The use of lactational amenorrhea as a fertility regulating method.

Abstract

Lactational amenorrhea has a contraceptive effect during at least the first six months postpartum when mothers fully or nearly fully breast feed. Women practicing the lactational amenorrhea method (LAM) need to know the factors related to the return of fertility. The longer the duration of fully or nearly fully breast feeding the longer the duration of amenorrhea and anovulation. Suckling inhibits secretion of follicle stimulating hormone and luteinizing hormone which thereby suppresses ovulation. No cases of ovulation have been found before the 56th day postpartum in fully or nearly fully breast feeding women. It appears that ovulation and a normal corpus luteum function often precede the first menses. The three criteria that must be met simultaneously for correct LAM use include: no return of menses no regular supplementation of breast milk and no more than six months postpartum. Another or complementary contraceptive method must be practiced immediately when any of these criteria is no longer met if the LAM client wishes to avoid pregnancy. LAM is more than 99% effective at preventing pregnancy. Family planning maternal and child health or primary health care programs should incorporate LAM as one of several family planning choices. They should offer various methods appropriate for breast feeding mothers. Informed voluntary choice is important. Family planning providers must be trained in the provision of LAM and all other family planning options and in counseling. The December 1995 Second Bellagio Conference proposed a practical definition of the return of fertility: the occurrence after day 56 postpartum of two consecutive days of bleeding/spotting or of the womans perception that her menses has returned whichever of the two comes first. It also found that it may be possible to expand LAM beyond six months postpartum. A study found that the pregnancy rate for lactating amenorrheic women at 12 months postpartum was 1.12%.