Lactational amenorrhea

Lactational amenorrhea
An infant breastfeeding
Background
Birth control type	Behavioral
First use	Prehistory; Ecological method 1971
Failure rates (First six months postpartum)
Perfect use	<2%
Typical use	?
Usage
Duration effect	Up to 6 months (longer in some cases, with greater failure rate)
Reversibility	Yes
User reminders	Adherence to protocols
Clinic review	None
Advantages and disadvantages
STD protection	No
Periods	Absent
Benefits	No external drugs or clinic visits required

Lactational amenorrhea is the temporary postnatal infertility that occurs when a woman is amenorrheic (not menstruating) and fully breastfeeding.

Breastfeeding infertility

For women who meet the criteria (listed below), LAM is >98% effective during the first six months postpartum.

• Breastfeeding must be the infant’s only (or almost only) source of nutrition. Feeding formula, pumping instead of nursing, and feeding solids all reduce the effectiveness of LAM.
• The infant must breastfeed at least every four hours during the day and at least every six hours at night.
• The infant must be less than six months old.
• The mother must not have had a period after 56 days post-partum (when determining fertility, bleeding prior to 56 days post-partum can be ignored).

If not combined with barrier contraceptives, spermicides, hormonal contraceptives, or intrauterine devices, lactational amenorrhea method (LAM) may be considered natural family planning by the Roman Catholic Church.

Return of fertility

Return of menstruation following childbirth varies widely among individuals. A strong relationship has been observed between the amount of suckling and the contraceptive effect, such that the combination of feeding on demand rather than on a schedule and feeding only breast milk rather than supplementing the diet with other foods will greatly extend the period of effective contraception. The closer a woman's behavior is to the Seven Standards of ecological breastfeeding, the later (on average) her cycles will return. Average return of menses for women following all seven criteria is 14 months after childbirth, with some reports being as soon as 2 months while others are as late as 42 months. Couples who desire spacing of 18 to 30 months between children can often achieve this through breastfeeding alone.

Although the first post-partum cycle is sometimes anovulatory (reducing the likelihood of becoming pregnant again before having a post-partum period), subsequent cycles are almost always ovulatory and therefore must be considered fertile. However, some women find that breastfeeding interferes with fertility even after ovulation has resumed. Luteal phases being too short to sustain pregnancy is a common example.

Further reading

• Kippley, Sheila. The Seven Standards of Ecological Breastfeeding: The Frequency Factor, 2008.