What should have settled

Bleeding. The NHS says postnatal bleeding "usually stops after 6 to 8 weeks, but it can last longer." At six months, bleeding is either a period or something to get checked.
Wound and stitch pain. Perineal or caesarean pain still present at six months is not part of the expected course.
Afterpains. The HSE says these cramps "should go away after a few days."
Night sweats. These usually taper over weeks to a few months.

None of that means something is wrong if one item is lingering. It means the item has moved from "expected" to "worth mentioning."

What legitimately has not settled yet

Periods, if you are breastfeeding. Absent periods at six months while feeding is common, not a problem in itself.
Hair. Shedding often continues into the second half of the year, and regrowth appears as short new hairs around the hairline before the density returns.
Vaginal dryness. The HSE says oestrogen levels "usually return to normal when you stop breastfeeding and your periods return."
Abdominal shape and core strength. Separation of the abdominal muscles takes months to improve and responds to specific rehabilitation rather than time alone.
Sleep. Six-month sleep is highly variable and is not a measure of anything.
Feeling like yourself. There is no published timeline for this, and nobody should give you one.

The four things not to keep waiting out

Leaking urine, wind or stool. The HSE's threshold was six weeks: contact your GP, public health nurse or physiotherapist "if your symptoms do not improve in the 6 weeks after the birth." At six months, this needs referral, not more time. NICE NG210 on pelvic floor dysfunction puts supervised pelvic floor muscle training with a specialist physiotherapist at the front of treatment, and POGP is clear that these symptoms "are not normal and should not be 'put up with' in silence." The NHS 6-week check page names it too, telling you to tell your doctor if "you're having trouble with farting or holding in your pee, or you're soiling yourself with poo."

A bulge, heaviness or dragging feeling. Prolapse symptoms that are still present at six months are not going to resolve by waiting. Physiotherapy, pessaries and, less often, surgery are all options, and the first referral should be to a pelvic health physiotherapist.

Pain during sex. The NHS lists "having sex is painful" among the things to tell your doctor. Scar tissue, pelvic floor overactivity and low oestrogen all have treatments, and none of them improve by persevering through the pain.

Low mood, anxiety or flashbacks. NICE CG192 defines the postnatal period for mental health purposes as the first year after birth, and its case-finding questions apply just as much now: "During the past month, have you often been bothered by feeling down, depressed or hopeless?" Symptoms of post-traumatic stress from the birth can surface at six months or later — the NHS notes PTSD symptoms may appear "straight after the traumatic event or many months, or even years, later."

The things that get missed at six months

Iron. Nobody rechecks it. If you were anaemic after the birth and were told to take iron for around six months, this is roughly when that course ends — and a repeat blood test is what tells you whether it worked.

Thyroid. Postnatal thyroid problems can appear months after birth and are easily mistaken for ordinary exhaustion or anxiety. A blood test settles it.

Cervical screening. If yours was deferred, the NHS says that if you were due for cervical screening while pregnant, "this should be rescheduled for 12 weeks after the birth." At six months, check it has actually been done rather than assuming an invitation will arrive.

Vaccinations. The NHS tells you to raise it at your postnatal check if "you're not sure you've had all of the current recommended adult vaccines, such as the MMR vaccine or COVID-19 vaccine." If that never happened, it can happen now.

Contraception. NICE NG194 lists contraception among the topics for postnatal discussion. If the plan was "we'll sort it later," later has arrived.

Returning to exercise properly

Six months is often when people decide to get serious about running or classes again. Doing that while leaking, or with prolapse symptoms, or with unresolved pelvic pain, is the route to a longer problem. Get assessed first. NICE NG210 and NG123 both put supervised pelvic floor training ahead of other interventions, and a pelvic health physiotherapist can tell you what your pelvic floor is actually doing rather than what it should be doing by now.

Why six months is a useful marker

Not because anything switches off, but because the pattern of what happens next is fairly predictable. Problems that are steadily improving at six months usually keep improving. Problems that have been static since the eight-week mark — the same leak, the same bulge, the same pain on the same movement — have generally stopped resolving on their own, and will keep being static until something is actively done. That distinction, improving versus static, is more useful than any date, and it is the one to bring to a GP appointment.

How to ask for help this far out

The obstacle is usually the feeling that you have missed your window. There is no window. Book an ordinary GP appointment, describe the symptom in plain terms with the timeframe attached, and ask for the specific thing you want: a referral to pelvic health physiotherapy, blood tests including ferritin and thyroid function, a referral to perinatal mental health, or an examination for prolapse or scar pain.

NICE NG194 requires that "All healthcare professionals should ensure appropriate referral if there are concerns about the woman's health." That obligation does not expire at eight weeks, and neither does your recovery.

6 Months Postpartum