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Bariatric surgery — operations such as gastric sleeve, gastric band, and Roux-en-Y gastric bypass that change the digestive tract — has enabled many obese people to approach and maintain a healthy weight while controlling life-threatening obesity-related medical conditions like heart disease, sleep apnea, diabetes, and high blood pressure. More than half of those who have benefitted from bariatric surgery are women, mostly in their childbearing years. If you are a woman considering bariatric surgery, you should be aware of some special issues.
It's generally a good idea to avoid pregnancy before most surgeries because of the stress placed on your body and the drugs that may be used during and after the operation. Most medical experts agree that women should delay pregnancy for 1 to 2 years after bariatric surgery. This type of surgery enables you to lose weight by altering your body's ability to absorb the nutrients in food — which also means that, if you get pregnant too soon, the fetus might not get the nutrients it needs to grow and develop normally. Once your nutrition has improved (usually with the help of a specialist such as a dietitian), your body can provide a better environment to support a healthy baby.
Even if you were unable to get pregnant before, you will need an effective method of contraception (pregnancy prevention). Women who are very overweight commonly don't release eggs from their ovaries, don't have regular periods, and have difficulty becoming pregnant. With weight loss after bariatric surgery, your ovaries may begin working normally again, making pregnancy possible.
The Most Effective Methods: IUDs and Implants
Whether you don't want to have children or you need to delay pregnancy for a while after surgery, consider one of the “get it and forget it” methods — the intrauterine device (IUD) or implant. These are the most effective methods available and do not require you to do anything other than decide to use them and have them placed (the IUD goes into the uterus, and the implant is inserted under the skin of the upper arm) by a clinician (doctor, nurse practitioner, nurse midwife, or physician assistant) during an office visit. There are several types of IUDs; the longest lasting can prevent pregnancy for up to 12 years. The implant works for up to 5 years. Either method can be removed in a brief office procedure if you are ready to get pregnant or want to stop using it. Your ability to become pregnant should return quickly.
Hormone-Containing Methods: Pill, Patch, Vaginal Ring, Shot
You can also choose to take a pill daily, use a contraceptive patch weekly, insert a vaginal ring monthly, or get a shot every 3 months. These methods are all considered safe after weight-loss surgery. However, some types of bariatric surgery (such as gastric bypass) may decrease the amount of hormones you can absorb from pills; therefore, pills may not work as well as other methods, and it's reasonable to suggest that you choose this option only if you are unable or unwilling to use other methods. The hormones in the patch are absorbed through the skin, those in the ring are absorbed through vaginal tissue, and those in the shot are absorbed from muscle or tissue under the skin. These methods do not depend on the digestive tract, so bariatric surgery does not affect how well they work. You should be aware, however, that some women gain weight with the shot.
If you are not satisfied with the contraceptive method you have chosen, talk to your clinician about changing methods until you find one you're comfortable with and can use correctly and consistently. If you are having unwanted side effects (such as irregular bleeding or spotting with the IUD or shot), check with your clinician to see if these problems can be controlled. Most side effects improve on their own after a few months of method use.
If you get pregnant within a year or two after bariatric surgery, you should work with a clinician and a nutrition expert to make sure you get proper nutrition. You will probably need to take nutritional supplements to provide the correct amounts of vitamins and minerals to the developing fetus. Regular blood tests to check nutrient levels will likely be recommended throughout the pregnancy.
Like all women who lose a large amount of weight, those who lose weight after bariatric surgery are apt to experience bone thinning, possibly causing bones to break easily. Although we generally think of osteoporosis (thinning bones) as something that occurs after menopause, even younger women can experience this problem after bariatric surgery. You will probably be advised to take calcium and vitamin D to help prevent bone loss, and the levels of these nutrients in your blood will be tested regularly. If you are postmenopausal (periods have stopped for at least 1 year), your clinician may recommend a test to check your bones before surgery and at regular intervals thereafter. As to when and how often these tests should be done, your clinician's recommendation should be individualized to you.
In addition to the above measures, if you are a smoker, quitting can help keep your bones healthy while also benefitting your health in other ways. Ask for help with smoking cessation; many effective options are available. Avoid excessive alcohol; you should not have more than 2 alcoholic drinks daily and not more than 7 weekly. Regular exercise also helps maintain bone strength.
Bariatric surgery has many benefits for obese women who have been unable to lose weight and/or have health conditions caused or worsened by excessive weight. After surgery, delaying pregnancy for 1 to 2 years is advisable; you should choose a contraceptive method that will work for you. In addition, be aware that changes in how you absorb vitamins and minerals after surgery may make osteoporosis a possibility. Work with your bariatric surgery team on measures to protect your bone health.
Association of Reproductive Health Professionals: Choosing a Contraceptive Method
http://www.arhp.org/methodmatch
National Osteoporosis Foundation