Breastfeeding and contraception: LAM and other options
After giving birth, sex is probably the last thing on your mind but it's amazing how time passes, and heals.
You could get pregnant when your baby is just three weeks old, so it's worth thinking about contraception.
If you're breastfeeding, a good temporary option is the lactational amenorrhea method, or LAM, which is a fertility awareness based method of contraception.
You could get pregnant when your baby is just three weeks old, so it's worth thinking about contraception.
If you're breastfeeding, a good temporary option is the lactational amenorrhea method, or LAM, which is a fertility awareness based method of contraception.
LAM criteria
LAM can be up to 98% effective so long as all three of these are true:
Scroll down to Moving on from LAM for more information.
- Lactational. You're fully breastfeeding, and I mean fully. Your baby is fed regularly day and night for food and comfort and does not receive any formula, water or solids.
- Amenorrhea. Your periods haven't returned - any bleeding at all after the first two months counts as a period and means you can't rely on LAM.
- Months. Your baby is less than 6 months old. Strictly speaking "M" stands for Method but hey, this is more helpful.
Scroll down to Moving on from LAM for more information.
How does LAM work?
LAM relies on the breastfeeding hormone (prolactin), suppressing oestrogen (the ovulation hormone).
These hormone changes also reduce the length of your luteal phase, which means that if you do ovulate the egg doesn't have time to implant in your womb.
These hormone changes also reduce the length of your luteal phase, which means that if you do ovulate the egg doesn't have time to implant in your womb.
Can you use LAM if you express milk, or use a dummy or soother?
No. This will reduce the amount of prolactin you produce. Avoid LAM if you express (pump) milk, or use a dummy or soother, especially if you spend much time away from your baby.
A woman who expresses her milk doesn't produce as much prolactin as a woman with a baby who feeds directly from her breast, which means LAM doesn't work so well [1,5].
If you don't mind a slightly reduced effectiveness rate, you could continue to rely on LAM so long as you only express "a few times a week" [4].
For similar reasons, LAM might not work so well if your baby uses a dummy or soother as that means they're getting comfort from that rather than your breast and your prolactin levels might drop.
A woman who expresses her milk doesn't produce as much prolactin as a woman with a baby who feeds directly from her breast, which means LAM doesn't work so well [1,5].
If you don't mind a slightly reduced effectiveness rate, you could continue to rely on LAM so long as you only express "a few times a week" [4].
For similar reasons, LAM might not work so well if your baby uses a dummy or soother as that means they're getting comfort from that rather than your breast and your prolactin levels might drop.
Boosting breastfeeding
If breastfeeding isn't going well, you might not produce enough prolactin so get support if you need it.
This means practical help from an experienced and trained breastfeeding supporter or lactation consultant, not an overstretched midwife telling you "breast is best" or "persevere".
Contact the National Breastfeeding Helpline on 0300 100 0212 or the ABM.
You could also read this brilliant book. Some very forward thinking types do this while they're pregnant!
This means practical help from an experienced and trained breastfeeding supporter or lactation consultant, not an overstretched midwife telling you "breast is best" or "persevere".
Contact the National Breastfeeding Helpline on 0300 100 0212 or the ABM.
You could also read this brilliant book. Some very forward thinking types do this while they're pregnant!
Does my BMI affect LAM?
The vast majority of LAM effectiveness research is based on women with a "healthy" weight, according to this BMI checker.
Women store oestrogen in their fat tissue. If you have more higher than average fat levels, you probably have higher than average oestrogen levels, which could make it harder for prolactin to suppress ovulation.
I'd like to see more research into this, but it probably makes sense to avoid LAM if you're overweight.
Women store oestrogen in their fat tissue. If you have more higher than average fat levels, you probably have higher than average oestrogen levels, which could make it harder for prolactin to suppress ovulation.
I'd like to see more research into this, but it probably makes sense to avoid LAM if you're overweight.
Moving on from LAM
Be ready for this. Those LAM criteria don't last long, and both fertility awareness and hormonal contraception can be tricky while you are breastfeeding.
Using fertility awareness as contraception
The easiest and most effective approach to fertility awareness as contraception after LAM is probably to use condoms or other precautions until you have had a period and used your waking temperature and fluid to confirm that ovulation has been and gone.
You just went through labour and/or a c-section. It's time for him to do his bit.
You could consider buying a TempDrop (wearable thermometer) to help you get accurate temperature readings. It's expensive, but it might be worth it while your nights are disrupted.
If you're curious, here's two of the key signs that your fertility is low:
You just went through labour and/or a c-section. It's time for him to do his bit.
You could consider buying a TempDrop (wearable thermometer) to help you get accurate temperature readings. It's expensive, but it might be worth it while your nights are disrupted.
If you're curious, here's two of the key signs that your fertility is low:
- Bumpy waking temperatures - until your fertility returns, you can expect a bumpy (zip zagging up and down) waking temperature. It it levels out your body could be getting ready to ovulate.
- Unchanging fluid - unchanging sticky (non-peak) fluid (or none) suggests your fertility is low. Any change, especially lots of the clear and stretchy stuff, is a sign that your fertility is returning.
Hormonal contraception while breastfeeding
Sexual health experts say it is safe to use the implant, injection, progestogen-only pill and other hormonal methods immediately after giving birth[1]. They say there is no evidence that it affects women's milk supply, or baby weight.
Breastfeeding experts are more cautious. They say there is substantial anecdotal evidence that artificial hormones can reduce milk supply for some women.
To avoid problems with your milk supply, the Breastfeeding Network suggests you:
If the progestogen-only pill (or any other medication) causes problems, report them using the yellow card scheme. This will help improve the quality of information about medication.
Breastfeeding experts are more cautious. They say there is substantial anecdotal evidence that artificial hormones can reduce milk supply for some women.
To avoid problems with your milk supply, the Breastfeeding Network suggests you:
- Avoid hormonal contraception for the first six weeks after giving birth.
- After six weeks, try taking the progestogen-only pill so you can stop it easily if there's a problem.
- If all goes well, you could then choose a longer acting method like the injection, implant or IUS (Mirena).
If the progestogen-only pill (or any other medication) causes problems, report them using the yellow card scheme. This will help improve the quality of information about medication.
What's the best contraception?
This is information not advice. The best method of birth control is the one that you feel most comfortable with. We all have different priorities.
What if you WANT to get pregnant?
Fertility is more like a dimmer switch than an on/off button.
Breastfeeding can reduce your fertility - even though your periods have returned and your baby is more than six months old.
You might not get pregnant until you reduce or stop breastfeeding. To find out more check out getting pregnant.
Breastfeeding can reduce your fertility - even though your periods have returned and your baby is more than six months old.
You might not get pregnant until you reduce or stop breastfeeding. To find out more check out getting pregnant.
More information
- Sex and contraception after birth. NHS
- Breastfeeding. Lactational Amenorrhoea Method. Fertility UK
- Contraception and Breastfeeding. The Breastfeeding Network
- Breastfeeding as Contraception [leaflet]. NHS Camden
- Contraception after a baby. BPAS
- Kelly Mom. Breastfeeding and fertility
- Breastfeeding, sex and libido podcast. The Boob Group
Articles and blogs
- Panzetta S and Pickett E. Journal of Family Planning and Reproductive Healthcare. Can postpartum contraception do more to support breastfeeding? [letter]. June 2016.
- Panzetta S and Shawe J. Journal of Family Planning and Reproductive Healthcare. LAM: the evidence is there, why don't we use it?
- Association of Breastfeeding Mothers magazine. Can breastfeeding work as contraception?
References
- Royal College of Obstetricians and Gynaecologists. Faculty of Sexual and Reproductive Health.
Clinical effectiveness Unit Guidance: Contraception after pregnancy. 2017. - Cochrane Collaboration. Lactational amennorrhea method for family planning. October 2015
- Institute for Reproductive Health. University of Georgetown. Lactational amenorrhea method [webpage & guidance].
- Royal College of Obstetricians and Gynaecologists. Faculty of Sexual and Reproductive Health.
Clinical Effectiveness Unit Guidance on Fertility Awareness Methods. 2015. - Academy of Breastfeeding Medicine. Clinical Protocol #13. Contraception during breastfeeding. Revised 2015.
- LAM Interagency Working Group. Consensus Statement on Rationale for Operationalizing LAM Criteria.
- Fabic MS and Choi Y, Assessing the quality of data regarding use of the lactational amenorrhea method, Studies in Family Planning, 2013, 44(2):205–221. [Abstract here - no online full-text available]
- Cochrane Collabortion. Hormonal and nonhormonal birth control during breastfeeding. 2015.
- Royal College of Obstetricians and Gynaecologist. Faculty of Sexual and Reproductive Health. UK Medical Eligibility Criteria for contraception. 2016.
- Contraception and Breastfeeding [leaflet]. Breastfeeding Network.
- Evidently Cochrane. New Lancet Breastfeeding Series is a Call to Action. 2016.
- BPAS. Sex and contraception after childbirth: supporting women's choices in the postnatal period. 2014.