Lactational Amenorrhoea (LAM)

Lactational Amenorrhoea refers to the absence of menstrual bleeding postpartum during breastfeeding.  From the dawn of time it has been known that breastfeeding is an effective means of spacing children.

In Bellagio (Italy) in 1988 a group of experts produced a consensus statement recommending LAM as an effective method of family planning. After carrying out studies in various countries, (including Australia), under the auspices of the World Health Organisation (WHO), the Bellagio consensus statement was reaffirmed in 1995.  Mothers are guaranteed 98% protection from pregnancy as long as they follow the guidelines.  It is essential for each individual woman to decide whether she can use LAM or an alternate method of NFP while breastfeeding.


How do you learn LAM?

Natural family planning educators have been trained to identify those clients who are able to use LAM.  They adhere strictly to the Bellagio guidelines and ask:

  • Is the mother amenorrhoeic?
  • Is she fully breastfeeding?
  • Is her baby less than 6 months old?  If so LAM is 98% effective during the first 6 months postpartum.

The ideal time to learn about LAM is prior to giving birth, or as soon as possible after giving birth.  Regular follow-up contacts with the NFP teacher throughout the first 6 months are recommended.


Can anyone use LAM?

Postpartum women who are breastfeeding can rely on LAM with confidence if they meet the criteria.  If they do not meet the criteria they will need to use an alternate method of family planning to avoid a pregnancy.

Women who choose to use natural family planning (NFP) or LAM are recommended to contact their local NFP Centre for a confidential appointment as soon as possible after the birth of the child.


Breastfeeding Advantages

Studies show that breastfeeding is regarded as the ideal source of nutrition for the human newborn because

  • Breastfeeding has evolved to be the pluperfect mechanism for nourishing newborn mammals/ human babies.
  • Breast milk is a living biological fluid (compared with its costly, sterile, inert, synthetic, counterpart) being adaptive to the mother’s microbial environment and providing the infant with both general and specific anti-infective factors.
  • Breast milk provides cost free ideal, not just adequate, nutrition to newborn babies.
  • Breastfeeding confers natural infertility for a time.
  • Breast milk supply is regulated by the infant’s demand.
  • Preterm infants who consume mother’s milk in the early weeks of life have higher IQ scores than formula fed infants.


Milk too Weak?  Never

Colostrum the high protein food secreted in the first few days postpartum protects against infection, helps prevent jaundice and satisfies the baby’s hunger and thirst. 

Breastmilk changes throughout the feeding process.  Foremilk is watery to satisfy thirst. Hindmilk is creamy to satisfy hunger.


Advantages of LAM

Lactational infertility is the body’s natural mechanism for spacing births, permitting the recuperation of the natural body reserves between successive pregnancies.  

The LAM guidelines augment a natural process rather than create an artificial state.  Breastfeeding:

  • postpones pregnancy as the baby’s suckling blocks the production of the hormones that activate ovulation
  • promotes emotional bonding between mother and baby
  • provides rapid return of uterine tone through nipple stimulation
  • produces rapid return to normal weight
  • protects against ovarian and pre-menopausal cancer


Effectiveness of LAM

The duration of LAM is influenced by breastfeeding practices, hormonal changes, cultural, socioeconomic, genetic and environmental influences.

Full breastfeeding on demand day and night (with no interval greater than 6 hours) will ensure that LAM is 98% effective for the first six months or until supplements are introduced in the baby’s feeding pattern. Then another method of family planning needs to be used immediately as fertility may possibly return prior to the first bleed.

Studies show that LAM effectiveness is comparable with the minipill without the side effects.


Breastfeeding on Demand

Each baby has its own individual feeding pattern.  Allow baby to feed on demand for as long as it wants on each breast.  This ensures that baby is satisfied by getting the thicker creamier milk as well as the thinner foremilk.  At the same time the baby’s suckling ensures that the mother remains infertile.  Any change in the feeding pattern may alter the fertility status of the mother.


Guidelines for LAM Use

The following guidelines must be observed for the successful use of LAM.  The mother must be:

fully or nearly fully breastfeeding

  1. ignore the first 56 days postpartum vaginal bleed when determining the return of menses or amenorrhoea
  2. feed baby on demand both night and day (approx. 6-8 feeds in 24 hours) with no interval greater than 6 hours
  3. not give dummies or pacifiers to baby as these will reduce the sucking action baby would normally use on the breast
  4. keep a lactation diary, when supplementary foods are introduced, to monitor your returning fertility
  5. monitor her fertility symptoms if baby is 6 months old or when baby is weaned
  6. remember menses often precedes ovulation in the early postpartum months but ovulation may precede menses in the later months of breastfeeding


LAM is 98% effective up to 6 months post-partum  but it is possible to fall pregnant while breastfeeding if  the criteria for LAM changes. 

Keep in contact with your NFP educator for support, particularly during the transition from LAM to NFP.


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