Fertility awareness

By Sara Kay Beaumont


Postpartum fertility can feel disorienting. Unfamiliar. A lot has changed! It’s hard to believe that your reproductive body has come (or will soon come) full circle, and that decisions related to birth control or pregnancy planning are coming back around.

If you’re considering natural birth control options for your fertility journey, this post will shine a light on Lactational Amenorrhea Method and Fertility Awareness Method – two great options that can work together (or separately) to support your family planning goals.

Return of Fertility Postpartum

The return of fertility postpartum varies and depends on many factors. Most notably, fertility suppression is strongly linked to suckling and the nursing relationship.

When a baby suckles at the breast/chest, your body releases a hormone called prolactin. Prolactin is believed to act on the pituitary gland and interfere with the action of two pituitary-regulated hormones called follicle stimulating hormone (FSH) and lutenizing hormone (LH). This interference results in less estrogen production and the suppression of ovulation. Ovulation is the main event of the menstrual cycle and the only time of the cycle when pregnancy can occur. No ovulation = No pregnancy.

In a cycle where ovulation is not adequately suppressed, FSH stimulates the egg follicles in the ovary to grow and produce estrogen. Circulating estrogen triggers the release of LH, which promotes ovulation.

Those who are not breast/chest feeding can expect their fertility to return about 4-6 weeks postpartum, and those who stop can expect their fertility to return about 2-4 weeks later. (Extended infertility past 12 weeks is worth investigating.)

How long fertility will remain suppressed while breast/chest feeding depends on the frequency of feedings as well as individualized hormonal profiles.

The transition to fertility commonly involves moving from anovulatory amenorrhea (no ovulation, no period) to a phase of ovarian activity, then ovulation prior to menstruation (or a bleed that is not preceded by ovulation), up to six months of irregular cycles that likely include long follicular phases and short luteal phases, and finally, the return to regular cycling. Many cycling bodies notice changes when their system is preparing to ovulate.

Lactational Amenorrhea Method (LAM)

Lactational Amenorrhea Method is one of the oldest forms of fertility awareness. Following LAM is an option for naturally avoiding pregnancy during the first six months postpartum. LAM can be used when the following criteria are met:

– The baby is less than 6 mo. old
– The lactating parent is not menstruating (amenorrhea). There’s been no bleeding outside of the first 56 days postpartum.
– The lactating parent is exclusively or nearly exclusively feeding human milk to the baby from their breast/chest on demand, and not going longer than 4-6 hours between feeds (including overnight). Supplements are rare or not given.

LAM makes sense for those who are in a close contact nursing relationship, and it provides a window of time before needing to select another method of birth control. It’s considered to be 98% effective at pregnancy prevention.

Some people aren’t able to meet the criteria for LAM, or find that they need to pivot quickly when the nursing relationship changes or suckling decreases. (My little one and I could not rely on LAM for long, because we started going 6+ hours between feeds overnight. I charted my first postpartum ovulation at 6.5 months.)

Fertility Awareness Method Charting

If LAM is not a reasonable or safe option for you, or you want a transition plan away from LAM, then learning how to observe, chart, and interpret your signs of fertility is another way to naturally avoid pregnancy.

Fertility awareness method (FAM) charting provides an individually-sensitive way to identify the return of postpartum fertility because it tracks ovulation. Ovulation may occur before your first menstrual bleed postpartum, so it’s advisable not to wait until your bleed returns to begin tracking.

A FAM practice can be formed as soon as postpartum bleeding stops, or more importantly, whenever you’re ready. Most folks need some time and practice to feel confident using FAM as their primary form of birth control. However, once you learn it, you can’t unlearn it! It’s a skill you can use for pregnancy avoidance, timing conception, and monitoring your health for the rest of your reproductive years.

A FAM Educator can guide you in making observations, establishing your basic infertile pattern, monitoring changes, and combining FAM with other natural methods of birth control (withdrawal, barrier options, etc.) if desired.

Whether you can’t wait to plan your next pregnancy, or you can’t imagine having another baby, FAM can support your fertility-related goals.

Do you have questions or interest in learning more? I offer free consultations and 1:1 teaching sessions at my website.


*Disclaimer: Any content provided by doulasmilwaukee.com is intended for informational and educational purposes only and should not be used as a substitute for personalized medical advice by your doctor, midwife, or other healthcare professional. Click return to homepage.

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