## Lactational Amenorrhea Method (LAM) **Key Point:** Elevated prolactin from frequent breastfeeding suppresses GnRH pulsatility, leading to inhibition of FSH and LH, which prevents follicular development and ovulation. ### Mechanism of Lactational Infertility 1. **Suckling stimulus** → Hypothalamic suppression of GnRH pulses 2. **Elevated prolactin** → Direct inhibition of GnRH secretion and reduced pituitary sensitivity to GnRH 3. **Low FSH/LH** → No follicular development, anovulation 4. **Amenorrhea** → Contraceptive effect ### Lactational Amenorrhea Method (LAM) Criteria | Criterion | Requirement | | --- | --- | | **Breastfeeding** | Exclusive (no formula/solids) | | **Frequency** | ≥8 feeds/24 hours (including night feeds) | | **Duration** | First 6 months postpartum | | **Amenorrhea** | Absence of menses | | **Efficacy** | ~98% if all criteria met | **High-Yield:** LAM is a WHO-recognized contraceptive method with efficacy comparable to barrier methods when criteria are strictly followed. Efficacy drops to ~70% if any criterion is not met. **Clinical Pearl:** The contraceptive effect is lost once: - Menses return - Breastfeeding becomes non-exclusive - 6 months postpartum is reached - Breastfeeding frequency drops below 8 feeds/day **Warning:** Many mothers believe LAM provides protection beyond 6 months or with partial breastfeeding — this is a common misconception leading to unplanned pregnancies.
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