Lactational amenorrhoea An almost similar question was asked previously in 'All India' examination. Note that previously 'Most effective' contraceptive was asked. Now the question is different -Ideal' contraceptive is asked. Practically, there are no ideal contraceptives (neither for lactating women, nor for non-lactating women). An Ideal contraceptive is one which is - 100% effective, 100% safe, reversible with no side effects, and minimal effect on lactation. The Barrier methods and Combined OCPs can be easily ruled out; as barrier methods have high failure rates if used alone, while combined OCPs have a negative effect on breast milk production. Lactational amenorrhoea is the most ideal contraceptive for a lactating women, as it has viually no side effects, rather it has plethora of benefits for both mother and child. About effectiveness, it is almost equally effective to Progesterone only pills (POPs) when used perfectly. (see the below table) Failure rates: Contraceptive method Typical use Perfect use LAM (6 months only) 2.0 0.5 IUD 0.8 0.6 POP 'mini pill' 8.0 0.5 Combined oral contraceptive 6-8 0.1 Barrier method 14 3.0 Lactational amenorrhoea (LAM) is a natural, safe and effective contraceptive method which can be used upto 6 months post paum if the following conditions are met. (Note that LAM is not pure simple exclusive breast feeding; following conditions need to be fulfilled) I. The mother should not experience vaginal bleeding after the 8 weeks postpaum. The baby is less than 6 months old. The baby is exclusively breastfed. Breast feeding is done at least every 4 hrs. during the day and every 6 hrs during night. If the above conditions are fulfilled then LAM can give more than 98% protection from pregnancy. It has the added benefit of promoting exclusive breast feeding which is the ideal nutrition for infants. Lactational Amenorrhoea Advantages Disadvantages * Very effective if used perfectly * Can be used only for a sho period * Has no side effects (6 months post paum) * Promotes exclusive breast feeding, and therefore enhances maternal and infant health. * Does not require inseion of any device at the time of sexual intercourse * Can be initiated immediately postpaum * Is economical and requires no commodities or supplies * Reduces mother's lifetime risk of breast cancer. Physiology of LAM: Infant's suckling is the stimulus that initiates the state of lactational amenorrhea for breastfeeding women. The act of suckling elevates prolactin levels, and reduces GnRH from the hypothalamus. This reduces LH release thus inhibiting .follicular maturation. This prevents ovulation. But, even with continued nursing, ovulation eventually returns after 6 months, so another method of contraception should be used 6 months postpaum, or sooner if the menses resume. Ovalation has been seen to resume even earlier in some patients, so some books advice 'Rule of 3' i.e. - another contraceptive method should be use along with LAM beginning from the 3rd postpaum month. - and if the women is paially breastfeeding or not breastfeeding, the contraceptive should begin by the 3rd postpaum week. Progesterone only pills are the most effective contraceptive during lactation amongst the options provided. They have drawbacks like: - Have to be taken regularly at the same time - Cause spotting or irregular bleeding, ectopic pregnancy, headache, nausea, acne, hirsuitism and weight gain