LACTATIONAL AMENORRHOEA

PRESENTED BY GROUP FOUR

Presentation objectives• define the method• Describe the method• Explain when to start using the method• Describe the effectiveness of the method• Explain the eligibility criteria• State the contraindications and contraindications• Explain the instruction o usage of the method• Side effects and management of the side effects• Misunderstandings about the method of planning

Definition of terms• lactation: breast feeding

• Amenorrhea: the absence of menstruation which occurs during a woman's reproductive age

• Lactation amenorrhea: family planning method which involves temporally postnatal infertility which occurs when a woman breast feed exclusively

• Family planning method based on the physiological infertility experienced by breast feeding women

Short description

• Lactation amenorrhea (LAM) Prevents pregnancy by interfering with the production and release of natural hormones which are responsible for release of ovum/egg from the ovaries.

MODE OF CTION

• Frequent and intense breast feeding prevents ovulation through a physiological sequence of events as follows

1. The baby's suckling of breast milk stimulates the nipples, during suckling the baby squeezes and rubs the nipples with its lips, gums and palate which causes pressure or mechanical stimulation of the nipples.

2. The stimulation of the nipples sends a neural signal to the mothers brain-specifically the pituitary gland which produces and secretes hormones related to many bodily processes including ovulation

Mode of action cont’d

3. The neural signal, signals the mothers brain and disrupts the production of hormones which would normally stimulate the ovaries to produce eggs

in response to suckling stimuli there is an increased production of prolactin which inhibits the secretion of Gonadotropin Releasing hormone (GnRH) by the hypothalamus.

disruption in the release of GnRH in turn disrupts the pituitary glands production of hormones directly responsible for ovulation

• The hormones responsible for ovulation are Luteinizing hormone (LH)Follicle stimulating hormone (FSH)

4. Without the above mentioned hormones ovulation is prevented Disruption in the release of FSH impedes the normal maturation of the

ovum/egg in the ovaries Disruption in the release of LH impede the release of mature ovum by

the ovaries

Baby’s suckling stimulates

the nipple Nipple stimulation triggers

signals to mother’s brain Signals disrupt hormone

production Disruption of hormones

suppresses ovulation

WHEN TO START USING LAM METHOD

• Every woman who want to use LAM as a family planning method begins using the method instantly the baby is born by starting to intensively breast feed within one hour after child delivery or as soon as possible following child birth.

EFFECTIVENESS OF THE LAM

• LAM is 98% effective if used perfectly i.e. when the three criteria are followed correctly.• thus fulfilling all of its conditions, chances of becoming pregnant

during the first six months after delivery are less than 2%.• 2 pregnancies per hundred women after birth.

MEDICAL ELIGIBILITY CRITERIA

• The criteria to have LAM as a successful family planning method are

1. Woman's menstrual bleeding has not returned within 56 days after delivery

2. When the woman exclusively breast feed her baby

3. The baby is only six months of age

INDICATIONS FOR LAM

• LAM is indicated to all women who can use the method effectively as long as the meet the three criteria's

• NOTE : HIV women can also use LAM as a method of contraceptive. All HIV-positive women for whom replacement feeding is not Affordable, Sustainable and Safe should be encouraged to only/exclusively breastfeed their infants for six months.

• After six months, they should continue breastfeeding in addition to supplemental feeds until they afford and sustain criteria are met.

CONTRAINDICATIONS OF LAM

• Lactational amenorrhea is contraindicated in women 1. Who's menses has returned 2. Who's baby's are more than six months old3. Women who are not exclusively breastfeeding

ADVANTAGES OF LAM• Effectively prevents pregnancy for at least six month• Does not require supplies or procedures thus it is non pharmacological

neither invasive.• Promote mother and child bonding• Raises no religious opposition/objection• Has no hormonal, or other, side effects (for breastfeeding mother or

infant)• Readily available to postpartum mothers universally• Economical/cheap

DISADVANTAGES OF LAM

• Offers only temporary contraceptive protection (up to six months)• Is not usually appropriate if mother will be separated from baby for

periods of time e.g. due to work or school.• Does not provide protection against HIV and other STDs• May pose concerns for HIV-positive mothers, i.e. Possibility of

transmitting HIV virus to the baby is high.

Side effects

• There are no side effects associated with the use of Lactational amenorrhea

INSTRUCTIONS ON USE OF LAM• woman who is using lactation amenorrhea is instructed ona) Exclusive breastfeeding at least 8-10 times a day and once during

the nightb) mothers whose baby's do not want to breast feed due to sleep or

illness should encourage baby's to breast feed 6-10 times a day c) Begin supplementing the baby's diet when the baby reach six month

of age d) When the mother stops to exclusively breastfeed she should start a

new family planning method

Instructions cont’d• Always keep a backup method of contraceptive such us condoms

when menses returns• The mother should be counseled on proper technique of breastfeeding

ELEMENTS OF LAM COUNSELING • educate about LAMs three criteria and why each is important Any conditions that exclude use of LAM• Discuss effectiveness of LAM• Select another modern method to which to transition to from LAM• Encourage spacing of pregnancies• Discuss optimal breastfeeding practices• Ensure that client knows to return if she has a problem

MISSUNDERSTANDINGS ASSOCIATED WITH LAM

• Pumping or bottle feeding breast milk is same as breast feeding and is part of LAM

• Exclusive breast feeding dries the breast milk

• LAM IS for big fat women

PROBLEMS ASSOCIATED WITH LAM

• The use of lactation amenorrhea may face the following challengesReduced production of breast milkSores on the breast and nipples

POSSIBLE SOLUTIONS

• Drink plenty of fluids and eat nutritious foods

• Breastfeed the baby on the less sore nipple• • Examine the mothers for signs of thrush and other fungi diseases for

prompt treatment

references• WHO. 2006. HIV and Infant Feeding: Report of a Technical Consultation.

25-27 October 2006. WHO: Geneva• Hatcher Rinehart, Blackburn Geller Shelton: the essentials of

contraceptive technology; John Hopkins population program• LAM workshop for maternal, newborn and child health(MNCH) service

2009• Paul FA Van look(2007) Family planning a global handbook for

providers: department of reproductive health and research(WHO)• A Learning Resource Package for Family Planning Service Providers and

Trainers. Georgetown University: Washington, D.C. www.irh.org

GROUP MEMBERS• Siyilen Chiliyapa• Bizwick Betha • Lucy Kassim• Elizerbeth Kanyemba• Marry Simwaka• Vestina olive oliva ofrinca Mlotha• Caroline Kabwatika • Thokozile Nkhoma• Getrude njewa • Gabriel Mjuma• Ibrahim Chiposyo