Fertility Awareness-Based Methods: Another Option for Family Planning

Stephen R. Pallone, MD; George R. Bergus, MD


J Am Board Fam Med. 2009;22(2):147-157. 

In This Article

Breast Feeding

Lactational amenorrhea results in a 2% pregnancy rate when used under 3 conditions. The first is that the lactating woman is supplying at least 90% of the infant's calories through breastfeeding at intervals no longer than every 4 hours during the day and every 6 hours at night, but ideally more frequently. Second, she has not resumed her menses. Third, she is in the first 6 months postpartum. Such women may not need additional contraception, therefore avoiding the controversy of taking hormones while breastfeeding.[4,27,28,29,30,31,32,33] The pregnancy rate increases to 5% in working women even if they express their milk every 4 hours, suggesting that the suckling of the infant contributes substantially to the contraceptive effect.[4,34] Beyond 6 months, the likelihood of ovulation preceding menses increases with time, raising the probability of conception.

The low pregnancy rate of lactational amenorrhea, in addition to the many other benefits of breastfeeding, may be another reason for women to consider strict breastfeeding. Cultural and work-related constraints may be barriers inhibiting more widespread use of the method. Women not wanting to conceive again or with regimented spacing ideas need adequate education to identify signs of returning fertility (mainly more than 6 months postpartum, return of menses, or supplementation of the infant's calories from sources other than maternal breast milk) so that they are prepared to switch to another method without delay. Modern FABMs, with the exception of SDM, are appropriate for this purpose.[21,62]


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