Lactational amenorrhea

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Lactational amenorrhea
Breastfeeding infant.jpg
An infant breastfeeding
Background
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
Advantages and disadvantages
STI 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[edit]

For women who follow the suggestions and meet the criteria (listed below), LAM is >98% effective during the first six months postpartum.[1]

  • Breastfeeding must be the infant's only (or almost only) source of nutrition. Feeding formula, pumping instead of nursing,[2] 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).
  • And to take full advantage of LAM, it is best that the baby's face not be covered when feeding. Routinely covering the baby reduces the baby's access to oxygen and visual contact with the mother, which trains the baby to speed up the suckling process and thus reduces the time period, rendering LAM less effective.

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.

Physiology[edit]

Breastfeeding delays the resumption of normal ovarian cycles by disrupting the pattern of pulsatile release of GnRH from the hypothalamus and hence LH from the pituitary.[3] The plasma concentrations of FSH during lactation are sufficient to induce follicle growth, but the inadequate pulsatile LH signal results in a reduced estradiol production by these follicles.[3] When follicle growth and estradiol secretion does increase to normal, the suckling stimulus prevents the generation of a normal preovulatory LH surge and follicles either fail to rupture, or become atretic or cystic. Only when the suckling stimulus declines sufficiently to allow generation of a normal preovulatory LH surge to occur will ovulation take place with the formation of a corpus luteum of variable normality. Thus suckling delays the resumption of normal ovarian cyclicity by disrupting but not totally inhibiting, the normal pattern of release of GnRH by the hypothalamus. The mechanism of suckling-induced disruption of GnRH release remains unknown.[3]

In women, hyperprolactinemia is often associated with amenorrhea, a condition that resembles the physiological situation during lactation (lactational amenorrhea). Mechanical detection of suckling increases prolactin levels in the body to increase milk synthesis. Excess Prolactin may inhibit the menstrual cycle directly, by a suppressive effect on the ovary, or indirectly, by decreasing the release of GnRH.[4]

Return of fertility[edit]

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. [citation needed] Couples who desire spacing of 18 to 30 months between children can often achieve this through breastfeeding alone.[5]

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. For women exclusive breastfeeding ovulation tends to return after their first menses after the 56 days postpartum time period. Supplementing nutritional intake can lead to an earlier return of menses and ovulation then exclusive breastfeeding.[6] Nursing more frequently for a shorter amount of time was shown to be more successful in prolonging amenorrhea then nursing longer but less frequently. The continuing of breastfeeding, while introducing solids after 6 months, to 12 months were shown to have an efficiency rate of 92.6 – 96.3 percent in pregnancy prevention.[7] Because of this some women find that breastfeeding interferes with fertility even after ovulation has resumed.

The Seven Standards: Phase 1 of Ecological Breastfeeding

  1. Breastfeed exclusively for the first six months of life; don’t use other liquids and solids, not even water.
  2. Pacify or comfort your baby at your breasts.
  3. Don’t use bottles and don’t use pacifiers.
  4. Sleep with your baby for night feedings.
  5. Sleep with your baby for a daily-nap feeding.
  6. Nurse frequently day and night, and avoid schedules.
  7. Avoid any practice that restricts nursing or separates you from your baby.

Phase 1 is the time of exclusive breastfeeding and thus usually lasts six to eight months.[8][citation needed]

Footnotes[edit]

  1. ^ Trussell, James (May 2011). "Contraceptive failure in the United States". Contraception. 83 (5): 397–404. doi:10.1016/j.contraception.2011.01.021. PMC 3638209Freely accessible. PMID 21477680. 
    Trussell, James (November 2011). "Contraceptive efficacy". In Hatcher, Robert A.; Trussell, James; Nelson, Anita L.; Cates, Willard Jr.; Kowal, Deborah; Policar, Michael S. (eds.). Contraceptive technology (20th revised ed.). New York: Ardent Media. pp. 779–863. ISBN 978-1-59708-004-0. ISSN 0091-9721. OCLC 781956734. 
  2. ^ ReproLine The Reading Room. Lactational Amenorrhea Method, which cites:
    Zinaman M, Hughes V, Queenan J, Labbok M, Albertson B (1992). "Acute prolactin and oxytocin responses and milk yield to infant suckling and artificial methods of expression in lactating women". Pediatrics. 89 (3): 437–40. PMID 1741218. 
  3. ^ a b c McNeilly, As (Feb 1994). "Physiological mechanisms underlying lactational amenorrhea". Ann N Y Acad Sci. 709: 145–155. doi:10.1111/j.1749-6632.1994.tb30394.x. PMID 8154698. 
  4. ^ "Lactational amenorrhea – an overview | ScienceDirect Topics". www.sciencedirect.com. Retrieved 2018-06-29. 
  5. ^ Kippley, S. K. (2008). The seven standards of ecological breastfeeding: The frequency factor. Stillwater, MN: Lulu.
  6. ^ Labbok, M. H. (2015). Postpartum Sexuality and the Lactational Amenorrhea Method for Contraception. Clinical Obstetrics and Gynecology, 58(4), 915–927. doi:10.1097/grf.0000000000000154
  7. ^ The World Health Organization multinational study of breast-feeding and lactational amenorrhea. III. Pregnancy during breast-feeding. (1999). Fertility and Sterility, 72(3), 431–440. doi:10.1016/s0015-0282(99)00274-5
  8. ^ Kippley, S. K. (2008). The seven standards of ecological breastfeeding: The frequency factor. Stillwater, MN: Lulu.

Further reading[edit]

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