Can You Get Pregnant While Breastfeeding?

Curious to know whether you can get pregnant while breastfeeding? Read on to understand how ovulation works after pregnancy and your likelihood of conceiving.

By Dr. Kenosha Gleaton, OBGYN and fertility expert

There are a lot of misconceptions about breastfeeding as a form of birth control. It’s important to know the truth behind lactational amenorrhea and family planning options when newly postpartum. Let’s talk about whether or not you can get pregnant while actively breastfeeding. 

How breastfeeding and fertility are linked

New mom life is full of tiring, exciting, and heartfelt moments. Whether you’re already planning on when to try for the next one, or if conceiving again is the last thing on your mind, it’s important that you have all the facts about breastfeeding and fertility. 

Hormonal changes

There are a lot of hormone fluctuations happening when newly postpartum and while breastfeeding. Two specific hormones that are at play are oxytocin and prolactin, both responsible for milk production and found in high amounts while breastfeeding. [1] Prolactin is released after suckling begins and is usually highest about 30 minutes after the beginning of a feed. This makes it an important hormone for preparing milk for a later feed. [1] This differs from oxytocin which is immediately released as a result of seeing, hearing, touching, or even thinking about the baby. Oxytocin allows any milk already present in the breast to flow and feed a baby quickly (this is known as the letdown reflex). [1]

Sucking and high prolactin levels suppress the release of other hormones such as gonadotropin releasing hormone (GnRH), follicle stimulating hormone (FSH), and luteinizing hormone (LH). These hormones play a big role in menstruation and ovulation, so suppressing them is what causes the delay in ovulation restarting after giving birth. When using this natural bodily response as a form of birth control, it is known as the lactational amenorrhea method (LAM). [1-2] LAM isn’t a foolproof method and requires exclusive breastfeeding fairly regularly. Sometimes LAM can be used in addition to another backup method of contraception for peace of mind. 

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When to expect ovulation to return while breastfeeding

How long does it take for ovulation and periods to come back postpartum? This may differ from person to person, but most experts agree that with exclusive and frequent breastfeeding, ovulation can be delayed for up to six months after childbirth. [2] In order for LAM to work, breastfeeding should occur at least once every four hours during the day and at least once every six hours at night. [2] If you are unable to breastfeed this frequently or if you’ve already had a menstrual period after giving birth, chances are you have already or will begin to ovulate within a few weeks. Unfortunately there isn’t enough data to determine whether pumping impacts the effectiveness of LAM. [2] Read more about postpartum life, like How to Prevent Mastitis. 

Signs and symptoms of ovulation while breastfeeding

It’s important to know the signs and symptoms of ovulation after giving birth so you can be prepared. Not everyone experiences the same symptoms of ovulation, but there are a few things you can do to help track your cycle.

LH surge

Luteinizing hormone is responsible for the release of an egg. [3] Ovulation tests can help you track your LH levels and can give you a better idea of if/when ovulation is occurring. After giving birth, this isn’t the most practical way to track ovulation by itself, as it would require peeing on a strip for days on end. However, if you suspect that ovulation may be returning soon or notice any other symptoms, ovulation tests may be useful for confirming an LH surge. 

Cervical mucus changes

Cervical mucus can tell you a lot about what phase of the menstrual cycle you’re in. Slippery, clear, stretchy mucus can be a sign that you’re ovulating soon. [3] This would be a good time to use an ovulation test to confirm. 

Cramping or pain

Around 40% of people experience ovulatory pain, which is characterized as a one-sided pain or cramping in the abdomen or lower back. [4] Ovulation pain can be a dull cramp or a sharp pain and shouldn’t last for more than a day or so. If you’re experiencing extreme pain or have a fever, bleeding, or nausea, you should see a healthcare provider to rule out other conditions. 

Menstruation

If you restart your period, chances are you will ovulate soon if you haven’t already. Ovulation typically occurs about two weeks before menstruation, so it’s possible that you’ve already ovulated. [2] Be sure to keep track of your menstrual cycle length if you’re hoping to pinpoint when you may ovulate next. 

There are other potential symptoms of ovulation as well, including breast pain, increased sex drive, and increased basal body temperature. [3,5,6]

Getting pregnant while breastfeeding

It is possible to get pregnant while breastfeeding, especially if you aren’t breastfeeding exclusively or regularly. LAM is reportedly at least 98% effective, however it’s only helpful in preventing pregnancy for up to six months after giving birth. [7] You should speak with your healthcare provider about your family planning goals to discuss what contraceptive methods, if any, are right for you. 

When can I have sex after giving birth?

Deciding when to be sexually active again after giving birth is a personal decision. Whether or not you had a vaginal delivery, your body will need time to heal and adjust to all of the recent changes. For most, sexual activity can resume around four to eight weeks postpartum, although a survey found that only about 32% were sexually active during this period. [8-9] The best thing you can do is follow your healthcare provider’s advice for resuming sex, and allow your body the time it needs to heal after delivery. 

Risks 

It’s recommended by many experts, including the American College of Obstetricians and Gynecologists (ACOG) and the World Health Organization (WHO), to wait between a year and a half to three years before attempting to conceive again. [10-11] This is because the risk of adverse maternal and fetal outcomes decreases the longer you wait. [11] This risk is especially high in those that wait less than six months between birth and a new pregnancy. [10] Be sure to speak with your healthcare provider about any plans to conceive in the future. 

Preventing pregnancy when breastfeeding

If you are hoping to prevent pregnancy after giving birth, there are a lot of options that are safe for both you and your baby during breastfeeding. As discussed, those that are using the LAM are likely (but not always guaranteed) to prevent pregnancy for up to six months after childbirth, as long as menstruation hasn’t returned and the baby is being exclusively breastfed. If you need more peace of mind when it comes to preventing another pregnancy, you should speak to your healthcare provider about other options for birth control while breastfeeding, including: [2]

IUD

An intrauterine device (IUD) is a small device that is inserted into the uterus. There are hormonal IUDs and copper IUDs available. Hormonal IUDs release progestin into the body and can be used for up to eight years depending on the type. Copper IUDs release small amounts of copper into the body and can be used for up to ten years. IUDs are safe after giving birth and in some cases can even be inserted immediately following childbirth. 

Implant

The birth control implant is a small rod that is inserted into the arm and releases progestin. This device can also be inserted immediately after childbirth and can be used for up to three years. 

Combined hormonal methods

Combined hormonal methods include birth control pills, patches, and vaginal rings. These methods contain both estrogen and progestin and require daily, weekly, or monthly maintenance. There is more room for user error with these methods when compared to the IUD and implant, which is something to consider when adapting to life with a newborn. In some cases, combined hormonal methods can be used as early as three weeks after birth. It is often recommended that those breastfeeding wait an additional four to six weeks before starting a combined hormonal method. 

Progestin-only methods

Progestin-only pills and injections are two more methods of birth control and do not contain estrogen. Pills need to be taken every day around the same time and are subject to more user error, while injections are given by a healthcare provider every three months. Progestin-only methods can also be started immediately after giving birth. 

Barrier methods

Barrier methods are another option for contraception after giving birth and include condoms, spermicide, diaphragms, etc. It’s important to note that the sponge and cervical cap are much less effective after you give birth, and you should be refitted after childbirth if you were previously using a diaphragm or cervical cap. Some of these barrier methods are not recommended for use until about six weeks after childbirth when the uterus and cervix have returned to their normal size. 

There are various risks associated with all contraceptive use including unpredictable bleeding, mood changes, headaches, deep vein thrombosis, increased cancer risk, and more. [2] Speak to your healthcare provider about specific risks of birth control methods.

To sum it up

Lactational amenorrhea method is a temporary type of birth control made possible by breastfeeding exclusively in the first few months postpartum. The hormones that are released during breastfeeding help to suppress ovulation. The effectiveness of LAM may vary if someone is unable to breastfeed exclusively or pumps frequently. Ovulation can resume within a few weeks after giving birth if not breastfeeding exclusively. The best way to know if you’re ovulating is to track LH surge with ovulation tests and to keep an eye out for ovulation symptoms or the return of the menstrual cycle. There are many other methods of birth control that can be used if LAM isn’t a good option for you. If you are hoping to conceive again, speak to your healthcare provider about how long you should wait to begin trying to conceive again. 

References:

1. Infant and Young Child Feeding: Model Chapter for Textbooks for Medical Students and Allied Health Professionals. Geneva: World Health Organization; 2009. SESSION 2, The physiological basis of breastfeeding. Available from: https://www.ncbi.nlm.nih.gov/books/NBK148970/
2. Postpartum Birth Control. ACOG. Last updated April 2023. URL. 
3. Owen M. Physiological signs of ovulation and fertility readily observable by women. Linacre Q. 2013;80(1):17-23. doi:10.1179/0024363912Z.0000000005
4. Brott NR, Le JK. Mittelschmerz. In: StatPearls. Treasure Island (FL): StatPearls Publishing; May 8, 2022.
5. Pillsworth EG, Haselton MG, Buss DM. Ovulatory shifts in female sexual desire. J Sex Res. 2004;41(1):55-65. doi:10.1080/00224490409552213
6. Tahir MT, Shamsudeen S. Mastalgia. [Updated 2022 Nov 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562195/
7. Vekemans M. Postpartum contraception: the lactational amenorrhea method. Eur J Contracept Reprod Health Care. 1997;2(2):105-111. doi:10.3109/13625189709167463
8. Delgado-Pérez E, Rodríguez-Costa I, Vergara-Pérez F, Blanco-Morales M, Torres-Lacomba M. Recovering Sexuality after Childbirth. What Strategies Do Women Adopt? A Qualitative Study. Int J Environ Res Public Health. 2022;19(2):950. Published 2022 Jan 15. doi:10.3390/ijerph19020950
9. Mbekenga CK, Pembe AB, Darj E, Christensson K, Olsson P. Prolonged sexual abstinence after childbirth: gendered norms and perceived family health risks. Focus group discussions in a Tanzanian suburb. BMC Int Health Hum Rights. 2013;13:4. Published 2013 Jan 15. doi:10.1186/1472-698X-13-4
10. Interpregnancy Care. Obstetric Care Consensus Number 8. ACOG. January 2019. URL. 
11. Birth spacing — report from a WHO technical consultation. World Health Organization Department of Reproductive Health and Research. June 2005. URL.