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In the modern high\u2010producing dairy cow, this transition is challenged by profound metabolic, endocrine, immunological, and structural demands that collectively influence uterine health, ovarian function, and subsequent reproductive performance. This review examines current understanding of the physiology of the puerperium in dairy cattle, with particular emphasis on uterine involution, immune clearance of postpartum contamination, endocrine regulation, and resumption of ovarian cyclicity. Further, it contrasts high\u2010yielding Holsteins with fertility selected dairy populations. Normal uterine involution involves coordinated myometrial contraction, tissue remodelling, endometrial regeneration, and tightly regulated inflammatory responses. Failure of these processes predisposes cows to postpartum uterine disorders, including retained fetal membranes, metritis, endometritis (purulent vaginal discharge with cytological confirmation), and pyometra, which remain major contributors to subfertility and economic loss. Central to the pathophysiology of puerperal disease is negative energy balance, which disrupts immune competence, alters hepatic steroid metabolism, impairs ovarian signalling, and compromises oocyte and embryo quality. Emerging evidence highlights the complex interplay between metabolism, immunity, and the uterine microbiome, shifting current perspectives away from pathogen\u2010centric models toward host resilience. Advances in biomarkers, genomic selection, and precision monitoring offer new opportunities for targeted reproductive management. Ultimately, optimisation of transition period management remains the cornerstone of supporting physiological puerperal recovery and sustaining reproductive efficiency in modern dairy systems.<\/jats:p>","DOI":"10.1111\/rda.70303","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T02:52:05Z","timestamp":1788403925000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Puerperium in the Modern Dairy Cow: A Review"],"prefix":"10.1111","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7420-4856","authenticated-orcid":false,"given":"Michael J.","family":"Morris","sequence":"first","affiliation":[{"name":"Department of Clinical Veterinary Sciences, School of Veterinary Medicine, Faculty of Medical Sciences The University of the West Indies  St. Augustine Trinidad and Tobago"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristen C.","family":"Jaggernath","sequence":"additional","affiliation":[{"name":"Department of Clinical Veterinary Sciences, School of Veterinary Medicine, Faculty of Medical Sciences The University of the West Indies  St. Augustine Trinidad and Tobago"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1974-1816","authenticated-orcid":false,"given":"Adam D.","family":"Martin","sequence":"additional","affiliation":[{"name":"Production Animal Clinic, Department of Production Animal Clinical Sciences, Faculty of Veterinary Medicine Norwegian University of Life Sciences  \u00c5s Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2803-6482","authenticated-orcid":false,"given":"Reshmi S.","family":"Ramdass","sequence":"additional","affiliation":[{"name":"Department of Clinical Veterinary Sciences, School of Veterinary Medicine, Faculty of Medical Sciences The University of the West Indies  St. Augustine Trinidad and Tobago"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,2]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.3390\/ani15172520"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/rda.14410"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.3168\/jds.S0022\u20100302(03)73866\u20101"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.theriogenology.2007.12.005"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/vr.165.21.623"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s42523\u2010023\u201000281\u20105"},{"key":"e_1_2_8_8_1","first-page":"411","article-title":"Effects of Energy Balance on Follicular Development and First Ovulation in Postpartum Dairy Cows","volume":"54","author":"Beam S. 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