Lactational amenorrhea
Lactational amenorrhea, also called postpartum infertility, is the temporary postnatal infertility that occurs when a woman is amenorrheic (not menstruating) and fully breastfeeding.
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Lactational amenorrhea
Behavioral
Prehistory;
Ecological method 1971
<2%
?
Up to 6 months (longer in some cases, with greater failure rate)
Yes
Adherence to protocols
None
No
Absent
No external drugs or clinic visits required
Physiology[edit]
Hormonal pathways and neuroendocrine control[edit]
Breastfeeding delays the resumption of normal ovarian cycles by disrupting the pattern of pulsatile release of gonadotropin-releasing hormone (GnRH) from the hypothalamus and hence luteinizing hormone (LH) from the pituitary.[1] The plasma concentrations of follicle-stimulating hormone (FSH) during lactation are sufficient to induce follicle growth, but the inadequate pulsatile LH signal results in a reduced estradiol production by these follicles.[1] When follicle growth and estradiol secretion does increase to normal, lactation prevents the generation of a normal preovulatory LH surge and follicles either fail to rupture, or become atretic or cystic. Only when lactation declines sufficiently to allow generation of a normal preovulatory LH surge to occur will ovulation take place with the formation of a corpus luteum of variable normality. Thus lactation delays the resumption of normal ovarian cyclicity by disrupting but not totally inhibiting, the normal pattern of release of GnRH by the hypothalamus. The mechanism of disruption of GnRH release remains unknown.[1]
In women, hyperprolactinemia is often associated with amenorrhea, a condition that resembles the physiological situation during lactation (lactational amenorrhea). Mechanical detection of suckling increases prolactin levels in the body to increase milk synthesis. Excess prolactin may inhibit the menstrual cycle directly, by a suppressive effect on the ovary, or indirectly, by decreasing the release of GnRH.[2]
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Cross cultural use of lactational amenorrhea[edit]
The use of lactational amenorrhea method (LAM) can be seen across the world. It is used in many different societies to varying extents. LAM can be used by itself or in combination with other methods. There are multiple examples of LAM use covered in studies conducted about postpartum birth control methods in various countries and areas of the world. Additionally, the connection between LAM use and infant nutrition and health has been examined in different contexts. Beyond the physiological factors that influence lactational amenorrhea, cross cultural differences can help account for many of the variations in lactational amenorrhea.[20]
In Turkey, exploration of LAM has exposed a distinct lack of knowledge surrounding the connection between lactational amenorrhea and birth control.[21] However, these findings are contrasted with the fact that mothers demonstrated a desire to learn about LAM as a method of contraception. This lack of knowledge is not necessarily evident in other parts of the globe as exemplified in South-Eastern Hungary with the use of post-partum contraceptives.[22] There is an imbalance of birth control method usage postpartum. LAM makes up nearly double the usage of other contraceptive usages. One of the primary factors influencing choice of contraceptive in this area is level of education. A higher level of education correlates to a bigger chance of utilizing effective contraception methods rather than LAM.
Nutrition and health of both the mother and infant are connected to the use of LAM in the international community. By promoting LAM, exclusive breastfeeding for the infant becomes more prominent in order to make LAM as effective as possible. In Egypt, this has been shown to combat poor nutritional practices of mothers. To make sure infants are getting fully enriching breast milk, mothers must take their own nutritional practices seriously, leading to an overall improvement of nutrition.[23] An area in Kenya further provides evidence that there is a substantial link between proper nutrition and LAM, specifically with infants.[24] This exclusive use of breastfeeding has a positive impact on preventing pregnancy as well as reducing child mortality. The promotion of LAM has shown an increase in breast feeding overall, resulting in better prospects of survival for infants.
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For women who follow the suggestions and meet the criteria (listed below), lactational amenorrhea method (LAM) is >98% effective during the first six months postpartum.[14][15]
If not combined with barrier contraceptives, spermicides, hormonal contraceptives, or intrauterine devices, LAM may be considered natural family planning by the Roman Catholic Church.[18][19]
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