By Alison Heyerdahl

While you’ve gone through the most exciting and miraculous time of your life – bringing a new person into the world, you may also notice that your body and emotions are vastly different from your pre-pregnancy state.  When we are pregnant, we tend to read as much as we can about what to expect  – how big our baby is, when we will feel his tiny movements in our belly, and how our bodies are changing to accommodate all these wondrous events.  The postpartum state is another story altogether – one that can be confusing, overwhelming and leave you reeling with emotion. Many women are ill-equipped to deal with the psychological and physical changes that accompany the postpartum period because we don’t often talk about it. 

However, postpartum anxiety and depression are more common than we appreciate but may be difficult to address because they are often linked to out-of-control hormones.  While these symptoms should resolve within one or two weeks after birth, some mothers experience more extreme and persistent symptoms that may require medical treatment.

Studies show that approximately 50-57% of women suffer from postpartum mood shifts to a greater or lesser extent.  Read on to find out more about this transitional time in your life and how these hormonal changes may affect you.

At a glance: Postpartum blues due to hormonal changes are common after childbirth.  These feelings arise because of a sharp drop in the pregnancy hormones, estrogen and progesterone, which affect our serotonin and dopamine levels (the “happy hormones”).  At the same time, oxytocin (the bonding hormone) and prolactin (the milk-stimulating hormone) increase, which can result in feelings of anxiety and depression.  While emotional and psychological changes are normal for one to two weeks after birth, more severe and prolonged symptoms may be a sign of postpartum depression, a condition for which you should seek medical help. 

How do your hormones change during pregnancy?

During pregnancy, your hormones are higher than they will be at any other time in your life (the equivalent of taking around 100 birth-control pills a day).  Your body produces increased levels of estrogen, which prepares your uterus and placenta to support and nourish your baby.  Estrogen also plays a role in the development and maturation of your growing fetus and reaches its peak during the third trimester.  In the second trimester, it causes the enlargement of your breasts in preparation for milk duct development.

Progesterone is another hormone that remains high during your pregnancy.  It is pivotal in preparing the endometrium (the inner lining of your womb) and its vessels for the growing fetus.  It also ensures that your body maintains the placenta – the womb’s thick lining which delivers nutrients to your baby.

The hormone relaxin causes a relaxation of the ligaments and joints in your body to accommodate your growing womb and ensures that your pelvis can stretch during the birth of your baby.  It is secreted by the lining of the uterus, ovaries, and placenta throughout your pregnancy.  It also inhibits the contraction of your uterus in the first and second trimesters to prevent early labor.  Interestingly it plays a vital role in childbirth, promoting the softening of the cervix and allowing your pelvis to open for the passage for your baby.  During pregnancy, and for about 5 months after birth, you are more prone to spraining ligaments, so take caution with physical activity.

In combination, estrogen and progesterone also cause a surge in the neurotransmitters dopamine and serotonin.  These neurotransmitters are known as the “happy hormones,” which make you feel good during pregnancy and give you that pregnancy glow.

What happens to your hormones after the birth of your baby

Directly after the birth of your baby, estrogen and progesterone drop dramatically, which can contribute to feelings of sadness, irritability, anxiety, depression, and moodiness.  “The postpartum hormone drop is considered the single largest sudden hormone change in the shortest amount of time for any human being, at any point of their life cycle” (Lukes, 2019). It’s almost like PMS on steroids – causing understandable emotional changes.  These symptoms generally resolve within a week or two after birth, but may sometimes last longer and disturb your daily life. Symptoms that last longer are known as postpartum depression. According to research, this is one of the most important public health problems we can address: “it not only affects women at a highly vulnerable time, but it also has deleterious effects on children and families” (Schiller, Meltzer-Brody & Rubinow, 2014).

While the hormones estrogen and progesterone plummet once the baby arrives, oxytocin and prolactin both flood our systems. 

Oxytocin is involved in the uterine contractions we experience during labor and moves milk into the breasts to prepare for breastfeeding.   Oxytocin is also responsible for the bonding between mother and baby. Research has found that it plays an important role in social behavior, helping us more accurately recognize others’ emotions and become vigilantly aware of what is taking place in our surroundings, which could arouse anxiety.  It also increases our empathy, promoting feelings of trust and attachment. 

After birth, prolactin surges into our systems.  It is responsible for milk production and continues to be produced until we stop breastfeeding.  Prolactin has been found to decrease dopamine levels, which could result in feelings of moodiness, low energy levels, and even slow your metabolism after birth. 

Thyroid hormone levels can also change postpartum resulting in postpartum thyroiditis.  It is a relatively rare condition, affecting around 5% of women within the first year of giving birth. Women prone to developing thyroiditis include those with Type 1 Diabetes or a history of thyroid dysfunction.  Symptoms associated with the condition include anxiety, irritability, palpitations, fatigue, excessive hair loss, and insomnia.  These symptoms may also contribute to the postpartum blues you may be experiencing.  You should seek prompt medical attention if you suspect you may have postpartum thyroiditis. 

Take-Aways

Experiencing postpartum blues due to hormonal changes is normal following the birth of your baby.  These feelings are caused by the dramatic decline in estrogen and progesterone levels which result in a decrease in serotonin and dopamine (our happy hormones).  At the same time, oxytocin (the bonding hormone) and prolactin (the milk-stimulating hormone) increase, which can have the effect of producing anxiety and depression.  While these feelings usually resolve themselves within one or two weeks after birth, more serious and prolonged symptoms could signify the presence of postpartum depression, a serious condition that requires medical treatment.