Efficacy and duration of LAM are enhanced with more intense breastfeeding patterns, especially during the earlier weeks and months. Less than 6 months postpartum . Back-up methods are not necessary while the LAM criteria are met. However, another method can be used during the period of LAM protection if the woman so wishes. Back-up methods should be limited to methods that are appropriate for breastfeeding women.
Nonhormonal methods have no effect on lactation or the infant.
It is appropriate for a LAM user to have a contraceptive method on hand that she can initiate herself. A service provider can be reasonably sure that a LAM user is not pregnant if the LAM criteria are met. Clients at risk for these diseases should be encouraged to use barrier methods and counseled about behaviors that can decrease risk. The duration of LAM protection may be extended for a few months in amenorrheic women through support for optimal breastfeeding practices. Lactational amenorrhea beyond 6 months postpartum conveys a good deal of protection from pregnancy, although it provides less protection than in the first 6 months.