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Referral and warning signs
When to refer
Referral needed for choosing and initiating another contraceptive method when LAM criteria are no longer met.
Red flags
- Return of menstruation
- Introduction of regular supplemental feeds
- Baby reaching 6 months of age
Signs and symptoms
- Not applicable - Based on meeting criteria.
Risk factors
- Not meeting all three criteria strictly.
Diagnosis
Clinical assessment
Confirmation that ALL three criteria are met: 1. Amenorrhoea: Mother has not had return of menstrual bleeding since delivery. 2. Fully or Nearly Fully Breastfeeding: Baby receives breast milk exclusively or almost exclusively (minimal supplements), feeding frequently day AND night. 3. Infant Age: Baby is less than 6 months old. If ANY criterion is not met, LAM is no longer effective.
Diagnostic criteria
Strict adherence to all three conditions (Amenorrhoea, Exclusive/Near-Exclusive Breastfeeding, Infant <6 months).
Management
Non-pharmacological management
- Counseling: Explain the three essential criteria and that effectiveness depends on meeting ALL of them.
- Reinforce importance of frequent, on-demand breastfeeding day AND night (at least 8-12 times/24h, interval <4h daytime, <6h nighttime).
- Explain that giving supplemental feeds (water, other liquids, solids) reduces effectiveness.
- Advise client to transition to another reliable method as soon as ANY of the three criteria are no longer met (menstruation returns, regular supplements introduced, or baby reaches 6 months).
Monitoring
Counsel client to self-monitor the three criteria. Follow-up advised around 3 months postpartum to reinforce teaching and discuss transition planning.
Complications
- Unintended pregnancy if criteria not strictly met or transition to another method delayed.
Prevention
- Strict adherence to the three LAM criteria.
- Timely transition to another effective contraceptive method.
Patient education
- Explain the 3 strict rules for LAM effectiveness.
- Importance of exclusive/near-exclusive breastfeeding on demand.
- LAM is temporary (up to 6 months maximum).
- Need to start another method immediately if period returns, supplements started, or baby turns 6 months.
- Does not protect against STIs/HIV.
- Benefits of breastfeeding for baby and mother.
Uganda-specific notes
Can be a useful postpartum method where breastfeeding is common, but correct understanding and application of the criteria are essential. Often needs reinforcement and timely transition planning.
References
- Uganda Clinical Guidelines (UCG) 2023
Chapter 15, Section 15.2.10