A 24-year-old primigravida is 5 months postpartum. She is exclusively breastfeeding day and night, her menses have not returned, and she reports no supplementation with formula feeds. She asks what contraception she needs right now. The BEST response is:
- A Lactational amenorrhoea provides about 98% protection while all three criteria hold, and a backup method is needed once menses return, supplementation starts, or the baby reaches 6 months ✓
- B Lactational amenorrhoea is reliable only for the first 3 months, so start a method today
- C Breastfeeding alone confers complete protection until weaning, whatever the duration
- D Only barrier methods are safe during lactation
Correct answer: A. Lactational amenorrhoea provides about 98% protection while all three criteria hold, and a backup method is needed once menses return, supplementation starts, or the baby reaches 6 months
Explanation
The lactational amenorrhoea method requires all three criteria: exclusive or near-exclusive breastfeeding on demand day and night, amenorrhoea, and infant age under 6 months. When all three are satisfied, failure is about 2%, comparable to other methods. Protection ends as soon as any single criterion breaks, typically with menses returning or supplemental feeding beginning. Hormonal progestogen-only methods are also compatible with lactation, so the claim that only barriers are safe is false.
Reference: Ian Donald's Practical Obstetric Problems, 8th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.