Can You Get Pregnant While Breastfeeding? Signs Ovulation Is Back

The Science Behind Breastfeeding and Fertility: Understanding the Lactational Amenorrhea Method (LAM)

To understand if you can get pregnant while breastfeeding, we first need to explore the beautiful and complex hormonal interplay that occurs during lactation. When your baby nurses, the nerve endings in your nipple send signals to your brain. In response, your pituitary gland releases prolactin, the primary hormone responsible for milk production. Prolactin has a secondary, powerful effect: it disrupts the normal production of Gonadotropin-Releasing Hormone (GnRH). GnRH is the master hormone that signals the body to release Follicle-Stimulating Hormone (FSH) and Luteinizing Hormone (LH), which are essential for maturing and releasing an egg (ovulation).

Essentially, high levels of prolactin from frequent breastfeeding keep the ovulatory hormones ‘switched off.’ This natural, hormone-based infertility is the basis for the Lactational Amenorrhea Method (LAM). ‘Lactational’ refers to breastfeeding, and ‘amenorrhea’ means the absence of menstruation.

However, for LAM to be considered a highly effective method of birth control (approximately 98% effective), three non-negotiable criteria must be met simultaneously:

• Your baby is younger than six months old. After six months, babies often start sleeping for longer stretches and begin eating solid foods, which naturally decreases the frequency and intensity of breastfeeding, causing prolactin levels to drop.
• You are exclusively breastfeeding on demand, day and night. This means your baby receives only breast milk. There should be no long gaps between feeds—typically no more than four hours during the day and six hours at night. Pumping, while excellent for maintaining supply, may not stimulate prolactin in the same ovulation-suppressing way as direct nursing.
• Your menstrual period has not yet returned. The return of your period is a definitive sign that the hormonal suppression is ending and your body is preparing to ovulate again, if it hasn’t already.

If any one of these conditions is not met, you can no longer rely on LAM for contraception and should consider using another form of birth control if you wish to prevent pregnancy.

The Telltale Signs: How to Know When Ovulation Is Returning

Your body provides subtle (and sometimes not-so-subtle) clues that your fertility is making a comeback. It’s crucial to remember that ovulation occurs before your first postpartum period. This means you can become pregnant before you ever see a drop of blood. Paying close attention to these signs is key to understanding your fertility window.

Changes in Breastfeeding Patterns

One of the first triggers for returning fertility is a change in your nursing routine. This can happen when:

• Your baby starts sleeping through the night, creating a long gap between feeds.
• You introduce solid foods or supplement with formula, reducing the frequency of nursing sessions.
• Your baby becomes a more efficient nurser and feeds for shorter durations.
• You return to work and begin pumping more and nursing less.

Any reduction in nipple stimulation can cause prolactin levels to fall, signaling your body that it’s time to restart the ovulatory cycle.

The Return of Cervical Mucus

Before your period returns, you’ll likely notice changes in your cervical mucus. During the non-fertile parts of your cycle, you may feel dry, or the mucus might be scant, sticky, or creamy. As your body gears up for ovulation, estrogen levels rise, causing your cervix to produce a more fertile-quality mucus. Look for mucus that is:

• Watery or slippery: It may feel like you’ve leaked a little urine.
• Stretchy and clear: Often described as having the consistency of raw egg whites, it can stretch an inch or more between your fingers. This is the most fertile type of mucus and indicates ovulation is near.

The Return of Your Menstrual Period

The return of your period is the most definitive sign that your fertility is back. Your first postpartum period might be different from what you were used to—it could be heavier, lighter, or more irregular at first. Remember, since you ovulated about two weeks before this period, it’s possible to conceive during that first fertile window without ever having a period.

Navigating Your Next Steps: Safe Contraceptive Options While Breastfeeding

Once you decide you want to prevent another pregnancy, or if you no longer meet the LAM criteria, it’s time to explore contraceptive options. It’s important to choose a method that is both effective and safe for you and your nursing baby. Always discuss these options with your healthcare provider to find the best fit for your lifestyle and medical history.

Barrier Methods

These methods create a physical barrier to prevent sperm from reaching the egg. They have no effect on your hormones or milk supply, making them an excellent choice during breastfeeding.

• Condoms (Male and Female): Readily available, effective at preventing pregnancy and STIs.
• Diaphragm or Cervical Cap: These require a fitting by your provider. You may need to be refitted after childbirth as your cervix may have changed size.

Hormonal Methods (Progestin-Only)

Hormonal methods containing only progestin are generally considered safe during breastfeeding as they do not typically impact milk supply. Methods containing estrogen are often avoided, at least in the early months, as they have a higher potential to decrease milk production.

• Progestin-Only Pill (POP or ‘Minipill’): A daily pill that must be taken at the same time each day to be effective.
• Hormonal IUD (e.g., Mirena, Kyleena): A small, T-shaped device inserted into the uterus by a provider. It releases a low dose of progestin locally and is effective for 5-8 years.
• Contraceptive Implant (e.g., Nexplanon): A small rod inserted under the skin of your upper arm that releases progestin and is effective for up to 3 years.
• Depo-Provera Shot: An injection of progestin given every three months.

Non-Hormonal IUD

The Copper IUD (ParaGard) is a highly effective, hormone-free option that can be used for up to 10 years. It works by creating an inflammatory reaction in the uterus that is toxic to sperm. It has no effect on milk supply, but it may make your periods heavier or more crampy.

Fertility Awareness-Based Methods (FABMs)

Also known as Natural Family Planning, these methods involve tracking your body’s fertility signs (like cervical mucus and basal body temperature) to identify your fertile window and avoid intercourse during that time. While hormone-free, they require significant commitment and diligence, and can be challenging to use during the postpartum period when cycles may be irregular.

When to Talk to Your Doctor or Midwife

Navigating postpartum health and fertility can feel overwhelming, and you don’t have to do it alone. Your healthcare provider is your best resource for personalized advice and care. It’s a good idea to schedule a conversation with your doctor, midwife, or OB-GYN if:

• You are within 6 months postpartum and want to discuss family planning. Your 6-week postpartum checkup is a perfect time to bring this up. They can help you choose a contraceptive method that aligns with your health and breastfeeding goals.
• You are actively trying to conceive again while breastfeeding. If you’ve been tracking your cycles and trying to get pregnant without success, your provider can offer guidance and assess if there are any underlying issues.
• Your periods have returned but are extremely irregular, painful, or heavy. While some irregularity is normal at first, persistent issues warrant a checkup.
• You have any concerns about your health, milk supply, or fertility. There are no silly questions when it comes to your well-being. Whether you’re worried about a strange symptom or just want reassurance, your provider is there to support you.

Your body has accomplished something extraordinary. Be patient and gentle with yourself as it finds its new rhythm. Open communication with your partner and your healthcare provider is the foundation of confident family planning.