contraceptives--postcoital and Puerperal-Disorders

The authors discuss the menstrual pattern during lactation, which lengthens the birth interval primarily by extending the period of postpartum amenorrhea. The length of postpartum amenorrhea varies greatly as it is influenced by such factors as breastfeeding practices (duration and extent of supplementry feeding); maternal constitution factors (e.g., maternal age and nutritional status); and pregnancy wastage and infant survival. Since full lactation prevents menstruation for a longer period of time than does partial lactation, supplementary feeding of suckling infants influences the return of menstruation. Also, increase in age and parity is frequently associated with longer periods of postpartum amenorrhea. It is difficult to determine if ovulation occurs during the 1st menstrual cycle after delivery or if it occurs regularly during subsequent menstrual cycles. It is assumed that the 1st 1 or 2 menstrual cycles following delivery are anovulatory, apparently in the cycle before menstruation. Thus about 1/2 of all nonlactating women are fertile before the 1st postpartum menstrual period. Ovulation is likely to precede menstruation in fully lactating women, but the longer menstruation is delayed by lactatioon, the more likely that the ust cycle will be ovulatory. The occurance of ovulation after return of menstruation is significantly higher than ovulation before the return of menstruation until 9th postpartum month during lactation. The incidence of pregnancy in fully lactating mothers is 1.3% by the 3rd postpartum month, increasing to 26% at the 12th postpartum month. The incidence of pregnancy before and after return of menstruation is significantly high. This is due to the high rate of ovulation after return of menstruation. When pregnancy rate in ovulating lactating mothers before and after return of menstruation is compared, no significant difference is detected. Also discussed are the ovulation inhibiting effects of progestational drugs (medroxyprogesterone acetate) used as a contraceptive during the postpartum period, as well as those of the nonhormonal drug, sulpiride, on the menstrual pattern during lactation. The authors' discussion refers to the results of other studies in the field.

Topics: Amenorrhea; Breast Feeding; Contraception; Contraceptives, Postcoital; Demography; Disease; Family Planning Services; Health; Hormones; Infant Mortality; Infant Nutritional Physiological Phenomena; Injections; Lactation; Maternal Age; Medroxyprogesterone Acetate; Menstrual Cycle; Menstruation; Nutritional Physiological Phenomena; Ovulation; Ovulation Detection; Parity; Population; Population Dynamics; Postpartum Period; Pregnancy; Puerperal Disorders; Reproduction; Time Factors