Accompanying mothers who try to conceive during lactation can be a professional challenge. On many occasions, women receive contradictory or frightening messages that make it difficult for them to make decisions regarding their reproductive health. Once again, there is a lack of scientific publications in this field.

Lactational amenorrhea

A more or less prolonged period of amenorrhea is very common during lactation. According to the scarce literature, it seems that it is very unlikely that when breastfeeding exclusively, ovulation will occur before the first uterine bleeding.

From the beginning of introducing solid food to the baby or when food other than direct breastfeeding is given, the possibility of ovulation before the first menstruation increases.

Even so, in some important cases, we find women with a desire to conceive, who are breastfeeding their children, and who have not yet restarted their menstrual cycle. What can be done in these cases?

Methods to restart ovulation

Direct breastfeeding is known to cause an increase in prolactin peaks in the blood, and this is possibly the leading cause of amenorrhea during lactation. Therefore, the main strategy is to decrease prolactin peaks by spacing breastfeeds.

It seems that night feeds are the most inhibitory to the ovarian cycle. One of the options would be to try to avoid night feeds between 1 am and 6 am.

There is no clear evidence, so this may be a starting point before moving to night weaning. To prove that reactivation of the ovarian cycle has occurred, a menstrual period or pregnancy should appear between 6 and 8 weeks after the change. If this is not the case, more spacing between feeds may be required, night weaning may be necessary, or sometimes, total weaning can be necessary. In clinical practice, we have observed that women with a lower BMI may need complete weaning more frequently, although this is not described in the literature.

When talking about restricting breastfeeds, in addition to the management that partial weaning means for a mother, we must take into account the nutritional needs of the baby and the management of the breast. It is not recommended to restrict access to feeding, whether breastfeeding or formula feeding, during the first year of the child’s life. Therefore, if the infant is less than one year old, the possibility of introducing formula should be considered. On the other hand, restricting these breastfeeds may have an impact on the milk supply, thus increasing the possibility of early weaning of the infant.

Something to keep in mind is that not every amenorrhea that occurs during lactation is due to breastfeeding. For this reason, it may be a good idea to look for different causes, especially before initiating an irreversible process such as total weaning.

A hormone analysis can give an idea of the hormonal condition and whether the amenorrhea is due to breastfeeding or to another reason.

As in situations where there is no lactation, it is recommended to take into account some aspects:

• It may be interesting to have a preconception consultation with a midwife. These visits can include everything from screening for infections to advice on habits and tips for trying to conceive. In addition, information should be provided on possible situations that may arise during pregnancy: safety of breastfeeding during pregnancy, nipple discomfort, decreased milk production after 16-18 weeks of gestation, onset of breastfeeding agitation, and so on.
• Taking active folic acid 3 months before conceiving and, at least during the first 3 months of pregnancy is recommended.
• Assess the need for iodine supplements according to the type of feeding (breastfeeding or bottle feeding) and according to the geographical location and national health recommendations.

Trying to conceive during breastfeeding is still a little studied topic, and therefore, we have few tools to offer to mothers, and this is something they should know. It is essential to make a plan together, where the mother has all the information to decide so you can accompany her in this stage.