How difficult is it to conceive while breastfeeding a 2-year-old?

Fertility While Breastfeeding a Two-Year-Old

While breastfeeding a two-year-old, you can get pregnant as the contraceptive effect of breastfeeding (lactational amenorrhea) is only reliable during the first 6 months postpartum when specific criteria are met. 1

Lactational Amenorrhea Method (LAM) and Its Limitations

Lactational amenorrhea provides contraceptive protection only when ALL three criteria are met:

1. Amenorrhea (no menstrual periods)
2. Fully or nearly fully breastfeeding
3. Less than 6 months postpartum 1

When breastfeeding a two-year-old:

• You are well beyond the 6-month protection period
• Breastfeeding frequency and duration are typically reduced
• Complementary foods have been introduced
• Ovulation likely resumed months ago

Effectiveness Rates

• LAM during first 6 months (when criteria met): 98% effective 1, 2
• After 6 months: No reliable contraceptive effect 3

Fertility Return Timeline

The return of fertility while breastfeeding follows this general pattern:

• 0-6 months: Very low risk if exclusively breastfeeding and amenorrheic (0.5-2% pregnancy risk) 3, 4
• 6+ months: Significantly increased risk of pregnancy even with continued breastfeeding 4
• By 2 years: Normal fertility is typically restored regardless of breastfeeding status

Factors Affecting Fertility While Breastfeeding a Toddler

1. Breastfeeding pattern: Toddlers typically nurse less frequently and for shorter durations than infants, reducing hormonal suppression of ovulation

2. Menstrual status: If your periods have returned, you are definitely ovulating and can get pregnant

3. Supplemental feeding: Two-year-olds receive most nutrition from solid foods, further reducing the contraceptive effect of breastfeeding

4. Sleep patterns: Longer sleep stretches (especially at night) reduce prolactin levels that suppress ovulation

Contraceptive Options While Breastfeeding a Two-Year-Old

Since breastfeeding a two-year-old provides minimal contraceptive protection, consider these options:

Recommended Options

• Progestin-only methods: Safe for breastfeeding without affecting milk production (implants, IUDs, mini-pills) 3
• Non-hormonal methods: Copper IUDs, barrier methods 3
• Permanent methods: Tubal sterilization or vasectomy if family is complete 4

Less Ideal Options

• Combined hormonal contraceptives: May reduce milk production, generally not first choice while breastfeeding 4
• Fertility awareness methods: Can be challenging during breastfeeding as fertility signs may be less reliable 1

Important Considerations

• Breastfeeding beyond 6 months continues to provide health benefits for both mother and child, including reduced risk of breast cancer, ovarian cancer, and type 2 diabetes 1, 5
• The World Health Organization recommends breastfeeding for up to 2 years or beyond 1, 6
• Unplanned pregnancy can impact breastfeeding relationship and maternal health

Common Pitfalls to Avoid

1. Assuming continued contraceptive protection: Many women incorrectly believe breastfeeding provides reliable contraception beyond 6 months

2. Waiting for menstruation to return: You can ovulate before your first postpartum period, making pregnancy possible before menstruation resumes

3. Inconsistent contraceptive use: The risk of pregnancy while breastfeeding a toddler is similar to non-breastfeeding women, requiring consistent contraception

4. Delaying contraception decisions: Implement effective contraception well before the 6-month mark to prevent unplanned pregnancy

In summary, while breastfeeding a two-year-old has many health benefits, it provides minimal protection against pregnancy. Reliable contraception should be used if pregnancy is not desired.