Revisiting optimal hormonal contraception following bariatric surgery

Abstract

Surgical weight loss alternatives most popularly gastric banding and gastric bypass are an increasingly common strategy for greater and more durable weight reduction among reproductive-aged women. As surgical weight loss becomes more commonly performed in women of reproductive age addressing the need for adequate contraception in post-bariatric-surgery patients is more frequently becoming an issue. There is limited an inconsistent evidence on the adverse effects of rapid weight loss on pregnancy and about the decreased effectiveness of hormonal contraceptive among obese women. A discussion and evaluation of the limited studies and evidence concerning OCP effectiveness after bariatric surgical procedures with malabsorption includes concerns about OCP and IUD use. In conclusion there is a critical need to establish a rational plan of action for women who undergo bariatric surgery and require contraception as the operation raises a number of concerns for women. To address these issues including reduced fertility future studies should compare the hormonal profiles of women who are taking OCPs following bariatric surgery to those of obese control women. Lastly there is a wide opportunity for clinicians to improve counseling and increase the use of an adequate contraception in this understudied population; health care coordination between gynecologists and bariatric surgeons is crucial. Copyright © 2013 Elsevier Inc. All rights reserved.