Intervention Review

Lactational amenorrhea for family planning

  1. Carla Van der Wijden2,*,
  2. Julie Brown3,
  3. Jos Kleijnen4

Editorial Group: Cochrane Fertility Regulation Group

Published Online: 20 OCT 2003

Assessed as up-to-date: 6 FEB 2008

DOI: 10.1002/14651858.CD001329

How to Cite

Van der Wijden C, Brown J, Kleijnen J. Lactational amenorrhea for family planning. Cochrane Database of Systematic Reviews 2003, Issue 4. Art. No.: CD001329. DOI: 10.1002/14651858.CD001329.

Author Information

  1. 2

    Ziekenhuis Amstelveen, Obstetrics & gynaecology, Amstelveen, Netherlands

  2. 3

    University of Auckland, Obstetrics and Gynaecology, Auckland, New Zealand

  3. 4

    Kleijnen Systematic Reviews Ltd, York, UK

*Carla Van der Wijden, Institute for Research in Extramural Medicine, VU University Medical Center, Van der Boechorststraat 7, Amsterdam, 1181 BT, Netherlands. c.vanderwijden@vumc.nl. c.l.vanderwijden@online.nl.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 20 OCT 2003

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Fifty percent of pregnancies are unwanted. For several reasons, eg difficulty in obtaining contraceptives, no or ineffective contraception is used to prevent these pregnancies. The lactational amenorrhea method (LAM) is a contraceptive method where the mother is informed and supported how to use breastfeeding, also for contraception. LAM is available and accessible to many women.

Objectives

To assess the effectiveness of LAM as a contraceptive method in fully breastfeeding women, who remain amenorrheic. We compared the effectiveness of LAM, as defined in the 1988 Bellagio Consensus statement, with alternative definitions of LAM using pregnancy and menstruation life tables.

Search methods

MEDLINE 1966 to 2008; EMBASE 1988 to 2008; reference lists of studies; review articles; books related to LAM; published abstracts from breastfeeding, reproductive health conferences; e-mails with study coordinators.

Selection criteria

Out of 459 potentially relevant studies, 159 investigated the risk of pregnancy during LAM or lactational amenorrhea. Inclusion criteria: prospective study, cases (intervention group) and, if available, controls, had to be sexually active; pregnancy had to be confirmed by physical examination or a pregnancy test. Our endpoints were life table menstruation rates and life table pregnancy rates. We included 14 studies reporting on 10 intervention groups and two control groups that met the inclusion criteria. We identified one additional study in the 2007 update.

Data collection and analysis

Two reviewers independently extracted data; disagreements were resolved through discussion. We analyzed the studies using narrative methods because of their heterogeneity.

Main results

For the primary outcome, two controlled studies of LAM users reported life table pregnancy rates at 6 months of 0.45 and 2.45 percent and six uncontrolled studies of LAM users reported 0-7.5 percent. Life table pregnancy rates for fully breastfeeding women who were amenorrheic but not using any contraceptive method were 0.88 percent in one study and 0.9 to 1.2 percent (95% confidence interval 0.0 to 2.4) in a second study, depending on the definition of menstruation used. The life table menstruation rate at 6 months in all studies varied between 11.1 and 39.4 percent.

Authors' conclusions

We found no clear differences in life table pregnancy rates between women using LAM and being supported in doing so, and fully breastfeeding amenorrheic women not using any method. Because the length of lactation amenorrhea in women using LAM was very different between the populations studied, and is population specific, it is uncertain whether the LAM extends lactational amenorrhea.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Fully breastfeeding and contraception

In appreciating the role of the lactational amenorrhea method (LAM, a contraceptive method where the mother is informed and supported how to use breastfeeding, also for contraception.) in child spacing, breastfeeding itself should be encouraged from a public health point of view. Breastfeeding while not giving supplementary feeds delays the return of fertility and menstruation, which is a physiological protection against pregnancy. It is not clear if practicing LAM as a contraceptive method itself decreases the risk of pregnancy compared with fully breastfeeding while remaining amenorrheic (no menstrual periods) in the first 6 months after childbirth.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

哺乳期無月經避孕法於家庭計劃的角色

大約50%的懷孕是不需要的。人們因為難以取得避孕藥等等理由,使用無效的避孕方式或是根本沒有避孕,導致這些意外懷孕。哺乳期無月經避孕法對女性而言是一個相對有效而易於使用的避孕方式。

目標

藉由全時哺育母乳而仍處於無月經狀態的女性,來評估哺乳期無月經避孕法的效力。此效力,依據1988年在Bellagio所作的定義,將會與另一個定義做比較,亦即懷孕率與月經率的交叉列表。

搜尋策略

資料來源:搜尋MEDLINE(從1966年到2002年)以及EMBASE(從1988年到2002年);相關研究的參考資料及回顧性文章;哺乳期無月經避孕法的相關書籍;哺乳、生殖醫學、避孕方法討論會的文獻摘要;以及與這些研究的主持人往來之電子信件。

選擇標準

從454個相關研究中,有154個調查了哺乳無月經期或是哺乳期無月經避孕法的懷孕機率。兩個作者依據以下納入標準:前瞻性研究,個案以及對照組(如果有的話)有活躍的性生活,懷孕由理學檢查或是懷孕試驗來確認。研究終點為懷孕率與月經率的交叉列表。有13個已發表的文獻,報告關於9個干預試驗及2個對照試驗的結果,皆符合上述標準而被納入本系統性回顧研究。這些研究報告的品質都經過仔細評估。

資料收集與分析

2個作者獨立摘取資料,互相討論敉平歧見。由於收案研究的異質性,故使用敘事分析。

主要結論

分析結果,2個對照試驗顯示哺乳期無月經避孕法在產後6個月的生命表懷孕率分別為0.45%和2.45%,其他5個非對照試驗則為0−7.5%。全時哺育母乳而仍處於無月經狀態的女性,在沒有使用其他避孕方式下,其生命表懷孕率,在一個研究中為0.88%,另一個研究中則為0.9−1.2%(95% CI 0.0−2.4),此差異主要在於兩個研究對於月經的定義不同。所有研究的產後6個月生命表月經率皆有所不同,範圍從11.1%到39.4%。

作者結論

無論是哺乳期無月經避孕法,或因為哺育母乳處於停經狀態,而且沒有使用其他避孕方式,生命表懷孕率是沒有差別的。因為使用哺乳期無月經避孕法的女性,其哺乳無月經期在不同人群種族中差異甚大,因此尚無法確定哺乳期無月經避孕法是否能延長哺乳無月經期。

翻譯人

本摘要由臺灣大學附設醫院陳芊彣翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

沒有證據證明哺育母乳(不給予副食品餵食)在產後這幾個月的時間是一種可靠的避孕方法。儘管產後很快又懷孕對母親跟孩子都有負面影響,這狀況仍然很常見。哺乳導致停經(沒有月經)。這會延遲生育力的恢復,但延遲的長短是無法準確預測的。哺乳期無月經避孕法,是有意利用哺乳來達到避孕的目的,產後整整6個月都不給予副食品餵食。希望僅靠哺乳來避孕的可信度因此提高。然而,本評論無法找到證據證明哺乳期無月經避孕法是一個值得信賴的避孕方法。