The use of contraception for patients after bariatric surgery

Abstract

Obesity in women of reproductive age is a serious concern regarding reproductive health. In many cases of infertility in obese women, reduction of body weight may lead to spontaneous pregnancy, without the need for more specific methods of treatment. Bariatric surgery is safe and is the most effective method for body weight reduction in obese and very obese patients. In practice there are two bariatric techniques; gastric banding, which leads to weight loss through intake restriction, and gastric bypass, leads to weight loss through food malabsorption. Gastric bypass surgery (the more frequently performed procedure), in most cases, leads to changes in eating habits and may result in vomiting, diarrhea and rapid body mass reduction. There are reliable data describing the continuous increase in the number of women who are trying to conceive, or are already pregnant, following bariatric surgery. Most medical specialists advise women to avoid pregnancy within 12-18 months after bariatric surgery. This allows for time to recover sufficiency from the decreased absorption of nutrients caused by the bariatric surgery. During this period there is a need for the use of reliable contraception. As there is a risk for malabsorption of hormones taken orally, the combined and progestogen-only pills are contraindicated, and displaced by non-oral hormonal contraception or non-hormonal methods, including intrauterine devices and condoms.

Bariatric Surgery and Fertility

“…Two pregnancies were detected among nine patients using oral contraceptives after making a biliopancreatic diversion (21). Oral intake or intramuscular injection of contraceptive medicines containing progesterone is not suitable for these patients because of their potential to gain weight (22). Intrauterine devices may cause additional menstrual irregularities.…”

Obesity management: sex-specific considerations

“…This is of particular relevance in women < 40 years of age. However, it is recommended that pregnancy should be avoided for approximately 12–24 months following bariatric surgery [ 37 ], since rapid weight loss is associated with higher rates of nutritional deficiencies and obstetrics complications including higher incidence of still birth [ 46 ]. Therefore, effective contraception is obligatory.…”

Mulheres submetidas à cirurgia bariátrica: um estudo reflexivo sobre os cuidados reprodutivos e psicossociais / Women undergoing bariatric surgery: a reflective study on reproductive and psychosocial care

“…As formas não orais de contracepção devem ser consideradas para pacientes bariátricos, devido ao aumento do risco de falha dos contraceptivos orais após este procedimento, secundário ao componente de má-absorção 37 . Além disso, recomenda-se também que os dispositivos intrauterinos devem ser considerados a primeira escolha para nulíparas, e em adolescentes; assim, o SIU-LNG é uma excelente proposta contraceptiva para as mulheres de todas as idades, contribuindo para uma contracepção eficaz, o controle da dismenorréia, dos ciclos menstruais e da dor pélvica associadas à endometriose 6 .…”