How Fertility Returns While Breastfeeding
Fertility is defined as the natural capability to conceive (become pregnant) or to induce conception. Breastfeeding/lactating can suppress your fertility, lowering the chance that you will become pregnant.
How Does Lactation Affect Fertility?
Lactation suppresses fertility after the baby’s birth by stopping the release of an egg from your ovary and preventing you from having a menstrual cycle.1,2 The suspension of your menstrual cycle occurs when the baby is frequently suckling at your breast or milk is frequently being expressed from your breast. Nipple stimulation from breastfeeding or expressing milk causes prolactin levels to remain high and a down-cycle (cascade effect) of your fertility hormones, specifically gonadotropin releasing hormone (GnRH), luteinizing hormone (LH), follicle-stimulating hormone (FSH), estrogen and progesterone.1,2 Usually, you will need to breastfeed or express milk at least every three hours to achieve the lowered hormone levels that suspend your cycle.
The absence of a menstrual cycle during breastfeeding is called “lactational amenorrhea”. This period of time in a mother’s life is temporary but can be lengthened or shortened by her baby’s and her behaviors. The length of lactational amenorrhea depends on the frequency, duration and exclusivity of lactation.1,2
- Frequency: The less often you initiate breastfeeding or expressing your milk, the higher the chance your menstrual cycle will return. Also, intentionally trying to nurse less at night or separation from your baby during the day due to work can increase your chances of fertility returning even while breastfeeding.1,2
- Duration: Fully meeting your baby’s sucking and emotional comfort needs at the breast keeps fertility at bay. Sleep training and any other techniques that interfere with baby’s innate desire to find comfort at the breast or be close to you will interrupt lactational amenorrhea.1,2
- Exclusivity: Only having your baby directly nurse and directly find comfort from your breast has a higher rate of suppressing your menstrual cycle than if pacifiers, automatic rocking machines or caregivers provide care to your baby.1,2
Planning Pregnancies While Breastfeeding
It is important to understand that not getting your period during breastfeeding means that your pregnancies with your children may be spaced farther apart than you planned. It is actually healthy to have at least 18 months between the end of a pregnancy and the beginning of another to allow your body time to rest and heal from pregnancy and birth.1,2.
For many breastfeeding women, levels of fertility hormones naturally increase to a pre-pregnancy state, and levels of prolactin naturally decrease to a pre-pregnancy state, sometime between 9 and 18 months after baby’s birth.1,2 At this time, your menstrual cycle is likely to return. Fully weaning from breastfeeding or breast pumping also will cause your menstrual cycle to return within a couple of weeks to a couple of months after milk is no longer being expressed.1,2
Generally, lactational amenorrhea can only be counted on as a birth control option if your baby is under six months old and you are nursing or expressing milk at least every three hours.3 Even if your period has not returned and you are frequently feeding or expressing but your baby is older than six months, you should plan for a possible conception or plan to use contraception depending on your family planning goals.
What If I Have Questions?
If you are interested in learning more, this Aeroflow class expands on some of the topics discussed above:
- Birth and Breastfeeding
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References