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Following childbirth, the biological process of breastfeeding triggers a temporary state of natural infertility known as lactational amenorrhea. It occurs due to the hormonal changes associated with breastfeeding, which suppress ovulation, delaying the return of menstruation. The term amenorrhea refers to the absence of menstruation, and in this context, it is directly connected to lactation.
A popular belief around lactational amenorrhea is that when you’re breastfeeding, and with the absence of ovulation, you won’t get pregnant. However, its effectiveness as a contraceptive method can vary based on several factors, including the frequency and exclusivity of breastfeeding. Read on to have a comprehensive knowledge of what lactational amenorrhea is all about and how it impacts your health and postpartum recovery.
The lactational amenorrhea method (LAM)(1) is grounded in the interaction between breastfeeding and the endocrine system. When you breastfeed, your body produces high levels of prolactin, which not only facilitates milk production but also inhibits the secretion of gonadotropin-releasing hormone (GnRH). This suppression prevents the pituitary gland from releasing luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which are essential for ovulation.
The absence of ovulation is what leads to the absence of menstruation, thus causing amenorrhea. The effectiveness of this natural birth control method is most potent during the first six months postpartum, especially if breastfeeding is exclusive and on-demand. In short, the baby is fed whenever hungry, and no other foods or liquids are introduced.
LAM is often hailed as a natural form of contraception based on the relationship between breastfeeding and fertility suppression. However, awareness of how it works falls short among many women. A study explored perceptions of the LAM among first-time pregnant women(2) in the U.S., highlighting that despite LAM being a highly effective postpartum contraceptive when used correctly, it appears to be underutilized, potentially due to insufficient counseling.
Pro Tip: To better understand and track your lactational amenorrhea, consider discussing a prolactin test with your healthcare provider. Monitoring your prolactin levels can provide valuable insights into the continuation of this natural method and help you make informed decisions about family planning.
Despite its natural basis, lactational amenorrhea is influenced by various factors. These include the frequency and duration of breastfeeding sessions, the time between feedings, and the mother’s overall health and nutritional status. Understanding these nuances can help women decide if this method is ideal for their family planning strategy.
One of the primary factors is the exclusivity of breastfeeding(3). Exclusive breastfeeding, where the infant receives only breast milk without supplementation, tends to prolong amenorrhea compared to mixed feeding practices.
If a mother stops exclusive breastfeeding, introduces formula or solids, or reduces the frequency and duration of feeds, the hormonal signals that suppress ovulation begin to change. The decrease in suckling results in a decline in prolactin levels and the inhibition of ovulation.
As prolactin levels fall and the hormonal balance shifts, the normal menstrual cycle gradually resumes. This means that the mother’s ovaries will start releasing eggs again, and menstruation will return, signifying a return to fertility. The natural contraceptive effect associated with lactational amenorrhea is lost, and the risk of pregnancy increases.
The frequency of breastfeeding also plays a crucial role. Frequent nursing sessions, especially night feedings, maintain high prolactin levels, thus delaying the return of menstruation.
On the other hand, as the intervals between feedings lengthen, such as when a baby sleeps for longer stretches or feedings become less frequent during the day, prolactin levels tend to drop. This decrease allows for the gradual resumption of pulsatile GnRH release, which then permits FSH and LH to stimulate the ovaries. This activity can potentially lead to follicle maturation, ovulation, and the return of menstrual cycles sooner.
Individual differences such as maternal age, health status, and nutritional intake can impact the duration of lactational amenorrhea. Women with higher body mass indices (BMIs) or those who experience stress or illness may see variations in the effectiveness of this natural birth control method. Even genetics can influence the hormonal environment and the timing of fertility return.
A higher BMI can be associated with altered hormonal profiles that may influence the timing of ovulation return. Research on the direct impact of higher BMI (4), specifically on LAM failure, is not entirely conclusive.
However, some studies present conflicting findings regarding contraceptive effectiveness in this group, with some evidence suggesting that maternal nutritional status(5), including lower BMI, might be linked to a prolonged period of amenorrhea. This implies that higher BMI could potentially be associated with an earlier return of fertility for some women using LAM.
Similarly, stress and illness can significantly impact a mother’s ability to maintain the consistent and frequent breastfeeding required for LAM to be effective. Psychological distress(6), in particular, has been shown to potentially interfere with the hormones necessary for milk production and let-down, such as oxytocin.
If stress or illness leads to a decrease in breastfeeding frequency or duration, or necessitates supplementation, it weakens the suckling stimulus that is crucial for suppressing ovulation. Additionally, systemic illness can directly affect a woman’s overall hormonal milieu, potentially triggering the resumption of her menstrual cycle and thus compromising LAM’s contraceptive protection sooner than expected.
The duration of lactational amenorrhea varies widely among women. Generally, it can last anywhere from a few months to over a year, depending on breastfeeding practices and individual physiological factors. The most reliable period for lactational amenorrhea is during the first six months postpartum, provided breastfeeding is exclusive and on-demand.
After six months, as complementary foods are introduced, the likelihood of ovulation increases. It’s not uncommon for menstruation to return before weaning is complete. However, some women may continue to experience amenorrhea until they fully wean their child, especially if breastfeeding remains frequent and prolonged.
To effectively use lactational amenorrhea as a contraceptive method, it’s important to adhere to the guidelines of exclusive breastfeeding and to be aware of the signs indicating the return of fertility. Keeping track of your menstrual cycle and any changes in breastfeeding patterns can help you anticipate when menstruation might resume.
Several myths and misconceptions surround lactational amenorrhea, leading to confusion and unintended pregnancies. A common myth is that any form of breastfeeding will prevent pregnancy, which is not true. Only exclusive and frequent breastfeeding can effectively suppress ovulation.
Another misconception is that lactational amenorrhea provides complete protection against pregnancy for as long as breastfeeding continues. In reality, as the baby grows and breastfeeding patterns change, the likelihood of ovulation and menstruation returning increases, even if breastfeeding continues.
It’s also mistakenly believed that once menstruation resumes, breastfeeding is less beneficial. However, breastfeeding continues to provide nutritional and emotional benefits for the baby, irrespective of the mother’s menstrual cycle. Dispelling these myths is essential for making informed decisions about your reproductive health.
Also Read: 8 Causes of Amenorrhea Among Young Women
While lactational amenorrhea is a natural and generally safe process, there are instances when seeking medical advice is advisable. If you experience prolonged amenorrhea beyond the expected timeframe without breastfeeding, it may indicate underlying health issues that need to be addressed.
Consult a healthcare professional if you are unsure about the effectiveness of lactational amenorrhea as a contraceptive method, especially if your breastfeeding practices do not align with the criteria for LAM. A healthcare provider can offer guidance on alternative birth control methods that suit your lifestyle and health needs.
Additionally, suppose you experience any unusual symptoms such as excessive bleeding or severe discomfort during lactational amenorrhea. In that case, it’s essential to seek medical advice to rule out any complications through blood tests for female hormones and other procedures. Regular check-ups and open communication with your healthcare provider can ensure your postpartum health and well-being.
While the lactational amenorrhea method (LAM) is a natural form of contraception that can be highly effective, it is not a guarantee against pregnancy. Its effectiveness relies on specific conditions being strictly met.
The lactational amenorrhea contraception or birth control is a temporary family planning method that requires three conditions to be met simultaneously for it to be effective. First, your menstrual period must not have returned since giving birth. Second, you must be wholly or nearly fully breastfeeding your baby on demand, day and night, with no long intervals between feeds. The third necessary condition is that your infant remains under six months of age.
Pregnancy can be detected while breastfeeding using a standard home pregnancy test, which measures the presence of human chorionic gonadotropin (hCG) in urine. Although breastfeeding can delay the return of menstruation, other early pregnancy symptoms like nausea, fatigue, or breast changes might still occur. They could be subtle or attributed to postpartum recovery or lactation.
Lactational amenorrhea is a valuable tool for postpartum family planning, but it’s not without its nuances. Remember that while lactational amenorrhea can be effective, it requires strict adherence to exclusive and frequent breastfeeding practices. For personalized advice and to address any concerns, consult with healthcare professionals who can provide guidance tailored to your individual needs.
1 Grandi, G., Del Savio, M. C., Tassi, A., & Facchinetti, F. (2023). Postpartum contraception: A matter of guidelines. International Journal of Gynecology & Obstetrics, 164(1), 56-65. https://doi.org/10.1002/ijgo.14928
2 Hoyt-Austin A, Chen MJ, Iwuagwu C, Brown SD, Fix M, Kair LR, Schwarz EB. Understanding of Lactational Amenorrhea As a Contraceptive Method Among U.S. Pregnant Women. Breastfeed Med. 2023 Aug;18(8):621-625. doi: 10.1089/bfm.2023.0105. Epub 2023 Aug 7. PMID: 37578450; PMCID: PMC10460681.
3 Ventura, L. M., White, M., Strasser, R., & Beatty, K. E. (2025). Exploration of the Intersection between Infant Feeding and Postpartum Contraception in Western North Carolina: Perspectives of Postpartum Individuals and Providers. Southern Medical Journal, 118(3), 189. https://doi.org/10.14423/SMJ.0000000000001798
4 Chen, L., Lu, Y., Zhou, F., Wang, Y., Zhan, F., Zhao, T., Wang, L., Zhang, F., Chen, H., & Li, X. (2023). The effects of weight loss-related amenorrhea on women’s health and the therapeutic approaches: A narrative review. Annals of Translational Medicine, 11(2), 132. https://doi.org/10.21037/atm-22-6366
5 Hong, J., Chang, J. Y., & Oh, S. (2023). The Current Status of Prolonged Breastfeeding and Its Related Factors in Korean Infants and Their Mothers: A Nationwide Cross-Sectional Study. Journal of Korean Medical Science, 38(33), e261. https://doi.org/10.3346/jkms.2023.38.e261
6 Ramya, S., Poornima, P., Jananisri, A., Geofferina, I. P., Bavyataa, V., Divya, M., Priyanga, P., Vadivukarasi, J., Sujitha, S., Elamathi, S., Anand, A. V., & Balamuralikrishnan, B. (2023). Role of Hormones and the Potential Impact of Multiple Stresses on Infertility. Stresses, 3(2), 454-474. https://doi.org/10.3390/stresses3020033
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