Lactational Amenorrhea: Frequently Asked

What is Lactational Amenorrhea?

Lactational amenorrhea is the natural infertility which occurs through breastfeeding.

Is LAM effective in postponing pregnancy?

Yes.  According to the Bellagio Conference, LAM is 99% effective during the first 6 months postpartum.

But I know someone who got pregnant while breastfeeding!

In order to best guarantee a long period of lactational amenorrhea, certain criteria must be met.  Was your friend using bottles or pacifiers?  Giving any supplements of water, formula or juice?  Did they spend time away from their baby?  These things can cause lactational amenorrhea to cease sooner.  Often not nursing frequently at night can cause lactational amenorrhea to cease sooner, even if you are exclusively breastfeeding.

For most women, lactational amenorrhea will be effective to prevent pregnancy for six months, or until food or supplements are given.  Then once you begin to feed your child food, then you should start charting your fertility signals, in order to look for the return of fertility.

What do I need to do to use LAM to postpone pregnancy?

Lactational amenorrhea is different for every woman.  Some women need more stimulation than others to maintain it. These are effective means: 

Breastfeeding exclusively - This means feeding the baby no formula, water, fruit juice, or food for at least the first six months
Pacifying the child at the breast, and not using pacifiers or bottles
Breastfeeding often
Sleeping with your child (or nursing frequently at night)
Not being away from your child for more than 3 hours
Taking a daily nap with your child
I did all those things, but I still got my period back early.  Why is that?

Well, first, have you been charting your temperatures to see if you are actually ovulating?  Rarely, some women will have regular annovulatory periods.

Do you have an overactive letdown or is your baby a very fast nurser?  Both of these would mean that while your baby is getting milk, you aren't getting lots of nipple stimulation to produce enough prolactin to keep you in amenorrhea.

Do I need to know how to use Natural Family Planning in order to use LAM to postpone pregnancy?

No, knowledge of Natural Family Planning is not necessary.  However, it is extremely beneficial in being able to detect the return of fertility.

What if I want to attain pregnancy, but cannot because I am experiencing lactational amenorrhea?

First try charting Basal body temperatures see if you're ovulating.  Often a woman who is experiencing lactational amenorrhea will have many anovulatory cycles complete with menstruation even though she is not ovulating.

If you are ovulating and you have a short luteal phase (the number of days between ovulation and menstruation) then that might be your problem.  The luteal phase needs to be at least 8 to 10 days for your body to be able to sustain a pregnancy.  A normal luteal phase is 12 to 14 days.  If the luteal phase is too short, the fertilized egg will not have enough time to implant in the uterus before the lining is shed during menstruation.  When the fertility returns after a period of lactational amenorrhea, the luteal phase is sometimes short for the first few cycles.  This problem usually clears up by itself with time.

If you are not ovulating, really the only way to get your fertility to return is to decrease the amount of nursings.  I would suggest decreasing slowly, so that your child isn't pushed into an early weaning.  Once you fall below the minimum amount of nursing needed by your body to maintain lactational amenorrhea, then your fertility will return.  Be aware that some women, though definitely not most, will not be able to conceive until their child is completely weaned.

So far I haven't gotten my period back, but I am experiencing pregnancy symptoms.  Do you think I could be pregnant?

The easiest way to tell is to take a home pregnancy test.  If it is negative, and you do not wish to become pregnant, you should probably start charting at this time.  If you took one and it was negative, but you still wonder if you could be pregnant, go see a doctor. If you are charting, see if you have a temperature rise sustained for more than 3 weeks. If you didn't have a temp rise, even after a mucus patch, you didn't ovulate and aren't pregnant.

I am working and pumping milk for my baby.  What can I expect in terms of amenorrhea?

It really depends on your body.  I have a few experiences from working mother's in the experiences section of the page, and you can read through them.

According to The Breastfeeding Answer Book, 2003 edition:

"A mother can use LAM if she is regularly separated from her baby, as long as she is expressing her milk at least as often as her baby was nursing, and never less than every four hours.  Two studies found LAM to be about 95 percent effective for women who hand-expressed their milk at work, as compared with 98 percent effective for the women who were not separated from their babies.  In one study, nearly half of the 170 working mothers in the group exclusively breastfed for six months despite their separation from their babies and half of these women (28.2 percent of the total) had not yet started menstruating at six months."

Only you can make the decision whether or not you feel comfortable using LAM for child spacing if you are pumping while working full time.

The studies cited:

Labbok, M. Breastfeeding and Child Spacing--The Lactational Amenorrhea Method.  Presented at LLLI 14th International Conference, July 1995.

Valdes, V. et al.  The efficacy of the lactational amenorrhea method (LAM) among working women.  Contraception 2000; 62:217-19.

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