Key Facts about Lactational Amenorrhea (LAM)

Lactational amenorrhoea (LAM) is the term used to describe the pause in menstruating while fully breastfeeding, and is essentially nature’s way of preventing pregnancy soon after birth to give your body a chance to heal.

It is highly recommended that you speak with your midwife, a nurse or doctor about LAM.

• If used perfectly the failure rate is less than 2%, making it a very effective post-birth contraceptive method.
• It does not protect you from STIs.

How it works

When you exclusively breastfeed — meaning you nurse at least every 4 hours during the day and every 6 hours at night, and feed your baby only breast milk — your body naturally stops ovulating. You can’t get pregnant if you don’t ovulate.

No ovulation means you won’t have your period, either. That’s why breastfeeding-as-birth control is also called the lactational amenorrhea method (LAM). “Lactational” refers to breastfeeding, and “amenorrhea” means not having your period.

Pros & cons

• LAM is natural family planning method.
• This is a good method for those who are fully breastfeeding.
• It does not protect you from STIs.

When a mother is exclusively breastfeeding her baby, the body produces high levels of an ovulation-suppressing hormone called prolactin. Studies have found that it seems to be specifically when the nipple is stimulated from the baby suckling that levels of prolactin in the blood increase. If the baby is exclusively breastfed, and at regular intervals (at least every 6 hours during the night and every 4 hours during the day), prolactin levels in the blood remain elevated for the first months following birth.

As long as prolactin levels are high, it is highly unlikely you will ovulate and therefore for your periods to come back, at least in the first six months following birth.

Prolactin levels can quickly decrease however if supplementary formula is introduced, and when baby starts on solid foods, as this reduces the frequency of breastfeeds. Prolactin levels also naturally decrease over time, which is why this method is only considered reliable for the first six months following birth. It only takes about seven days from when breastfeeding ceases for prolactin levels to go back to what they were pre-pregnancy.

If you do get your period (at least two consecutive days of bleeding any time from about 6 – 8 weeks after giving birth) even if you are fully breastfeeding, you are at risk of getting pregnant.

Interestingly, studies have shown that expressing milk may not be as effective at stimulating the production of prolactin, and similarly if the nipples have been numbed with for example an anaesthetic. There are also other factors that can affect prolactin levels such as smoking and depression.

While it is difficult to know exactly when your menstrual cycle will resume, you can be certain that the less you breastfeed the more likely that your cycle will kick back into action. If you choose not to breastfeed at all, you can expect your menstrual cycle to resume within the first few months after birth.

As you can never be quite sure when ovulation will begin after birth, you may want to use other methods of contraception after birth to be on the safe side. 

(Source: Family Planning, 1 August 2019)

Pros

• LAM is natural family planning method.
• This is a good method for those who are fully breastfeeding.
• The risk of conception up to six months is about 2% when followed correctly.

Cons

• If you get your period you may be at risk of getting pregnant.
• It doesn’t protect you against sexually transmitted infections (STIs), so you will need to use a barrier method such as condoms.

Where do I find out more abut LAM?

Speak with your midwife, nurse or doctor to find out more about LAM.