PHYSIOLOGY

OF LACTATION
AMENORRHEA
 BELLAGIO CONSENSUS

CONFERENCE 1988
> review of extensive data on LAM
A postpartum woman has at least 98%
protection from pregnancy for six (6) months
when she remains ammenorrheic and fully
or nearly fully breastfeeds.
> Georgetown University 1989
 Review of Consensus
 LAM algorithm
LAM ALGORITHM
Italy, December 1995
 24 researchers and clinicians
 Conclusion: “The efficacy of LAM has now
been well established in prospective
studies, and programs should regard LAM
as an additional method that increases the
family planning choices for postpartum
women. The Lactational Amenorrhea
Method should receive the programmatic
and policy support necessary to become
available worldwide”
 LAM Criteria

1. Menses must not have returned

(Lactational Amenorrhea)
2. Woman must fully or nearly fully
breastfeed.( 6x or more, night and day)
3. Infant must be less than six months.

* If any criteria change, start another method.

How often to breastfeed?
 Its use and efficacy is dependent on
intensity of the breastfeeding
 Whenever the baby desires (watch for
signs)
 Breastfeed frequently
 Do not give other foods or liquids
regularly
EFFICACY  98% - 99%

Indications:
• For lactating woman who choose to
delay the use of another complementary
method
• For the woman who wishes to take the
time to decide between methods
• For the woman whom the chosen
method is not immediately available.
 EFFICACY  98% - 99%

Its use and efficacy is dependent on

intensity of the breastfeeding

Precautions: Should not be used as a

method by women who for any
reason cannot fully or nearly fully
breastfeed her infant.
 LAM Advantages
 Universally available
 98% effective (or more)
 Begins immediately postpartum
 Natural ( no hormonal side effects)
 No commodities /supplies required / no cost
 Does not interfere with intercourse
 Bridge to other contraceptives
 Builds on established cultural and religious practices
 Improves breastfeeding and weaning patterns
 Postpones use of steroids until infant is more mature
 LAM Disadvantages

 Breastfeeding pattern may be

difficult to maintain
 No STD or HIV protection

 Duration of method limited

 Only useful for breastfeeding women

Instruction for use
1. Menstrual bleeding

2. How often to breastfeed?

3. Age of the baby

4. Family planning for the breastfeeding

woman
When should women start practicing
another method?
 When she has resumed her menses, or

 When the frequency of breastfeeding has

decreased as follows:
 Any 2 breastfeeding are regularly more
then six (6) hours apart
 The mother starts regularly giving her baby
food or liquids as substitutes for breastmilk
meals, or
 When the baby is six (6) months old or older.
FIRST CHOICE
- Non-Hormonal Methods

 Diaphragm

 Male and Female Condoms

 IUDs
 Spermicides

 Male and Female

Sterilization

 Natural Family
Planning Method
Disadvantages of Natural FP
 Fertility signs and symptoms may be
difficult to interpret during breastfeeding
 May require extended periods of
abstinence.
 Calendar/rhythm method does not apply
during amenorrhea
 Training is necessary
 SECOND CHOICE
- Progestin-only methods

 Progestin-only Pill
(POPs)

 Injectables (DMPA,
NET-EN)

 Subdermal Implants
(Norplant)
Mini-Pill/Injectables/Implants
 Some hormones may pass into breastmilk
 No evidence of adverse effects on the infant
 Milk production may be reduced prior to 8
weeks
Advantages
 No action required at time of intercourse
 Mini-Pill: 99.5% effective
 Injectables: 99.7% effective
 Implants: 99.9% effective
Other Contraceptive Options for
Breastfeeding Women

Third Choice
- methods containing
estrogen

 Combines Oral
Contraceptives (COCs)

 Monthly Injectables
(Mesigyna, Cyclofem)
Combined Oral Contraceptives
 Estrogens may reduce milk supply
 Some hormones may pass into breastmilk
 Decreased milk supply can lead to earlier
cessation of breastfeeding.
 Breastfeeding can and should continue
during method use as it supplies important
health and nutritional benefits for the infant
 99.9% effective
 WHO recommends: delay at least 6 months
8 Optimal Breastfeeding Behaviors

1. Allow newborn to breastfeed as soon as

possible after birth, and to remain with the
mother for at least several hours following
delivery.

2. Breastfeed frequently, whenever the infant is

hungry, both day and night.

3. Breastfeed exclusively for the first six

months.
 8 Optimal Breastfeeding Behaviors

4. After the first six months when

complementary foods are introduced,
breastfeeding should precede each
complementary feeding

5. Continue to breastfeed for up to two years

and beyond.

6. Continue breastfeeding even if the mother or

the baby becomes ill
 8 Optimal Breastfeeding Behaviors

7. Avoid using bottles, pacifiers (dummies), or

other artificial nipples.

8. Mothers should eat and drink sufficient

quantities to satisfy their hunger and thirst.
Provision of Method
 Information – and behavior-based method that does
not require any supplies, it can be provided in a
variety of settings
 FP clinics, MCH clinics, breastfeeding support
groups
 Mother to mother support groups
 Community-bases distribution systems, hospitals,
maternities
 As long as there is a referral system in place to
ensure timely adoption of another method when
LAM no longer applies
 CONCLUSION
LACTATION AMENORRHEA METHOD

 Safe and effective

 Scientifically validated
 Universally available
 Many advantages / few disadvantages
 Requires counseling
 Viable contraceptive option