The relationship of exclusive breastfeeding with the return of menstrual time in mothers who have babies aged 6 -12 months in the work area of Pekik Nyaring Puskesmas, Bengkulu Central District

Background: Exclusive breastfeeding means giving only breast milk to babies from 30 minutes after birth (after birth) until the age of 6 months, without additional fluids, such as formula milk, fruit juices, water, honey, tea water and solid complementary foods such as fruit, biscuits, milk porridge. , rice porridge and team rice. Mothers who breastfeed exclusively, in principle, will get menstruation longer than those who do not exclusively breastfeed their babies.


INTRODUCTION
Objectives: The purpose of this study was to determine the relationship between exclusive breastfeeding and the duration of the return of menstruation in mothers who have babies aged [6][7][8][9][10][11][12]  Exclusive breastfeeding means giving only breast milk to babies from 30 minutes after birth (after birth) until the age of 6 months, without additional fluids such as formula milk, fruit juices, water, honey, tea water and solid additives such as fruit, biscuits, milk porridge, rice porridge and team rice (1). Exclusive breastfeeding brings many benefits, both for the mother and for the baby. Through breast milk, babies will get optimal nutrition and antibodies for their immune system.
B r e a s t f e e d i n g c a n a l s o i m p r o v e t h e psychological relationship between mother and baby (2). Breastfeeding can also reduce fertility after delivery.
In principle, women who breastfeed exclusively will get menstruation longer than those who do not exclusively breastfeed their babies (3). Giving MP-ASI early will speed up menstruation, because breastfeeding will delay ovulation so that the occurrence of postpartum menstruation is delayed (4).
Menstruation is an early sign of a woman's fertile period. At this time a woman's ovaries are able to produce eggs, so it can be said that the woman is of reproductive age.
Meanwhile, in women who have just given birth, women will experience a setback. This Hormone) to be limited. (11). These two hormones are hormones that are used for the growth of egg cells in the ovaries, so that if the level of the hormone prolactin in the body is high, ovulation will not occur so it will be difficult for a pregnancy to occur.
Prolactin is involved in alveolar lactation. The release of prolactin is also stimulated by the emptying of milk from the lactiferous sinuses, so that more milk is released from the breast, which increases milk production (3). Conversely, if the baby rarely breastfeeds or stops breastfeeding, milk production will decrease (12). Therefore, the MAL method can only be used if the mother is exclusively breastfeeding. Prolactin relies heavily on emptying the breasts to continue producing milk, and mothers need to use proper breastfeeding management (13).  The data analysis method used in this study is chi square analysis using the SPSS statistical program.

Characteristics of Respondents, Exclusive
Breastfeeding     Table 3).

The relationship between the frequency of breastfeeding for mothers with babies 6-12 and the duration of the return of menstruation
Based on   The results showed that mothers who gave exclusive breastfeeding had a 3.09-fold DISCUSSION tendency to return to menstruation for more than six months than those who did not give exclusive breastfeeding. This is in line with the opinion of (4) that mothers who are not  (9) that there is a relationship between exclusive breastfeeding and the return of menstruation in breastfeeding mothers. Another study that is also in line with this study is a study conducted by (8) which stated that there was a relationship between exclusive breastfeeding and the return of menstruation.
Exclusive breastfeeding will affect the time of the first menstruation for breastfeeding mothers (15). Mothers who give breast milk directly to their babies will experience longer m e n s t r u a t i o n o r r e t u r n t o n o r m a l menstruation, this is because when the mother breastfeeds on the mother's breast it will stimulate nipples (16). This stimulus will send a message to the hypothalamus, after receiving the message, the hypothalamus will stimulate the pituitary gland to secrete the hormone prolactin (17). This prolactin hormone will suppress the ovaries to stimulate the formation of estrogen, so that mothers who give exclusive breastfeeding will tend to have longer periods or return to normal (5). MAL uses the anovulatory effect caused by breastfeeding. The process of breastfeeding as a method of family planning (4). Exclusive breastfeeding is a temporary method of contraception that is quite effective, as long as the mother has not had her period, the time is less than six months after delivery (3).
Based on Table 4.2, as many as 27.7% of mothers who gave exclusive breastfeeding experienced the return of menstruation in less than six months and a small proportion (14.3%) of mothers who did not give exclusive breastfeeding had their menstruation return for more than six months. This is because there are other factors that affect maternal fertility after giving birth, such as nutritional status, malnourished mothers tend to have longer amenorrhea. Prolactin is a hormone that regulates milk production. During breastfeeding, the activity of this hormone will increase as a result, the ovulation period will be delayed so that breastfeeding mothers usually will not get their period immediately after giving birth. Psychological problems such as mothers who suffer from depression after giving birth such as baby blues and stress (18). The more often the baby suckles at the mother's breast, the more milk production and expenditure will be. It is recommended to breastfeed at least eight times per day in the early postpartum period (2). The frequency of breastfeeding is related to the ability to stimulate hormones in the breast glands (3).
Mothers who breastfeed effectively, will experience hormonal changes that were originally high in estrogen and progesterone, after giving birth will experience a decrease, coupled with the presence of baby sucking which stimulates the nipples and sometimes the breasts hit the sensory nerve endings that function as mechanical receptors (19).
Stimulation is continued to the hypothalamus which will suppress the release of factors that inhibit prolactin, this condition will affect the return of menstruation (20).

CONCLUSION AND RECOMMENDATION
The characteristics of the respondents are mostly under 35 years old with the highest level of education being high school graduates. Most of the respondents work as housewives.