Selected woman’s characteristics
Breastfeeding Status:
Time Selected: Between 0 hours and 12 months
Method Selected: Lactational Amenorrhea Method
Note: Some methods are unavailable for specific time ranges

Description

Temporary contraception for new mothers whose monthly bleeding has not returned; requires exclusive or full breastfeeding day and night of an infant less than 6 months old

How it works

Prevents the release of eggs from the ovaries (ovulation)

 

Effectiveness to prevent pregnancy

99% with correct and consistent use

98% as commonly used

Comments

A temporary family planning method based on the natural effect of breastfeeding on fertility
 

Conditions / Subconditions

Breastfeeding Status:

No breastfeeding status was selected using the "Women’s characteristics" filters.

Breastfeeding Category Clarifications/Special considerations
Breastfeeding <6 months postpartum There are no medical conditions in which the use of the LAM is restricted. ALL of the following three criteria must be met to ensure adequate protection from an unplanned pregnancy:
1. amenorrhoea
2. fully or nearly fully breastfeeding
3. less than six months postpartum.
Non-breastfeeding Category Clarifications/Special considerations
Non-breastfeeding Not eligible for method

Medical Condition:

No medical conditions were selected using the "Women’s characteristics" filters.

Cardiovascular disease Category Clarifications/Special considerations
Current and history of ischaemic heart disease There are no medical conditions in which the use of the LAM is restricted and there is no documented evidence of its negative impact on maternal health. Women with conditions that make pregnancy an unacceptable risk should be advised that the LAM may not be appropriate for them because of its relatively higher typical-use failure rates.
Stroke
Diabetes Category Clarifications/Special considerations
a) History of gestational disease There are no medical conditions in which the use of the LAM is restricted and there is no documented evidence of its negative impact on maternal health. Women with conditions that make pregnancy an unacceptable risk should be advised that the LAM may not be appropriate for them because of its relatively higher typical-use failure rates.
b) Non-vascular disease
i) non-insulin dependent
ii) insulin dependent
c) Nephropathy / retinopathy / neuropathy
d) Other vascular disease or diabetes of > 20 years’ duration
Headaches Category Clarifications/Special considerations
a) Non-migrainous (mild or severe) There are no medical conditions in which the use of the LAM is restricted and there is no documented evidence of its negative impact on maternal health. Women with conditions that make pregnancy an unacceptable risk should be advised that the LAM may not be appropriate for them because of its relatively higher typical-use failure rates.
b) Migraine
i) without aura
   age < 35 years
   age > 35 years
ii) with aura, at any age
HIV WHO Stage 3 or 4 Category Clarifications/Special considerations
Severe or advanced HIV clinical disease (WHO stage 3 or 4) There are no medical conditions in which the use of the LAM is restricted and there is no documented evidence of its negative impact on maternal health. Women with conditions that make pregnancy an unacceptable risk should be advised that the LAM may not be appropriate for them because of its relatively higher typical-use failure rates.
Read More

HIV WHO Stage 3 or 4

Women with conditions that make pregnancy an unacceptable risk should be advised that the LAM may not be appropriate for them because of its relatively higher typical-use failure rates.

A woman living with HIV can transmit the virus to her child through breastfeeding. Yet breastfeeding, and especially early and exclusive breastfeeding, is one of the most critical factors for improving child survival.

Breastfeeding also confers many other benefits in addition to reducing the risk of death.

Giving antiretroviral medications (ARVs) to either the HIV-positive mother or the HIV-exposed infant or both can significantly reduce the risk of transmitting HIV through breastfeeding.

In the presence of ARVs – either lifelong antiretroviral therapy (ART) to the mother or other ARV interventions to the mother or infant – the infant can receive all the benefits of breastfeeding with little risk of acquiring HIV.

In some well-resourced countries with low infant and child mortality rates, avoidance of all breastfeeding will still be appropriate.

Mothers living with HIV should receive the appropriate ARV interventions and should exclusively breastfeed their infants for the first six months of life, introducing appropriate complementary foods thereafter, and should continue breastfeeding their infants for the first 12 months of life.

If the infant is HIV-negative or of unknown HIV status: A mother known to be living with HIV should only give commercial infant formula milk as a replacement feed to this infant when all of the following specific conditions are met: 1. safe water and sanitation are assured at the household level and in the community, and 2. the mother or other caregiver can reliably provide sufficient infant formula milk to support normal growth and development of the infant, and 3. the mother or caregiver can prepare it cleanly and frequently enough so that it is safe and carries a low risk of diarrhoea and malnutrition, and 4. the mother or caregiver can, in the first six months, exclusively give infant formula milk, and 5. the family is supportive of this practice, and 6. the mother or caregiver can access health care that offers comprehensive child health services.

If the infant is known to be HIV-positive:

The mother is strongly encouraged to exclusively breastfeed for the first six months of the infant’s life and to continue breastfeeding as per the recommendations for the general population, that is up to two years or beyond.

Hypertension Category Clarifications/Special considerations
a) History of hypertension, where blood pressure CANNOT be evaluated (including hypertension in pregnancy) There are no medical conditions in which the use of the LAM is restricted and there is no documented evidence of its negative impact on maternal health. Women with conditions that make pregnancy an unacceptable risk should be advised that the LAM may not be appropriate for them because of its relatively higher typical-use failure rates.
b) Adequately controlled hypertension, where blood pressure CAN be evaluated
c) Elevated blood pressure levels (properly taken measurements)
   i) systolic 140-159 or diastolic 90-99 mm Hg
   ii) systolic ≥ 160 or diastolic ≥ 100 mm Hg
d) Vascular disease
Obesity Category Clarifications/Special considerations
a) > 30 kg/m2 BMI There are no medical conditions in which the use of the LAM is restricted and there is no documented evidence of its negative impact on maternal health. Women with conditions that make pregnancy an unacceptable risk should be advised that the LAM may not be appropriate for them because of its relatively higher typical-use failure rates.
b) Menarche to < 18 years and ≥30 kg/m2 BMI
Pelvic infection Category Clarifications/Special considerations
Current purulent cervicitis or chlamydial infection or gonorrhoea/Pelvic inflammatory disease/Sepsis There are no medical conditions in which the use of the LAM is restricted and there is no documented evidence of its negative impact on maternal health. Women with conditions that make pregnancy an unacceptable risk should be advised that the LAM may not be appropriate for them because of its relatively higher typical-use failure rates.

Pelvic infection

    Women with conditions that make pregnancy an unacceptable risk should be advised that the LAM may not be appropriate for them because of its relatively higher typical-use failure rates.
Tuberculosis Category Clarifications/Special considerations
a) Non-pelvic There are no medical conditions in which the use of the LAM is restricted and there is no documented evidence of its negative impact on maternal health. Women with conditions that make pregnancy an unacceptable risk should be advised that the LAM may not be appropriate for them because of its relatively higher typical-use failure rates.
b) Pelvic
Venous thromboembolism Category Clarifications/Special considerations
a) History of DVT/PE There are no medical conditions in which the use of the LAM is restricted and there is no documented evidence of its negative impact on maternal health. Women with conditions that make pregnancy an unacceptable risk should be advised that the LAM may not be appropriate for them because of its relatively higher typical-use failure rates.
b) Acute DVT/PE
c) DVT/PE and established on anticoagulant therapy
d) Family history (first-degree relatives)

Drug Interactions:

No drug interactions were selected using the "Women’s characteristics" filters.

Anticonvulsants Category Clarifications/Special considerations
a) Certain anticonvulsants,(phenytoin, carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine) No assigned category In order to protect infant health, breastfeeding is not recommended for women using such drugs as: anti-metabolites, bromocriptine, certain anticoagulants, corticosteroids (high doses), ciclosporin, ergotamine,
lithium, mood-altering drugs, radioactive drugs and reserpine.

For information about the use of specific medications while breast feeding, please see: http://apps.who.int/iris/bitstream/10665/62435/1/55732.pdf

b) Lamotrigine
Antimicrobial Therapy Category Clarifications/Special considerations
a) Broad-spectrum antibiotics No assigned category In order to protect infant health, breastfeeding is not recommended for women using such drugs as: anti-metabolites, bromocriptine, certain anticoagulants, corticosteroids (high doses), ciclosporin, ergotamine, lithium, mood-altering drugs, radioactive drugs and reserpine.

For information about the use of specific medications while breast feeding, please see: http://apps.who.int/iris/bitstream/10665/62435/1/55732.pdf

b) Antifungals
c) Antiparasitics
Antiretroviral Therapy Category Clarifications/Special considerations
a) Nucleoside reverse transcriptase inhibitors (NRTIs) No assigned category Giving antiretroviral medications (ARVs) to either the HIV-positive mother or the HIV-exposed infant or both can significantly reduce the risk of transmitting HIV through breastfeeding.
Read More
Abacavir (ABC)
Tenofovir (TDF)
Zidovudine (AZT)
Lamivudine (3TC)
Didanosine (DDI)
Emtricitabine (FTC)
Stavudine (D4T)
b) Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
Efavirenz (EFV)
Etravirine (ETR)
Nevirapine (NVP)
Rilpivirine (RPV)
c) Protease
inhibitors (PIs)
Ritonavir-boosted atazanavir (ATV/r)
Ritonavir-boosted lopinavir (LPV/r)
Ritonavir-boosted darunavir (DRV/r)
Ritonavir (RTV)
d) Integrase inhibitors
Raltegravir (RAL)

Antiretroviral therapy

  • Giving antiretroviral medications (ARVs) to either the HIV-positive mother or the HIV-exposed infant or both can significantly reduce the risk of transmitting HIV through breastfeeding.
  • In the presence of ARVs – either lifelong antiretroviral therapy (ART) to the mother or other ARV interventions to the mother or infant – the infant can receive all the benefits of breastfeeding with little risk of acquiring HIV.
  • In some well-resourced countries with low infant and child mortality rates, avoidance of all breastfeeding will still be appropriate.
  • Mothers living with HIV should receive the appropriate ARV interventions and should exclusively breastfeed their infants for the first six months of life, introducing appropriate complementary foods thereafter, and should continue breastfeeding their infants for the first 12 months of life.
  • If the infant is HIV-negative or of unknown HIV status: A mother known to be living with HIV should only give commercial infant formula milk as a replacement feed to this infant when all of the following specific conditions are met:
    1. safe water and sanitation are assured at the household level and in the community, and
    2. the mother or other caregiver can reliably provide sufficient infant formula milk to support normal growth and development of the infant, and
    3. the mother or caregiver can prepare it cleanly and frequently enough so that it is safe and carries a low risk of diarrhoea and malnutrition, and
    4. the mother or caregiver can, in the first six months, exclusively give infant formula milk, and 5. the family is supportive of this practice, and
    6. the mother or caregiver can access health care that offers comprehensive child health services.
  • For information about the use of specific medications while breast feeding, please see this document

Other:

No other conditions were selected using the "Women’s characteristics" filters.

Adolescents Category Clarifications/Special considerations
Adolescents There are no medical conditions in which the use of the LAM is restricted and there is no documented evidence of its negative impact on maternal health. Special consideration: Adolescents, In general, adolescents are eligible to use any method of contraception and must have access to a variety of contraceptive choices.
Read More

Adolescents

    Special consideration:
  • Adolescents, In general, adolescents are eligible to use any method of contraception and must have access to a variety of contraceptive choices. See more
  • Age alone does not constitute a medical reason for denying any method to adolescents. While some concerns have been expressed regarding the use of certain contraceptive methods in adolescents (e.g. the use of progestogen-only injectables by those below 18 years), these concerns must be balanced against the advantages of avoiding pregnancy. It is clear that many of the same eligibility criteria that apply to older clients apply to young people.

    However, some conditions (e.g. cardiovascular disorders) that may limit use of some methods in older women do not generally affect young people since these conditions are rare in this age group. Social and behavioural issues should be important considerations in the choice of contraceptive methods by adolescents. For example, in some settings, adolescents are also at increased risk for STIs, including HIV. While adolescents may choose to use any one of the contraceptive methods available in their communities, in some cases, using methods that do not require a daily regimen may be more appropriate.

    Adolescents, married or unmarried, have also been shown to be less tolerant of side-effects and therefore have high discontinuation rates. Method choice may also be influenced by factors such as sporadic patterns of intercourse and the need to conceal sexual activity and contraceptive use. For instance, sexually active adolescents who are unmarried have very different needs from those who are married and want to postpone, space or limit pregnancy.

    Expanding the number of method choices offered can lead to improved satisfaction, increased acceptance and increased prevalence of contraceptive use. Proper education and counselling both before and at the time of method selection can help adolescents address their specific problems and make informed and voluntary decisions. Every effort should be made to prevent service and method cost from limiting the options available.
Smoking Category Clarifications/Special considerations
a) Age < 35 years There are no medical conditions in which the use of the LAM is restricted and there is no documented evidence of its negative impact on maternal health. There are no medical conditions in which the use of the LAM is restricted and there is no documented evidence of its negative impact on maternal health.

Women with conditions that make pregnancy an unacceptable risk should be advised that the LAM may not be appropriate for them because of its relatively higher typical-use failure rates.

b) Age > 35 years
   i) < 15 cigarettes/day
   ii) > 15 cigarettes/day
Note: Some methods are unavailable for specific time ranges