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
Lactational Amenorrhea Method
For a woman using LAM, ALL of the following three criteria must be met to ensure adequate protection from an unplanned pregnancy:
amenorrhoea
fully or nearly fully breastfeeding
less than six months postpartum
MEC categories for contraceptive eligibility
Category 1
A condition for which there is no restriction for the use of the contraceptive method
Category 2
A condition where the advantages of using the method generally outweigh the theoretical or proven risks
Category 3
A condition where the theoretical or proven risks usually outweigh the advantages of using the method
Category 4
A condition which represents an unacceptable health risk if the contraceptive method is used
There is no medical reason to deny sterilization to a person with this condition.
C = caution
The procedure is normally conducted in a routine setting, but with extra preparation and precautions.
D = delay
The procedure is delayed until the condition is evaluated and/or corrected. Alternative temporary methods of contraception should be provided.
S = special
The procedure should be undertaken in a setting with an experienced surgeon and staff, equipment needed to provide general anaesthesia, and other back-up medical support. For these conditions, the capacity to decide on the most appropriate procedure and anaesthesia regimen is also needed. Alternative temporary methods of contraception should be provided if referral is required or there is otherwise any delay.
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.
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.
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.
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
