Bariatric surgery and contraception: what you need to know

Contraception is essential after bariatric surgery.As an obese woman starts to lose weight, her chances of getting pregnancy increase (obesity negatively affects fertility for many women).Depending on your method of contraception and the type of weight loss procedure you may need to make some contraception changes after surgery.

The big issue is wether you have a restrictive procedure or a malabsorptive one.Restrictive procedures decrease the functional size of your stomach so it holds less food.These procedures include vertical banded gastroplasty, laparoscopic adjustable gastric band, and laparoscopic sleeve gastrectomy.If you have one of these procedures there is no impact of the procedure on your choice of contraception.

However, that is not the case with malabsorptive procedures.These surgeries (such as Roux-en-Y gastric bypa*s and biliopancreatic diversion) decrease absorption of nutrients and calories by shortening the length of the small intestine.This also affects absorption of medications, like the birth control pill.There is conflicting medical evidence whether or not this affects the pill.

Because the evidence isn’t clear the Centers for Disease Control give the birth control pill (every one of them) a category 3 rating, meaning the risks (in this case the risk of failure) typically outweigh the benefits.The patch and ring are fine choices for women who have a malabsorptive procedure and prefer a hormonal method, as they are absorbed from the skin or vagina and so bypa*s the intestine altogether.

Depo-provera (shot) and Implanon (implant) are fine choices for all types of bariatric surgery as they also bypa*s the intestines and the Mirena and copper IUDs are also excellent choices.

If you are planning bariatric surgery contraception methods might not be first and foremost on your mind, but if you are of reproductive age it is an essential consideration and your surgeon should discuss it with you.It is safest for you and your baby if you are at a stable weight before attempting pregnancy.

It’s just one more vital piece of information to help you be empowered about your health and medical care.

Source: U.S.Medical Eligibility Criteria for Contraceptive Use, 2010.Centers for Disease Control and Prevention.MMWR May 28, 2010/Vol.59.

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