Lactational Amenorrhea: Breastfeeding As An Effective Form of Birth Control

One of the most popular questions posed by my patient's is none other than:

"What is the best form of natural birth control?"

Firstly, it is important to note that there is no "one size fits all." What works for some women, may not work for others. Additionally, using certain forms of birth control "properly" matters significantly. For example, condoms are 98% effective at preventing pregnancy when used "properly", but in reality studies have shown that they are really only 82% effective at pregnancy when used by your "average male." Ha!

The list of choices for birth control includes abstinence, fertility awareness-based methods, birth control implants, patches, oral contraceptive pills, birth control shots, sponges, vaginal rings, breastfeeding, cervical caps, condoms, diaphragms, female condoms, IUDs, outercourse, spermicide, sterilization, vasectomies, and withdrawal method. Some forms of birth control are less invasive and gentler on your body, but the most important factor is that you feel safe, responsible, and comfortable with the method you choose. For breastfeeding mothers, we have a very unique form of birth control available to us, that not many practitioners are willing to talk about...


Lactational Amenorrhea Method (LAM), AKA Breastfeeding as Birth Control  

How does it work?

Breastfeeding can suppress ovulation and thus serve as a form of birth control. When you breastfeed, prolactin (the hormone that makes milk) also suppresses the release of hormones that cause eggs to mature and become fertile. This is also the reason why breastfeeding mothers usually notice a delay in the return of their menstrual periods. This delay is called lactational amenorrhea, or LAM. As a natural method of birth control, LAM's effectiveness rate can be as high as 98 percent (similar to artificial methods), but only if you observe the following practices:

  1. Your baby is less than six months old

  2. Your menstrual periods have not yet returned

  3. Baby is breastfeeding on cue (both day & night), and gets nothing but breastmilk or only token amounts of other foods.

Timing for the return to fertility varies greatly from woman to woman and depends upon baby’s nursing pattern and how sensitive mom’s body is to the hormones involved in lactation. Breastfeeding frequency and total amount of time spent breastfeeding per 24 hours are the strongest factors leading to the return of fertility: a mother is more likely to see the return of fertility if baby’s nursing frequency and/or duration is reduced, particularly if the change is abrupt. The best ways to maximize LAM's effectiveness is by practicing ecological breastfeeding. These methods include:

  1. keeping baby close (baby wearing, co-sleeping, etc.) 
  2. breastfeeding on cue (day and night)
  3. using breastfeeding to comfort your baby
  4. breastfeeding in a lying-down position for naps and at night
  5. using no bottles or pacifiers

If you practice ecological breastfeeding, your chance of pregnancy in the first three months is almost 0%, between 3 and 6 months your chance of pregnancy is less than 2%, and after 6 months it increases to about 6% as long as your menstrual periods have not returned. 

Women who practice ecological breastfeeding average 14.6 months of amenorrhea. 7% experience a return of their menses in the first six months following childbirth. 37% get their periods back during months seven to twelve. 48% percent get their periods back sometime during the second year after childbirth. 8% go longer than two years without periods.

While it is possible for a nursing mom to become pregnant while she is breastfeeding and before she has her first menstrual period, it is rare. Most moms do not get pregnant until after their first period (often referred to as the “warning period”). Even after that, while some can become pregnant the first cycle, others will require months of cycles before pregnancy can occur. Still others (this is quite uncommon) may not be able to become pregnant until complete weaning has occurred.

A great method of birth control to practice once you are out of the lactational safety blanket, or once menstruation/fertility has returned is Fertility Awareness Method. This is also a great way to get in touch with the cycles of your body before getting pregnant for the first time as well. More on this to come, but for now, Toni Weschler's book is the best resource. 

If you would like to know more about Lactational Amenorrhea Method, or have specific questions about your fertility while breastfeeding, please contact me for private consultation, or leave a question or comment below in the comments section. 



Photo by @daniellarech of @helena.vestergaard