1. The lactation amenorrhea method can provide contraception in the early postpartum months.
2. Mechanism of action.
a. There are decreased progesterone and estrogen levels after delivery.
b. Ovulation suppression lasts 70 to 100 days after delivery.
c. Nipple stimulation sends nerve impulses to the hypothalamus that cause release of beta-endorphin, which decreases gonadotropin-releasing hormone (GNRH) secretion; there is no follicle development.
d. Increased levels of prolactin make ovaries unresponsive to LH, suppressing positive feedback effects of estrogen on the midcycle rise of GNRH or directly interfering with ovarian steroid production.
e. The sucking mechanism is crucial for effectiveness. A woman who is fully or nearly fully breast-feeding and remains amenorrheic for 6 months postpartum is protected against pregnancy.
f. Breast-feeding is effective as birth control for 6 months if 15 or more feedings lasting 10 minutes are accomplished daily.
g. This method depends on the intensity of breast-feeding and rate of menses return.
h. Most of the women in the United States do not practice full, on-demand breast-feeding, which is the basis of the lactation amenorrhea method; they need to use complementary contraceptive methods.