In this article:
This blog will tell you what Sheehan’s syndrome is, why it is essential to your reproductive health, what symptoms to look out for, and how you can treat it, more so, before you conceive again.
What Is Sheehan’s Syndrome?
Sheehan’s syndrome occurs when severe bleeding during or soon after labour cuts off blood flow to your pituitary gland, a small gland located at the bottom of your brain, but it has significant effects. This gland regulates many hormones, including those that cause menstruation and ovulation, thyroid function, and how you respond to stress.Your pituitary gland may be affected, resulting in inadequate secretion of these hormones. The effects are often not immediate. It may take days, weeks, months, or even years after giving birth before you realise it, but gradually, your body starts to suffer, and so do your reproductive organs.
Why Does It Affect Fertility?
Your pituitary gland releases specific hormones that guide your ovaries:- FSH (Follicle Stimulating Hormone)
- LH (Luteinising Hormone)
- Prolactin
When those hormones are low because of pituitary damage:
- Your periods may stop or become irregular.
- You might not ovulate.
- Your thyroid and adrenal systems may be affected, potentially further impacting your fertility.
Signs and Symptoms to Watch For
Most of the symptoms of Sheehan’s syndrome may be non-obvious and emerge over time. You can experience some of the following:- No periods or irregular cycles after childbirth.
- Difficulty producing breast milk or stopping unexpectedly.
- Lethargy, low energy, and fatigue.
- Low blood pressure, primarily upon standing.
- Weight changes, cold intolerance.
- Low libido.
- Low stress tolerance and signs of adrenal insufficiency.
How Is Sheehan’s Syndrome Diagnosed?
In case you are suspected of having postpartum hypopituitarism, your doctor will most likely:- Take a detailed childbirth history, focusing on the volume of bleeding and any transfusions.
- Check hormone levels: FSH, LH, thyroid hormones (TSH, Free T4), cortisol, and others.
- Perform stimulation or dynamic tests, such as ACTH stimulation, to assess adrenal function.
- Have an MRI scan of your pituitary gland, which can reveal damage or shrinkage of the gland.
How Is Sheehan’s Syndrome Treated?
The treatment of Sheehan’s syndrome aims to supplement the hormones that your body is no longer able to produce in sufficient amounts. These hormones are essential to your general health and reproductive well-being. Treatment usually involves:- Cortisol (Hydrocortisone): Supports your adrenal glands and helps your body respond to stressful situations. It is usually the initial hormone to be replaced, particularly when adrenal insufficiency exists.
- Thyroid hormone (Levothyroxine): Thyroid hormone deficiency is often caused by damage to the pituitary gland. This helps regulate metabolism, energy levels, and menstrual health.
- Oestrogen and Progesterone Replacement: Often given cyclically to help resume your menstrual periods, maintain uterine health, and prepare your body for potential pregnancy.
- FSH/LH or Ovulation Induction Therapy: When you are trying to get pregnant, your doctor can prescribe you drugs to induce ovulation because your body might not be able to produce these hormones on its own.
Who Should Be on the Lookout?
You should consider an evaluation after heavy postpartum bleeding or transfusion:- You’ve had missing or irregular menstruation.
- You experienced poor milk production or lactation failure.
- You may notice persistent fatigue, low blood pressure, or symptoms associated with low levels of thyroid or adrenal hormones.
- You are trying to conceive, and nothing else explains the menstrual loss.
Long-Term Considerations
Sheehan’s syndrome is chronic: hormone replacement continues for life unless pituitary function recovers partially (rarely). You’ll need to:- Visit your endocrinologist regularly for blood tests and dose adjustments as needed.
- Monitor fertility readiness, ideally with FSH/LH tests and ovulation tracking.
- Be vigilant in pregnancy, adjusting hormone doses under close medical supervision.
- Stay supported postpartum, as your pituitary function is crucial again if you plan future pregnancies.
When to Consult a Specialist
If you suspect Sheehan’s syndrome or are struggling with delayed fertility after postpartum haemorrhage, knowing whom to approach can make all the difference. It’s wise to speak with:- Your obstetrician, especially if your symptoms began shortly after childbirth. They can review your delivery history and guide initial hormone evaluations.
- An endocrinologist will perform detailed testing of your hormone levels and assess pituitary gland function through blood work and imaging.
- A fertility specialist when you're ready to start trying for a baby. They can help manage ovulation induction, monitor cycle regularity, and support conception efforts in coordination with your hormone therapy.
Collaborating with these specialists ensures that you address both hormone replacement and assisted conception, giving you the best possible chance at a healthy pregnancy.
How You Can Prepare for the Conversation
If you suspect Sheehan’s syndrome:- Track your symptoms: cycles, energy, temperature, libido
- Note childbirth details: blood loss, transfusions, pituitary impact.
- Request specific hormone tests: FSH, LH, TSH, cortisol.
- Ask about imaging: an MRI scan of your pituitary gland.
While Sheehan’s syndrome is rare, its delayed effects can significantly affect your fertility long after you’ve recovered from childbirth. Recognising symptoms like absent periods, low energy, difficulty breastfeeding, and hormonal imbalance can lead to timely testing and diagnosis.
If Sheehan’s syndrome is confirmed, hormone replacement and fertility planning can resume, giving you real chances to conceive and grow your family. With proper care, many women return to fertility, have healthy pregnancies, and get back to feeling like themselves again.
FAQs On Sheehan’s Syndrome: Recognising Delayed Fertility Impact After Postpartum Haemorrhage
- Can Sheehan’s syndrome be cured?
No, it's a lifelong condition that requires ongoing hormone replacement. However, with treatment, many women regain fertility and carry pregnancies successfully. - How soon after childbirth does Sheehan’s syndrome appear?
Symptoms can appear instantly or gradually over months to even years. However, it is very common in breastfeeding women to not have their periods 6–12 months postpartum. - Can you get pregnant on hormone replacement?
Yes! With proper oestrogen/progesterone dosing and ovulation induction (when trying), many women conceive despite having Sheehan’s syndrome.
