Our month-long series on Breastfeeding continues below…

One Woman’s Experience with Lactational Amenorrhea

August 14, 2018
By Katie Douglas

Editor’s Note: This week, we continue to celebrate National Breastfeeding Month by highlighting the impact of ecological breastfeeding on a married couple and their children. This is a summary of interviews conducted by two medical students who spoke to Jessica, a user of FABMs. The interviews were summarized by Katie Douglas, an intern with FACTS this summer. This article provides an overview of lactational amenorrhea and the seven standards of ecological breastfeeding.

A Couple’s Path to FABMs
Jessica is a former elementary school teacher and the mother of four children. She is expecting her fifth child at the time of this writing. She has used ecological breastfeeding to space her pregnancies naturally. Her initial interest in natural methods of family planning was multifaceted. Fertility Awareness Based Methods (FABMs) were attractive because of their safety for both her body and the environment. As a young woman, she had taken oral contraceptives after her gynecologist offered this as the only option for dysmenorrhea. Looking back, Jessica regrets taking the medication for as long as she did. She attributes that decision to a lack of knowledge about alternatives that may be available for women like her. Finding a natural method that was consistent with their Catholic faith was also very important to Jessica and her husband. Additionally, as a young couple living in a city in the United States, FABMs appealed to them as an inexpensive option for family planning.

During her engagement, Jessica learned about FABMs and decided to start tracking her cycles and fertility. She learned about the Creighton Model from a library book rather than the recommended approach of learning from a trained instructor. She admits this may have led to less than accurate tracking early in her marriage and at the time of conceiving her first child.

Unexpected Benefits of Lactation
After her first pregnancy, Jessica breastfed mostly on demand and co-slept with her child (similar to what was described in ecological breastfeeding).[i] Eventually, she went to see her physician, curious as to why her menstruation had not returned after one year. The physician’s reaction was immediate concern! She was told to put on weight, stop breastfeeding, and see an endocrinologist if the amenorrhea persisted. Jessica was unaware that lactational amenorrhea was feasible and normal. She chose to continue to nurse, aware of the many benefits of breastfeeding for her child and herself. Later on, she consulted a physician friend knowledgeable about FABMs and was relieved to learn that this lactation-induced amenorrhea was normal. This conversation affirmed that continuing to breastfeed was safe and desirable for both mother and child.

Jessica’s fertility returned about two years after the birth of her first child. This pattern of extended infertility occurred after her second pregnancy as well. After her third child, she was surprised to see her ovulatory cycles return sooner, at 17 months, which is still significantly longer than the average period of amenorrhea (14.6 months) with ecological breastfeeding.

Ecological Breastfeeding in Practice
While Jessica has used other FABMs upon the return of ovulation, she enjoys the benefits of ecological breastfeeding for her children and marriage. By exclusively breastfeeding, she knows that her children receive optimal nutrition and immunity. She has weaned each child naturally rather than keeping them on a strict schedule or stopping on her terms. Jessica has felt more bonded with each child through the frequency and nature of her nursing. She was fine waking up in the middle of the night to nurse and let her husband sleep. He would find other ways to contribute to the family by preparing breakfast or doing more household chores.

Jessica noted the freedom she has experienced using ecological breastfeeding. Longer periods of infertility provide natural spacing of pregnancies. She emphasizes that one of the benefits of any FABM is the frank conversations it requires the couple to have. She believes this honest and ongoing evaluation has been vital to their family life and future plans as it helps them support one another. Jessica also praises her husband for always being comfortable and supportive when discussing her body and pregnancy.

The use of natural family planning and exclusive breastfeeding have not come without some difficulties. Jessica mentioned negative responses from healthcare providers years ago, when she was told that breastfeeding for extended amounts of time was bad for her kids and that breast milk lost its health benefits after nine months. Fortunately, she found a physician who endorses and is more knowledgeable about lactational amenorrhea and FABMs. She also noted difficulties in nursing a child who took longer to wean than expected. Despite these challenges, she feels the benefits of breastfeeding to both mother and child outweigh any struggles along the way.

Jessica realizes that some aspects of ecological breastfeeding may not be practical for some mothers, as it requires a strict devotion to physical nursing. However, ecological breastfeeding was best for Jessica and her family, and she is grateful to have learned about this effective method of family planning. She hopes to see more physicians learn about the use of LAM and ecological breastfeeding in family planning and understand that long periods of infertility while nursing are completely normal.

Editor’s Note: Mary-Kate Crane (MKC), currently a 3rd year medical student and JW, a Georgetown alum, were in medical school when they interviewed Jessica as part of Dr. Marguerite Duane’s online course on FABMs. We are grateful for their contribution to FACTS through this patient interview.


Author Bio: Katie Douglas is a junior at the University of Illinois at Urbana-Champaign, where she studies Molecular & Cellular Biology. She has worked as a research assistant in the Nutrition and Cancer Epidemiology & Survivorship Lab on campus for almost two years. We are grateful for Katie’s outstanding contributions to our work at FACTS while serving as an intern with us and FMEC this summer.



[i] Among its many benefits, breastfeeding is associated with a decreased risk of sudden infant death syndrome (SIDS). However, the practice of co-sleeping has been associated with SIDS in some cases (although other unsafe conditions are also present in the majority of these cases). The American Academy of Pediatrics (AAP) recommends supine positioning for sleep, room-sharing without bed-sharing, and avoiding soft beds and overheating. The AAP policy statement discusses safety considerations related to breastfeeding and co-sleeping. For the 2017 Guide for Health Professionals from UNICEF on this topic, please follow this link.



The FACTS Ambassador Program is growing!

We invite you to take advantage of this unique opportunity! Enjoy monthly calls with experts in the field.
Learn how to handle questions that come up in clinical settings regarding women’s health, fertility awareness, charting, and much more.

Here’s what your peers love about being a FACTS Ambassador:

  • Participating in research
  • Getting published
  • Developing public speaking and presentation skills early in your career
  • Attending national meetings and learning from experts in the field
  • Expanding your clinical knowledge and skills in women’s health
  • Building and growing your network
  • Making connections that will last your entire career
  • Working with other students & residents interested in fertility awareness
  • The opportunity to become a trained speaker for FACTS
  • Learning from one another and growing professionally together
  • Getting to work with the FACTS team!


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