Mom feeding baby, taken by Hefferilt Photography

Postpartum Fertility, Lactational Amenorrhea Method & Fertility Awareness Charting

JULY 31, 2022

If some of the oldest forms of birth control are brand new to you, you're not alone! A lot of folks come prepared for birth with a birth plan, and some even go as far as to hire a lactation consultant, but taking your fertility into your own hands postpartum can feel so intimidating. You just had a baby, and birth control probably hasn't been on your mind for awhile. Understanding your fertility postpartum can help you to make informed decisions about birth control -- whenever you're ready.

Postpartum Return of Fertility

The return of fertility postpartum varies and depends on many factors. Most notably, fertility suppression is strongly linked to suckling and the nursing relationship.

When a baby suckles at the breast/chest, your body releases a hormone called prolactin. Prolactin is believed to act on the pituitary gland and interfere with the action of two pituitary-regulated hormones called follicle stimulating hormone (FSH) and lutenizing hormone (LH). This interference results in less estrogen production and the suppression of ovulation. Ovulation is the main event of the menstrual cycle and the only time of the cycle when pregnancy can occur. No ovulation = No pregnancy.

In a cycle where ovulation is not adequately suppressed, FSH stimulates the egg follicles in the ovary to grow and produce estrogen. Circulating estrogen triggers the release of LH, which promotes ovulation.

Those who are not breast/chest feeding can expect their fertility to return about 4-6 weeks postpartum, and those who stop can expect their fertility to return about 2-4 weeks later. (Extended infertility past 12 weeks is worth investigating.)

How long fertility will remain suppressed while breast/chest feeding depends on the frequency of feedings as well as individualized hormonal profiles.

The transition to fertility commonly involves moving from anovulatory amenorrhea (no ovulation, no period) to a phase of ovarian activity, then ovulation prior to menstruation (or a bleed that is not preceded by ovulation), up to six months of irregular cycles that likely include long follicular phases and short luteal phases, and finally, the return to regular cycling. Many cycling bodies notice changes when their system is preparing to ovulate.

Lactational Amenorrhea Method (LAM)

Following Lactational Amenorrhea Method is an option for naturally avoiding pregnancy during the first six months postpartum. LAM can be used when the following criteria are met:

- The baby is less than 6 mo. old
- The lactating parent is not menstruating (amenorrhea). There’s been no bleeding outside of the first 56 days postpartum.
- The lactating parent is exclusively or nearly exclusively feeding human milk to the baby from their breast/chest on demand, and not going longer than 4-6 hours between feeds (including overnight).

(Something I didn’t know when I began breastfeeding is that the clock starts ticking at the start of a feed, not when the feed ends.)

Benefits of LAM:
- Can be used immediately after birth
- There’s no need to take hormonal contraceptives
- Does not require a pause in sexual activity to apply the method
- Provides benefits associated with lactation and human milk feeding
- Is 98% effective at preventing pregnancy

Drawbacks of LAM:
- It’s a short-term form of birth control
- The criteria is strict
- Requires the lactating parent’s capacity for and commitment to the method
- Cannot account for individual biological differences that may affect fertility

LAM makes sense for those who are in a committed, close contact nursing relationship, and it provides a window of time to adjust before selecting a longer term method of birth control.

Many people aren’t able to meet the criteria for LAM, or find that they need to pivot quickly when the nursing relationship changes or suckling decreases.

My Experience with Postpartum Fertility

It was around the 10-week mark when I started to see the light. Sunlight was literally pouring into my kitchen, and mentally I was feeling uplifted.

My baby was making sweet cooing sounds from the floor. It was the best relief after the witching hour the evening before. I remember looking at her, pouring myself a hot cup of coffee and thinking, “We’re doing it.” We’ve got this.

She and I had started going for long (6+ hours) stretches at night without nursing, and I wondered if my cycle would remain suppressed. Baby was taking a liquid supplement every evening, occasionally using a pacifier, and generally falling into a predictable pattern with feedings. I knew we weren’t meeting the criteria for LAM. I also knew my body, and I had a feeling that my estrogen would wrestle prolactin and win. That’s just how she handles her business.

Up until that 10-week mark, my partner and I were abstinent. I was healing, adjusting, and waiting until I felt ready. I wasn’t ready until the baby and I were in a rhythm, and I had time to orient myself to what happened to my body in the process of giving birth, no longer being pregnant, and now, being a new parent who breastfeeds. In case no one has mentioned it to you yet, there’s no normal length of time needed here.

We used condoms until I was confident in my postpartum charting using the Justisse Method of fertility awareness. Even though I was an experienced charter with years of cycles behind me, I didn’t start charting consistency right after the birth, so I needed time to observe and interpret my signs of fertility before I could use the method as a primary form of birth control again.

Through charting, I noticed variable mucus patterns that correlated with mood shifts and interestingly, my baby’s tendency toward spitting up. I charted my first postpartum ovulation at 6.5 months, and nine days later, on my 36th birthday, my period arrived.

Postpartum Charting with Fertility Awareness Method

If you’re interested in alternatives to hormonal contraception, if LAM is not a reasonable or safe option for you, or you want a transition plan away from LAM, then I recommend learning how to observe, chart, and interpret your signs of fertility.

Charting provides an individually-sensitive method for accurately identifying the return of postpartum fertility and determining fertile and infertile days in the cycles that follow.

A FAM practice can be formed as soon as postpartum bleeding stops, or more importantly, whenever you’re ready. Most folks need some time and practice to feel confident using FAM as their primary form of birth control. However, once you learn it, you can’t unlearn it! It’s a skill you can use for pregnancy avoidance, timing conception, and monitoring your health for the rest of your reproductive years.

A FAM Educator can guide you in making observations, establishing your basic infertile pattern, monitoring changes, and combining FAM with other natural methods of birth control (withdrawal, barrier options, etc.) if desired.

Whether you can’t wait to plan your next pregnancy, or you can’t imagine having another baby, FAM can support your fertility-related goals.

For more information on getting started, you can schedule a free consultation with me. This is a space where we can chat about your intentions and develop a plan of action.

To your health and fertility,

- Sara

Source: PMID: 9262927 | DOI: 10.1016/s0010-7824(97)00040-1

This post is intended to support folks in understanding their return of fertility postpartum and to provide information on Lactational Amenorrhea Method (LAM) and fertility awareness method. It is not medical advice. At any point, this information may become outdated as new research is introduced.

Next: Nature's Gate to Another Dimension
Fertility Awareness Educator Sara at Reverence Fertility

About the Author

Sara (she/her) is a Holistic Reproductive Health Practitioner and Fertility Awareness Educator serving clients virtually and locally in Milwaukee, Wisconsin. Since 2016, Sara has used fertility awareness based methods to avoid pregnancy, optimize her fertility, time a pregnancy with her partner and navigate postpartum fertility.