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Obstetric anal sphincter injuries (OASI) are severe perineal tears that can occur during vaginal birth and involve damage to the anal sphincter muscles. These injuries are estimated to affect around 1–5% of women following childbirth and may have important implications for pelvic floor function and overall wellbeing.

Women who sustain an OASI may experience symptoms such as difficulty controlling gas or bowel motions, faecal urgency, pelvic or perineal pain, urinary symptoms, or discomfort with sexual activity. While prompt recognition and immediate surgical repair after birth are essential components of care, recovery can take time and some women may continue to notice ongoing symptoms in the months or years following delivery.

Research shows that persistent bowel or pelvic floor symptoms can impact confidence with exercise, social participation and intimacy, highlighting the importance of comprehensive follow-up and rehabilitation. Contemporary clinical guidelines recommend pelvic health physiotherapy as part of multidisciplinary recovery, supporting women to optimise pelvic floor function, improve symptom control and safely return to valued daily activities.

Future birth planning is also an important part of recovery after OASI. Women are often supported to make informed decisions about the mode of delivery in subsequent pregnancies, taking into account their current symptoms, pelvic floor function and individual preferences. Collaborative care involving obstetric providers and pelvic health physiotherapy can help guide this process, with the aim of reducing the risk of further injury while supporting confidence and wellbeing in future pregnancies.

Early assessment and individualised rehabilitation can make a meaningful difference to long-term outcomes. If you have experienced a severe tear during childbirth and are noticing ongoing pelvic floor symptoms, seeking specialised pelvic health support may help you regain comfort, confidence and function.

New research published in Medicine & Science in Sports & Exercise (the flagship journal of the American College of Sports Medicine) is challenging long-held assumptions about high-intensity and high-load resistance training in early pregnancy.

This study examined women in their first trimester who were already engaged in high-load resistance training prior to pregnancy. Importantly, it explored an area often missing from pregnancy exercise research: pelvic floor health.

Key findings included:

• Pelvic floor symptoms (including stress urinary incontinence) did not worsen in the first trimester and, in many cases, improved
• Many women safely maintained high training loads (>80% of pre-pregnancy 1RM)
• Miscarriage rates were consistent with population norms, with no increased risk associated with high-load training
• Pre-conception pelvic floor symptoms were common — highlighting the importance of pelvic health assessment before and during pregnancy
• Fatigue and nausea, rather than safety concerns, were the main barriers to exercise in early pregnancy

This research reinforces the importance of individualised, evidence-informed guidance rather than blanket restrictions — particularly for active and athletic women. It also highlights a critical gap in care following miscarriage, where many women receive little or no guidance on returning to exercise.

(Prevett & Davenport, 2026)

The Knack: Timing Matters for Bladder Control

Did you know that timing your pelvic floor contraction can significantly reduce urinary leakage?

The Knack is a pelvic floor strategy that involves a gentle lift of the pelvic floor muscles just before activities that increase abdominal pressure — such as coughing, sneezing, lifting, or jumping.

Research shows that performing a well-timed pelvic floor contraction before these moments can dramatically reduce urine leakage, particularly for women with stress urinary incontinence. In some studies, leakage during coughing was reduced by up to 98% when the Knack was used correctly (Miller et al., 2008).

The Knack works by helping the pelvic floor brace and support the bladder neck and urethra before pressure hits. While strength is important, evidence shows that timing and coordination are just as critical.

He mea nui te wā tika — timing matters.

It’s important to know that the Knack is not just a simple squeeze. Correct activation, timing, and integration with breathing and movement are key for it to be effective. Research shows that women who receive guidance and practice with a physiotherapist report significant improvements in bladder control compared with general advice alone (Miller et al., 2020).

Ū tonu ki te wā tika.
Consistency and correct technique are essential.

A pelvic health physiotherapist can:

• Check that you’re activating the correct muscles
• Tailor the technique to your body, symptoms, and activities
• Integrate it safely into daily tasks, exercise, and sport

Learning and practising the Knack under professional guidance ensures maximum benefit and safety

 

• MHT is the most effective treatment for hot flushes & quality-of-life symptoms in menopause. Confusion following the early 2000s Women’s Health Initiative (WHI) led to fear & misinformation… Evidence has been updated… He maramatanga hou, he oranga hou – new knowledge supports better wellbeing. 

 

Myth 1: MHT will make you gain weight – He whakaaro hē tēnei – this is incorrect. 

• Women using MHT do not gain more weight than women who don’t. Midlife weight changes are mainly due to ageing, lifestyle & social factors. Menopause can shift fat distribution toward the abdomen – not caused by MHT. Ko te pakeketanga te take matua – ageing is the main driver. 

 

Myth 2: Breast cancer is the most common cause of death after menopause. 

• Fear of breast cancer is a major reason women avoid MHT. Heart disease & stroke are far more common causes of death. Breast cancer deaths are lower than cardiovascular causes. Me matua titiro ki te katoa o te hauora – we must look at the whole picture of health. 

 

Myth 3: 1 in 4 women on MHT get breast cancer – He iti noa te tūraru – the risk is small & time dependent. 

• This is misreported MHI data. Updates evidence shows: 

Combined MHT (oestrogen + progestogen) 

No increase in breast cancer risk in women  aged 50 – 49 or within 10 years of menopause.

After 13 years: Small increase (9 extra cases per 10,000)

Oestrogen-only MHT – no breast cancer risk even after long term follow-up. 

 

Myth 4: MHT increases heart disease risk. 

• Analysis of 40,000+ women shows:

No increase in deaths from heart or blood vessel disease. 

No increase in heart atacks or angina. 

This applies to healthy women & those with existing cardiovascular disease. 

Mā te mohio tika ka heke te mataku – knowledge reduces fear. 

 

Myth 5: You need a blood test to diagnose menopause – Ehara i te mea me whakamātou toto – it is not necessary to have a blood test. 

• Menopause is a clinical diagnosis + 12 monthjs after your last period – blood tests may help only: 

Women under 40.

Women with a hysterectomy & symptoms. 

Ka rangona te tinana – the body tells the story 

 

Myth 6: Natural therapies are safer & just as effective – He iti noa te tainakitanga mō ēnei rongoā – there is limited evidence for these treatments. 

• MHT remains the most effective treatment for menopause symptoms. Many “natural” products lack evidence, regulation or safety testing. Some (e.g soy) may be insafe for women who can’t take MHT. online products may be contaminated or unreliable. Kōreri ki tō rata – always discuss options with your doctor.

 

Myth 7 & 8: Bioidenticals & progestogens – Ngā tangirua e rua – 2 areas of confusion. 

• Compounded bioidentical hormones:

Are not safer or better than prescribes MHT. they are not regulated, quality & safety are not checked. Associated with serious risks (e.g endometrial cancer). 

• Progestogens:

Not all progestogens carry the same risks 

Progesterone is different from synthetic progestins

He rongoā mō te tangata, ehara i te rongoā kotahi mō te katoa – Treatment should be individualised, there is no one size fits all. 

 

Myth 9: Non-hormonal options work just as well – He iti ake te whai hua i te MHT.

• Non-hormonal medications are less effective for hot flushes.
• Useful when MHT isn’t appropriate or desired. 
• Decision making should be shared and informed. 

 

KEY MESSAGES: 

Many myths stem from early MHI reporting. 

Modern evidence shows that MHT is effective & safe for many women. 

Best outcomes occur when MHT is started within 10 years of menopause. 

He mana tō te wahine ki te kōwhiri – women deserve informed choice. 

 

 

AMS_9_MHT_Myths (1)

Sleep Disturbance in Perimenopause: An Early, Evidence-Based Health Signal

Sleep disturbance is one of the most common and distressing concerns reported by women during the perimenopausal transition. Importantly, growing evidence shows that disrupted sleep often begins years before the final menstrual period, and cannot be explained solely by ageing or vasomotor symptoms such as hot flushes.

The Study of Women’s Health Across the Nation (SWAN) has provided original insights, more recent high-quality research confirms that perimenopausal sleep disturbance is an early, biologically driven phenomenon, linked to hormonal variability and interacting physiological systems.

What the research shows

Longitudinal and mechanistic studies demonstrate that during perimenopause, women experience increased night-time awakenings, fragmented sleep, difficulty maintaining sleep, and non-restorative sleep, even when total sleep duration appears unchanged (Baker et al., 2022). These sleep disruptions have been shown to correlate with rising follicle-stimulating hormone (FSH) and fluctuating oestradiol levels, and notably can occur independent of hot flushes or night sweats.

Meta-analytic data further confirm that sleep disturbance during perimenopause is multifactorial, influenced not only by hormonal changes, but also by mood symptoms, anxiety, metabolic health, and emerging cardiometabolic risk factors (Zhang et al., 2023). This aligns with newer community-based studies identifying distinct sleep-disturbance profiles in perimenopausal women, including difficulties with sleep initiation, sleep maintenance, and early morning waking, each associated with different physiological and psychosocial contributors (Li et al., 2025).

Why sleep changes occur before menopause

Perimenopause is characterised less by absolute oestrogen deficiency and more by hormonal variability and disrupted signalling. Oestradiol plays a role in sleep regulation through its effects on thermoregulation, circadian rhythms, neurotransmitters, and vascular function. Fluctuating levels — rather than low levels alone — appear to destabilise these systems, contributing to sleep fragmentation well before menstruation ceases.

Emerging evidence also links perimenopausal sleep disturbance with early endothelial and cardiometabolic changes, suggesting that poor sleep may be both a symptom and a contributor to broader health risk during the menopause transition (Khoudary et al., 2020; Davis, 2024).

Clinical relevance

From a clinical perspective, this body of evidence reframes sleep disturbance in perimenopause as a meaningful health signal, not simply a nuisance symptom to be endured. Poor sleep during this transition is associated with reduced exercise tolerance, impaired recovery, mood disturbance, increased visceral fat accumulation, insulin resistance, and rising cardiovascular risk.

Recognising sleep disruption early provides an opportunity for preventative, whole-system care, including education, lifestyle and exercise interventions, psychological support, and — where appropriate — discussion of evidence-based menopausal hormone therapy options within an individualised risk–benefit framework.

Key takeaway

Current evidence clearly shows that sleep disturbance is a core feature of perimenopause, emerging early in the transition and reflecting complex interactions between hormonal variability, vascular health, metabolic changes, and psychosocial stressors. Addressing sleep proactively is therefore central to supporting women’s health, function, and long-term wellbeing during midlife.

References (APA 7th)

Baker, F. C., de Zambotti, M., Colrain, I. M., & Bei, B. (2022). Sleep problems during the menopausal transition: Prevalence, mechanisms, and consequences. Journal of Clinical Endocrinology & Metabolism, 107(10), e4144–e4156. https://doi.org/10.1210/clinem/dgac423

Khoudary, S. R. E., et al. (2020). Menopause transition and cardiovascular disease risk: Implications for timing of early prevention. Circulation, 142(25), 2403–2414. https://doi.org/10.1161/CIRCULATIONAHA.120.047182

Li, X., et al. (2025). Sleep quality profiles and associated factors in perimenopausal women: A community-based study. BMC Women’s Health, 25, Article 217.

Zhang, Y., et al. (2023). Risk factors for sleep disorders in perimenopausal women: A systematic review and meta-analysis. Menopause, 30(9), 1021–1032.

Sleep Changes in Perimenopause: What This Means for You

Many women notice changes in their sleep years before their periods stop. This can include waking during the night, lighter or less refreshing sleep, difficulty staying asleep, or feeling tired despite “getting enough hours.”

Importantly, research now shows that these sleep changes are not just about hot flushes or getting older. During perimenopause, hormones such as oestrogen don’t simply drop — they fluctuate. This hormonal variability can affect how the brain regulates sleep, body temperature, mood, and stress responses.

Sleep disruption in this stage is often part of wider body changes happening at the same time. These may include:

• increased fatigue or reduced exercise tolerance
• changes in mood or anxiety
• weight gain around the abdomen
• blood pressure or blood sugar changes

This tells us that poor sleep during perimenopause is a signal, not a failure — a sign that the body is adapting to a major transition.

A whole-person approach matters

Addressing sleep in perimenopause works best when we look beyond a single hormone or symptom. Support may include:

• education about what’s happening in the body
• movement and strength training that supports nervous system regulation
• strategies to support recovery and energy
• discussion of evidence-based medical options when appropriate

He wā whakawhiti tēnei — this is a time of transition.
Supporting sleep early can help protect long-term wellbeing, energy, and cardiovascular health.

The key message

If your sleep has changed in your 40s or early 50s, you’re not imagining it — and you’re not alone. These changes are common, real, and increasingly well-understood. With the right support, sleep and wellbeing can improve.

Ko te moe te pou o te oranga — sleep is a pillar of health.

If sleep disruption is affecting your energy, recovery, or quality of life, early support can make a meaningful difference.

References:

Baker, F. C., de Zambotti, M., Colrain, I. M., & Bei, B. (2022). Sleep problems during the menopausal transition: Prevalence, mechanisms, and consequences. Journal of Clinical Endocrinology & Metabolism, 107(10), e4144–e4156. https://doi.org/10.1210/clinem/dgac423

El Khoudary, S. R., Aggarwal, B., Beckie, T. M., et al. (2020). Menopause transition and cardiovascular disease risk: Implications for timing of early prevention. Circulation, 142(25), 2403–2414. https://doi.org/10.1161/CIRCULATIONAHA.120.047182

Li, X., Zhang, Y., Wang, Y., et al. (2025). Sleep quality profiles and associated factors in perimenopausal women: A community-based study. BMC Women’s Health, 25, Article 217.

Zhang, Y., Liu, H., Li, S., et al. (2023). Risk factors for sleep disorders in perimenopausal women: A systematic review and meta-analysis. Menopause, 30(9), 1021–1032.

Davis, S. R. (2024). Understanding cardiometabolic and vascular changes across the menopause transition [Paul Dudley White International Lecture].

The World Health Organisation (WHO) & UNICEF recommend: 🍒
early initiation of breastfeeding within 1 hour of birth; 🍒
exclusive breastfeeding for the first 6 months of life; 🍒 &
introduction of nutritionally-adequate & safe complementary (solid) foods at 6 months together with continued breastfeeding up to 2 years of age or beyond. 🍒

Breast Milk – contains antibodies which help protect against many common childhood illnesses. 🍒
It provides all the energy & nutrients that the infant needs for the first months of life, & it continues to provide up to half or more of a child’s nutritional needs during the second half of the first year & up to one third during the second year of life. 🍒

Benefits of breastfeeding to Mother & can help lower the risk for :- 🍒
→ Breast & ovarian cancer 🍒
→ Type 2 diabetes 🍒
→ High blood pressure 🍒

Benefits to infants – it is the best nutritional source & can help lower the risk for :- 🍒
→ Asthma 🍒
→ Obesity 🍒
→ Sever lower respiratory disease 🍒
→ Acute otitis media (ear infections) 🍒
→ Gastrointestinal infections (diarrhea/ vomiting) 🍒
→ Type 1 diabetes 🍒
→ Sudden Infant Death Syndrome (SIDS) 🍒

We must create supportive & safe environments for mothers who choose to breastfeed…. 🍒

#supportformums #everyfeedingjourney #breastfeedingsupport #everymumeverybaby #noshameinfeeding #inclusiveparenting #compassionovercomparison #maternalhealth 🍒

The World Health Organisation (WHO) & UNICEF recommend: 🍒
early initiation of breastfeeding within 1 hour of birth; 🍒
exclusive breastfeeding for the first 6 months of life; 🍒 &
introduction of nutritionally-adequate & safe complementary (solid) foods at 6 months together with continued breastfeeding up to 2 years of age or beyond. 🍒

Breast Milk – contains antibodies which help protect against many common childhood illnesses. 🍒
It provides all the energy & nutrients that the infant needs for the first months of life, & it continues to provide up to half or more of a child’s nutritional needs during the second half of the first year & up to one third during the second year of life. 🍒

Benefits of breastfeeding to Mother 🍒
Lower risk for :- 🍒
→ Breast & ovarian cancer 🍒
→ Type 2 diabetes 🍒
→ High blood pressure 🍒

Benefits to infants – it is the best nutritional source & lowers the risk for :- 🍒
→ Asthma 🍒
→ Obesity 🍒
→ Sever lower respiratory disease 🍒
→ Acute otitis media (ear infections) 🍒
→ Gastrointestinal infections (diarrhea/ vomiting) 🍒
→ Type 1 diabetes 🍒
→ Sudden Infant Death Syndrome (SIDS) 🍒

We must create supportive & safe environments for mothers who choose to breastfeed 🍒

Hormones that are responsible for milk production & maintenance 🍒

Oestrogen + Progesterone + hPL (human placental lactogen) in the placenta lead to the development of the ductal system in the breast. 🍒
Prolactin transforms mammary epithelial cells into lactocytes (milk making cells) 🍒

LACTOGENESIS I = from 12 weeks gestation/pregnant, COLOSTRUM starts to be formed 🍒
The breast = a milk-producing organ. 🍒
Oestrogen & progesterone suppress prolactin during pregnancy 🍒

Hormones that are responsible for milk production & maintenance 🍒

LACTOGENESIS II = “Milk coming in” 🍒
From birth – 48 hours postpartum 🍒
Placenta expulsion from the uterus triggers → 🍒
↓ hPL (within hours) 🍒
↓ Progesterone & oestrogen → 🍒
↑ Prolactin → copious milk secretion. 🍒
Nipple stimulation/suckling → 🍒
Prolactin ( + insulin + cortisol) = → milk synthesis 🍒
Oxytocin → ‘Let-down’ (milk ejection reflex). 🍒
Oxytocin release = pulsatile for 20-60 seconds (….. gulp, gulp, gulp….) 🍒
Prolactin levels decrease 30 minutes after a feed 🍒

Hormones that are responsible for milk production & maintenance 🍒

LACTOGENESIS III = Galactopoiesis (Supply & Demand = Autocrine control). 🍒
Removal of breast milk (by baby or breast pump) & stimulation of breasts is the primary regulator of long term milk supply. 🍒
If milk accumulates, Feedback Inhibitor of Lactation (FIL, a small whey protein produced in the breast) slows further synthesis. 🍒

Te timatanga o te reo, Kei nga waiū o te whaea 🍒
The beginning of language, is at the breast of a mother 🍒

Iron Deficiency in Female Athletes
Iron deficiency (ID) is one of the most common micronutrient deficiencies affecting female athletes,
with prevalence rates reported as high as 60% in endurance sports. Unlike the general population,
female athletes face a unique set of risk factors that increase their vulnerability to low iron stores,
even before progressing to iron deficiency anaemia (IDA).

Why Female Athletes Are at Greater Risk
The combination of menstrual blood loss (approximately 10–40 mg of iron per cycle), increased iron
turnover from high training loads, gastrointestinal blood losses, and low dietary intake or low
energy availability (LEA) puts female athletes at particular risk. Endurance training (including
altitude exposure), vegetarian/vegan diets, sweat losses, foot-strike haemolysis, and conditions like
coeliac disease or Crohn’s disease further contribute.

The Three Stages of Iron Deficiency
1. Stage 1 (Depleted Iron Stores):
Low serum ferritin (<35 µg/L) but normal haemoglobin (Hb >120g/L) and transferrin
saturation (Tsat >16%).
2. Stage 2 (Iron-Deficient Erythropoiesis):
Ferritin drops below 20 µg/L, Hb remains stable, but Tsat may begin to fall.
3. Stage 3 (Iron Deficiency Anaemia – IDA):
Both ferritin (<12 µg/L) and Hb (<120g/L) are low, impacting oxygen transport capacity and
leading to clear performance impairments.

Impact on Health and Performance
Iron plays a crucial role in oxygen transport (via haemoglobin and myoglobin) and cellular energy
production (as a cofactor in mitochondrial oxidative phosphorylation). Evidence from systematic
reviews and randomised trials shows that correcting ID improves endurance capacity, VO₂ max, and
energetic efficiency in female athletes, even before anaemia develops (Burden et al., 2015;
Dellavalle & Haas, 2014; Pengelly et al., 2024).
Common but often misattributed symptoms include:

 Fatigue

 Reduced endurance

 Frequent illness

 Mood changes

 Sleep disturbances (restless legs)

 Poor training motivation

 Jelly legs &/or light-headedness during/after exercise

Role of Hepcidin and Timing of Iron Intake
Hepcidin, a hormone regulating iron absorption, typically rises 3–6 hours after exercise, reducing
iron uptake from the gut. Hepcidin levels are higher when iron stores are sufficient and lower when
stores are depleted (ferritin <30 µg/L). To maximise absorption, athletes should take oral iron in the
morning or within 30 minutes post-training, avoiding the post-exercise hepcidin spike (McCormick
et al., 2020).

Blood Testing and Biomarkers
Assessment should include:

 Serum Ferritin (sFer)

 Haemoglobin (Hb)

 Transferrin Saturation (Tsat)

 C-reactive protein (CRP) – to identify inflammation that may falsely elevate ferritin

 Optional: Soluble transferrin receptor (sTfR) for further clarification
For accurate results:

 Test in the morning

 Athlete should be well-hydrated (urine specific gravity <1.025)

 Minimise exercise in the 24–48 hours prior

 Ensure no recent infection or illness

Nutrition and Supplementation
A ‘food first’ approach is always the starting point, focusing on both haem iron sources (meat, fish,
poultry – 5–35% absorption) and non-haem sources (wholegrains, legumes, green leafy vegetables,
fortified cereals – 2–20% absorption).
Vitamin C (50–100 mg) co-ingestion enhances absorption, while phytates, polyphenols, calcium,
and zinc inhibit it.

Oral Iron Supplementation
When dietary changes are insufficient, oral iron supplements (typically ~100 mg elemental iron per
day) are recommended for 8–12 weeks. Taking iron on an empty stomach with Vitamin C can enhance absorption but may cause gastrointestinal side effects such as nausea, constipation, and
abdominal discomfort. If poorly tolerated, strategies include:

 Alternate day dosing

 Lower doses (e.g., 60 mg/day)

 Controlled-release formulations

(McCormick et al., 2020)

Intravenous (IV) Iron
IV iron is reserved for athletes with severe IDA, poor oral tolerance, or failure of oral treatment,
and is typically coordinated with a sports physician.

Important:

 IV iron is a prohibited method under WADA (World Anti-Doping Agency) unless it meets
Therapeutic Use Exemption (TUE) criteria.

 Infusions exceeding 100 mL over 12 hours require a TUE, with full documentation and
justification (WADA, 2024).

Ongoing Monitoring
Regular blood monitoring (every 3–6 months in at-risk athletes) is essential to prevent recurrence,
assess treatment efficacy, and avoid over-supplementation, which can lead to iron overload or
oxidative stress.

Summary
If you’re a female athlete experiencing unexplained fatigue, low mood, frequent illness, or
declining performance, assessing and managing iron status could make a critical difference to both
your health and your results.

Canadian Guidelines for Physical Activity, Sedentary Behaviour & Sleep in the First Year After Birth.

(Davenport et al., 2025)

These national guidelines, developed by a panel of interdisciplinary experts, offer evidence-based recommendations to support postpartum women and people in safely engaging in physical activity, improving sleep, and reducing sedentary behaviour during the first year after childbirth.

Key Recommendations

1. Be Physically Active
   All postpartum women and people without contraindications should engage in physical activity for clinically meaningful benefits such as improved mood and reduced depressive symptoms.
   → Strong recommendation | Moderate certainty evidence
2. Medical Guidance if Needed
   Those with potential contraindications (see below) should consult a primary healthcare provider before starting or continuing moderate-to-vigorous physical activity (MVPA).
   → Conditional recommendation | Low certainty evidence
3. MVPA Goal
   Aim to accumulate at least 120 minutes of MVPA weekly, spread over 4+ days, including aerobic and resistance training.
   → Strong recommendation | Moderate certainty evidence
4. Pelvic Floor Muscle Training (PFMT)
   Practice daily PFMT to support pelvic recovery and reduce urinary incontinence. Seek instruction from a pelvic floor physiotherapist for best results.
   → Strong recommendation | High certainty evidence
5. Early Return to Activity
   Returning to MVPA within the first 12 weeks postpartum supports mental health.
   → Strong recommendation | Moderate certainty evidence
6. Light Activity Before MVPA
   Start with light-intensity movement (e.g. gentle walking, PFMT) and gradually increase to MVPA once healing allows and lochia (vaginal bleeding) does not worsen.
   → Conditional recommendation | Low certainty evidence
7. Individualised Progression
   Follow a symptom-based, gradual progression toward 120+ minutes/week of MVPA.
   → Conditional recommendation | Low certainty evidence
8. Sleep Hygiene
   Adopt healthy sleep habits (e.g. limit screens, keep the bedroom dark and quiet) to improve maternal mental health and recovery.
   → Strong recommendation | Moderate certainty evidence
9. Reduce Sedentary Time
   Limit sedentary time to <8 hours/day, with ≤3 hours of recreational screen time, and break up long sitting periods.
   → Conditional recommendation | Very low certainty evidence

 

Relative Contraindications to MVPA Postpartum

Medical advice is recommended if any of the following are present:

• Severe abdominal or incision pain
• Heavy or unexplained vaginal bleeding
• Postpartum cardiomyopathy
• High blood pressure (>140/90 mmHg)
• Malnutrition or eating disorders
• Deep vein thrombosis symptoms
• Neurological symptoms (e.g. muscle weakness, ataxia)
• Chest pain, shortness of breath, or heart-related symptoms
• Acute infection with fever
• Musculoskeletal injuries or fractures
• Excessive fatigue or signs of low energy availability
• Kidney disease
• Other serious or unstable medical conditions

Helpful Tool: Get Active Questionnaire for Postpartum

Created by the Canadian Society for Exercise Physiology (CSEP), this self-screening tool helps identify whether medical advice is needed before beginning MVPA postpartum.

Get Active Questionnaire for Postpartum 

 

Safety Tips for MVPA in the First Year Postpartum

• Avoid rapid return to MVPA if experiencing pain, bleeding, or mental health challenges.
• Ensure adequate nutrition, hydration, and rest, especially while lactating.
• Prioritise quality sleep to support physical and emotional recovery.
• Seek and maintain social, family, and emotional support.