A 27-year-old woman is 5 months postpartum. She is exclusively breastfeeding her infant day and night, has had no vaginal bleeding since the lochia ceased, and requests the lactational amenorrhoea method (LAM) for contraception. At 4 months postpartum she had one episode of spotting lasting 2 days. What is the MOST appropriate advice?

• A LAM remains fully effective because the bleeding was only spotting
• B She should start combined oral contraceptive pills immediately
• C LAM can be continued until 12 months if breastfeeding remains exclusive
• D LAM is no longer reliable because any bleeding before 6 months signals return of ovulation ✓

Explanation

All three LAM criteria must hold simultaneously: exclusive breastfeeding day and night, infant younger than 6 months, and true amenorrhoea. Any bleeding or spotting after the first 56 days postpartum indicates returning ovarian activity, so LAM can no longer be relied upon and another method is needed. The distractor C fails because even perfect breastfeeding does not extend LAM beyond 6 months. Combined pills are also poor here because they can reduce milk supply in a lactating woman.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.