Contraceptive Technology and Reproductive Health Series:
Lactational Amenorrhea Method (LAM)
Post-test
The first three questions refer to the essential criteria for LAM. In each instance, please
choose the best answer.
1. The level of breastfeeding required for LAM is:
a. Full, partial or token breastfeeding.
b. Full or partial breastfeeding.
c. Fully or nearly fully breastfeeding.
d. No amount of breastfeeding is required for LAM.
2. The allowable age of the infant for LAM is:
a. Younger than three months.
b. Younger than six months.
c. Younger than nine months.
d. No specific infant age is a requirement for LAM.
3. The requirements for a woman's menstrual cycle in LAM are:
a. Intermittent menses since delivery.
b. One menses, but not two, since delivery.
c. No return of menses since delivery.
d. No involvement of menstrual cycle in LAM.
Lactational Amenorrhea Method (LAM)
1
4. The mechanism of action for LAM is best described as:
a. A hormonal change that involves estrogen levels.
b. An inhibitory stimulation created by the infant’s suckling, which alters
hypothalamic/pituitary function and thus ovarian function, which results in a
lack of menses.
c. A physical change only.
d. A hormonal change only.
5. Which of the following women would you characterize as “fully or nearly fully”
breastfeeding for purposes of LAM? Check all that apply.
a. A woman who is breastfeeding exclusively, which means no other liquid or
solid is given to the infant.
b. A breastfeeding mother who has returned to full time work and whose baby is
receiving bottles while she is at work.
c. A woman who is breastfeeding and has started supplementing her infant's
nutrition with solid food at daytime meals to account for no more than 25
percent of the infant's nutrition.
d. A woman who is partially breastfeeding her infant, but there are no intervals
greater than four to six hours between breastfeeds – about 90 percent of the
infant’s feeds are provided through breastfeeding.
6. Why is a mother practicing LAM not likely to become pregnant due to an early
menses?
a. Ovulation never precedes menses.
b. Even if ovulation precedes menses, her progesterone production will likely not
be sufficient to prepare the uterus and sustain a pregnancy.
c. The high progesterone levels protect her uterus from implantation.
7. Which of the following were important to the creation of guidelines for LAM? Check
all that apply.
a. Bellagio Consensus, 1988.
b. LAM efficacy studies completed in Chile, Ecuador, Pakistan, and the
Philippines.
c. Georgetown Conference, 1989.
d. All of the above.
8. What were the outcomes of the Georgetown Conference in 1989? Check all that
apply.
a. LAM was established as a contraceptive method for breastfeeding women.
b. An algorithm was designed for LAM.
c. LAM was declared the only appropriate contraceptive method for postpartum
women up to six months after delivery.
d. Emphasis was given to the timely introduction of another contraceptive
method for women who want to continue delaying pregnancy after LAM
expires.
Lactational Amenorrhea Method (LAM)
2
9. The six-month failure rate of LAM from clinical studies performed to date is:
a. One percent or less.
b. Two to five percent.
c. Ten percent.
d. Greater than 15 percent.
10. The return of menses for a woman practicing LAM indicates which two of the
following?
a. It is the halfway point of LAM’s effectiveness.
b. It is a sign of the return to fertility.
c. It is time to introduce supplemental foods to the infant.
d. It is time to begin a new contraceptive method.
11. Advantages for women using LAM include which of the following? Check all that
apply.
a. Proven health benefits for the mother and infant.
b. Postpones use of contraceptive steroids until infant is more mature.
c. Provides protection against STDs, including HIV.
d. Universally available to all breastfeeding women.
e. Contraceptive protection begins immediately postpartum.
f. It is at least 98 percent effective.
g. It requires commodities and supplies that can be costly.
12. Disadvantages for women using LAM include which of the following? Check all that
apply.
a. Interferes with constructive breastfeeding and weaning patterns.
b. LAM is only available in certain countries.
c. The duration of LAM is limited to a brief postpartum period.
d. Social circumstances in some regions may make it difficult to fully breastfeed.
e. LAM offers no protection against STDs, including HIV.
13. Recommended behaviors to ensure successful use of LAM include all of the
following except two:
a. Breastfeed as early as possible after delivery.
b. Establish a fixed feeding schedule.
c. Avoid the use of bottles and pacifiers.
d. Avoid intervals longer than four to six hours between feedings.
e. The mother should follow good nutritional practices.
f. Once supplements are introduced, supplemental feedings should always
precede breastfeedings.
Lactational Amenorrhea Method (LAM)
3
14. Please indicate whether the following statement is True or False:
To determine if LAM is effective, providers should teach the woman to ask
herself the three questions in the LAM algorithm: 1) Have your menses
returned?; 2) Are you regularly supplementing or allowing more than four to six
hours between breastfeedings?; and 3) Is your baby more than six months old?
If the answer to one of the questions is yes, the woman should initiate another
contraceptive method which does not interfere with breastfeeding.
True … False …
15. Important programmatic issues for family planning providers include which of the
following? Check all that apply.
a. Providers should receive training and develop skills to effectively teach LAM
to clients.
b. Provisions should be made to ensure that women have access to other
contraceptive methods before LAM expires.
c. Providers should offer information and counseling about LAM after the infant
is born.
d. Breastfeeding and the introduction of LAM as a contraceptive option do not
require any special cultural considerations.
e. Ongoing research is still needed to examine which strategies and procedures
are most effective when introducing LAM into a family planning program.
16. Which two of the following are key counseling messages for LAM?
a. It is important to make advance plans with the client for the initiation of
another contraceptive method before LAM expires.
b. The choice to initiate LAM should be made by the provider, once the woman
is considered to be a good candidate.
c. LAM is a safe and highly effective contraceptive option for breastfeeding
mothers and their infants when used correctly.
d. Most women who choose LAM have used several other contraceptive options
before, so it will not be necessary to cover all the available postpartum family
planning options in detail.
17. Which two of the following are recommended for women who wish to extend LAM
beyond the traditional six-month limit?
a. Always breastfeed before giving supplements of liquid or food.
b. Begin weaning earlier than six months postpartum.
c. Never supplement with anything other than water for at least ten months.
d. Begin weaning foods, one at a time, at six months postpartum.
Lactational Amenorrhea Method (LAM)
4
18. Which of the following contraceptive methods can be used without restriction by
breastfeeding women immediately postpartum? Check all that apply.
a. POPs.
b. Condoms.
c. COCs.
d. Female sterilization.
e. IUDs.
19. Combined estrogen/progestin contraceptive options are categorized as a “third
choice” for breastfeeding women primarily because:
a. They pass through the mother's bloodstream and into the breastmilk.
b. They cause excessive weight gain in the baby.
c. They decrease the amount of milk produced by the mother.
d. They interfere with the return of initial menses for the mother.
20. Please indicate whether the following statement is True or False.
Some family planning policies prohibit providers from dispensing steroidal
contraceptives to women who are breastfeeding – this type of policy places many
women at risk for pregnancy because they choose to continue breastfeeding
after the period of lactational amenorrhea. Other countries, however, have
adopted policies that encourage the immediate postpartum use of combined
estrogenic contraceptive methods that are inappropriate for breastfeeding
women. Acceptance and promotion of LAM as a contraceptive option may lessen
the problems of providing appropriate contraceptive choices for breastfeeding
women. True … False …
21. In a situation with limited nutritional supplements and a malnourished mother, it is
preferable to:
a. Supplement the baby’s diet.
b. Supplement the mother’s diet.
c. Wean the baby.
d. Malnourished women should not be encouraged to breastfeed.
22. Please indicate whether the following statements related to use of LAM by working
women are True or False.
a. Long intervals between breastfeeds while a mother is at work do not affect LAM’s
effectiveness. True … False …
b. Women who are separated from their infants during the day may be able to
express milk manually to maintain their supply of breastmilk, but this option
should not replace suckling for more than 10 percent of feeds if LAM is to be fully
effective. True … False …
Lactational Amenorrhea Method (LAM)
5
Contraceptive Technology and Reproductive Health Series:
Lactational Amenorrhea Method (LAM)
Post-test Answer Key
The first three questions refer to the essential criteria for LAM. In each instance, please
choose the best answer.
1. The level of breastfeeding required for LAM is:
c. Full, partial or token breastfeeding.
d. Full or partial breastfeeding.
e. Fully or nearly fully breastfeeding.
f. No amount of breastfeeding is required for LAM.
2. The allowable age of the infant for LAM is:
a. Younger than three months.
b. Younger than six months.
c. Younger than nine months.
d. No specific infant age is a requirement for LAM.
3. The requirements for a woman's menstrual cycle in LAM are:
a. Intermittent menses since delivery.
b. One menses, but not two, since delivery.
c. No return of menses since delivery.
d. No involvement of menstrual cycle in LAM.
Lactational Amenorrhea Method (LAM)
1
4. The mechanism of action for LAM is best described as:
a. A hormonal change that involves estrogen levels.
b. An inhibitory stimulation created by the infant’s suckling, which alters
hypothalamic/pituitary function and thus ovarian function, which results
in a lack of menses.
c. A physical change only.
d. A hormonal change only.
5. A hormonal change only. Which of the following women would you characterize as
“fully or nearly fully” breastfeeding for purposes of LAM? Check all that apply.
a. A woman who is breastfeeding exclusively, which means no other
liquid or solid is given to the infant.
b. A breastfeeding mother who has returned to full time work and whose baby is
receiving bottles while she is at work.
c. A woman who is breastfeeding and has started supplementing her infant's
nutrition with solid food at daytime meals to account for no more than 25
percent of the infant's nutrition.
d. A woman who is partially breastfeeding her infant, but there are no
intervals greater than four to six hours between breastfeeds – about 90
percent of the infant’s feeds are provided through breastfeeding.
6. Why is a mother practicing LAM not likely to become pregnant due to an early
menses?
a. Ovulation never precedes menses.
b. Even if ovulation precedes menses, her progesterone production will
likely not be sufficient to prepare the uterus and sustain a pregnancy.
c. The high progesterone levels protect her uterus from implantation.
7. Which of the following were important to the creation of guidelines for LAM? Check
all that apply.
a. Bellagio Consensus, 1988.
b. LAM efficacy studies completed in Chile, Ecuador, Pakistan, and the
Philippines.
c. Georgetown Conference, 1989.
d. All of the above.
8. What were the outcomes of the Georgetown Conference in 1989? Check all that
apply.
a. LAM was established as a contraceptive method for breastfeeding women.
b. An algorithm was designed for LAM.
c. LAM was declared the only appropriate contraceptive method for postpartum
women up to six months after delivery.
d. Emphasis was given to the timely introduction of another contraceptive
method for women who want to continue delaying pregnancy after LAM
expires.
Lactational Amenorrhea Method (LAM)
2
9. The six-month failure rate of LAM from clinical studies performed to date is:
a. One percent or less.
b. Two to five percent.
c. Ten percent.
d. Greater than 15 percent.
10. The return of menses for a woman practicing LAM indicates which two of the
following?
a. It is the halfway point of LAM’s effectiveness.
b. It is a sign of the return to fertility.
c. It is time to introduce supplemental foods to the infant.
d. It is time to begin a new contraceptive method.
11. Advantages for women using LAM include which of the following? Check all that
apply.
a. Proven health benefits for the mother and infant.
b. Postpones use of contraceptive steroids until infant is more mature.
c. Provides protection against STDs, including HIV.
d. Universally available to all breastfeeding women.
e. Contraceptive protection begins immediately postpartum.
f. It is at least 98 percent effective.
g. It requires commodities and supplies that can be costly.
12. Disadvantages for women using LAM include which of the following? Check all that
apply.
a. Interferes with constructive breastfeeding and weaning patterns.
b. LAM is only available in certain countries.
c. The duration of LAM is limited to a brief postpartum period.
d. Social circumstances in some regions may make it difficult to fully
breastfeed.
e. LAM offers no protection against STDs, including HIV.
13. Recommended behaviors to ensure successful use of LAM include all of the
following except two:
a. Breastfeed as early as possible after delivery.
b. Establish a fixed feeding schedule.
c. Avoid the use of bottles and pacifiers.
d. Avoid intervals longer than four to six hours between feedings.
e. The mother should follow good nutritional practices.
f. Once supplements are introduced, supplemental feedings should
always precede breastfeedings.
Lactational Amenorrhea Method (LAM)
3
14. Please indicate whether the following statement is True or False.
To determine if LAM is effective, providers should teach the woman to ask
herself the three questions in the LAM algorithm: 1) Have your menses
returned?; 2) Are you regularly supplementing or allowing more than four to six
hours between breastfeedings?; and 3) Is your baby more than six months old?
If the answer to one of the questions is yes, the woman should initiate another
contraceptive method which does not interfere with breastfeeding.
True … False …
15. Important programmatic issues for family planning providers include which of the
following? Check all that apply.
a. Providers should receive training and develop skills to effectively teach
LAM to clients.
b. Provisions should be made to ensure that women have access to other
contraceptive methods before LAM expires.
c. Providers should offer information and counseling about LAM after the infant
is born.
d. Breastfeeding and the introduction of LAM as a contraceptive option do not
require any special cultural considerations.
e. Ongoing research is still needed to examine which strategies and
procedures are most effective when introducing LAM into a family
planning program.
16. Which two of the following are key counseling messages for LAM?
a. It is important to make advance plans with the client for the initiation of
another contraceptive method before LAM expires.
b. The choice to initiate LAM should be made by the provider, once the woman
is considered to be a good candidate.
c. LAM is a safe and highly effective contraceptive option for
breastfeeding mothers and their infants when used correctly.
d. Most women who choose LAM have used several other contraceptive options
before, so it will not be necessary to cover all the available postpartum family
planning options in detail.
17. Which two of the following are recommended for women who wish to extend LAM
beyond the traditional six-month limit?
a. Always breastfeed before giving supplements of liquid or food.
b. Begin weaning earlier than six months postpartum.
c. Never supplement with anything other than water for at least ten months.
d. Begin weaning foods, one at a time, at six months postpartum.
Lactational Amenorrhea Method (LAM)
4
18. Which of the following contraceptive methods can be used without restriction by
breastfeeding women immediately postpartum? Check all that apply.
a. POPs.
b. Condoms.
c. COCs.
d. Female sterilization.
e. IUDs.
19. Combined estrogen/progestin contraceptive options are categorized as a “third
choice” for breastfeeding women primarily because:
a. They pass through the mother's bloodstream and into the breastmilk.
b. They cause excessive weight gain in the baby.
c. They decrease the amount of milk produced by the mother.
d. They interfere with the return of initial menses for the mother.
20. Please indicate whether the following statement is True or False.
Some family planning policies prohibit providers from dispensing steroidal
contraceptives to women who are breastfeeding – this type of policy places many
women at risk for pregnancy because they choose to continue breastfeeding
after the period of lactational amenorrhea. Other countries, however, have
adopted policies that encourage the immediate postpartum use of combined
estrogenic contraceptive methods that are inappropriate for breastfeeding
women. Acceptance and promotion of LAM as a contraceptive option may lessen
the problems of providing appropriate contraceptive choices for breastfeeding
women. True … False …
21. In a situation with limited nutritional supplements and a malnourished mother, it is
preferable to:
a. Supplement the baby’s diet.
b. Supplement the mother’s diet.
c. Wean the baby.
d. Malnourished women should not be encouraged to breastfeed.
22. Please indicate whether the following statements related to use of LAM by working
women are True or False.
a. Long intervals between breastfeeds while a mother is at work do not affect LAM’s
effectiveness. True … False …
b. Women who are separated from their infants during the day may be able to
express milk manually to maintain their supply of breastmilk, but this option
should not replace suckling for more than 10 percent of feeds if LAM is to be fully
effective. True … False …
Lactational Amenorrhea Method (LAM)
5