Can comfort nursing (breastfeeding for comfort) a 3-year-old child who still produces some milk affect fertility and ovulation in the mother, potentially making it difficult to conceive?

Comfort Nursing and Fertility Impact

Yes, comfort nursing a 3-year-old with continued milk production can suppress ovulation and reduce fertility, but the effect is highly dependent on nursing frequency and intensity—if you are nursing fewer than 5 times daily with less than 65 minutes total duration, the contraceptive effect is minimal and you should not rely on it for birth spacing. 1, 2

Understanding the Mechanism

The suckling stimulus disrupts normal pulsatile secretion of gonadotropin-releasing hormone (GnRH) in the hypothalamus, which reduces luteinizing hormone (LH) secretion from the pituitary. 1 This hormonal disruption prevents adequate estradiol secretion needed to trigger an LH surge and ovulation, even when follicles develop under FSH influence. 1

• The effect operates through intracerebral opioid pathways where beta-endorphins inhibit GnRH and dopamine secretions, which in turn stimulates prolactin secretion. 3
• However, this mechanism requires intensive, frequent suckling to maintain suppression of ovulation. 1, 3

Critical Thresholds for Fertility Suppression

The lactational amenorrhea method (LAM) provides ≥98% contraceptive efficacy only when ALL three conditions are met simultaneously: 4, 3

1. Baby is under 6 months postpartum
2. Mother remains completely amenorrheic
3. Exclusive or nearly exclusive breastfeeding (≥85% of feeds) on demand, day and night

Your Situation at 3 Years Postpartum

At 3 years postpartum with only comfort nursing, you are far outside the protective window for lactational infertility:

• The 6-month threshold is absolute—beyond this timeframe, even with amenorrhea and frequent nursing, fertility protection drops dramatically. 4
• Research shows that ovulation rates reach 37% by 6 months and 97% by 12 months postpartum in nursing mothers. 5
• 67% of ovulations occur during continued amenorrhea, meaning lack of menstruation does not guarantee infertility. 5

Specific Nursing Frequency Requirements

If you want to rely on breastfeeding for contraception (which is not recommended at 3 years), you would need:

• Minimum 5 sucklings per day with total duration exceeding 65 minutes daily (>10 minutes per feed). 2
• No mother in research studies conceived with suckling frequency greater than 3 times daily, but some ovulated without conceiving at 4 times daily. 2
• Any reduction below these thresholds results in return of fertility. 2

Common pitfall: Assuming amenorrhea equals infertility. This is a dangerous clinical error—amenorrhea does not always equal anovulation, and the relationship depends entirely on the underlying cause. 6

Practical Recommendation for Your Situation

You should assume normal fertility and use contraception if pregnancy is not desired. 4

• Even if you are amenorrheic at 3 years postpartum, this likely represents a different etiology (possibly functional hypothalamic amenorrhea from prolonged lactation) rather than protective lactational amenorrhea. 6
• Women with amenorrhea from various causes can maintain sporadic ovarian function and should not be presumed infertile. 6
• The risk of pregnancy after first menses in nursing mothers is 93% ovulation rate with 7% pregnancy risk per cycle. 5

If You Are Trying to Conceive

If difficulty conceiving is your concern, consider:

• Reducing or stopping comfort nursing to allow full restoration of the hypothalamic-pituitary-ovarian axis. 1, 2
• Any significant decrease in suckling frequency and duration can trigger resumption of ovulation. 2
• The endocrine profile typically normalizes within 1-2 cycles after reducing nursing intensity, even if some nursing continues. 5

Bottom line: At 3 years postpartum with comfort nursing, the contraceptive effect is unreliable at best and likely negligible. If you want to conceive, reducing nursing frequency will likely restore normal ovulation. If you want to avoid pregnancy, use contraception regardless of nursing status or menstrual pattern.