Contraception, Menstruation, and Sexuality after Bariatric Surgery: a Prospective Cohort Study

  • Julie Luyssen
  • Goele Jans
  • Annick Bogaerts
  • Dries Ceulemans
  • Christophe Matthys
  • Bart Van der Schueren
  • Matthias Lannoo
  • Johan Verhaeghe
  • Luc Lemmens
  • Lore Lannoo
  • Jill Shawe
  • Roland Devlieger
Original Contributions

Abstract

Background

Women with a history of bariatric surgery are recommended to avoid pregnancy at least 12 months after surgery. Evidence on the impact of bariatric surgery on contraception, menstrual cycle, and sexuality in the first year postoperative is therefore indispensable.

Objectives

The objective of this paper is to prospectively study changes in contraception, menstrual cycle and sexuality in women of reproductive age following bariatric surgery.

Setting

The study was conducted in two secondary medical centers and a tertiary academic medical center.

Methods

Women attending for bariatric surgery or who recently underwent bariatric surgery completed online questionnaires about contraception, menstrual cycle, and sexual behavior before surgery and 6 and 12 months after surgery.

Results

The study included data from 71 women, including 70 and 47 women at 6 and 12 months after bariatric surgery, respectively. Preoperatively, 43.6% (n = 31/71) used a short-acting hormonal contraceptive, the usage of which decreased significantly to, respectively, 32.8% (n = 23/70; p = .031) and 27.7% (n = 13/47; p = .022) 6 and 12 months post-surgery. Usage of long-acting contraceptive methods increased from 26.7% (n = 19/71) preoperatively to 38.6% (n = 27/70; p = .021) and 42.6% (n = 20/47; p = .004) at 6 and 12 months. Combined oral contraceptives (COC) remained used (39.4% preoperatively, 27.1 and 14.9% at 6 and 12 months postoperatively). Menstrual cycle (frequency, pattern, duration of the cycle, and the menstruation itself) and sexual behavior (intimate relationship, frequency of intercourse, and satisfaction) did not differ significantly before and after surgery.

Conclusions

Women undergoing bariatric surgery appear to switch their type of contraceptive from oral, short-acting hormonal contraceptives to non-oral, long-acting contraceptives. No changes in menstrual cycle and sexual behavior were shown.

Keywords

Bariatric surgery Contraception Menstruation Sexuality 

Notes

Contribution to Authorship

Author 1 performed the analysis on the results of the study and drafted the manuscript. Author 2, Author 5, and Author 12 have made substantial contributions to the design of the study and have been involved in drafting the manuscript. Author 3 advised in analyses of results and drafting of the manuscript. Author 4, Author 6, Author 7, Author 8, Author 9, Author 10, and Author 11 have been involved in revising it critically for important intellectual content. All authors read and approved the final version.

Compliance with Ethical Standards

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the central Ethical Committee of the University Hospitals of Leuven and all local Ethical Committees.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Conflict of Interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Gosman G, King W, Schrope B, et al. Reproductive health of women electing bariatric surgery. Fertil Steril. 2010;94(4):1426–31.  https://doi.org/10.1016/j.fertnstert.2009.08.028.CrossRefPubMedGoogle Scholar
  2. 2.
    Merhi Z. Impact of bariatric surgery on female reproduction. J Fertil Steril. 2009;92(5):1501–8.  https://doi.org/10.1016/j.fertnstert.2009.06.046.CrossRefGoogle Scholar
  3. 3.
    Pournaras D, Manning L, et al. Polycystic ovary syndrome is common in patients undergoing bariatric surgery in a British center. Fertil Steril. 2010;94(2):e41.  https://doi.org/10.1016/j.fertnstert.2010.04.046.CrossRefPubMedGoogle Scholar
  4. 4.
    Patel J, Collela J, Esaka E, et al. Improvement in infertility and pregnancy outcomes after weight loss surgery. Med Clin N Am. 2007;91(3):515–28.  https://doi.org/10.1016/j.mcna.2007.01.002.CrossRefPubMedGoogle Scholar
  5. 5.
    Edison E, Whyte M, van Vlymen J, et al. Bariatric surgery in obese women of reproductive age improves conditions that underlie fertility and pregnancy outcomes: retrospective cohort study of UK National Bariatric Surgery Registry (NBSR). Obes Surg. 2016;26(12):2837–42.  https://doi.org/10.1007/s11695-016-2202-4.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Parent B, Martopullo I, Weiss NS, et al. Bariatric surgery in women of childbearing age, timing between an operation and birth, and associated perinatal complications. JAMA Surg. 2016;152(2):128.  https://doi.org/10.1001/jamasurg.2016.3621.CrossRefGoogle Scholar
  7. 7.
    Chiofalo F, Ciuoli C, Formichi C, et al. Bariatric surgery reduces serum anti-mullerian hormone levels in obese women with and without polycystic ovarian syndrome. Obes Surg. 2017;27(7):1750–4.  https://doi.org/10.1007/s11695-016-2528-y.CrossRefPubMedGoogle Scholar
  8. 8.
    Deitel M, Stone E, Kassam HA, et al. Gynecologic-obstetric changes after loss of massive excess weight following bariatric surgery. J Am Coll Nutr. 1988;7(2):147–53.  https://doi.org/10.1080/07315724.1988.10720232.CrossRefPubMedGoogle Scholar
  9. 9.
    Marceau P, Kaufman D, Biron S, et al. Outcome of pregnancies after biliopancreatic diversion. Obes Surg. 2004;14(3):318–24.  https://doi.org/10.1381/096089204322917819.CrossRefPubMedGoogle Scholar
  10. 10.
    Paulen M, Zapata L, Cansino C, et al. Contraceptive use among women with a history of bariatric surgery: a systematic review. Contraception. 2010;82(1):86–94.  https://doi.org/10.1016/j.contraception.2010.02.008.CrossRefPubMedGoogle Scholar
  11. 11.
    Merhi Z. Revisiting optimal hormonal contraception following bariatric surgery. Contraception. 2013;87(2):131–3.  https://doi.org/10.1016/j.contraception.2012.06.013.CrossRefPubMedGoogle Scholar
  12. 12.
    Chor J, Chico P, Ayloo S, et al. Reproductive health counseling and practices: a cross-sectional survey of bariatric surgeons. Surg Obes Relat Dis. 2015;11(1):187–92.  https://doi.org/10.1016/j.soard.2014.05.031.CrossRefPubMedGoogle Scholar
  13. 13.
    Mody S, Hacker M, Dodge L, et al. Contraceptive counseling for women who undergo bariatric surgery. J Women's Health. 2011;20(12):1785–8.  https://doi.org/10.1089/jwh.2010.2704.CrossRefGoogle Scholar
  14. 14.
    Jatlaoui T, Cordes S, Goedken P, et al. Family planning knowledge, attitudes and practices among bariatric healthcare providers. Contraception. 2016;93(5):455–62.  https://doi.org/10.1016/j.contraception.2015.12.016.CrossRefPubMedGoogle Scholar
  15. 15.
    Kaneshiro B, Jensen J, Carlson N, et al. Body mass index and sexual behavior. Obstet Gynecol. 2008;112(3):586–92.  https://doi.org/10.1097/AOG.0b013e31818425ec.CrossRefPubMedGoogle Scholar
  16. 16.
    Jans G, Matthys C, Bel S, et al. AURORA: bariatric surgery registration in women of reproductive age—a multicenter prospective cohort study. BMC Pregnancy Childbirth. 2016;16(1):195.  https://doi.org/10.1186/s12884-016-0992-y.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Charafeddine R. Seksuele gezondheid. In: Gisle L, Demarest S, et al., editors. Gezondheidsenquête 2013. Rapport 2: Gezondheidsgedrag en leefstijl. Brussel: WIV-ISP; 2014.Google Scholar
  18. 18.
    Ginstman C, Frisk J, Ottosson J, et al. Contraceptive use before and after gastric bypass: a questionnaire study. Obes Surg. 2015;25(11):2066–70.  https://doi.org/10.1007/s11695-015-1641-7.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Graham Y, Mansour D, Small P, et al. A survey of bariatric surgical and reproductive health professionals’knowledge and provision of contraception to reproductive-aged bariatric surgical patients. Obes Surg. 2016(8):1918-23. doi: 10.1007/s11695-015-2037-4.
  20. 20.
    Graham Y, Wilkes S, Mansour D, et al. Contraceptive needs of women following bariatric surgery. J Fam Plann Reprod Health Care. 2014;40(4):241–4.  https://doi.org/10.1136/jfprhc-2014-100959.CrossRefPubMedGoogle Scholar
  21. 21.
    Edelman AB. SFP clinical guidelines: contraceptive considerations in obese women. Contraception. 2009;80(6):583–90.  https://doi.org/10.1016/j.contraception.2009.08.001.CrossRefGoogle Scholar
  22. 22.
    Eid GM, Cottam DR, Velcu LM, et al. Effective treatment of polycystic ovarian syndrome with Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2005;1(2):77–80.  https://doi.org/10.1016/j.soard.2005.02.008.CrossRefPubMedGoogle Scholar
  23. 23.
    Teitelman M, Grotegut CA, et al. The impact of bariatric surgery on menstrual patterns. Obes Surg. 2006;16(11):1457–63.  https://doi.org/10.1381/096089206778870148.CrossRefPubMedGoogle Scholar
  24. 24.
    Legro R, Dodson W, Gnatuk C, et al. Effects of gastric bypass surgery on female reproductive function. J Clin Endocrinol Metab. 2012;97(12):4540–8.  https://doi.org/10.1210/jc.2012-2205.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  • Julie Luyssen
    • 1
  • Goele Jans
    • 2
    • 3
  • Annick Bogaerts
    • 2
    • 3
    • 4
  • Dries Ceulemans
    • 5
  • Christophe Matthys
    • 6
    • 7
  • Bart Van der Schueren
    • 6
    • 7
  • Matthias Lannoo
    • 6
    • 8
  • Johan Verhaeghe
    • 2
    • 5
  • Luc Lemmens
    • 9
  • Lore Lannoo
    • 5
  • Jill Shawe
    • 10
  • Roland Devlieger
    • 2
    • 5
    • 11
  1. 1.Master of Family MedicineKU LeuvenLeuvenBelgium
  2. 2.Department of Development and RegenerationKU LeuvenLeuvenBelgium
  3. 3.Faculty of Health and Social Work, Research Unit Healthy LivingUC Leuven-LimburgLeuvenBelgium
  4. 4.Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care (CRIC)University of AntwerpAntwerpBelgium
  5. 5.Department of Obstetrics and GynecologyUniversity Hospitals LeuvenLeuvenBelgium
  6. 6.Department of Clinical and Experimental MedicineKU LeuvenLeuvenBelgium
  7. 7.Department of EndocrinologyUniversity Hospitals LeuvenLeuvenBelgium
  8. 8.Department of Abdominal SurgeryUniversity Hospitals LeuvenLeuvenBelgium
  9. 9.Department of Abdominal SurgerySt-Niklaas HospitalSt-NiklaasBelgium
  10. 10.Faculty of Health and Medical SciencesUniversity of SurreyGuildfordUK
  11. 11.Department of Obstetrics, Gynecology and ReproductionSt-Augustinus Hospital WilrijkWilrijkBelgium

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