I have no experience in this field, but have read a book "Breastfeeding and
natural child spacing " by Sheila Kippley which talks about a bleed then
returning to ammenorrhea by increasing the bf.
However, at 13 months, this is outside the LAM guidelines - < 6 mo, no other
food or fluid, no feed longer than 6 hours apart, no bleeding etc.
Perhaps this woman has returned to an ammennorheic state, but she can't rely
on LAM as a full contraceptive measure any longer!
A quick preg test maybe?

Fiona Hermann
midwife

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