LACTATIONAL

AMENORRHOEA
PRESENTED BY GROUP FOUR

Presentation objectives
define the method
Describe the method
Explain when to start using the method
Describe the effectiveness of the method
Explain the eligibility criteria
State the contraindications and contraindications
Explain the instruction o usage of the method
Side effects and management of the side effects
Misunderstandings about the method of planning

Definition of terms
lactation: breast feeding

Amenorrhea: the absence of menstruation which occurs during a

woman's reproductive age
Lactation amenorrhea: family planning method which involves
temporally postnatal infertility which occurs when a woman breast feed
exclusively
Family planning method based on the physiological infertility
experienced by breast feeding women

Short description
Lactation amenorrhea (LAM) Prevents pregnancy by interfering with
the production and release of natural hormones which are responsible
for release of ovum/egg from the ovaries.

MODE OF CTION
Frequent and intense breast feeding prevents ovulation through a
physiological sequence of events as follows
1. The baby's suckling of breast milk stimulates the nipples, during
suckling the baby squeezes and rubs the nipples with its lips, gums
and palate which causes pressure or mechanical stimulation of the
nipples.
2. The stimulation of the nipples sends a neural signal to the mothers
brain-specifically the pituitary gland which produces and secretes
hormones related to many bodily processes including ovulation

Mode of action contd

3. The neural signal, signals the mothers brain and disrupts the production
of hormones which would normally stimulate the ovaries to produce eggs
in response to suckling stimuli there is an increased production of
prolactin which inhibits the secretion of Gonadotropin Releasing hormone
(GnRH) by the hypothalamus.
disruption in the release of GnRH in turn disrupts the pituitary glands
production of hormones directly responsible for ovulation

 The hormones responsible for ovulation are

Luteinizing hormone (LH)
Follicle stimulating hormone (FSH)
4. Without the above mentioned hormones ovulation is prevented
Disruption in the release of FSH impedes the normal maturation of the
ovum/egg in the ovaries
Disruption in the release of LH impede the release of mature ovum by
the ovaries

 Babys suckling stimulates

the nipple
Nipple stimulation triggers
signals to mothers brain
Signals disrupt hormone
production
Disruption of hormones
suppresses ovulation

WHEN TO START USING LAM METHOD

Every woman who want to use LAM as a family planning method
begins using the method instantly the baby is born by starting to
intensively breast feed within one hour after child delivery or as soon
as possible following child birth.

EFFECTIVENESS OF THE LAM

LAM is 98% effective if used perfectly i.e. when the three criteria are
followed correctly.
thus fulfilling all of its conditions, chances of becoming pregnant
during the first six months after delivery are less than 2%.
2 pregnancies per hundred women after birth.

MEDICAL ELIGIBILITY CRITERIA

The criteria to have LAM as a successful family planning method are
1. Woman's menstrual bleeding has not returned within 56 days after
delivery
2. When the woman exclusively breast feed her baby
3. The baby is only six months of age

INDICATIONS FOR LAM

LAM is indicated to all women who can use the method effectively as
long as the meet the three criteria's
NOTE : HIV women can also use LAM as a method of contraceptive. All
HIV-positive women for whom replacement feeding is not Affordable,
Sustainable and Safe should be encouraged to only/exclusively breastfeed
their infants for six months.
After six months, they should continue breastfeeding in addition to
supplemental feeds until they afford and sustain criteria are met.

CONTRAINDICATIONS OF LAM
Lactational amenorrhea is contraindicated in women
1. Who's menses has returned
2. Who's baby's are more than six months old
3. Women who are not exclusively breastfeeding

ADVANTAGES OF LAM
Effectively prevents pregnancy for at least six month
Does not require supplies or procedures thus it is non pharmacological
neither invasive.
Promote mother and child bonding
Raises no religious opposition/objection
Has no hormonal, or other, side effects (for breastfeeding mother or
infant)
Readily available to postpartum mothers universally
Economical/cheap

DISADVANTAGES OF LAM
Offers only temporary contraceptive protection (up to six months)
Is not usually appropriate if mother will be separated from baby for
periods of time e.g. due to work or school.
Does not provide protection against HIV and other STDs
May pose concerns for HIV-positive mothers, i.e. Possibility of
transmitting HIV virus to the baby is high.

Side effects
There are no side effects associated with the use of Lactational
amenorrhea

INSTRUCTIONS ON USE OF LAM

woman who is using lactation amenorrhea is instructed on
a) Exclusive breastfeeding at least 8-10 times a day and once during
the night
b) mothers whose baby's do not want to breast feed due to sleep or
illness should encourage baby's to breast feed 6-10 times a day
c) Begin supplementing the baby's diet when the baby reach six month
of age
d) When the mother stops to exclusively breastfeed she should start a
new family planning method

Instructions contd
Always keep a backup method of contraceptive such us condoms
when menses returns
The mother should be counseled on proper technique of breastfeeding

ELEMENTS OF LAM COUNSELING

educate about LAMs
three criteria and why each is important
Any conditions that exclude use of LAM
Discuss effectiveness of LAM
Select another modern method to which to transition to from LAM
Encourage spacing of pregnancies
Discuss optimal breastfeeding practices
Ensure that client knows to return if she has a problem

MISSUNDERSTANDINGS ASSOCIATED
WITH LAM
Pumping or bottle feeding breast milk is same as breast feeding and is
part of LAM
Exclusive breast feeding dries the breast milk
LAM IS for big fat women

PROBLEMS ASSOCIATED WITH LAM

The use of lactation amenorrhea may face the following challenges
Reduced production of breast milk
Sores on the breast and nipples

POSSIBLE SOLUTIONS
Drink plenty of fluids and eat nutritious foods
Breastfeed the baby on the less sore nipple

Examine the mothers for signs of thrush and other fungi diseases for
prompt treatment

references
WHO. 2006. HIV and Infant Feeding: Report of a Technical
Consultation. 25-27 October 2006. WHO: Geneva
Hatcher Rinehart, Blackburn Geller Shelton: the essentials of
contraceptive technology; John Hopkins population program
LAM workshop for maternal, newborn and child health(MNCH)
service 2009
Paul FA Van look(2007) Family planning a global handbook for
providers: department of reproductive health and research(WHO)
A Learning Resource Package for Family Planning Service Providers
and Trainers. Georgetown University: Washington, D.C. www.irh.org

GROUP MEMBERS
Siyilen Chiliyapa
Bizwick Betha
Lucy Kassim
Elizerbeth Kanyemba
Marry Simwaka
Vestina olive oliva ofrinca Mlotha
Caroline Kabwatika
Thokozile Nkhoma
Getrude njewa
Gabriel Mjuma
Ibrahim Chiposyo