After having your baby, you may be back to thinking about your options for contraception. An increasingly common method is the Lactational Amenorrhoea Method (LAM) which refers to using breastfeeding as a form of contraception in the 6 months following birth.

The LAM method was developed following the observation that, in the absence of breastfeeding, ovulation may occur as early as 3 weeks following birth. 

What are the benefits of using breastfeeding as contraception?

• Decreased blood loss in the days following childbirth

• Uterus recovers to its normal size quicker

• Reduces risk of infection to baby and provides most beneficial nutrition

• Reduces hormonal impact of oral contraceptives which can decrease milk supply as well as cause weight gain and mood changes.

How does breastfeeding as contraception work?

In order for the body to produce breastmilk, hormones play a crucial role – oestrogen and prolactin are major components. When exclusively breastfeeding, oestrogen levels are reduced, and prolactin levels are increased. This increase in prolactin suppresses GnRH, (Gonadrotrophin releasing hormone) which is the follicule-stimulating hormone involved with ovulation. If GnRH is supressed, ovulation will be delayed.

When breast stimulation decreases, supplements are introduced or baby commences solid foods – normal menstrual cycles may resume and fertility can return. This is why in order for this form of contraception  to be effective, you must be exclusively breastfeeding.

Important points to consider when using breastfeeding as contraception:

• Have your periods started returning while breastfeeding? (Blood loss 2+ consecutive days)
• Is this bleeding occurring >8 weeks following birth?
• Are you giving baby any supplementary foods/fluids in addition to breastfeeding?
• Is baby older than 6 months of age?

Many women and healthcare providers often believe the breastfeeding is  not as effective as alternative contraception options.

However, when exclusively breastfeeding and adhering to the criteria perfectly, LAM can be more effective than the Progestin-only pill, at 98% effectiveness. The only other contraceptive methods considered more effective being Intra-uterine devices and surgical sterilisation.

 Written by Keryn Thompson, RM & IBCLC (L-301766)

References

Labbok, M., 2015. Postpartum Sexuality and the Lactational Amenorrhea Method for Contraception. Clinical Obstetrics & Gynecology, 58(4), pp.915-927.

Romero-Gutiérrez, G., Vaca-Ortiz, N., Ponce-Ponce de León, A. and López-Martínez, M., 2007. Actual use of the lactational amenorrhoea method. The European Journal of Contraception & Reproductive Health Care, 12(4), pp.340-344.

Starbird, E., Norton, M. and Marcus, R., 2016. Investing in Family Planning: Key to Achieving the Sustainable Development Goals. Global Health: Science and Practice, 4(2), pp.191-210.

Tiwari, K., Khanam, I. and Savarna, N., 2018. A study on effectiveness of lactational amenorrhea as a method of contraception. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 7(10), p.3946.

Van der Wijden, C. and Manion, C., 2015. Lactational amenorrhoea method for family planning. Cochrane Database of Systematic Reviews,.

Van der Wijden, C., Brown, J. and Kleijnen, J., 2010. Lactational amenorrhea for family planning. Cochrane Database of Systematic Reviews,.

Vekemans, M., 2014. Postpartum contraception: The lactational amenorrhea method. The European Journal of Contraception & Reproductive Health Care, 2(2), pp.105-111.