Choosing the right contraceptive method is truly a journey. This decision, which evolves depending on life stages, sexuality, metabolism, health, needs, desires, and feelings, is most often made by women and is rarely simple or without constraints. That’s why more and more women are turning to alternative contraception and natural contraceptive methods. Among these is the LAM method, raising the question: can you get pregnant while breastfeeding?
TABLE OF CONTENTS:
- Natural contraception and hormonal contraceptives: a definition and key differences
- LAM: The Lactational Amenorrhea Method
- The limitations of the LAM method for preventing another pregnancy
Natural contraception and hormonal contraceptives: a definition and key differences
Gynecologists talk about products, methods, or contraceptive devices. You probably speak more readily about the pill, IUD, withdrawal, or implant. Whether hormonal or natural, contraceptives are designed to prevent intercourse from resulting in the conception of a child. But there are different types of contraception—or more precisely, hormonal contraception and natural contraception.
Hormonal contraceptives—the pill, hormonal IUD (intrauterine device or IUD), patch, implant, vaginal ring, or injectable contraceptives—use hormones to block ovulation, thicken cervical mucus, and/or thin the endometrium, preventing implantation of a fertilized egg. Progestin or estrogen-progestin based, these methods are highly effective (over 90% in practice) but often come with side effects.
Natural contraception—such as the Billings and Ogino-Knaus methods, withdrawal, abstinence, tracking basal body temperature, or symptothermal monitoring—does not use synthetic hormones or devices. Instead, it relies on observing the menstrual cycle and identifying periods of fertility to avoid pregnancy. These natural methods are more subjective and also less effective (about 75% in actual use), but free from side effects.
LAM: The Lactational Amenorrhea Method
LAM is unique. It is a short-term and completely natural contraceptive method, and it is very effective when correctly implemented. Without involving hormones or any devices, it is naturally triggered by the female body during breastfeeding. In fact, LAM stands for the Lactational Amenorrhea Method.
The principle is as follows: after giving birth, a mother who exclusively breastfeeds her baby is protected from a new pregnancy by lactation hormones. In reality, prolactin suppresses ovulation. This is sometimes referred to as “lactational infertility” or “lactational amenorrhea.”
However, for “contraceptive breastfeeding” to work, it must strictly meet several cumulative and exhaustive criteria:
- the mother must have a baby less than 6 months old,
- not have experienced the return of menstruation since childbirth,
- exclusively feed her baby at the breast, at least every four hours during the day and every six hours at night.
The limitations of the LAM method for preventing another pregnancy
For the lactational amenorrhea method to be fully effective as a contraceptive, it needs to be followed closely. While the risk of conceiving a child during breastfeeding is less than 2%, the LAM method does not protect against sexually transmitted diseases and infections. Additionally, because prolactin levels can vary, after 6 months it no longer effectively prevents ovulation.
Before your baby reaches the age of 6 months, it is therefore recommended to combine the LAM method with a second contraceptive that is compatible with breastfeeding if you choose to continue nursing.
What is exclusive breastfeeding?
Exclusive breastfeeding is recommended by the WHO (World Health Organization) until babies are six months old. This means that, from birth, the infant is fed only and exclusively at the breast by the mother, with no bottles or pumping involved.
According to the Haute Autorité de Santé, for exclusive breastfeeding to fully serve as a natural contraceptive, it is essential that exclusive breastfeeding takes place day and night at a rhythm of about 6 to 10 feedings in 24 hours. Additionally, the interval between breastfeeding sessions must remain less than 6 hours at night and less than 4 hours during the day.
Returning to work or switching to mixed feeding? Did you know that Élhée bottles can be equipped with adapter rings compatible with Avent and Medela breast pumps? A lovely way to treat yourself to the BibRond while continuing to breastfeed or partly breastfeed your baby!
Periods, return of menstruation, and lochia: how to anticipate your menstrual cycle’s return?
In the vast majority of cases, breastfeeding delays the return of menstruation and, therefore, the return of fertility. However, since the female body is a complex system, you may nonetheless experience bleeding.
In the hours following childbirth, this bleeding is called lochia. Bright red and initially very heavy, these are completely normal and occur as the uterus returns to its normal size by expelling endometrial debris and blood clots. Lochia generally lasts for a few days, then subsides on its own.
Following the lochia, between the 10th and 15th days after your child’s birth, you may experience additional bleeding for a few more hours or days, referred to as “petit retour de couches” (“small return of menstruation”). Again, these can be quite heavy and signal that the uterus is continuing to heal.
Generally, the “retour de couches”—the true return of your period—occurs between 4 and 8 weeks after childbirth. However, this timing can be much longer, especially if you decide to breastfeed your baby.
As every woman and every birth is unique, timing and symptoms may vary. For example, after a cesarean, bleeding—especially lochia and the small return of menstruation—tends to be less abundant.
After 6 months: contraceptives compatible with breastfeeding
Once the limits of natural birth control via breastfeeding are reached, you will need to choose another contraceptive method. Only estrogen-progestin contraceptives are not recommended during the first 6 months after your baby’s birth. Progestin-only methods (pill, subcutaneous implant, or intramuscular injection) can be used starting 21 days after birth, and IUDs (hormonal or copper) starting at 4 weeks.
The choice of a contraceptive method is never final but should always consider three essential criteria: whether or not you are breastfeeding, the risk of thrombosis (which is higher during pregnancy and the first weeks postpartum), and any health complications during pregnancy.
Although often perceived as more restrictive, barrier methods—condoms, diaphragms, cervical caps, and spermicides—can also be used. Some couples may opt for permanent contraception instead. Tubal ligation, electrocoagulation, application of rings or clips, and vasectomy all require a 4-month waiting period for reflection, but may be performed for the mother within 7 days after delivery.
And what about male contraception?
Although less common, there are natural contraceptive methods for men. In fact, after childbirth, resuming sexual activity as a couple is not always easy, so new mothers would probably appreciate if their partner sometimes took on the responsibility for contraception.
The testicular bath or Coso method involves temporarily immobilizing sperm with ultrasound. The thermal underwear method works using gentle, temporary elevation of testicular temperature to render sperm temporarily inactive.
It is therefore entirely possible to consider breastfeeding as an effective short-term contraceptive method, provided that several strict criteria are followed and keeping in mind that the female body remains full of mysteries—including the fact that it does not always adhere to physiological logic.
