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Thread: LAM not working?

  1. #1

    Default LAM not working?

    I had been having light to heavy spotting (heavy being almost like a period but not as heavy as I used to have them) up until 11 weeks PP. I finally had some time without anything but the occasional very light spotting here and there, and now at almost 14 weeks PP I'm getting heavy spotting again 30 days after my last heavy spotting.

    Could this actually be my period or is it just spotting, and if it is, is that normal? I've been EBF, no bottles after one month, and baby was given some formula and I was pumping for the first week while LO was in the NICU. Also, baby feeds frequently; every 30min to 2 hours during the day and every 2-4 hours at night, and gaining weight very well.

  2. #2
    Join Date
    May 2006
    Posts
    21,341

    Default Re: LAM not working?

    So you're not on any form of birth control aside from breastfeeding, right?

    If not, I think you have to treat this as your period or close enough to your period to imply that LAM isn't working for you. It doesn't mean you're doing something wrong- LAM doesn't work for everyone, even if they follow all the rules!
    Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
    Coolest thing my little girl sang recently: "I love dat one-two pupples!"

  3. #3
    Join Date
    Jun 2009
    Posts
    5,895

    Default Re: LAM not working?

    LAM is not a promise your period will not return in the early months post partum if you are breastfeeding. LAM is a birth control method that requires that mother's period has not returned. So, if a mother’s period has returned, she no longer meet the criteria for LAM to be used as an effective bc method. So, It's not that it's not working, it's that you (probably) no longer fit the criteria. I know it sounds as if I am splitting hairs, but it is an important distinction. A mother whose period has not returned and meets all other criteria as well can use LAM as a bc method and be assured her pregnancy risk is very, very low, similar to the pill. Unfortunately, you no longer can do so. But until your period returned, you could use it, and, assuming sexual activity that could result in pregnancy and no pregnancy, it was effective.

    LAM requires-
    baby is under 6 months
    baby cue feeds, and is exclusively breastfed
    baby does not receive supplementation, not even water
    Moms period has not returned (If a mother is less than 56 days post partum, spotting and bleeding is normal post partum bleeding, not a period.)

    If ALL the above criteria is in place, LAM has 98-99% effectiveness in preventing pregnancy.

    While lactation may delay the return of fertility for months or even well over a year, other moms who ebf may still see a return of their period in the very early months postpartum, (and of course everything in between.) It's entirely normal.

    (Source for above info on LAM -The Womanly Art of Breastfeeding, 8th edition)
    Last edited by @llli*lllmeg; April 25th, 2013 at 12:33 PM.

  4. #4

    Default Re: LAM not working?

    I'm not on any form of birth control.

    That is very disappointing because I have endometriosis which has done a lot of damage to my insides already and I wanted to go on the pill to control my period but my ob/gyn advised me against it because of milk supply. I guess there is/was nothing I can do.

  5. #5
    Join Date
    Jun 2009
    Posts
    5,895

    Default Re: LAM not working?

    Yes few mothers are happy when their period returns earlier than they expected post partum. Of course, if you were not breastfeeding, your fertility may have returned almost immediately.

    However, if your endometrioses is causing you problems currently and you do not want to put off starting the pill in order to treat it, then I suggest calling these folks www.infantrisk.org. They can talk to you specifically about what the risks to milk production of the pill are. You could talk to your doctor about options- for example, would the “minipill” suffice? If you started the pill and found it lowered production, could you go off the pill? I suggest you discuss all this with your doctor and maybe an IBCLC before starting the pill. You could also talk about alternative treatments, including, what the drawbacks of waiting a few more months to begin treatment are. Your doctor is rare -and right-in that she is considering the risk of the pill potentially harming a nursing mother’s milk production and consequently, harming or shortening the breastfeeding relationship which of course is a health risk to both mother and child. But what risks you are willing to take with milk production in order to treat the endometriosis is up to you.

  6. #6
    Join Date
    Oct 2012
    Posts
    2,214

    Default Re: LAM not working?

    I think it's a great idea to talk to the folks at infantrisk. I'm not on birth control pills but my ob/gyn told me at one point that there were new data examining the question of the effect of combined (estrogen + progestin) oral contraceptives on milk supply. So I just looked up the article. It is a randomized, double-blind, controlled trial (basically the highest quality study you can do) in which breastfeeding mothers were randomly assigned to either combined pill or "minipill" (progestin only). (Reference: Espey E et al, Obstetrics & Gynecology 2012, volume 119, p 5-13). If you look at the curves for breastfeeding discontinuation, they are the same for the two types of pill. They also analyzed reasons for discontinuing breastfeeding, such as problems with milk supply (other reasons were return to work/school, BF uncomfortable/difficult, latch problems, infection, pregnancy, mother changing her mind) - again no differences between minipill and combined pill. 11 patients on the combined pill discontinued breastfeeding due to concern over milk supply, compared to 12 patients in the mini-pill arm. Also no differences in infant weight gain, length change, or head growth. Of course, this is only one study, that was done at one center, with 197 women. And it compared these two different pill types, but it did not compare against women on non-hormonal forms of contraceptive. It doesn't mean that an individual woman won't experience a drop in supply after starting on the pill. But it does suggest that even the combined pill perhaps should not be considered absolutely contraindicated in a nursing mother, especially if there are other indications for its use, as it sounds like there are in your case. Again, the folks at infantrisk can hopefully give you additional estimates of the risk of the pill decreasing your milk supply, so that you can make an informed decision about that risk versus the benefit it may have on your endometriosis.

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