Aetiological approach of female reproductive physiology in lactational amenorrhoea

Abstract

There is a wide range of duration of post-partum amenorrhoea and resumption of ovulation between individuals, within an individual or between populations. Several extraneous variables, such as parity, mother's age, sex of the breast-fed baby, socioeconomic status and cultural level of the family, can be controlled; then the remaining variables will probably explain a part of the total variability in post-partum amenorrhoea duration but say nothing about the physiological process. In attempting to question physiological aspects of the return of fertility several observational studies have tended to favour one of the different factors which are supposed to play a major role in the regulation and have compared different levels of it, such as body composition of the mother (Frisch & McArthur, 1974), breast-feeding pattern (Jones, 1989) or the life style of the women. Life style can be related to women's physical activity in normal life (Ellison, 1991), the difference between urban and rural life (Carael, 1981) or the environment (Laurenson et al., 1985). Prolactin as a possible mediator of the central regulation has been carefully considered (Lunn, Austin & Whitehead, 1984; Howie et al., 1982). These studies were mainly observational rather than experimental, supplementing mothers during the lactating period or during the pregnancy. If this information is added to what is known of other animal species (Loudon, 1987) or animal experimentation (Plant et al., 1989; Williams et al., 1990a; Williams et al., 1990b), the combination of several of the main factors believed to have a major role in the human species can be clarified and the aetiology of the resumption of fertility in nursing women investigated.