Family planning: lactational amenorrhoea method: practice question

A PSM question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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PSM · Family planning: lactational amenorrhoea method

Sample item

Four postpartum women ask about relying on the lactational amenorrhoea method (LAM). Who qualifies to use it as a contraceptive?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. A woman 4 months after delivery who is exclusively breastfeeding on demand day and night and has had no menses

LAM is effective, with failure rates below 2%, only when all three conditions are met: the baby is under 6 months, the mother is amenorrhoeic (bleeding after the first 56 days postpartum counts as menses) and breastfeeding is exclusive or nearly so, day and night. If any condition fails, another method should be started.

Option by option

  • A. A woman 3 months after delivery who is exclusively breastfeeding but had bleeding at 12 weeks

    Return of menses after the first 56 days means fertility may have returned.

  • B. A woman 4 months after delivery who is exclusively breastfeeding on demand day and night and has had no menses (correct)

    All three criteria of age under 6 months, amenorrhoea and exclusive breastfeeding are met.

  • C. A woman 4 months after delivery who is amenorrhoeic but giving her baby regular bottle feeds

    Regular supplementary feeds reduce suckling and ovulation suppression, so LAM no longer applies.

  • D. A woman 7 months after delivery who is amenorrhoeic and exclusively breastfeeding

    After 6 months the protection is no longer reliable, even with amenorrhoea.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this PSM question

What is the answer to this PSM question?

The best answer is B, A woman 4 months after delivery who is exclusively breastfeeding on demand day and night and has had no menses. LAM is effective, with failure rates below 2%, only when all three conditions are met: the baby is under 6 months, the mother is amenorrhoeic (bleeding after the first 56 days postpartum counts as menses) and breastfeeding is exclusive or nearly so, day and night.

Why is "A woman 3 months after delivery who is exclusively breastfeeding but…" not the answer?

Return of menses after the first 56 days means fertility may have returned.

Why is "A woman 4 months after delivery who is amenorrhoeic but giving her ba…" not the answer?

Regular supplementary feeds reduce suckling and ovulation suppression, so LAM no longer applies.

Why is "A woman 7 months after delivery who is amenorrhoeic and exclusively b…" not the answer?

After 6 months the protection is no longer reliable, even with amenorrhoea.

What concept does this question test?

It tests Family planning: lactational amenorrhoea method in PSM. If any condition fails, another method should be started.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Family planning: lactational amenorrhoea method?

Practise biostatistics with small calculations until sensitivity, predictive values and risk measures are automatic. Then use the flashcards and the other PSM questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.