Breastfeeding and contraception

Most couples start thinking about birth control soon after their baby is born. If you’re breastfeeding, you might be wondering about your options and what’s best for you right now. The good news is there are safe and effective choices for you and your family. 

This guide covers how breastfeeding can act as contraception, what other methods are available, and how to choose what’s right for you. You may find that the type of contraception you used previously may not suit your situation now. 

The focus of this article is only on the effects on breastfeeding. You may also consider other factors such as effectiveness, ease of use and cost. 

Breastfeeding as contraception

The Lactational Amenorrhea Method (LAM)

Breastfeeding can delay the return of your periods and ovulation after birth. The Lactational Amenorrhea Method (LAM) is listed by the World Health Organization as an accepted and effective method of contraception. 

LAM relies on breastfeeding hormones to reduce your fertility. It’s up to 98% effective if ALL of these are true for you:¹

• Your baby is under 6 months old.
• Your periods haven’t returned.
• You are fully breastfeeding - no formula or other drinks or foods.
• Your baby breastfeeds regularly, day and night.

Important: LAM only works if all these conditions are met. If you don’t want to get pregnant, you’ll need to use another method of contraception once: 

• you get your period or
• your baby starts to have formula or other food or drink or
• they sleep more than 6 hours during the night. 

How breastfeeding suppresses fertility

Frequent breastfeeding keeps hormone levels high, which can delay ovulation. Every mum is different. Some get their periods back within months, for others it takes a year or more. 

In one Australian study, the median duration of lactational amenorrhoea (the time without periods due to breastfeeding) was over 8.5 months. This means that half of the women had their periods return before 8.5 months, and half after. 

Just remember, even if your period hasn’t returned, you could still be fertile. Watch for changes in vaginal mucus or any unexpected bleeding. These can be signs that your fertility is returning.

Non-hormonal contraceptive methods

These are safe to use while breastfeeding and won’t affect your milk supply. They include:

• Condoms (use water-based lubricant if needed)
• Copper IUD
• Diaphragm
• Ovulation awareness methods (like the Billings Method)

Hormonal contraceptive methods

Some contraceptive methods use hormones. Many are suitable while breastfeeding. Some don’t affect milk supply at all, while others may affect supply for some mums, especially when started soon after birth.

One helpful way to think about hormonal methods is where they act in the body and how easy they are to stop or change if you notice a change in your milk supply.

Progesterone-only methods

Hormones that act mostly in the uterus (long acting, removable)

These methods release hormones mainly in the uterus. Very little hormone enters the bloodstream.

• Example: hormonal IUDs
• Many breastfeeding mums use these without changes to milk supply.
• Will need to be removed by a doctor if you want to stop using it.

Short acting hormonal methods (easy to stop)

These methods work throughout the body but leave your system quickly once you stop using them. 

• Example: the progesterone-only pill, sometimes called the ‘mini pill’.
• May affect milk supply for some mums, especially early on.
• Can usually be stopped straight away if needed.

Long acting hormonal methods (not easy to reverse)

These methods work throughout the body and last for months or years. 

• Examples: hormonal implants and hormonal injections.
• No evidence that they affect milk supply,² but some women notice a decrease.
• Can’t be stopped quickly once started.

Combined hormonal methods (contain oestrogen)

These contain oestrogen as well as progesterone. 

• Examples: combined pill and combined hormonal vaginal ring.
• Not recommended for the first six weeks and even after that, it may reduce milk supply for some mums.

Emergency contraception

Emergency contraception can be used after sex if you don’t want to become pregnant.

• Some options are suitable while breastfeeding.
• With some options, you may need to express breastmilk and throw it away for one week after [FPNSW Emergency contraception]
• A pharmacist or doctor can help you choose the option that best fits your situation.

If you notice changes in your milk supply after starting a new method, talk to your doctor or child health nurse. Sometimes feeding more often can help, but you may need to try a different method if your supply doesn’t return to normal.

It’s normal to have questions or feel unsure about which contraception to choose. This article focuses on how different methods may affect breastfeeding. Your doctor, pharmacist or family planning nurse can help you weigh up other factors such as cost, effectiveness, how long each method lasts and how easily it can be changed if you decide it doesn't suit you or you want to become pregnant.

Talk with your partner about your family’s needs, your health and your breastfeeding goals. 

Better Health Channel (Victoria State Government) Contraception after giving birth https://www.betterhealth.vic.gov.au/health/healthyliving/contraception-after-giving-birth 

NSW Health: Contraception after you have had a baby Factsheet https://www.mhcs.health.nsw.gov.au/publications/contraception-after-you-have-had-a-baby/english/@@display-file/file/English.pdf