What is the Lactational Amenorrhea Method (LAM)?

Lactational Amenorrhea Method (LAM)

The Lactational Amenorrhea Method (LAM) is a temporary contraceptive method that provides 98% effectiveness when three specific criteria are met simultaneously: the woman must be amenorrheic (no menstruation), fully or nearly fully breastfeeding, and less than 6 months postpartum. 1

Definition and Mechanism

LAM works through the natural postpartum infertility caused by intensive breastfeeding. When a woman breastfeeds frequently, the suckling stimulus triggers the release of beta-endorphins that inhibit gonadotropin-releasing hormone (GnRH) and dopamine secretion. This hormonal cascade:

• Increases prolactin secretion (promoting milk production)
• Suppresses follicle-stimulating hormone (FSH) and luteinizing hormone (LH)
• Prevents ovulation
• Results in amenorrhea

Effectiveness

LAM is highly effective when all criteria are met:

• 98% effective during the first 6 months postpartum with perfect use 1
• Comparable to other modern contraceptive methods in effectiveness 2
• Typical-use failure rates range from 0-7.5% at 6 months 3

The effectiveness table from CDC shows LAM as "a highly effective, temporary method of contraception" 1.

Three Essential Criteria

For LAM to be effective, ALL three conditions must be met 1:

1. Amenorrhea: The woman has not had any menstrual bleeding since delivery
2. Full or nearly full breastfeeding: Breastfeeding must be the primary source of nutrition for the infant, with minimal supplementation
3. Less than 6 months postpartum: The method is only reliable during the first 6 months after childbirth

Important Considerations and Limitations

When to Transition to Another Method

A woman should transition to another contraceptive method when ANY of these occur:

• Menstruation returns (any bleeding after 56 days postpartum)
• Supplemental feeding becomes regular (reducing breastfeeding frequency)
• Baby reaches 6 months of age

Common Pitfalls Leading to Method Failure

Research shows high failure rates in real-world settings, with 82.8% of women in one study not properly following one or more criteria 4. The most common reasons for failure were:

• Return of menses (43.8% of women)
• Introduction of supplemental feeding (70.3% of women)
• Lack of understanding about proper implementation

Medical Contraindications

While no medical conditions restrict the use of LAM for contraception, breastfeeding itself may be contraindicated in certain situations 1:

• HIV infection (in developed countries where safe alternatives exist)
• Active untreated tuberculosis
• Human T-cell lymphotropic virus types I or II
• Herpes simplex lesions on breast (can feed from unaffected breast)
• Infant with classic galactosemia
• Maternal use of certain medications:
  • Radioactive isotopes
  • Antimetabolites or chemotherapeutic agents
  • Drugs of abuse

Counseling Points

When counseling women about LAM:

1. Emphasize all three criteria must be met simultaneously
2. Discuss transition planning to another contraceptive method before any criteria are no longer met
3. Explain that LAM does not protect against STIs/HIV - condoms should be used if risk exists 1
4. Advise women with high-risk pregnancy conditions that LAM may not be appropriate due to its higher typical-use failure rates compared to more effective methods like IUDs or implants 1, 5
5. Provide education about proper breastfeeding techniques to maintain lactational amenorrhea

Advantages of LAM

• No cost
• No chemicals or hormones
• Immediately available postpartum
• Promotes optimal infant nutrition and maternal-infant bonding
• Provides time to decide on a longer-term contraceptive method
• Culturally and religiously acceptable to many populations

LAM serves as both a contraceptive method and a bridge to other family planning methods while supporting the health benefits of breastfeeding for both mother and infant 6.