Vekemans M
Université Libre de Bruxelles, Belgium.
Eur J Contracept Reprod Health Care. 1997 Jun;2(2):105-11. doi: 10.3109/13625189709167463.
Breastfeeding still accounts for a significant proportion of all fertility reduction, the average birth interval being longer among populations that breastfeed. However, per se it is not reliable for individual fertility suppression. The lactational amenorrhea method (LAM) is a highly efficient tool for the individual woman to utilize physiology to space births. Suckling induces a reduction in gonadotropin releasing hormone, luteinizing hormone and follicle stimulating hormone release, resulting in amenorrhea, through an intracerebral opioid pathway: beta-endorphins inhibit gonadotropin releasing hormone and dopamine secretions, which, in turn stimulates prolactin secretion and milk production. Reduced suckling precipitates the return of ovulation. During lactation, menses before 6 months are mostly anovulatory, and fertility remains low. The lactational amenorrhea method is based on three simultaneous conditions: (1) the baby is under 6 months; (2) the mother is still amenorrheic; and (3) she practises exclusive or quasi-exclusive breastfeeding on demand, day and night. Experiments with LAM extended to 9-12 months are ongoing. We use a standardized algorithm to present LAM. The lactational amenorrhea method is a way both to space births and to support breastfeeding, which should be replaced by a contraceptive method in due course. A 'Breastfeeding-LAM-Family Planning' team is very helpful in maternity wards for promoting modern breastfeeding, LAM, and contraception, and for alleviating barriers and misconceptions. The lactational amenorrhea method is at least 98% effective, comparing favorably with other contraceptive methods. Acceptability and continuity are not very well known; as with other 'natural' methods the figures are probably low in a general population but high for motivated couples. The lactational amenorrhea method avoids double protection, and thus saves resources, is especially (but not exclusively) suitable for couples interested in natural family planning and is accepted by religious authorities. The lactational amenorrhea method gives time to decide upon a long-term method of contraception. Unwanted pregnancies, although infrequent, conceived while using LAM result in very short, high-risk birth intervals. Introduction of LAM in family planning programs demands training, attention to be given to working mothers, positive attitudes of health personnel, close links between postpartum and family planning teams, situation analysis, budgets, evaluations, follow-up activities, modifications of record keeping systems and computing programs, and of national family planning guidelines. In conclusion, LAM is an efficient family planning method which should be promoted. The lactational amenorrhea method should always include the shift to another method when its criteria are no longer implemented.
母乳喂养在所有降低生育率的因素中仍占很大比例，在进行母乳喂养的人群中，平均生育间隔更长。然而，就其本身而言，它对于个体抑制生育并不可靠。哺乳期闭经法（LAM）是个体女性利用生理机制来延长生育间隔的一种高效工具。通过脑内阿片类物质途径，哺乳会导致促性腺激素释放激素、黄体生成素和卵泡刺激素的释放减少，从而引起闭经：β-内啡肽抑制促性腺激素释放激素和多巴胺的分泌，进而刺激催乳素分泌和乳汁生成。哺乳减少会促使排卵恢复。在哺乳期，6个月前的月经大多无排卵，受孕几率仍然较低。哺乳期闭经法基于三个同时存在的条件：（1）婴儿未满6个月；（2）母亲仍处于闭经状态；（3）她日夜按需进行纯母乳喂养或近乎纯母乳喂养。将哺乳期闭经法延长至9至12个月的试验正在进行中。我们使用标准化算法来介绍哺乳期闭经法。哺乳期闭经法既是延长生育间隔的一种方式，也是支持母乳喂养的一种方式，适时应被一种避孕方法所取代。一个“母乳喂养-LAM-计划生育”团队在产科病房对于推广现代母乳喂养、哺乳期闭经法和避孕措施，以及消除障碍和误解非常有帮助。哺乳期闭经法的有效性至少为98%，与其他避孕方法相比具有优势。其可接受性和持续性不太为人所知；与其他“自然”方法一样，在普通人群中的数据可能较低，但对于有意愿的夫妇来说数据可能较高。哺乳期闭经法避免了双重保护，从而节省了资源，特别（但并非唯一）适用于对自然计划生育感兴趣的夫妇，并且得到宗教当局的认可。哺乳期闭经法为决定长期避孕方法留出了时间。在使用哺乳期闭经法期间意外怀孕的情况虽然不常见，但会导致生育间隔非常短且风险高。在计划生育项目中引入哺乳期闭经法需要进行培训，关注职业母亲，卫生人员要有积极的态度，产后团队和计划生育团队之间要有紧密联系，进行情况分析、预算、评估、后续活动，修改记录保存系统和计算程序，以及修改国家计划生育指南。总之，哺乳期闭经法是一种应予以推广的高效计划生育方法。当哺乳期闭经法的标准不再适用时，应始终包括向另一种方法的转变。
