What Is Lactational Amenorrhea Method (LAM)?
Lactation refers to breastfeeding, and amenorrhea denotes not having monthly menstruation. This is a temporary family planning method that relies on the natural effect of breastfeeding on fertility. LAM requires three conditions, all of which must be met for it to be effective; they are:
The mother's menstruation should not have restarted yet. The resumption of menstruation after childbirth translates into her return to ovulation (fertility). LAM is effective in a woman who breastfeeds because that limits her chances to ovulate; however, once menstruation begins, it is obvious that she will eventually ovulate.
Postpartum bleeding in the first two months is called lochial discharge and is not to be confused with menstrual bleeding. In the context of LAM, menstruation refers to two consecutive days of bleeding or when a woman perceives that she has had a bleed similar to her menstrual bleed, either of which occurs at least two months postpartum.
1. The baby must be less than six months old. At six months, the baby starts receiving complementary foods while continuing to breastfeed. Introducing water, liquids, and foods can reduce the amount of breastfeeds, triggering hormonal mechanism that causes ovulation.
2. The baby should be completely or nearly breastfed and fed day and night.
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Fully breastfeeding includes exclusive breastfeeding is when the infant does not receive any food or liquids, including water, apart from breast milk.
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Almost-exclusive breastfeeding is where the infant receives vitamins, water, and juice once in a while in addition to breast milk.
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Nearly fully breastfeeding means the infant receives some liquid for food apart from breast milk, but most feedings (more than three-fourths of the feeds) are breast milk.
Sometimes the mother may desire to continue with the LAM even though she no longer meets the criteria. In such cases, the mother should be counseled to keep breastfeeding frequently and to breastfeed before giving the infant other foods. She should also be informed that her risk of pregnancy increases as the infant grows.
What Is the Mechanism Behind Lactational Amenorrhea Method?
LAM works primarily by preventing ovulation. Breastfeeding frequently inhibits the release of natural hormones that cause ovulation temporarily. It disrupts the GnRH (gonadotropin-releasing hormone) rhythm to suppress the hypothalamic-pituitary-ovarian-axis. This reduces luteinizing hormone (LH), which will lead to anovulation (absence of ovulation).
Who Can Use Lactational Amenorrhea Method?
All breastfeeding mothers can safely use LAM, but women in the following circumstances may want to consider other contraceptive methods.
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Has HIV (human immunodeficiency virus) infection.
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Using certain medications during breastfeeding. The medication includes but is not limited to mood-altering drugs, Cyclosporine, Bromocriptine, corticosteroids, Reserpine, Lithium, Ergotamine, radioactive drugs, and anticoagulants.
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The newborn has certain conditions that make it difficult to breastfeed. The conditions include infants born prematurely, cannot digest food normally, or have mouth, jaw, or palate deformities.
When to Use Lactational Amenorrhea Method?
A breastfeeding woman can use LAM to space her next pregnancy and transition to another contraception method. She may start LAM if she meets all three criteria for using the method.
The antenatal period is the best time to start counseling a woman about different methods of family planning, including LAM, so that she can make an informed decision about which method she wants to use following the birth of her baby.
The healthcare provider can help prepare the woman to breastfeed immediately after birth. However, if the new mother decides to use LAM, it is the provider's responsibility to ensure that she understands the criteria for LAM.
If the woman wants to initiate LAM within the first two months postpartum. The mother must verify that she has fully or nearly fully breastfed her baby since birth. She may still be having postpartum bleeding (lochial discharge) that may be similar to menstrual bleeding. If the woman is fully or nearly fully breastfeeding, irrespective of the bleeding in the first two months, she can initiate LAM during this period.
If the woman wants to start using LAM after two months postpartum, the healthcare provider must carefully verify that she has met the criteria for LAM since delivery.
Can a Woman Who Is Separated From Her Baby Use LAM for Longer Periods?
The time a woman is separated from her baby is a key factor in determining her eligibility for LAM. A woman separated from her baby regularly for more than four to six hours cannot expect a high level of contraceptive protection from LAM, even if she expresses milk during separation. In addition, expressing breast milk may not be as effective as suckling at the breast in suppressing ovulation.
The pregnancy rate rose to 12 % in a study on LAM in working women, which is significantly higher compared to the 2 % pregnancy rate in regular women using LAM as a contraceptive.
A few women can make plans to have their babies bought to nurse or go to their babies at regular intervals. Additionally, women who can get their babies to work to be breastfed can rely on LAM frequently.
What Methods of Contraception Can Be Used Following Lactational Amenorrhea Method?
When any of the three criteria are no longer applicable, or the mother chooses to stop using LAM, she should start using another method of birth control for the duration that she wants to avoid becoming pregnant again.
Breastfeeding women who want to choose a different contraception option should be guided accordingly. A few methods, like COC (combined oral contraceptive pills) and combined injectables, must be avoided before six months postpartum because of estrogen, which will decrease the quantity of breast milk.
After six months postpartum, a breastfeeding woman can use any method of her choice as long as she is properly screened and meets the eligibility criteria.
Conclusion:
LAM is a cost-effective and efficient method of contraception that can be used for 0.5 CYPs (couple years protection). In addition, it has no side effects and does not require the insertion of any device at the time of sexual intercourse. It is also acceptable to all religious groups, making it the ideal method of contraception for women worldwide.
