By: Alexis Samples
Editor’s Note: Alexis Samples was on the FACTS elective in fertility awareness as a medical student when she wrote this summary of research about the lactational amenorrhea method. The article [1] she reviewed was published by Carla Van der Wijden and Carol Manion in the Cochrane Database of Systematic Reviews in 2015.
Introduction
The Lactational Amenorrhea Method (LAM) is an evidence-based method for pregnancy prevention that leverages the natural delay in ovulation induced by exclusive breastfeeding. By relying on the physiological effects of lactation on fertility, LAM offers a non-invasive, easily accessible family planning option for postpartum women. This method is particularly significant in low-resource settings where access to modern contraceptive methods may be limited.
Methodology
This review systematically examined studies retrieved from MEDLINE, EMBASE, POPLINE, and LILACS databases. Out of 459 potentially relevant studies, 15 were included, encompassing 11 intervention groups and 3 control groups. The studies analyzed the pregnancy rates and menstruation recurrence using life table rates and other statistical methods to determine the effectiveness of LAM.
Results
The study findings indicated that pregnancy rates among LAM users ranged from 0% to 7.5% across different studies, with controlled studies showing life table pregnancy rates of 0.45% to 2.45%. Menstruation rates varied between 11% and 39% across studies. While LAM was shown to be effective to prevent pregnancy in breastfeeding women, no significant differences were found between LAM users and those exclusively breastfeeding without specific guidance.
Discussion
The research highlights that while LAM can be an effective method to prevent pregnancy in the first six months postpartum, its success largely depends on the consistent practice of exclusive breastfeeding. LAM can provide 98% effectiveness against pregnancy in the first six months postpartum, provided its criteria are met (exclusive breastfeeding, no menstruation, and baby under six months of age). The method is particularly valuable in low-resource settings, where access to other contraceptive methods is limited. However, challenges remain to ensure correct usage, as many women may not fully adhere to LAM criteria, leading to higher pregnancy rates.
“While LAM can be an effective method to prevent pregnancy in the first six months postpartum, its success largely depends on the consistent practice of exclusive breastfeeding.”
Research shows that suckling frequency and duration are the most significant factors in maintaining lactational amenorrhea. A review of the scientific literature on the role of LAM [2] cites data from two small controlled studies by Andersen et al (48 participants in 1982) and Campbell et al (22 participants in 1993). These studies suggest that to suppress the ovaries and prevent ovulation, a minimum of breastfeeding at least five times per day is needed, with each session lasting no less than 10 minutes. Furthermore, the total daily suckling time should be no less than 65 minutes. When the total suckling time or frequency drops below these levels, the risk of resuming ovulation significantly increases. Supplemental feeding (formula or solids) and longer intervals between breastfeeding sessions disrupt hormonal suppression, increasing the risk of ovulation. [2]
Relevance to Women’s Health and Family Planning
This research is quite relevant to women’s health and family planning, as LAM offers women an effective, hormone-free method of contraception while simultaneously supporting breastfeeding — a practice widely recognized for its numerous health benefits for both mother and infant. For women with limited resources, LAM provides a readily available and cost-effective solution for family planning. It empowers women by allowing them to take control of their fertility in a way that does not interfere with breastfeeding, a critical health-promoting activity for infants. As discussed in the FACTS elective, FABMs like LAM promote body literacy, which encourages women to understand their reproductive cycles better, leading to more informed decisions about family planning and their reproductive health.
“LAM provides a readily available and cost-effective solution for family planning. It empowers women by allowing them to take control of their fertility in a way that does not interfere with breastfeeding, a critical health-promoting activity for infants.”
Strengths and Limitations of the Research
A strength of this research is its focus on the effectiveness of LAM across a range of settings, which helps validate its use globally. By drawing on a variety of studies, the research provides a comprehensive view of LAM’s success rates, demonstrating that pregnancy rates range from 0% to 7.5% in different populations. This wide range also highlights one of the study’s limitations — the variability in outcomes due to inconsistent definitions of key terms, such as “amenorrhoea” and “menstruation.” These inconsistencies complicate the comparability of data across studies, making it difficult to draw definitive conclusions about LAM’s effectiveness in certain populations. Additionally, the research focuses predominantly on the initial six months postpartum, leaving open questions about LAM’s effectiveness beyond this period, and how best to transition women to other methods of contraception after this window closes.
Another limitation is the over-reliance on participants’ self-reported adherence to LAM criteria, which can vary significantly. In particular, the requirement for exclusive breastfeeding is often difficult to maintain due to social, cultural, and economic factors, all of which influence a woman’s ability to meet the strict demands of LAM. As noted during the elective on fertility awareness and FABMs, the absence of consistent breastfeeding support, especially in low-income communities, presents an additional barrier to LAM’s efficacy.
Insights Gained and Questions Elicited
One of the key insights gained from this research is the significant potential for LAM to serve as a bridge between postpartum care and ongoing family planning. It highlights the need for physicians, other clinicians, and educators to offer structured guidance and education to women about LAM’s criteria, particularly in settings where breastfeeding support may be limited. The FACTS elective emphasized the importance of patient education in the successful implementation of any fertility awareness-based method, and this research further underscores that message.
“This research … highlights the need for physicians, other clinicians, and educators to offer structured guidance and education to women about LAM’s criteria, particularly in settings where breastfeeding support may be limited.”
Need for Future Research
Given the limitations of the existing studies, future research should aim to standardize the definitions used to measure key outcomes, such as the return of menstruation and the incidence of pregnancy. Future studies should examine the long-term effects of LAM, particularly in terms of how women transition from LAM to other family planning methods after six months postpartum.
Future research is essential to further define the specific amount of daily breastfeeding required to effectively suppress ovulation, particularly in scenarios where exclusive breastfeeding is not feasible for many women. Understanding how varying breastfeeding patterns, such as partial or supplemental feeding, impact ovulation suppression could help develop more flexible guidelines for lactational amenorrhea as a contraceptive method. Larger studies that explore the minimum effective suckling duration and frequency in mixed feeding practices would offer valuable insights for mothers who cannot exclusively breastfeed but still wish to benefit from natural contraceptive effects during lactation. By doing so, we can further optimize the LAM method to accommodate varying socio-economic contexts, ensuring it remains a viable and accessible family planning option for diverse populations.
Editor’s Note: Follow the links below to learn more about the lactational amenorrhea method:
- The Lactational Amenorrhea Method: Effectiveness Data Combats Myths
- Working Women and the Lactational Amenorrhea Method: A Review of Research
- The Lactational Amenorrhea Method: Two Success Stories
References
[1] Van der Wijden C, Manion C. Lactational amenorrhoea method for family planning. Cochrane Database Syst Rev. 2015;2015(10):CD001329. Published 2015 Oct 12. doi:10.1002/14651858.CD001329.pub2
[2] Calik-Ksepka A, Stradczuk M, Czarnecka K, Grymowicz M, Smolarczyk R. Lactational Amenorrhea: Neuroendocrine Pathways Controlling Fertility and Bone Turnover. International Journal of Molecular Sciences. 2022; 23(3):1633. https://doi.org/10.3390/ijms23031633
ABOUT THE AUTHOR
Alexis Samples
Alexis Samples is a fourth-year medical student at Western University of Health Sciences College of Osteopathic Medicine of the Pacific in Pomona, CA. She completed her undergraduate education at Erskine College in Due West, South Carolina. She plans to pursue residency in obstetrics and gynecology in the U.S. Navy and is interested in healthcare equity and reproductive health. She enrolled in the FACTS elective to gain a deeper understanding of natural family planning methods to offer personalized, empowering reproductive health options to her patients, including underserved communities and military families. She hopes to provide more comprehensive women’s healthcare through this patient-centered approach.
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