Contraceptive Pearl: Contraception and Bariatric Surgery
As the number of bariatric surgical procedures among reproductive-aged women increases, contraceptive counseling before surgery rises in importance. Family planning is especially important among adolescents, as 12.8% of adolescents will get pregnant soon after bariatric surgery as compared to only 6.4% of the general adolescent population.
Some bariatric procedures (gastric bypass, biliopancreatic diversion) affect absorption of nutrients and medications, while other procedures (laparoscopic gastric banding) affect stomach size. According to the U.S Medical Eligibility Criteria for Contraceptive Use, women who have had a malabsorptive bariatric procedure should use oral contraceptives (OCPs) with caution. Because post-surgical changes in drug absorption place these women at higher risk of unintended pregnancy, OCPs get a “3” rating in this group of women. In contrast, women who have had a stomach-banding procedure (such as a lap-band) may use OCPs without restriction. Non-oral contraceptive methods carry no special caution among women who have had either type of bariatric surgery.
An intrauterine device (IUD) or implant is a good choice after bariatric surgery. Insertion prior to weight loss surgery is ideal, as it prevents unintended pregnancies that may occur when patients lose weight and regain fertility.
Resources
Medical Eligibility for Initiating Contraception
Sources
Centers for Disease Control and Prevention. U.S Selected Practice Recommendations for Contraceptive Use, 2013: Adapted from the World Health Organization Selected Practice Recommendations for Contraceptive Use, 2nd Edition. June 21, 2013; 62(RR05): 1-46.
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The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or contraception. The information in the Contraceptive Pearls is unbiased, based on science alone.
