and beans. How much protein do women need? Aim for at least 50 grams, but ideally more, up to 100 grams daily, especially if breastfeeding.
  • Eat regularly: Consume regular meals, not allowing yourself to go long periods without eating. Eating every few hours prevents low blood sugar, which is hard on the adrenals.
  • Go easy on sugar: It's tempting to eat lots of sweets to keep your energy up when you're tired, but this can backfire and lead to blood sugar swings. Nourish yourself with unrefined carbs as much as possible, aiming to eat lots of fibrous whole grains and fruits for steady energy. But listen, no one is judging if you need a piece of dark chocolate.
  • Drink bone broth: Bone broth is full of collagen and minerals that help support the body's healing processes. I encourage all my patients to make a big batch of bone broth and freeze it prior to delivery, this way, they can defrost it as needed and have something nourishing to sip on. If you don't have bone broth, try adding collagen powder to your smoothies, oatmeal, or yogurt.

2. As Much Sleep and Rest as Possible

Adequate sleep is vital for keeping your energy and mood up and for hormonal balance. New mothers should aim for quality sleep and rest whenever and however possible to support their body's recovery and reduce stress on the adrenals.

As a mom, I know the struggle well and just how challenging it can be to get everything done in the day, plus tend to a baby (or toddler) at night. Be gentle with yourself and focus on your wins.

  • Go to sleep early: You'll clock in more hours by heading to bed early rather than doing mindless activities like watching TV or scrolling on your phone. Go to bed by 10 pm most nights if possible.
  • Make your bedroom conducive to restful sleep: Make sure your bedroom is cool and completely dark. You can even try some white noise in the background.
  • Aim for 6 to 7+ hours of sleep each night: This amount can make a huge difference in your hormones. Try having your partner help do night feedings or other tasks to give you more time to rest. Ask your partner to take the children on the weekend and allow you to sleep in or take a nap. If you're a solo parent and have the means to have a night nurse or postpartum doula, this can help you get more sleep. Otherwise, know that every effort you make to get sleep when you can does count towards your health.
  • Nap: You've probably heard this before, but “nap when the baby naps!” Lay down when you can, especially during the first two weeks after childbirth when your body is still recovering.

3. Stress Management

Anything that you can do to lower stress in your life, such as gentle exercise or time spent outdoors in nature, is helpful. Find what works for you and do short bursts of these techniques as often as you can.

  • Be gentle with yourself: You are one wonderful woman, and you are doing an amazing job! Please remember this as often as possible. Being a mom is hard and being gentle with yourself is important.
  • Try mindfulness: Deep breathing exercises, meditation, and mindfulness can help manage stress levels, taking some of the burden off of your adrenals.
  • Go for walks outside: Take the baby and stroller to get some fresh air and movement.
  • Keep a journal: Write down things you're grateful for each day or what's worrying you to get it off your chest.
  • Read something inspiring each day: Find books and articles that resonate with you and help you process this period of life that you're in.

4. Gentle Exercise

Gentle exercise, such as walking or yoga, can improve your mood and energy levels without overtaxing the adrenals.

  • Keep it short and sweet: Light strength training, gentle cardio, and stretching are best for adrenal health. These don't have to be time-consuming or intense; 20 minutes most days of the week, done at home, is enough to make a difference in how you feel.
  • Avoid long cardio sessions: Strenuous exercise can often make adrenal conditions worse, so limit these while you're recovering.
  • Ask for professional help: When in doubt, meet with a healthcare provider, such as your OBGYN or a physical therapist, to determine the right type of exercise for your current needs and energy level.

5. Supplementation and Herbs

Supplements and adaptogenic herbs can help support adrenal function and hormonal balance among many new moms who are dealing with stress. In fact, the importance of nutrition doesn't disappear after you give birth, so I tell my patients to continue taking prenatal vitamins for at least six months postpartum to help meet their needs.

Supplements should ideally be used under the guidance of a healthcare professional, ideally one experienced in postpartum care, to ensure they're safe, especially if you're taking any medications or have a known health condition, such as a thyroid issue.

Here are the supplements I recommend considering to help in balancing porstpartum hormones:

  • Multivitamin: It is advised for women to continue their prenatal multivitamin into postpartum. This can help with replenishing iron and help ensure you meet your nutritional demands. You'll find nutrients in Prenatal Plus formula, such as B vitamins, which assist in energy, and vitamin C, zinc, and vitamin D, which support healing and manage inflammation. My Prenatal Plus formula also offers thyroid support for moms who are postpartum by supplying a balance of iodine and selenium, which the thyroid relies on for hormone production. Additionally, a multi is important if you're nursing because breastfeeding increases your nutritional needs, plus it supplies crucial nutrients for your baby's development, such as calcium, magnesium, and others.
  • Omega-3 fatty acids: Omega-3s, especially EPA, can help reduce inflammation and support mental health. I generally recommend taking between 1,000 and 2,000 milligrams of total omega-3s daily (EPA and DHA combined). You'll find a balanced ratio of omega-3s in Omega Plus formula, which is also included in my Pregnancy Support Kit that can be used postpartum for nutritional support.
  • Adaptogenic herbs: A number of herbs, such as ashwagandha and Rhodiola, can help support adrenal health, balance stress hormones such as cortisol, support healthy hormone production, and optimize energy. The Adrenal Support supplement is a combination of adaptogenic herbs and nutrients such as vitamin C and B vitamins, which are known to contribute to rejuvenating the adrenals. This product is designed to help support healthy cortisol levels, hypothalamic and pituitary function (HPTA axis), and catecholamine production (dopamine, norepinephrine, and epinephrine). It is important to talk with your provider before beginning herbal supplements.
  • Selenium (200 mcg/day): For moms dealing with thyroiditis, selenium has been shown to lower thyroid antibodies and is an important nutrient for thyroid hormone production. Women with anti-thyroid antibodies present prior to conception or during pregnancy are recommended to begin selenium in order to reduce the risk of postpartum thyroid disease.

6. Medical Interventions When Helpful

For some women, bioidentical hormones or other medical interventions may be necessary to address significant hormonal imbalances. These should be considered in consultation with a provider who specializes in postpartum health.

If you do take medications, the steps above—including eating well, resting more, managing stress, and limiting strenuous exercise—are still helpful in supporting your recovery. You can talk to your provider about combining additional therapies with your medications for extra support.

How Long Will It Take for Postpartum Hormones to Return to Normal?

While many women are told they are cleared for exercise or sex at 6 weeks postpartum, healing postpartum actually takes longer. 

Many experts agree that 12 months from birth is a reasonable amount of time for postpartum healing to take place. With regards to hormones, estrogen and progesterone levels will not resume to their pre-pregnancy levels until you've starting ovulating (and therefore menstruating) again. 

If you suspect a thyroid hormone imbalance, your doctor can test and provide you options, including thyroid medication. Depending on the cause, you may be able to normalize thyroid levels in a matter of 6-12 weeks.

In iron deficiency anemia it can take a couple of weeks to start to see improvements and several months to correct the deficiency and have restored energy. 

With regards to cortisol, as improvements are made in sleep, routine, and habits (which often happens as the baby grows), cortisol levels will also begin to improve. 

When your menstrual cycle returns, estrogen and progesterone levels will normalize.

Should You Have Your Hormones Tested After Pregnancy?

If your menstrual cycle hasn't returned, testing estrogen and progesterone won't likely be very helpful. Testing for vitamin D deficiency, iron deficiency (CBC and ferritin), thyroid disorders, inflammation, and nutritional issues can help identify potential causes of fatigue and other signs of hormonal imbalance after pregnancy.

I also suggest having thyroid testing done, especially if you're at risk of postpartum thyroiditis and have a history of thyroid issues. Make sure to have your TSH, free T3, free T4, Reverse T3, anti-thyroglobulin, and anti-TPO antibodies tested at the three to six-month postpartum mark.

Key Takeaways on Balancing Postpartum Hormones

Significant fatigue or exhaustion shouldn't be considered normal. If you're struggling with signs of hormonal imbalance after pregnancy, meeting with your provider to discuss your symptoms and lab testing can help provide you answers.

By getting more rest when you can, eating balanced meals, finding ways to unwind, and considering supplementation, you can navigate the postpartum period with greater ease and savor this period of life.

Feeling like your postpartum hormones are off? Grab my guide to navigating motherhood and balancing your hormones, Healing Your Body Naturally After Childbirth.

Additionally, here are more resources you may find helpful as a new mom:

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References

  1. Mughal S, Azhar Y, Siddiqui W. Postpartum Depression. StatPearls Publishing. 2024.
  2. Nakić Radoš S, Tadinac M, Herman R. Anxiety During Pregnancy and Postpartum: Course, Predictors and Comorbidity with Postpartum Depression. Acta Clin Croat. 2018. 57(1). 39-51.
  3. Trifu S, Vladuti A, Popescu A. THE NEUROENDOCRINOLOGICAL ASPECTS OF PREGNANCY AND POSTPARTUM DEPRESSION. Acta Endocrinol (Buchar). 2019. 15(3). 410-415.
  4. Yildiz G, Senturk MB, Yildiz P, Cakmak Y, Budak MS, Cakar E. Serum serotonin, leptin, and adiponectin changes in women with postpartum depression: controlled study. Arch Gynecol Obstet. 2017. 295(4). 853-858.
About The Author

Dr. Jolene Brighten

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Dr. Jolene Brighten, NMD, is a women’s hormone expert and prominent leader in women’s medicine. As a licensed naturopathic physician who is board certified in naturopathic endocrinology, she takes an integrative approach in her clinical practice. A fierce patient advocate and completely dedicated to uncovering the root cause of hormonal imbalances, Dr. Brighten empowers women worldwide to take control of their health and their hormones. She is the best selling author of Beyond the Pill and Healing Your Body Naturally After Childbirth. Dr. Brighten is an international speaker, clinical educator, medical advisor within the tech community, and considered a leading authority on women’s health. She is a member of the MindBodyGreen Collective and a faculty member for the American Academy of Anti Aging Medicine. Her work has been featured in the New York Post, Forbes, Cosmopolitan, Huffington Post, Bustle, The Guardian, Sports Illustrated, Elle, and ABC News. Read more about me here.